Abstract:
Introduction
Studies in the literature indicate that women are vulnerable to develop psychiatric conditions
during the perinatal period. Mental health is a neglected topic and that of women’s mental
health to a greater extent, with limited attention paid to these women in the South African
public health sector. Furthermore, maternal mortality persists as a major public health
problem in developing countries, despite global initiatives and strategies aimed at improving
maternal health and decreasing mortality. An improvement in maternal health can ensue if
together with a decrease in the number of maternal deaths, a reduction in the complications
during pregnancy and the postpartum period occurs. Recognition and treatment of severe
complications are important as they can have an adverse effect on women’s health not only
from a biological but a psychosocial perspective too. The study set out to determine
whether women who experience severe life-threatening stressors during pregnancy are
more vulnerable to develop psychiatric complications and what are their lived experiences
after discharge from hospital?
Methods
A mixed-method study conducted at two hospitals in Pretoria, South Africa consisted of two
arms, a qualitative and a quantitative arm executed in a parallel convergent manner. Data
collection occurred concurrently and merging of the data occurred at the level of
interpretation. Two groups of participants namely women who experienced life-threatening
complications and those with uneventful pregnancies were selected and interviewed at fourtime
intervals namely, shortly after delivery, at six weeks, three months and six months
postpartum. The quantitative arm consisted of completion of Level 1, symptom appropriate
Level 2 cross-cutting symptoms measures and a WHO Disability Assessment. The
qualitative arm consisted of in-depth semi-structured interviews of sixteen participants who
were purposefully sampled to obtain maximum variation and richness of information.
Results
A total of eighty-nine women participated in the study. (Forty-six of whom were women with
life-threatening complications and forty-three were women with uneventful pregnancies.)
Women with life-threatening complications were more vulnerable to develop psychiatric
sequelae and presented with a greater variation in their levels of functioning as compared to
women with uneventful pregnancies. Psychiatric sequelae included major depressive disorder, anxiety disorders, somatic
symptoms, and cognitive impairments; sleep disturbances, anger, psychotic disorders and
substance abuse. Common themes identified from the lived experiences included amongst
others, feelings of inadequacy, guilt, loss and disappointment, fear of rejection,
abandonment, and infidelity and feelings of anger.
Conclusion
Women in the present study were not only susceptible to risk that predisposed them to
develop postpartum psychiatric complications, but also experienced life-threatening
complications. These women displayed resilience in that they were able to adapt despite
experiencing severe stressors and adversity. The women displayed acceptance, a will to
survive and cope as well as strong belief and unwavering faith in God.
