Lived experiences of women who developed uterine rupture following severe obstructed labor in Mulago hospital, Uganda.
BACKGROUND
Maternal mortality is a major public health challenge in Uganda. Whereas uterine rupture remains a major cause of maternal morbidity and mortality, there is limited research into what happens to women who survive such severe obstetric complications. Understanding their experiences might delineate strategies to support survivors.


METHODS
This qualitative study used a phenomenological approach to explore lived experiences of women who developed uterine rupture following obstructed labor. In-depth interviews initially conducted during their hospitalization were repeated 3-6 months after the childbirth event to explore their health and meanings they attached to the traumatic events and their outcomes. Data were analyzed using thematic analysis.


RESULTS
The resultant themes included barriers to access healthcare, multiple "losses" and enduring physical, psychosocial and economic consequences. Many women who develop uterine rupture fail to access critical care needed due to failure to recognise danger signs of obstructed labor, late decision making for accessing care, geographical barriers to health facilities, late or failure to diagnose obstructed labor at health facilities, and failure to promptly perform caesarean section. Secondly, the sequel of uterine rupture includes several losses (loss of lives, loss of fertility, loss of body image, poor quality of life and disrupted marital relationships). Thirdly, uterine rupture has grim economic consequences for the survivors (with financial loss and loss of income during and after the calamitous events).


CONCLUSIONS
Uterine rupture is associated with poor quality of care due to factors that operate at personal, household, family, community and society levels, and results in dire physical, psychosocial and financial consequences for survivors. There is need to improve access to and provision of emergency obstetric care in order to prevent uterine rupture consequent to obstructed labor. There is also critical need to provide counselling and support to survivors to enable them cope with physical, social, psychological and economic consequences.
Department of Obstetrics and Gynecology, School of Medicine, College of Health Sciences, Makerere University, P,O, Box 7072, Kampala, Uganda. dankkaye@yahoo.com.
Dan K
DK
Kaye
Othman
O
Kakaire
Annettee
A
Nakimuli
Michael O
MO
Osinde
Scovia N
SN
Mbalinda
Nelson
N
Kakande
D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D008428:Maternal Mortality; D007744:Obstetric Labor Complications / Q000523:psychology* / Q000628:therapy; D011247:Pregnancy; D011788:Quality of Life; D017741:Survivors / Q000523:psychology*; D014454:Uganda; D014597:Uterine Rupture / Q000523:psychology* / Q000628:therapy