Understanding Maternal Morbidity from the Perspectives of Women and People with Pregnancy Experience: A Concept Analysis

Abstract

Background Maternal morbidity (MM) describes adverse pregnancy-related outcomes, excluding mortality, among the pregnant and postpartum population. It is a concept without a universal definition, and most of the literature consists of clinical definitions rooted within the biomedical model of health. The MM perspectives of women and people with pregnancy experience (WPPE) are less well understood, which has resulted in a recent increase in qualitative research on the topic. However, the literature varies in its descriptions of MM which limits data comparisons across institutions and regions that measure differently.

Objectives This study aims to a) understand the conditions and events that WPPE conceptualize as MM, b) identify the themes that arise across WPPE’s experiences, and c) produce a schematic representation of how WPPE conceptualize MM.

Methods A concept analysis adapted from the evolutionary model investigated MM from WPPE’s perspectives. The steps included: 1) Identifying and naming the concept and surrogate terms (synonyms) 2) Data collection: literature search consisting of title/abstract and full-text screenings, appraisal, and chart extraction 3) Identifying the concept’s ‘antecedents’ (events that lead to the concept), ‘attributes’ (events that form concept), and ‘consequences’ (events that result from the concept) 4) Analyzing data using thematic analysis 5) Developing a model of the concept

Results A literature search identified 40 eligible studies. Analysis of WPPE’s MM perceptions from these studies resulted in a MM concept consisting of four attributes – physical (themes relating to pain, bleeding, and adverse infant outcomes), social (themes relating to financial distress, lack of support, abuse, and mothering), psychological (themes relating to fear and distress), and healthcare-related (themes relating to the provider-patient relationship and healthcare facility). Antecedents that preceded MM included being labelled high-risk, access to care, financial stress, cultural norms, physical symptoms, previous adverse experience, lack of support, lack of information, effects of pregnancy on WPPE’s life, and lack of resources. The consequences that followed MM included continued morbidity, inability or reluctance to conceive again, changes to bodily function, strained relationship with partner, financial stress, and in some instances positive outcomes (e.g., gratitude for surviving, good health of baby).

Conclusions This study illustrated the concept of MM from WPPE’s perspectives by identifying its antecedents, attributes and consequences. In doing so, it demonstrated that MM as perceived by WPPE encompasses more than physical attributes, which largely form the basis of current classification systems. Incorporating these findings into clinical definitions can help inform health and community care approaches to increasingly meet WPPE’s needs.