Cesarean Wound Care After Hospital Discharge: A Qualitative Study in Rural Haiti

Abstract

Part 1 discusses the current situation in Haiti and challenges women face in receiving healthcare while Part 2 details a research project completed on the topic of C-section wound care. The number of cesarean section (C-section) deliveries has risen dramatically over the last few decades, with an estimated global number of 29.7 million C-sections in 2015 (Boerma, 2018). C-section delivery may be accompanied by many complications, surgical site infection (SSI) being the most prevalent. Post-cesarean SSI may increase maternal morbidity and mortality (Salim, 2012; Awad, 2012). In 2018, Hôpital Universitaire de Mirebalais (HUM) in rural Haiti registered 5,007 births. Of these, 30% (1,502) were C-sections (Personal communication). This study assesses the information HUM clinicians share with women at discharge for C-section wound care and how women receive and can follow these recommendations. Data collected through semi-structured interviews with clinicians resulted in a consensus-based C-section discharge checklist and interviews with clinicans and women who have recently had a C-section provided insight on the discharge process. Clinicians focused recommendations in five areas, including bandage change, bathing, changing clothes, restricting physical effort, and infection prevention. Most women interviewed for the study reported receiving no information at discharge or limited information before leaving the hospital. For women that received discharge instructions, many left the hospital confused by the information and unable to ask questions. HUM should work towards formalizing the discharge process after a C-section by finalizing the checklist developed in this study and train clinicians. HUM should also review providing a set of writing or illustrated instructions that a woman and her family could take home for review after discharge. Additional research should take place to improve understanding on the discharge process in low and middle-income countries by exploring what women understand in order to best equip women in avoiding complications after a C-section.