The Needs of Women Who Have Experienced “Maternal Near Miss”: A Systematic Review of Literature

Sedigheh Abdollahpour, Abbas Heydari, Hosein Ebrahimipour, Farhad Faridhosseini, Talat Khadivzadeh



Background: Maternal Near Miss (MNM) event is associated with emotional, psychological, and social effects on women. Determining the needs of women with these experiences is the key to programming for providing high‑quality care and reducing its burden. Hence, this study was conducted to determine the needs of women who have experienced MNM.

Materials and Methods: In this literature systematic review, to achieve the intended information, articles published in Web of Science and PubMed databases were systematically searched. The search strategy focused on three keywords or phrases: “maternal morbidity” OR “maternal near miss” AND “needs.” Publication date was all relevant articles before 2019, and publication language was restricted to English. Article search was conducted by two independent reviewers. After the primary search, 2140 articles were found. Eventually, 77 articles, including 20 qualitative studies and 57 quantitative studies, were enrolled for final evaluation.

Results: According to the results, the needs of these women could be categorized into six groups of “Management and care needs of health system,” “Educational needs of health system,” “Follow up and continuity of care at the primary care level,” “Need to develop a physical, psychological and social of care packages,” “Social support,” and “Psychosocial support and counseling.”

Conclusions: The near‑miss events change the mothers’ living conditions, and therefore, they need to receive special support, given the difficult conditions they are undergoing. It is necessary that a supportive program be designed to follow‑up MNM after the discharge to be run by the primary care team.


Childbirth, maternal morbidity, maternal near miss, pregnancy, systematic review

Full Text:



Geller SE, Rosenberg D, Cox SM, Kilpatrick S. Defining a conceptual framework for near miss maternal morbidity. J Am Med Womens Assoc (1972) 2002;57:135 9.

Pattinson R, Hall M. Near misses: A useful adjunct to maternal death enquiries. Br Med Bull 2003;67:231 43.

Cochet L, Pattinson R, Macdonald A. Severe acute maternal morbidity and maternal death audit a rapid diagnostic tool for evaluating maternal care. South Afr Med J 2003;93:700 2.

Oliveira LC, da Costa AA. Maternal near miss in the intensive care unit: Clinical and epidemiological aspects. Rev Bras Tera Intensiva 2015;27:220 7.

Abha S, Chandrashekhar S, Sonal D. Maternal near miss: A valuable contribution in maternal care. J Obstet Gynecol India 2016;66:217 22.

Abdollahpour S, Miri H, Khadivzadeh T. The maternal near miss incidence ratio with WHO Approach in Iran: A systematic review and meta analysis. Iran J Nurs Midwifery Res 2019;24:159 66.

Hinton L, Locock L, Knight M. Support for mothers and their families after life threatening illness in pregnancy and childbirth: A qualitative study in primary care. Br J Gen Pract 2015;65:e563 9.

Hinton L, Locock L, Knight M. Maternal critical care: What can we learn from patient experience? A qualitative study. BMJ Open 2015;5:e006676.

Filippi V, Ronsmans C, Campbell OM, Graham WJ, Mills A, Borghi J, et al. Maternal health in poor countries: The broader context and a call for action. Lancet 2006;368:1535 41.

Langer A, Meleis A, Knaul FM, Atun R, Aran M, Arreola Ornelas H, et al. Women and health: The key for sustainable development. Lancet 2015;386:1165 210.

Knaul FM, Langer A, Atun R, Rodin D, Frenk J, Bonita R. Rethinking maternal health. Lancet Global Health 2016;4:e227 8.

Knight M, Acosta C, Brocklehurst P, Cheshire A, Fitzpatrick K, Hinton L, et al. Beyond maternal death: Improving the quality of maternal care through national studies of “near miss” maternal morbidity. Programme Grants Applied Research 2016;4:1 180.

Abdollahpour S, Mousavi SA, Motaghi Z, Keramat A, Khosravi A. Prevalence and risk factors for developing traumatic childbirth in Iran. J Public Health 2017;25:275 80.

Hinton L, Locock L, Knight M. Experiences of the quality of care of women with near-miss maternal morbidities in the UK. BJOG 2014;121:20 3.

Abdollahpour S, Keramat A, Mousavi SA, Khosravi A. The effect of debriefing and brief cognitive behavioral therapy on postpartum depression in traumatic childbirth: A randomized clinical trial. J Midwifery Reprod Health 2018;6:1122 31.

Abdollahpour S, Bolbolhaghighi N, Khosravi A. The effect of early skin to skin contact on the mental health of mothers in traumatic childbirths. Int J Health Stud 2016;2:5-9.

Firoz T, Chou D, von Dadelszen P, Agrawal P, Vanderkruik R, Tunçalp O, et al. Measuring maternal health: Focus on maternal morbidity. Bull World Health Organ 2013;91:794 6.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta analyses: The PRISMA statement. Ann Inter Med 2009;151:264 9.

World Health Organization. Making pregnancy safer: Multi country review meeting on maternal mortality and morbidity audit “Beyond the Numbers”: Report of a WHO meeting, Charvak, Uzbekistan 14 17 June 2010. Making pregnancy safer: Multi country review meeting on maternal mortality and morbidity audit “Beyond the Numbers”: Report of a WHO meeting, Charvak, Uzbekistan 14 17 June 2010.

Venkatesh S, Ramkumar V, Sheela C, Thomas A. Implementation of WHO near miss approach for maternal health at a tertiary care hospital: An audit. J Obstet Gynecol India 2016;66:259 62.

Kleppel L, Suplee PD, Stuebe AM, Bingham D. National initiatives to improve systems for postpartum care. Mater Child Health J 2016;20:66 70.

Mbachu II, Ezeama C, Osuagwu K, Umeononihu OS, Obiannika C, Ezeama N. A cross sectional study of maternal near miss and mortality at a rural tertiary centre in southern nigeria. BMC Pregnancy Childbirth 2017;17:251.

Mohammadi S, Carlbom A, Taheripanah R, Essen B. Experiences of inequitable care among Afghan mothers surviving near miss morbidity in Tehran, Iran: A qualitative interview study. Int J Equity Health 2017;16:121.

Zafar H, Ameer H, Fiaz R, Aleem S, Abid S. Low socioeconomic status leading to unsafe abortion related complications: A third world country dilemma. Cureus 2018;10:e3458.

Iwuh I, Fawcus S, Schoeman L. Maternal near miss audit in the metro west maternity service, Cape Town, South Africa: A retrospective observational study. South Afr Med J 2018;108:171 5.

Mahmood NA, Sharif KM. Thromboembolism prophylaxis after cesarean section. Bahrain Med Bull 2018;40:22-5.

Tuli A, Rathi J, Garg N, Vashisht R. Foetomaternal outcome in eclampsia in tertiary care hospital. Education 2018;35:6.

Eadie IJ, Sheridan NF. Midwives’ experiences of working in an obstetric high dependency unit: A qualitative study. Midwifery 2017;47:1 7.

Widyaningsih V, Khotijah K. The patterns of self reported maternal complications in Indonesia: Are there rural urban differences? Rural Remote Health 2018;18:4609.

Suplee PD, Bingham D, Kleppel L. Nurses’ knowledge and teaching of possible postpartum complications. MCN Am J Mater Child Nurs 2017;42:338 44.

Filippi V, Chou D, Barreix M, Say L, Group WMMW, Barbour K, et al. A new conceptual framework for maternal morbidity. Int J Gynecol Obstet 2018;141:4 9.

David E, Machungo F, Zanconato G, Cavaliere E, Fiosse S, Sululu C, et al. Maternal near miss and maternal deaths in Mozambique: A cross sectional, region wide study of 635 consecutive cases assisted in health facilities of Maputo province. BMC Pregnancy Childbirth 2014;14:401.

Norhayati MN, Surianti S, Nik Hazlina NH. Metasynthesis: Experiences of women with severe maternal morbidity and their perception of the quality of health care. PLoS One 2015;10:e0130452.

Elmir R, Schmied V, Jackson D, Wilkes L. Between life and death: Women’s experiences of coming close to death, and surviving a severe postpartum haemorrhage and emergency hysterectomy. Midwifery 2012;28:228 35.

Furniss M, Conroy M, Filoche S, MacDonald EJ, Geller SE, Lawton B. Information, support, and follow up offered to women who experienced severe maternal morbidity. Int J Gynaecol Obstet 2018;141:384 8.

Snowdon C. Information hungry and disempowered:A qualitative study of women and their partners’ experiences of severe postpartum haemorrhage. Midwifery 2012;28:791 9.

Hinton L, Locock L, Knight M. Partner experiences of “near miss” events in pregnancy and childbirth in the UK: A qualitative study. PLoS One 2014;9:e91735.

Mbalinda SN, Nakimuli A, Nakubulwa S, Kakaire O, Osinde MO, Kakande N, et al. Male partners’ perceptions of maternal near miss obstetric morbidity experienced by their spouses. Reprod Health 2015;12:23.

Shorey S, Chee C, Chong YS, Ng ED, Lau Y, Dennis CL. Evaluation of technology based peer support intervention program for preventing postnatal depression: Protocol for a randomized controlled trial. JMIR Res Protoc 2018;7:e81.

Furuta M, Sandall J, Cooper D, Bick D. Severe maternal morbidity and breastfeeding outcomes in the early post-natal period: A prospective cohort study from one E nglish maternity unit. Matern Child Nutr 2016;12:808 25.

Kaye DK, Kakaire O, Nakimuli A, Osinde MO, Mbalinda SN, Kakande N. Lived experiences of women who developed uterine rupture following severe obstructed labor in Mulago hospital, Uganda. Reprod Health 2014;11:31.

Souza JP, Cecatti JG, Parpinelli MA, Krupa F, Osis MJ. An emerging “maternal near-miss syndrome”: Narratives of women who almost died during pregnancy and childbirth. Birth 2009;36:149 58.

Furuta M, Sandall J, Bick D. Women’s perceptions and experiences of severe maternal morbidity – A synthesis of qualitative studies using a meta ethnographic approach. Midwifery 2014;30:158 69.

Thompson JF, Heal LJ, Roberts CL, Ellwood DA. Women’s breastfeeding experiences following a significant primary postpartum haemorrhage: A multicentre cohort study. Int Breastfeed J 2010;5:5.

la Cruz CZ, Coulter ML, O’rourke K, Amina Alio P, Daley EM, Mahan CS. Women’s experiences, emotional responses, and perceptions of care after emergency peripartum hysterectomy: A qualitative survey of women from 6 months to 3 years postpartum. Birth 2013;40:256 63.

Fenech G, Thomson G. Tormented by ghosts from their past: A meta synthesis to explore the psychosocial implications of a traumatic birth on maternal well being. Midwifery 2014;30:185 93.

Jarrett PM. Pregnant women’s experience of depression care. J Mental Health Train Educ Pract 2016;11:33 47.

Abdollahpour S, Khosravi A, Bolbolhaghighi N. The effect of the magical hour on post traumatic stress disorder (PTSD) in traumatic childbirth: A clinical trial. J Reprod Infant Psychol 2016;34:403 12.

Cram F, Stevenson K, Geller S, MacDonald EJ, Lawton B. A qualitative inquiry into women’s experiences of severe maternal morbidity. Kōtuitui: N Z J Soc Sci Online 2019;14:52-67.

Andreucci CB, Bussadori JC, Pacagnella RC, Chou D, Filippi V, Say L, et al. Sexual life and dysfunction after maternal morbidity: A systematic review. BMC Pregnancy Childbirth 2015;15:307.

Waterstone M, Wolfe C, Hooper R, Bewley S. Postnatal morbidity after childbirth and severe obstetric morbidity. BJOG 2003;110:128 33.

Abdollahpour S MZ. Lived traumatic childbirth experiences of newly delivered mothers admitted to the postpartum ward: A phenomenological study. J Caring Sci 2019;8:23 31.


  • There are currently no refbacks.