The costs of 'being with the woman': secondary traumatic stress in midwifery.
OBJECTIVE
it is widely acknowledged that caring can cause emotional suffering in health-care professionals. The concepts of compassion fatigue, post-traumatic stress disorder and secondary traumatic stress are used to describe the potential consequences of caring for people who are or have experienced trauma. Empathy between the professional and patient or client is a key feature in the development of secondary traumatic stress. The aim of this paper is to contribute to the conceptual development of theory about dynamics in the midwife-woman relationship in the context of traumatic birth events, and to stimulate debate and research into the potential for traumatic stress in midwives who provide care in and through relationships with women.


METHODS
the relevant literature addressing secondary traumatic stress in health-care professionals was reviewed.


RESULTS
it is argued that the high degree of empathic identification which characterises the midwife-woman relationship in midwifery practice places midwives at risk of experiencing secondary traumatic stress when caring for women experiencing traumatic birth. It is suggested that this has harmful consequences for midwives' own mental health and for their capacity to provide care in their relationships with women, threatening the distinct nature of midwifery care.


CONCLUSIONS
opportunities for research to establish the existence of this phenomenon, and the potential implications for midwifery practice are identified.
Leinweber
Julia
J
Key Centre for Women's Health in Society, School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Vic. 3010, Australia. julia.leinweber@gmx.at
Rowe
Heather J
HJ
D002055:Burnout, Professional / Q000453:epidemiology; D004645:Empathy; D005260:Female; D014943:Global Health; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008880:Midwifery / Q000706:statistics & numerical data*; D009723:Nurse-Patient Relations; D009784:Occupational Diseases / Q000453:epidemiology* / Q000517:prevention & control; D036801:Parturition / Q000523:psychology; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000517:prevention & control