Characteristics of Participants:
Ten participants were interviewed with age range from 24–37 years. Four were under 30 years and six were 30 years or older. The oldest participant was 37 years. According to their first trimester ultrasound studies, three participants were in their ninth month of gestation, one in her eighth month, three in their seventh month, and the remaining three participants in their fifth month of gestation. All participants were married, employed, and had experienced prenatal complications. Eight participants had attained tertiary education, while two participants had Senior High School Certificates. Four participants were pregnant for the first time, and the six others had been pregnant before and/or had delivered before.
The following themes were created following the qualitative analysis of data: perception of causes of prenatal complications, awareness of prenatal complications, categories of prenatal complications, responses to prenatal complications, referral, treatment of prenatal complications and barriers to seeking care for prenatal complications.
Perception of Causes of Prenatal Complications:
Participants shared their perceptions regarding the causes of some prenatal complications. Three subthemes: stress, rigorous activities and unpleasant smell were created in response to participants’ answers.
Stress:
Some participants attributed complications such as bleeding, abdominal pains, swollen feet, and vomiting to stress.
Rigorous Activity:
Other participants described the cause of some PC as engaging in strenuous activities. One participant mentioned rigorous activity triggered her complications. Some participants who experienced spotting (intermittent loss of small amounts of blood through the vagina) considered it as a normal occurrence and delayed in seeking medical attention until the situation worsened.
Unpleasant Smell:
Participants responses to the cause of excessive vomiting experienced during pregnancy was diverse. Some considered this as a normal occurrence in pregnancy. However, participants who viewed this as a prenatal complication indicated the cause as being from unpleasant smells from medication, food, drinks, or the environment, which they described as heightened during pregnancy. Other participants who considered excessive vomiting as a normal aspect of pregnancy, did not realize the significance of this prenatal complication and the potential long-term impact it could have on both the mother and the baby.
For vomiting some don’t actually know that with frequent vomiting you have to see the doctor. They think it is normal because others say you have to vomit in the first trimester but by my research on the internet I learnt if you are vomiting severely you have to see the doctor immediately. For bleeding they do come to the clinic but for vomiting they think it’s normal for a pregnant woman to vomit but they don’t know that if it becomes severe, it can affect the pregnant mother and the baby.P 5, age 34.
Awareness of Prenatal Complications
The theme of awareness of prenatal complications emerged as a significant finding in the study. Several participants demonstrated poor knowledge regarding the danger signs associated with prenatal complications. Two subthemes were generated from this main theme: diagnosing complications and nature of prenatal complications.
Diagnosing complications:
The subtheme “Diagnosing complications” highlighted the challenges faced by pregnant women in identifying and understanding their prenatal complications. Some participants struggled to accurately describe their experiences. While discussing prenatal complications, the majority of participants mentioned bleeding as a significant concern:
"I experienced sudden and excessive bleeding right after I submitted my work results. I sought treatment at a nearby hospital, received care, and returned home. However, one day later, I noticed that I was bleeding again." (Participant, age 33)
Nature of prenatal complications:
The subtheme “nature of prenatal complications” describes participants’ poor understanding of the presentation and characteristics of prenatal complications. Some first-time pregnant participants interviewed expressed ignorance about the nature of their complications. This subtheme was not observed among responses from pregnant women who regularly attended antenatal clinics:
“During my first pregnancy, I had no awareness of the danger signs. Sometimes, I would experience severe headaches and assume it was a normal part of pregnancy. Although I sensed that something was wrong, it was difficult to pinpoint the exact issue. I didn’t feel like myself.” (Participant 5, age 34)
By exploring these sub-themes, the study shed light on the participants' varying levels of understanding and awareness regarding prenatal complications.
Categories of Prenatal Complications
The study identified the following types of prenatal complications: vaginal bleeding, excessive vomiting, severe headaches, severe abdominal pains, swelling of the feet, and anemia. Among these, vaginal bleeding was recognized as the most common prenatal complication by the participants. One participant shared her experience:
“When I noticed excessive bleeding, I immediately rushed to the hospital for treatment. I was scared because I knew that bleeding could pose risks to my health and the well-being of my unborn baby. I followed all the instructions given by the doctors and nurses to prevent it from happening again. Despite this, I still worry about the possibility of bleeding, so I regularly visit the hospital for antenatal care to safeguard my baby.” (Participant 6, age 24)
Vomiting was frequently experienced by most participants during the first trimester, with some continuing to vomit throughout their pregnancy. One participant described her experience with constant vomiting and subsequent dehydration, which led to hospitalization:
"I experienced excessive vomiting during the first trimester. I couldn't keep anything in my stomach, even water, food, or medication. I sought medical attention, and the doctor prescribed medication that helped alleviate the symptoms. I gradually improved after that." (Participant 5, age 34)
Another participant compared her current pregnancy to her previous one, highlighting the difference in vomiting frequency:
"In contrast to my first pregnancy, where I vomited once a day, I experienced vomiting throughout this pregnancy until the ninth month, at least twice a day." (Participant 4, age 30)
Severe abdominal pains, characterized by intense pain in the abdomen, were reported by some participants. One participant, who had previously given birth, shared her experience:
"I had a smooth first pregnancy without any problems, but this time I experienced severe abdominal pains. It was really painful, and I had to rush to the hospital for treatment." (Participant 5, age 34)
A few participants experienced continuous or intermittent swelling in their feet during pregnancy. While some considered it a normal occurrence during pregnancy, others perceived it as a danger sign and sought medical assistance:
"Since I know that swollen feet can indicate a serious issue, I would go to the hospital for evaluation. Although I can endure backaches, swollen feet require immediate medical attention. Sometimes, I elevate my legs on pillows to alleviate the discomfort, especially when I have been standing or walking for an extended period." (Participant 8, age 28).
Most participants reported experiencing signs of anemia at some point during their pregnancy. One participant described how she experienced weakness and dizziness, which led her to seek treatment:
"I experienced severe anemia during this pregnancy, which made me feel extremely weak and dizzy. It varies for each individual. The condition became quite severe, so I went to the hospital and received treatment." (Participant 2, age 33).
Consequences of Prenatal Complications on Mother and Baby:
The study findings revealed the effects of prenatal complications on both the pregnant women and babies. Working mothers reported difficulties concentrating at work due to the complications. Some participants had considered changing careers to better accommodate their needs and those of their unborn babies. Thirty-three-year-old participant #2 described it as follows:
"It affects us in so many ways depending on the conditions. I have to stop work for my second baby and start my own business because I decided to stop and have time for my kids... instead of having something in the office; I would want to start my own business to be able to have time for them. Sometimes it is not easy, but it depends on how far you want to go as an individual and what you want for your family”. (Participant 2, age 33).
Responses to Prenatal Complications
This theme focused on the actions taken by pregnant women upon realizing they were experiencing prenatal complications. Several sub-themes emerged within this category, including reporting immediately to the hospital, promptly seeking medical care, enduring the complications, adopting a slower pace, opting for bed rest, exploring home remedies, experiencing delays in decision-making, and seeking care.
Reporting immediately to the hospital was a common response among the pregnant women who experienced complications. They recognized the urgency of seeking immediate medical attention and did not delay their decision to visit the hospital. One participant expressed this sentiment:
"I understand that if I don't seek medical help, something serious might happen. So, my instinct tells me to rush to the hospital before things become dangerous. It could even lead to death. The sooner you see the doctor, the better it is for you and your baby." (Participant 4, age 30)
Two other participants described similar sentiments:
"I just rushed to the hospital. Most pregnant women do the same when complications arise, especially when it comes to bleeding during pregnancy. There's nothing else you can do but seek medical care at the hospital." (Participant 1, age 33).
However, some participants experienced delays in their decision-making process when it came to seeking care for their prenatal complications. Participants cited various reasons for this delay, including childcare responsibilities, relying on advice from elderly family members, and waiting to confirm whether the symptoms were truly related to prenatal complications. One participant shared her perspective:
"I waited because we had exams coming up—it was the end of the term, and I didn't have anyone to take care of my children. Since it was crucial for their promotion to the next class, I made the sacrifice and decided to wait until the weekend. I knew that asking for permission might not be granted, so I had to prioritize”. (Participant 3, age 37).
These responses highlight the range of actions taken by pregnant women when faced with prenatal complications. While some promptly sought medical care, others encountered delays due to personal circumstances or uncertainties surrounding their symptoms. Understanding these responses is essential for healthcare providers to address barriers and improve timely access to appropriate care for pregnant women experiencing complications.
Referral
The theme “referral” described how participants obtained healthcare following prenatal complication. Participants either self-reported to health facilities or were referred by other healthcare professionals.
For the self-referral participants reported to the hospital without a healthcare worker's referral. One participant described her experience:
"I went to the polyclinic because I was feeling unwell and was advised to undergo a lab test. The test results revealed that I was pregnant, so I visited the antenatal clinic on Friday. The healthcare provider informed me that my blood pressure was high and recommended that I come to the hospital. I felt relieved and comfortable with the care, so I decided to go." (Participant 7, age 29)
Another participant shared her decision to be referred to a specific hospital due to concerns about her pregnancy:
"I was supposed to go to the hospital. Initially, I considered having a Caesarean section, but since I had previously delivered naturally, I wanted to try that again. I was scheduled for my fifth scan yesterday, and it showed that the baby weighed 4kg. So, I informed the doctor that I didn't want to take any risks with this pregnancy and requested a referral to this hospital." (Participant 2, age 33)
Treatment of Prenatal Complications
The theme “treatment of prenatal complications” describes the care received by pregnant women at the hospital. Some participants were treated as in-patients following admission, and others were treated on outpatient basis. Participants had varied opinions regarding the medical care they received. The duration and methods of treatment differed depending on the type of prenatal complication. One participant shared her experience:
"Fortunately, I was still able to carry out my daily activities until I noticed certain symptoms and went to the hospital. The dilation reached 3cm but didn't progress further, so I was admitted for three days. On the third day, the doctor observed that it was still at 3cm, and the baby wasn't descending, so they decided to induce labor. I received injections and a drip. I successfully delivered a healthy baby without undergoing surgery." (Participant 5, age 34).
Support during Prenatal Complications
This section focuses on the individuals who provided support during prenatal complications. Participants mentioned their husbands, mothers-in-law, friends, colleagues, and religion played significant roles in helping them cope with their complications. One participant described seeking assistance due to her weakened state:
"I became pale and weak, and I experienced dehydration because of the continuous symptoms. I was too weak to perform tasks as I normally would, so I had to rely on others for assistance."
Most participants expressed gratitude for the support they received from their relatives, particularly their husbands. Their husbands were consistently available to offer help:
"I don't have a housemaid; it's just my husband and me. Sometimes he helps me, but he's not always at home due to work commitments. So, there are times when I have to manage on my own. " (Participant 3, age 37).
"He enjoys wearing perfume, but he refrains from doing so. I don't have to handle all the chores by myself. Sometimes he does the laundry while I cook, and if I wake him up at night for tea, he willingly prepares it. He's always helpful." (Participant 8, age 28).
One participant highlighted the support she received from her mother-in-law:
"My mother-in-law came to stay with me. She encouraged me to eat, even when I didn't feel like it. She always reminded me that the baby needed the extra nourishment. I'm not sure if other people have experienced the same level of support." (Participant 6, age 24).
Faith-based support encompassed participants' beliefs in prayer, spirituality, or religion. They believed that only God could guide them through pregnancy and delivery:
"God is so wonderful. I was prepared for surgery, but unfortunately, there was chaos in the theater, with scattered nurses and doctors. The delivery happened as if I needed to use the restroom, but I didn't want to. I had the urge to touch my thigh, and the doctor inside the theater noticed and told them to leave me. The only name I could utter was 'Jesus.' I prayed to the Lord, saying that He was the only one who could save me, even if others had rejected me." (Participant 4, age 30).
Faith, religion, or spirituality played a vital role in providing support for pregnant women facing complications. Some participants believed that by placing their trust in God, they could successfully navigate pregnancy and delivery.
Barriers to Seeking Care for Prenatal Complications
This theme describes the obstacles encountered by pregnant women when seeking care for prenatal complications. The reasons given by participants included location-based barriers, financial-related barriers, and health-insurance-related barriers in accessing healthcare. These barriers presented challenges for pregnant women seeking care. A participant’s location from the hospital influenced their decision-making either delayed or hastened reporting for prompt care. Some participants who lived at greater distances from the health facility recounted the challenges they faced in reaching the hospital:
"I live in Spintex, and I undergo my medical check-ups at Korle Bu. If I experience back or headaches, I hesitate to drive through the traffic to Korle Bu. So, unless I observe other signs like bleeding, I endure the discomfort. Sometimes financial constraints force you to endure whatever you're going through." (Participant 8, age 28)
"It's usually best to go to the nearest clinic in most cases. Even if it's a private clinic and you can't afford it, it's still safer to seek treatment there in such situations. That's what I believe." (Participant 1, age 33).
Financial constraints were another significant barrier affecting the seeking of care for prenatal complications. The majority of participants described facing economic challenges, which impacted their ability to access healthcare:
"Financial issues can prevent women from seeking medical care. If you don't have the money, you may fear being judged and may not go to the nearest clinic or hospital, even if you know something is wrong. Many pregnant women fail to realize their rights to medical care due to financial constraints. The biggest barrier is money, followed by distance." (Participant 2, age 33).
Participants’ past experiences with prenatal complications also influenced their health-seeking behavior. Some participants mentioned seeking the opinions of elderly individuals before deciding to go to the hospital. However, they acknowledged that relying solely on the advice of the elderly might not always be appropriate:
"We tend to rely on our parents and seek the advice of others. When complications arise, the thought of going to the hospital doesn't always come to mind. We prefer to consult with older people to determine if the situation is serious, unless they tell us it's not necessary. However, if we rely too much on the elderly, we may be deceived because their knowledge may be based on experiences from many years ago, which may not apply to the present." (Participant 5, age 34).