title: Bearing witness: midwives experiences of witnessing traumatic birth.
abstract: BACKGROUND
  Traumatic birth is a phenomenon that has been identified in women's birthing experiences, yet there has been no primary research conducted into midwives experiences of witnessing traumatic birth. Traumatic stress from witnessing and working with traumatised clients has been identified in other caring professionals such as nurses, social workers and emergency department personnel. This includes evidence of posttraumatic stress disorder, secondary traumatic stress, vicarious traumatisation and compassion fatigue. A distinct gap in the literature about midwives experiences of witnessing traumatic birth and the effects of working with potentially traumatised women formed the basis for this research.
  
  
  METHODS
  A descriptive qualitative study was used to explore midwives experiences of witnessing traumatic birth. The aim of this research was to enable midwives to describe their experiences and to determine if they are at risk of negative psychological sequalae similar to those in other caring professions. Ten currently or previously Registered Midwives with varying amounts of experience were interviewed, and transcripts of those interviews formed the raw data for the study. The data were independently thematically analysed by the two authors to identify common themes used to describe the experience of witnessing traumatic birth.
  
  
  RESULTS
  'Stuck between two philosophies', 'What could I have done differently', and 'Feeling for the woman', emerged as the main themes from the research. The participants described their emotional distress from feeling 'stuck' between wishing they could practice according to their midwifery philosophy, and the reality of working within a medical model of care. Feelings of responsibility for women and babies' outcomes, and repeatedly questioning what they could have done differently to prevent a traumatic birth was also reported. Feeling for the woman emerged as a major factor in midwives' experiences of witnessing traumatic birth.
  
  
  CONCLUSIONS
  As far as we can determine this is the first study to explicitly examine the phenomenon of midwives witnessing traumatic birth from the midwives point of view. While it was anticipated that midwives might describe being emotionally distressed by their experiences, the extent of their empathy and feelings of being stuck between two philosophies provide new knowledge into what affects midwives when working with birthing women. Further research into these areas is warranted. Better understanding of how witnessing traumatic birth impacts on midwives and what kind of support after these experiences is required to ensure midwives are equipped to cope when witnessing traumatic birth.
authors: School of Nursing and Midwifery, University of South Australia, City East Campus, North Terrace Adelaide 5000, Australia.
authors: Hannah
authors: H
authors: Rice
authors: Jane
authors: J
authors: Warland
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008880:Midwifery; D009721:Nurse Midwives / Q000523:psychology*; D009723:Nurse-Patient Relations; D007744:Obstetric Labor Complications / Q000451:nursing / Q000523:psychology; D011247:Pregnancy; D036301:Qualitative Research; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control / Q000523:psychology
keywords: Midwives; Secondary traumatic stress; Trauma; Vicarious traumatisation