Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda
# Background In low- and middle-income countries (LMICs), c-section is the most commonly performed operation, and surgical site infection (SSI) is the most common post-operative complication following all surgical procedures performed. Whilst multiple interventions have been rolled out to address hi...
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| Format: | Article |
| Language: | English |
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Inishmore Laser Scientific Publishing Ltd
2021-06-01
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| Series: | Journal of Global Health Reports |
| Online Access: | https://doi.org/10.29392/001c.23615 |
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| author | Brittany L Powell Theoneste Nkurunziza Fredrick Kateera Leila Dusabe Marthe Kubwimana Rachel Koch Bethany L Hedt-Gauthier Robert Riviello |
| author_facet | Brittany L Powell Theoneste Nkurunziza Fredrick Kateera Leila Dusabe Marthe Kubwimana Rachel Koch Bethany L Hedt-Gauthier Robert Riviello |
| author_sort | Brittany L Powell |
| collection | DOAJ |
| description | # Background
In low- and middle-income countries (LMICs), c-section is the most commonly performed operation, and surgical site infection (SSI) is the most common post-operative complication following all surgical procedures performed. Whilst multiple interventions have been rolled out to address high SSI rates, strategies for optimal care of patients at risk of developing SSIs need to include an understanding of the general care seeking behaviors, facilitators, and barriers among high-risk groups, including mothers delivering via c-section. This study explores the healthcare experiences of women who delivered by c-section section, from giving birth through recovery, and their associated decision-making, perceptions of care, and social and financial supports.
# Methods
We conducted protocol-guided interviews in rural Kirehe District, Rwanda with twenty-five mothers who delivered by c-section at Kirehe District Hospital between February-April 2018, exploring their experience with delivery, hospitalization, recovery, and complications. Coded interviews were analyzed using the Grounded Theory approach to identify emergent themes. Thematic saturation was achieved.
# Results
Overall, women largely followed the tiered referral system, as it was designed. A majority faced financial barriers to returning to care, and a majority were not able to describe the reason for their c-section, the complications experienced, or the treatment prescribed. We constructed a process map to summarize key steps where interventions should be designed to promote facilitators, to reduce barriers, and to identify and target the women being diverted from this designated path.
# Conclusions
Understanding the existing healthcare pathway and the associated facilitators and barriers among postpartum women is critical to designing appropriate interventions that properly serve their needs. Our findings strongly suggest that moving or complimenting post-operative wound assessments from the health center into home-based care, and ensuring unified messaging around c-section indications, care, and complications at the community-level are two of the areas that may improve utilization of existing healthcare infrastructure for women who deliver by c-section in rural districts in Rwanda. |
| format | Article |
| id | doaj-art-e61970206e824820a7f824985bb79a4b |
| institution | DOAJ |
| issn | 2399-1623 |
| language | English |
| publishDate | 2021-06-01 |
| publisher | Inishmore Laser Scientific Publishing Ltd |
| record_format | Article |
| series | Journal of Global Health Reports |
| spelling | doaj-art-e61970206e824820a7f824985bb79a4b2025-08-20T02:40:08ZengInishmore Laser Scientific Publishing LtdJournal of Global Health Reports2399-16232021-06-01510.29392/001c.23615Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural RwandaBrittany L PowellTheoneste NkurunzizaFredrick KateeraLeila DusabeMarthe KubwimanaRachel KochBethany L Hedt-GauthierRobert Riviello# Background In low- and middle-income countries (LMICs), c-section is the most commonly performed operation, and surgical site infection (SSI) is the most common post-operative complication following all surgical procedures performed. Whilst multiple interventions have been rolled out to address high SSI rates, strategies for optimal care of patients at risk of developing SSIs need to include an understanding of the general care seeking behaviors, facilitators, and barriers among high-risk groups, including mothers delivering via c-section. This study explores the healthcare experiences of women who delivered by c-section section, from giving birth through recovery, and their associated decision-making, perceptions of care, and social and financial supports. # Methods We conducted protocol-guided interviews in rural Kirehe District, Rwanda with twenty-five mothers who delivered by c-section at Kirehe District Hospital between February-April 2018, exploring their experience with delivery, hospitalization, recovery, and complications. Coded interviews were analyzed using the Grounded Theory approach to identify emergent themes. Thematic saturation was achieved. # Results Overall, women largely followed the tiered referral system, as it was designed. A majority faced financial barriers to returning to care, and a majority were not able to describe the reason for their c-section, the complications experienced, or the treatment prescribed. We constructed a process map to summarize key steps where interventions should be designed to promote facilitators, to reduce barriers, and to identify and target the women being diverted from this designated path. # Conclusions Understanding the existing healthcare pathway and the associated facilitators and barriers among postpartum women is critical to designing appropriate interventions that properly serve their needs. Our findings strongly suggest that moving or complimenting post-operative wound assessments from the health center into home-based care, and ensuring unified messaging around c-section indications, care, and complications at the community-level are two of the areas that may improve utilization of existing healthcare infrastructure for women who deliver by c-section in rural districts in Rwanda.https://doi.org/10.29392/001c.23615 |
| spellingShingle | Brittany L Powell Theoneste Nkurunziza Fredrick Kateera Leila Dusabe Marthe Kubwimana Rachel Koch Bethany L Hedt-Gauthier Robert Riviello Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda Journal of Global Health Reports |
| title | Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda |
| title_full | Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda |
| title_fullStr | Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda |
| title_full_unstemmed | Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda |
| title_short | Synthesizing postpartum care pathways, facilitators, and barriers for women after cesarean section: a qualitative analysis from rural Rwanda |
| title_sort | synthesizing postpartum care pathways facilitators and barriers for women after cesarean section a qualitative analysis from rural rwanda |
| url | https://doi.org/10.29392/001c.23615 |
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