Lugina Africa Midwives' Research Network, Kenyatta National Hospital, Nairobi, Kenya.
Department of International Public Health, Centre for Childbirth, Women's and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Health Expect. 2023 Dec;26(6):2475-2484. doi: 10.1111/hex.13841. Epub 2023 Aug 17.
Stillbirth and (obstetric) fistula are traumatic life events, commonly experienced together following an obstructed labour in low- and middle-income countries with limited access to maternity care. Few studies have explored women's experiences of the combined trauma of stillbirth and fistula.
To explore the lived experiences of women following stillbirth and fistula.
Qualitative, guided by Heideggerian phenomenology. Twenty women who had experienced a stillbirth were interviewed while attending a specialist Hospital fistula service in urban Kenya. Data were analysed following Van Manen's reflexive approach.
Three main themes summarised participants' experiences: 'Treated like an alien' reflected the isolation and stigma felt by women. The additive and multiplying impacts of stillbirth and fistula and the ways in which women coped with their situations were summarised in 'Shattered dreams'. The impact of beliefs and practices of women and those around them were encapsulated in 'It was not written on my forehead'.
The distress women experienced following the death of a baby was intensified by the development of a fistula. Health professionals lacked an understanding of the pathophysiology and identification of fistula and its association with stillbirth. Women were isolated as they were stigmatised and blamed for both conditions. Difficulty accessing follow-up care meant that women suffered for long periods while living with a constant reminder of their baby's death. Cultural beliefs, faith and family support affected women's resilience, mental health and recovery. Specialist services, staff training and inclusive policies are needed to improve knowledge and awareness and enhance women's experiences.
A Community Engagement and Involvement group of bereaved mothers with lived experience of stillbirth and neonatal death assisted with the review of the study protocol, participant-facing materials and confirmation of findings.
死产和（产科）瘘是创伤性的生活事件，在获得产妇保健服务有限的中低收入国家，常因分娩受阻而同时发生。很少有研究探讨过妇女同时经历死产和瘘管这两种创伤的经历。
探讨死产和瘘管后妇女的生活体验。
定性研究，以海德格尔现象学为指导。在肯尼亚城市的一家专科医院瘘管服务机构就诊时，对 20 名经历过死产的妇女进行了访谈。根据范马南的反思方法对数据进行了分析。
三个主要主题总结了参与者的经历：“被当作外星人对待”反映了妇女的孤立和耻辱感。死产和瘘管的累加和倍增影响，以及妇女应对其处境的方式，被概括为“梦想破灭”。妇女及其周围人的信仰和实践的影响被概括为“这不是写在我额头上的”。
在婴儿死亡后，妇女经历的痛苦因瘘管的发展而加剧。卫生专业人员对瘘管的病理生理学和识别及其与死产的关联缺乏了解。妇女因被孤立而感到耻辱，并因两种情况而受到指责。由于难以获得后续护理，妇女在长期忍受着对婴儿死亡的持续提醒的同时，遭受了痛苦。文化信仰、信仰和家庭支持影响了妇女的韧性、心理健康和康复。需要有专门的服务、工作人员培训和包容性政策，以提高知识和认识，改善妇女的体验。
有过死产和新生儿死亡经历的悲痛欲绝的母亲社区参与和参与小组协助审查研究方案、面向参与者的材料并确认研究结果。
