Women's experience of severe early onset preeclampsia : a hermeneutic analysis
Preeclampsia is a complex, baffling and unpredictable syndrome. The condition affects the lives of approximately one in every twenty pregnant women. Most cases are mild but some are serious enough to threaten the life of mother and baby. Medical research has yet to identify a cause, and the search for a cure continues. Delivery remains the only method of resolving this dangerous complication of pregnancy and may need to be effected before the foetus has become mature enough to avoid the risks associated with preterm birth. Women's experience of preeclampsia has received little attention in midwifery and obstetric literature. This hermeneutic phenomenological study has been designed to answer the question "What is women's experience with preeclampsia before 34 weeks of gestation?" Eight women who had experienced severe preeclampsia were interviewed. Their narratives are analyzed to uncover the meaning of the lived experience of preeclampsia from diagnosis to postpartum recovery. Three data chapters reveal some of the ways that preeclampsia reveals itself as the disease progresses. The findings of this study indicate that there are many atypical presentations of preeclampsia and that sometimes early "showing" goes unrecognized. The woman may in fact feel better as the disease progresses. Late diagnosis leaves the woman and her family shocked and may compromise foetal and maternal safety. Having preeclampsia changes the reality of pregnancy and early parenting for a woman. Emotional consequences are significant and include an increased risk of post-traumatic stress disorder. The unpredictable manner in which preeclampsia first "shows itself" is analyzed in the first data chapter and the following two chapters explore the way in which a woman's life may be thrown out of control by diagnosis and management of the disease. Paradoxically, women with severe preeclampsia often lose continuity of care with their midwife at a time when they most need the support of a familiar and trusted professional. Provision of continuity creates a challenge for the midwife when the woman's care is taken over by secondary services. Innovative ideas to enhance the safety and holistic quality of care for women with preeclampsia are discussed.