Abstract
BackgroundPostpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity. Reducing deaths from PPH is a global challenge. The voices of women and healthcare providers have been missing from the debate around best practices for PPH prevention. The aim of this review was to identify, appraise and synthesize available evidence about the views and experiences of women and healthcare providers on interventions to prevent PPH.MethodsWe searched eight electronic databases and reference lists of eligible studies published between 1996 and 2018, reporting qualitative data on views and experiences of PPH in general, and of any specific preventative intervention(s). Authors’ findings were extracted and synthesised using meta-ethnographic techniques. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting themes was assessed using GRADE-CERQual. A line of argument synthesis was developed.ResultsThirty-five studies from 29 countries met our inclusion criteria. Our results indicate that women and healthcare providers recognise the dangers of severe blood loss in the perinatal and postpartum period, but don’t always share the same beliefs about the causes and consequences of PPH. Skilled birth attendants and traditional birth attendants (TBA’s) want to prevent PPH but may lack the required resources and training. Women generally appreciate PPH prevention strategies, especially where their individual needs, beliefs and values are taken into account. Women and healthcare providers also recognize the value of using uterotonics (medications that contract the uterus) to prevent PPH but highlight safety concerns and potential misuse of the drugs as acceptability and implementation issues.ConclusionsBased on stakeholder views and experiences, PPH prevention strategies are more likely to be successful where all stakeholders agree on the causes and consequences of severe postpartum blood loss, especially in the context of sufficient resources and effective implementation by competent, suitably trained providers.
Highlights
An estimated 303,000 maternal deaths occurred in 2015 [1]
Our results indicate that women and healthcare providers recognise the dangers of severe blood loss in the perinatal and postpartum period, but don’t always share the same beliefs about the causes and consequences of PPH
Based on stakeholder views and experiences, PPH prevention strategies are more likely to be successful where all stakeholders agree on the causes and consequences of severe postpartum blood loss, especially in the context of sufficient resources and effective implementation by competent, suitably trained providers
Summary
An estimated 303,000 maternal deaths occurred in 2015 [1]. Recent figures would suggest that more than a quarter of these deaths were due to haemorrhage, with post-partum haemorrhage accounting for almost 20% of all direct deaths [2]. Primary PPH is commonly defined as a blood loss of 500 ml or more within 24 hours after birth, and, by this definition, approximately 14 million cases of postpartum haemorrhage (PPH) occur each year [2], affecting about 6% of all women giving birth around the world [4,5]. There is debate about the accuracy of blood loss measurement in maternity care settings [7], which complicates the assessment of the effectiveness of preventative techniques. Individual risk factors are poor predictors of PPH occurrence [10] and the appropriate care practices to reduce the risk of PPH are not well defined or carried out effectively, in lowincome settings [11,12]. The aim of this review was to identify, appraise and synthesize available evidence about the views and experiences of women and healthcare providers on interventions to prevent PPH
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