title: An emerging "maternal near-miss syndrome": narratives of women who almost died during pregnancy and childbirth.
abstract: BACKGROUND
  An improvement in maternal health conditions can only be achieved when a reduction in the number of deaths is accompanied by a reduction in the frequency of severe complications of pregnancy. The objective of this study was to investigate women's experiences related to the burden of severe maternal morbidity.
  
  
  METHODS
  This qualitative study is based on narratives of women who survived severe complications of pregnancy and who were admitted to the intensive care unit of a public university hospital in the city of Campinas, Brazil. A sample of 30 women was recruited between April 2007 and January 2008. Before hospital discharge, eligible women who agreed to participate responded to a semidirected interview. The interviews were recorded and the transcripts received a thematic analysis.
  
  
  RESULTS
  Two major themes were identified, one more closely related to the experience of a critical illness and the other to the experience of care. A complex set of reactions was found in the women who survived, indicating the occurrence of acute stress-related disorders.
  
  
  CONCLUSIONS
  On the basis of narratives of women who almost died during pregnancy and childbirth, we reported on an acute stress disorder that may be associated with the occurrence of severe maternal complications, which we named, the "maternal near-miss syndrome." The implementation of integrated care that encompasses the physical, psychological, social, and spiritual aspects of women's health may help to alleviate the burden that maternal complications impose on millions of women around the world.
authors.affiliation: Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil.
authors.forename: Joao P
authors.initials: JP
authors.lastname: Souza
authors.forename: Jose G
authors.initials: JG
authors.lastname: Cecatti
authors.forename: Mary A
authors.initials: MA
authors.lastname: Parpinelli
authors.forename: Fabiana
authors.initials: F
authors.lastname: Krupa
authors.forename: Maria J D
authors.initials: MJ
authors.lastname: Osis
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D005239:Fear; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008016:Life Change Events; D008429:Maternal Welfare; D009017:Morbidity; D033262:Narration; D007744:Obstetric Labor Complications / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011644:Puerperal Disorders / Q000523:psychology*; D036301:Qualitative Research; D012959:Socioeconomic Factors; D013577:Syndrome; D055815:Young Adult