title: Women's experiences, emotional responses, and perceptions of care after emergency peripartum hysterectomy: a qualitative survey of women from 6 months to 3 years postpartum.
abstract: BACKGROUND
  Little is known of the experience and perceptions of care for survivors of emergency peripartum hysterectomy (EPH), an obstetric event that is increasing in incidence. We sought to explore women's experiences of EPH to make recommendations for care.
  
  
  METHODS
  This qualitative study utilized purposive sampling through an online support group of women who experienced EPH. Eligible participants were at least 18 years old, had their hysterectomy at least 6 months but no more than 3 years before the interview, had a surviving infant associated with the delivery, and did not report suicidal ideation. In-depth, semi-structured telephone interviews were conducted and analyzed using Constant Comparative Analysis. Kappa statistics assessed interrater reliability for two independent coders.
  
  
  RESULTS
  Fifteen women participated with a mean age of 32.5 years. Most had a cesarean section, with uterine atony as the most common indication for EPH. Kappa statistics indicated near-perfect interrater agreement between two coders, ranging from .82 to .89. Seven major themes were identified: fear; pain; death and dying; numbness or delay in emotional reaction; bonding with baby; communication; and the need for information. Psychological upset occurred postpartum and was often delayed. A major finding is the need for additional follow-up visits to address the emotional after-effects and to fill in gaps in women's understanding and memory of what had occurred.
  
  
  CONCLUSIONS
  Understanding women's experiences with EPH can help practitioners address not only women's initial complications but provide needed long-term support.
authors.affiliation: Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, FL, USA.
authors.forename: Cara Z
authors.initials: CZ
authors.lastname: de la Cruz
authors.forename: Martha L
authors.initials: ML
authors.lastname: Coulter
authors.forename: Kathleen
authors.initials: K
authors.lastname: O'Rourke
authors.forename: P
authors.initials: P
authors.lastname: Amina Alio
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Daley
authors.forename: Charles S
authors.initials: CS
authors.lastname: Mahan
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D007044:Hysterectomy / Q000523:psychology*; D007407:Interviews as Topic; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D058725:Peripartum Period; D010817:Physician-Patient Relations; D006473:Postpartum Hemorrhage / Q000601:surgery*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D016896:Treatment Outcome; D014593:Uterine Inertia / Q000601:surgery*; D055815:Young Adult
keywords: emergency peripartum hysterectomy; maternal morbidity; perceptions of care; traumatic childbirth