Background
Methods
Study setting
Study design
Sampling
Interviews
Research team and reflexivity
Analysis
Ethical considerations
Results
S. No | Gestational Age at Stillbirth (weeks) | Place of Stillbirth | Parity | Antepartum / Intrapartum | Cause of Stillbirth |
---|---|---|---|---|---|
1 | 38 | Primary Health Centre | Primi | Antepartum | Not determined |
2 | 32 | Primary Health Centre | 5th Para | Intrapartum | Cervical Incompetence |
3 | 36 | Primary Health Centre | Primi | Intrapartum | Not determined |
4 | 38 | Primary Health Centre | First Para (previous abortion) | Antepartum | Not determined |
5 | 36 | Primary Health Centre | Primi | Antepartum | Abruptio placentae |
6 | 38 | Primary Health Centre | Primi | Antepartum | Severe Pregnancy Induced Hypertension |
7 | 36 | Primary Health Centre | Primi | Intrapartum | Not determined |
8 | 38 | Primary Health Centre | Primi | Intrapartum | Not determined |
Insensitive attitudes of health care providers
“to protect themselves, the nurse came outside the labour room and told everybody waiting outside that the mother’s life is in danger. They told this lie to protect themselves because now if the baby died they will be relieved that at least the mother is saved” – husband of a mother who suffered a stillbirth
“the doctor said that in government hospital they can provide only these services, if we want more, we should go to private hospitals” – mother in law of a woman who had a stillbirth
“when I was admitted to the labour ward, I had pain all night. In the morning during duty change time, the sister on duty for the morning shift did not come. So, they had to call another nurse who was not on duty that day. It was a Sunday morning and she was very much irritated. She showed her irritation on me” – a mother who suffered a stillbirth
“They never told us or explained to us the reason for the stillbirth. We were also extremely upset and so we couldn’t ask.” – a mother who had a stillbirth
“The nurses attending on me in the labour ward were disrespectful. They scolded me and verbally abused me. What happened to me is over, I hope this never happens to any other person” – a mother who suffered a stillbirth
Poor quality of health system and services
“I myself could feel that my baby is not moving, and my baby is dead. But they could not diagnose it and could not explain anything to me.” – a mother who suffered a stillbirth.
“two nurses and then an aayah (housekeeping staff) – all three of them repeatedly applied pressure on my abdomen to force the delivery of the dead baby. They repeatedly put their hands inside my private parts and because of that my private parts got swollen up. Because of the pain I was biting my lips and my lips were also swollen up. I couldn’t take the way they handled me. I was screaming in pain” – a mother who suffered a stillbirth.
“None of the staff do their assigned roles and duties. Ayah (housekeeping staff) is doing the work of the nurse and nurse is doing the work of the doctor. Therefore, finally, nobody is answerable to patients.” – husband of a woman who suffered a stillbirth
“I was suffering from pain all night and I did not feel the baby movements. If they had immediately done a scan, I think they could have saved the baby. They did not do the scan.” – husband of a mother who suffered a stillbirth
Search for cause and blame
“I developed labour pains in the 9 th month. Immediately after the onset of pains, I went to the hospital. The pain was present all through the night. In the morning, suddenly the sister checked and told me that the baby’s heart beat has stopped. I was shocked.”- mother who suffered stillbirth
“it was all so sudden, we did not know why the baby died. I am worried what will happen to the next baby. But nobody seems to know the cause” – mother in law of a mother who suffered a stillbirth
“My anger is completely focused on my husband. If he had only paid proper attention to me during pregnancy, I would have had a live baby” – a mother who suffered a stillbirth
“I was much older than other women when I got pregnant. This was because I took treatment for a long time for getting pregnant. My husband had low sperm count and he also took treatment. It is because of my age, and weakness in both me and my husband that my baby died” – a mother who suffered a stillbirth.
Guilt and remorse
“the biggest mistake I did was going to that hospital (primary health centre) for my delivery. If only I had gone to a private hospital, I would have had a normal baby. My guilt is killing me, if only I had chosen the right hospital…” – a mother who suffered a stillbirth
“I felt very guilty. I felt worthless that I am not even able to give birth to a normal healthy child.” – a mother who suffered a stillbirth
“when I got pain I called my husband to the office. He came in his two-wheeler. I climbed on to it and we both went to the hospital. I should have taken a firm decision to go to private hospital. I should not have gone to the primary health centre. I am feeling guilty for not taking a firm decision” – a mother who suffered a stillbirth
Grief
“I never believed that my baby died. It took me some time to realize the truth” – a mother who suffered a stillbirth
“the death of our baby was totally because of the negligence of the doctor and sisters in the hospital. we are very angry with them. I went and shouted at the staff of the hospital immediately” – mother in law of a woman who suffered a stillbirth
“nowadays I am unable to concentrate on any work. I am always crying. I am not even able to engage in a conversation with anyone.” – a mother who suffered a stillbirth
“I have now accepted the fact that my baby has died. I have to become normal for the sake of the family.” – a mother who suffered a stillbirth
Factors aggravating grief and guilt
“After the stillbirth, I was admitted in the general ward where other women who had delivery were also admitted. I used to feel very sad when I saw the other mothers with healthy babies” – a mother who suffered a stillbirth
“our neighbours called us murderers. That made us feel very bad” – a mother who suffered a stillbirth
“After the stillbirth, there is a lot of fights between my husband and me. We don’t have a cordial relationship. I think only having another baby will set it right.” – a woman who suffered a stillbirth
“when I see other mothers in my area with babies, I feel very sad. Nowadays I don’t go to buy milk. My friends who have healthy babies will come to buy milk at the same time and if I see them I feel like crying” – a mother who suffered a stillbirth
“because of the repeated blood tests, scans and check-up, we had to incur a lot of expenditure. We had to take a lot of loans. Already, the stillbirth made us feel bad. Above this, the loan and financial burden made us feel worse” – a mother who suffered a stillbirth
Coping strategies
“I don’t even go to temples. I don’t go anywhere. I stay inside the house. I know if I see people, they will feel sad for me and that will make me feel sad.” – a mother who suffered a stillbirth
“the best way to overcome my sadness is to get immersed in household work. I started doing all cooking, cleaning and household work immediately. This helps me forget the pain a little bit” – a mother who suffered a stillbirth
“I take care of my sister-in-law’s children. On Sundays, we sit and watch television together and play together. This helps me forget my stillbirth pain. I also help in preparing them for school daily and help them with their homework” – a mother who suffered a stillbirth
“my neighbours and relatives were very supportive. They spoke to me nicely and helped me overcome my sadness.” – a woman who suffered a stillbirth
“I have hope that I can have a normal baby next time. I need to know what all I have to do to give birth to a normal baby”- a mother who suffered a stillbirth
“Going to the temple helps me to cope with my sadness.” – mother who suffered stillbirth
Perspectives of health care providers
Strategies adopted to support mothers suffering stillbirth
Overburdened and understaffed health system
“I am working as a village health nurse (Community Health Worker) for the past 27 years. In those days, we had innocent women who were younger as our clients. Nowadays women get pregnant much later. This leads to complications. Not only this, the women and their families are well informed. They know everything and ask a lot of questions. Because of this, we are seeing a lot of complications” – a Community Health Worker.
Lopsided health system functioning
“we used to have a very skilled doctor in this hospital previously. Now madam has retired. They have posted a young male doctor in our primary health centre. He is good but does not know much. Therefore, mistakes have increased. We have scan machine, but the doctor who does scan moves from this centre to the other centre nearby and is not always available. So even though we are a 24-hour delivery facility, we don’t have enough people to work or to operate the equipment. How can we say this and explain to the patients?” – a Duty Nurse in a Primary Health Centre
Community health workers caught in the cross fire
“They say a drum gets beatings from both sides. Like that, we get abused by the higher officials as well as from the community. when something bad like a stillbirth or a neonatal death happens, the higher authorities also question and scold us. The families in the community also scold us. We must take abuse from both sides. Sometimes the nurses in the primary health centre will treat the patients badly. For this also, we will get scolded in the community” – a Village Health Nurse