Department of Nursing, Umeå University, 901 87, Umeå, Sweden.
Department of Community Medicine and Rehabilitation, Section of Physiotherapy, Umeå University, 901 87, Umeå, Sweden.
BMC Health Serv Res. 2024 May 9;24(1):610. doi: 10.1186/s12913-024-11037-5.
During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.
In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 - February 2022. The data was analysed using inductive qualitative content analysis.
Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women's difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a 'key person' in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.
Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.
在产后第一年，大约 25%的瑞典重度会阴创伤（SPT）女性，即分娩时三度或四度会阴裂伤，对其医疗保健接触不满意。此外，对于持续性 SPT 相关健康问题女性的更长期医疗保健接触经验，研究也相对较少。本研究旨在探讨在 SPT 发生后 18 个月至 5 年内，自我报告持续性 SPT 相关健康问题的女性如何体验她们与医疗保健服务的接触。
在这项描述性定性研究中，我们对 12 名自我报告 SPT 后持续性健康问题的女性进行了有针对性的个体访谈，访谈时间为 2020 年 11 月至 2022 年 2 月。使用归纳定性内容分析法分析数据。
我们的研究结果表明，持续性 SPT 相关健康问题的女性处于一种矛盾的境地。她们与自己受伤的身体作斗争，但医疗保健专业人员却将她们的健康问题视为产后正常现象而不予理会。这种矛盾凸显了女性在获得产后保健、康复和病假方面的困难，这导致她们的医疗保健需求未得到满足，情绪健康受到影响，经济和社会地位下降。我们的研究结果表明，这些健康问题不会随着时间的推移而减轻。因此，这些女性不得不不断寻找医疗保健中的“关键人物”，这个人承认她们的持续性问题是合理的，从而能够获得所需的护理、康复和病假，使她们感到有力量。
我们的研究揭示了持续性 SPT 相关健康问题女性所面临的复杂健康挑战，以及她们对医疗、康复和病假的需求在很大程度上被忽视。因此，该研究突显了瑞典 SPT 相关医疗保健服务提供的不平等问题，包括在获得医疗保健方面的地区差异。因此，作者建议制定和实施基于女性为中心的瑞典 SPT 相关护理国家指南，以确保公平、有效和可及的医疗保健。
