Table 1. Socio-demographic Characteristics
Participant No.
|
Age group
(Yrs)
|
Parity
|
Delivery Mode
|
Indication for EPH
|
Education level
|
Occupation
|
Religion
|
Marital status
|
Living children
|
1
|
25-30
|
2
|
SVD
|
Uterine atony
|
Degree
|
Sales manager
|
Moslem
|
Married
|
2
|
2
|
30-35
|
3
|
C/S
|
Uterine atony
|
Degree
|
Business lady
|
Catholic
|
Married
|
3
|
3
|
30-35
|
3
|
C/S
|
Placenta accrete
|
Diploma
|
House wife
|
Catholic
|
Married
|
3
|
4
|
30-35
|
4
|
C/S
|
Abruption placenta
|
Degree
|
Police officer
|
Protestant
|
Married
|
4
|
5
|
25-30
|
3
|
SVD
|
Cervical tear
|
Degree
|
House wife
|
Protestant
|
Married
|
2
|
6
|
45-50
|
10
|
C/S
|
Ruptured uterus
|
Primary
|
Business lady
|
Protestant
|
Widowed
|
8
|
7
|
30-35
|
1
|
C/S
|
Uterine atony
|
Diploma
|
Teacher
|
Catholic
|
Widowed
|
1
|
8
|
35-40
|
6
|
C/S
|
Placenta previa
|
Secondary
|
Business lady
|
Born again
|
Married
|
5
|
9
|
20-25
|
2
|
C/S
|
Uterine Atony
|
Secondary
|
Business lady
|
Catholic
|
Married
|
2
|
10
|
35-40
|
5
|
C/S
|
Placenta Previa
|
Secondary
|
House wife
|
Catholic
|
Married
|
4
|
11
|
25-30
|
3
|
C/S
|
Ruptured uterus
|
Secondary
|
Business lady
|
Moslem
|
Separated
|
2
|
12
|
30-35
|
3
|
C/S
|
Uterine atony
|
Degree
|
Banker
|
Catholic
|
separated
|
3
|
13
|
35-40
|
4
|
SVD
|
Ruptured uterus
|
Degree
|
Business lady
|
Catholic
|
Married
|
3
|
14
|
35-40
|
4
|
C/S
|
Ruptured uterus
|
Diploma
|
House wife
|
Catholic
|
Married
|
3
|
15
|
35-40
|
3
|
C/S
|
Placenta accrete
|
Secondary
|
Housewife
|
Protestant
|
Married
|
3
|
16
|
35-40
|
3
|
C/S
|
Uterine Atony
|
Degree
|
Teacher
|
Catholic
|
Married
|
3
|
17
|
35-40
|
6
|
C/S
|
Uterine Atony
|
Secondary
|
Business lady
|
Born again
|
Separated
|
6
|
18
|
40-45
|
3
|
C/S
|
Uterine Atony
|
Degree
|
Business lady
|
Catholic
|
Married
|
3
|
18 women were interviewed. The average age at the time of the hysterectomy was 34 years, nearly all the women except one were multiparous and all had a minimum of secondary education. Caesarian section was the commonest mode of delivery with uterine atony being the number one indication for EPH. All the women except two were married and gainfully employed. 15 out of the 18 women ethnic Baganda and Christians. The average time after the hysterectomy was two years.
WOMEN’S EXPERIENCES FOLLOWING EPH
Four major themes emerged on women’s experiences following EPH. They were loss of womanhood, Joy for being alive, Uncertainty about the future and An over-whelming need for emotional support.
LOSS OF WOMANHOOD
To most women being a woman means having a uterus, getting monthly periods and being able to bear children, if she could not achieve these three basic things, it meant loss your womanliness. Most expressed sadness, emptiness, incompleteness and a sense of loss.
“I felt sad, lost and empty…I wanted five children of my own but I only have two, Its like being a woman has now lost meaning…” Participant No.2.
“I am an only child, I wanted to have a big family of my own that’s why I decided to start producing at an early age, now look at what has happened hmmm, i can no longer achieve my goal so being a woman is now meaningless”Participant No.1
These women also experienced loss feminine attributes such as stamina in bed and attractiveness.
“Ever since the operation I feel less attractive to my husband and I have lost all my confidence in bed” Participant No.7
“After my first operation I was determined to push the next baby. The doctors said my bones would not allow but I insisted. I wanted to be like other real women…unfortunately I got complications which has led to me losing my uterus, now I feel less of a woman”. Participant No.9.
JOY FOR BEING ALIVE
Not all the women experienced sadness, hopeless or worthless, quite a number said they felt a sense of pleasure, gratefulness and delight for being alive. They believed life was more important than the uterus.
“Me I knew I was dead because by the time they took me to theatre i was no longer understanding anything... being alive is a miracle to me, am so happy to God and the doctors for saving my life” Participant No.13
“I was giving birth to my tenth child, so loosing the uterus was not an issue to me, in any case am happy because it has saved me from having more children” Participant No.6
Some felt God had given them a second chance to live again and for that they were grateful. They said they now have the time to focus on their children and other important things in their lives instead of looking for more children.
“Initially I was very depressed, stopped working and kept away from people. One day my good friend came to visit me and told me to count myself lucky for being alive because two of her other friends didn’t make it even after their uteruses were removed…from that day forward my life changed, I now appreciate life more than before and thank God for saving it… Participant No.3.
UNCERTAINTY ABOUT THE FUTURE
Questions like so what will happen to me as time goes on? Is my life span reduced? Am I at risk of cancer? These and other questions kept being repeated through out the interview processes. Most of the women looked worried and less sure about their future.
“I have heard people say when your uterus is removed, you will die early…now am so worried for my life, what exactly happens after such an operation? Participant No.2.
Fear, anxiety and worry were very common among these women, they reported getting night mares about the future.
“Whenever I remember how I nearly died that day, my heart starts beating very fast and I start sweating. These things make me worry so much about the future” Participant No.1.
PROFESIONAL ABANDONMENT
After living the hospital, a number of women felt abandoned, not valued and not adequately supported by the hospital. They said after going through such a dreadful event, they expected close follow-up, counseling, empathy and even home visits.
“Do you people really have hearts? After four years of being abandoned now you want us to talk (she looked anry), I nearly died in that hospital and on top of that I was neglected after the operation, you people had better improve…” Participant No.10.
“Frankly speaking, I felt emotionally unsupported, there was so much going on, at least I needed some one to talk to from the hospital since I lost my uterus from here” Participant No.14.
WOMEN’S COPING STRATEGIES FOLLOWING EPH
LIVING IN DENIAL
Losing a uterus is considered untenable and unimaginable so to be able to cope with this catastrophe most of the women said they had to suppress their emotions, live in denial, isolate themselves and pretend that everything was fine.
“I thought the doctors were joking when they told me they have failed to stop the bleeding so the only solution was to remove the uterus, I never imagined myself being without a uterus so I guess am still in denial” Participant No.4.
“Not telling people is the only thing that has kept me going, even my husband is not aware, since I was the one who signed the papers” Participant No.14.
“Deep inside me I was hurting, I wanted to cry until all the tears were over but I kept on pretending that every thing was ok, I didn’t want to appear weak and feminine” Participant No.1.
BELIEVING IN GOD
He knows why everything happened, he created me and gave me the uterus, I have faith in him and I know he has spared me for a reason. These were some of the common expressions from some women especially those who were strong believers. They believed nothing could happen without God’s plan. So it is useless to blame people or the doctors, it is God alone who gives and takes.
“Without God nothing is possible, he is the alpha and omega of every thing so I know it was his plan, I cannot complain, how about those who were born without a uterus or those completely infertile, me I have my three children so am fine with it” Participant No.13.
“Miracles happen, Virgin Mary gave birth without a husband, so am also waiting for my miracle so that I can have my three remaining children. Next year (2019) am planning to go to Rome and pray at St. Peter’s Basillica together with the Pope and after that you will see” Participant No.7.
“Am grateful to God for sparing my life, I have heard others died following these operation, so I believe it was Gods plan to save my life for the sake of my children. Participant No.8.
ACCEPTANCE
Whether you cry, blame, hide or deny it, what has happened has happened and there was nothing they could do about it. The only thing left to do was to accept it and move on with life. These were mainly women who described themselves as realists, they didn’t want to pretend or have hope that a miracle would happen so it was better to accept it.
“I watched a TV program and the pastor said that the uterus can grow back and you can have as many children as you want so I kept on waiting and waiting, but nothing happened I had to accept it” Participant No.15
“I knew from antenatal care that the placenta was lying low so the doctors told me during the operation if bleeding does not stop my uterus will have to be removed so by the time I went to theatre I had accepted my fate” Participant No.10.