Outcomes and impact of an ICU admission for severe maternal complications during pregnancy or birth: a case study

Abstract

Pregnancy and childbirth is a sacred time in a woman's life, experienced as a normal physiological event for most women. Alterations to a woman's physiology during pregnancy means that an admission to an intensive care unit (ICU) during pregnancy or birth is likely to represent an episode of severe maternal morbidity. An integrated literature review found that there was a paucity of literature relating to critically ill women requiring admission to the ICU for severe maternal complications during pregnancy or birth. The literature relating to these women was largely focused on the pathophysiological processes with maternal outcomes primarily described as morbidity and mortality rates. The aim of this study was to explore the health and wellbeing of women who experienced an ICU admission for severe maternal complications during pregnancy or birth. Multiple methods were employed to collect qualitative and quantitative data from pregnant and postnatal women who had received care in the ICU of an Australian regional tertiary hospital. Case study methodology was applied to describe the outcomes and impact of an ICU admission during pregnancy or birth. Outcomes were described through non-parametric analysis of quantitative data collected via the Short Form 36 (SF36), Hospital Anxiety and Depression Scale (HADS), Edinburgh Postnatal Depression Scale (EPDS), Pittsburgh Sleep Quality index (PSQI) and Postnatal Bonding Questionnaire (PBQ). Outcomes concluded that at six weeks after birth, women who received care in the ICU during pregnancy or birth were more limited in their physical ability to conduct daily activities, had some aspects of poorer sleep, and were more anxious when compared to healthy women who had a normal vaginal birth. However, there was no difference between the two groups in postnatal depression, or bonding with their baby. The impact of an ICU admission during pregnancy or birth was explored through semistructured interviews with a sample of five women. The interviews were conducted at approximately six weeks after the woman had given birth. Qualitative analysis was conducted using thematic analysis. Three themes emerged to reflect the women's experience: • Responding to the situation: being anxious, managing anxiety, moving on • Being separated from the baby: physical isolation, emotional concerns • Being a supportive partner: being present, being a protector The findings of this study will fill a gap in the knowledge of the experience of women who are admitted to ICU during pregnancy and birth and will inform the development of models of care to better meet the needs of women who require this level of care. Institutional ethical approval was provided to conduct this study.