Beyond survival: The impact of birth complications on postpartum wellbeing for mothers, babies, and households in Kenya.

Evidence is lacking on how birth complications affect postpartum wellbeing in low-resource settings, and how to support post-complication recovery in these settings. To address this gap, we conducted a mixed methods study at three county referral hospitals in Kenya to explore the impact of birth complications on mothers' and families' postpartum experiences and wellbeing. We used a convergent parallel study design, including a quantitative cross-sectional survey of 120 mothers at 5-10 weeks postpartum and qualitative semi-structured narrative interviews with 52 mothers and 19 family members at 1-2 weeks and 6-8 weeks after birth. The quantitative and qualitative strands were implemented and analyzed independently, then merged during interpretation. We found that birth complications often come as an unexpected physical, emotional and financial shock to mothers and families, with immediate impacts at delivery and lingering effects in the postpartum period. Complications have a "multiplier effect" above and beyond the typical challenges of childbirth and postpartum recovery, with ripple effects on the broader household. Mothers' physical and emotional health are affected by quality-of-care gaps for complications in facilities, leading to subsequent post-discharge challenges. Mothers' emotional wellbeing is closely linked with their baby's health, feeding and growth. Our results offer a comprehensive view of postpartum wellbeing, adding to the evidence base on post-complication experiences. Our findings suggest key areas of opportunity, including patient-centered care improvements and resource linkages, to better support mothers and newborns with birth complications.