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Overlooked by the obstetric gaze - how women with persistent health problems due to severe perineal trauma experience encounters with healthcare services: a qualitative study
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0002-1767-5712
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Section of Physiotherapy.ORCID iD: 0000-0001-6636-9597
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0002-5300-0990
2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 610Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.

METHODS: In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 - February 2022. The data was analysed using inductive qualitative content analysis.

RESULTS: Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women's difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a 'key person' in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.

CONCLUSIONS: Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024. Vol. 24, no 1, article id 610
Keywords [en]
Access to care, Empowerment, Healthcare encounters, Key person, Normalisation, Persistent health problems, Postpartum healthcare, Qualitative content analysis, Severe perineal trauma
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-224330DOI: 10.1186/s12913-024-11037-5ISI: 001219637700002PubMedID: 38724992Scopus ID: 2-s2.0-85192535018OAI: oai:DiVA.org:umu-224330DiVA, id: diva2:1857795
Available from: 2024-05-14 Created: 2024-05-14 Last updated: 2024-07-02Bibliographically approved

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Tjernström, KatharinaLindberg, IngerWiklund, MariaPersson, Margareta

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