Gaining Insight into the Prevention of Maternal Death Using Narrative Analysis: An Experience from Kerman, Iran

Document Type : Short Communication

Authors

1 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran

2 Research Center for Social Determinants of Health, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

3 Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Reduction in maternal mortality requires an in-depth knowledge of the causes of death. This study was conducted to explore the circumstances and events leading to maternal mortality through a holistic approach. Using narrative text analysis, all documents related to maternal deaths occurred from 2007 to 2011 in Kerman province/Iran were reviewed thoroughly by an expert panel. A 93-item chart abstraction instrument was developed according to the expert panel and literature. The instrument consisted of demographic and pregnancy related variables, underlying and contributing causes of death, and type of delays regarding public health aspects, medical and system performance issues. A total of 64 maternal deaths were examined. One third of deaths occurred in women less than 18 or higher than 35 years. Nearly 95% of them lived in a low or mid socioeconomic status. In half of the cases, inappropriate or nonuse of contraceptives was seen. Delay in the provision of any adequate treatment after arrival at the health facility was seen in 59% of cases. The most common medical causes of death were preeclampsia/eclampsia (15.6%), postpartum hemorrhage (12.5%) and deep phlebothrombosis (10.9%), respectively. Negligence was accounted for 95% of maternal deaths. To overcome the root causes of maternal death, more emphasis should be devoted to system failures and patient safety rather than the underlying causes of death and medical issues solely.

Keywords

Main Subjects

References

1. World Health Organization. The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: IDC MM. Geneva: WHO; 2012.
2. Godal T, Quam L. Accelerating the global response to reduce maternal mortality. Lancet 2012; 379: 2025–6. doi: 10.1016/s0140-6736(12)60863-0
3. Berer M. Maternal mortality or women’s health: time for action. Reprod Health Matters 2012; 20: 5–10. doi: 10.1016/s0968-8080(12)39632-8
4. Milliez J. Rights to safe motherhood and newborn health: ethical issues. Int J Gynaecol Obstet 2009; 106: 110–1. doi: 10.1016/j.ijgo.2009.03.019
5. WHO, UNICEF, UNFPA, The World Bank. Trends in Maternal Mortality: 1990 to 2010. Geneva: WHO; 2012. doi: 10.1017/s0021932002242832
6. Moazzeni MS. Maternal mortality in the Islamic republic of Iran: on track and in transition. Matern Child Health J 2013; 17: 577–80. doi: 10.1007/s10995-012-1043-6
7. Tajik P, Nedjat S, Afshar NE, Changizi N,Yazdizadeh B, Azemikhah A, et al. Inequality in maternal mortality in Iran: an ecologic study. Int J Prev Med 2012; 3: 116–21.
8. Clark SL. Strategies for reducing maternal mortality. Semin Perinatol 2012; 36: 42–7. doi: 10.1053/j.semperi.2011.09.009
9. Main EK. Decisions required for operating a maternal mortality review committee: the California experience. Semin Perinatol 2012; 36: 37–41. Doi: 10.1053/j.semperi.2011.09.008
10. Azemikhah A, Amirkhani MA, Jalilvand P, Emami Afshar N, Radpooyan L, Changizi N. Maternal mortality surveillance system in Iran. Iran J Public Health 2009; 38: 90–2.
11. World Health Organization. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Geneva: WHO; 2004. doi: 10.1007/BF03084278
12. Williamson A, Feyer AM, Stout N, Driscoll T, Usher H. Use of narrative analysis for comparisons of the causes of fatal accidents in three countries: New Zealand, Australia, and the United States. Inj Prev 2001; 7: i15–20. doi: 10.1136/ip.7.suppl_1.i15
13. Fins JJ, Schwager Guest R, Acres CA. Gaining insight into the care of hospitalized dying patients: an interpretative narrative analysis. J Pain Symptom Manage 2000; 20: 399–407. doi: 10.1016/s0885-3924(00)00220-7
14. Bingley AF, Thomas C, Brown J, Reeve J, Payne S. Developing narrative research in supportive and palliative care: the focus on illness narratives. Palliat Med 2008; 22: 653–8. doi: 10.1177/0269216308089842
15. Eslami M, Yazdanpanah M, Taheripanah R, Andalib P, Rahimi A, Nakhaee N. Profile of high risk pregnancies in Iran. International Journal of Health Policy and Management 2013; 1: 213–8. doi: 10.15171/ijhpm.2013.39
16. Nour NM. An introduction to maternal mortality. Rev Obstet Gynecol 2008; 1: 77–81.
17. Blanc AK, Winfrey W, Ross J. New findings for maternal mortality age patterns: aggregated results for 38 countries. PLoS One 2013; 8: e59864. doi: 10.1371/journal.pone.0059864
18. Pacagnella RC, Cecatti JG, Osis MJ, Souza JP. The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework. Reprod Health Matters 2012; 20: 155–63. doi: 10.1016/s0968-8080(12)39601-8
19. The Joint Commission. Sentinel Event Alert, Issue 44: Preventing Maternal Death. 2010. Available from: http://www.jointcommission.org/sentinel_event_alert_issue_44_preventing_maternal_death/
20. Grossman J. Health education: the leading edge of primary healthcare and maternal and child health. In: Wallace HM, Giri DK (eds). Health care of women and children in developing countries. Oakdale: Third Party Publishing Company; 1990. p.56–67.
 
 
 

Files

History

  • Receive Date: 13 September 2013
  • Revise Date: 05 October 2013
  • Accept Date: 01 October 2013
  • First Publish Date: 05 October 2013

Share

How to cite

Statistics