title: The experience and impact of traumatic perinatal event experiences in midwives: A qualitative investigation.
abstract: BACKGROUND
  Through their work midwives may experience distressing events that fulfil criteria for trauma. However, there is a paucity of research examining the impact of these events, or what is perceived to be helpful/unhelpful by midwives afterwards.
  
  
  OBJECTIVE
  To investigate midwives' experiences of traumatic perinatal events and to provide insights into experiences and responses reported by midwives with and without subsequent posttraumatic stress symptoms.
  
  
  METHODS
  Semi-structured telephone interviews were conducted with a purposive sample of midwives following participation in a previous postal survey.
  
  
  METHODS
  35 midwives who had all experienced a traumatic perinatal event defined using the Diagnostic and Statistical Manual of Mental Disorders (version IV) Criterion A for posttraumatic stress disorder were interviewed. Two groups of midwives with high or low distress (as reported during the postal survey) were purposefully recruited. High distress was defined as the presence of clinical levels of PTSD symptomatology and high perceived impairment in terms of impacts on daily life. Low distress was defined as any symptoms of PTSD present were below clinical threshold and low perceived life impairment. Interviews were analysed using template analysis, an iterative process of organising and coding qualitative data chosen for this study for its flexibility. An initial template of four a priori codes was used to structure the analysis: event characteristics, perceived responses and impacts, supportive and helpful strategies and reflection of change over time codes were amended, integrated and collapsed as appropriate through the process of analysis. A final template of themes from each group is presented together with differences outlined where applicable.
  
  
  RESULTS
  Event characteristics were similar between groups, and involved severe, unexpected episodes contributing to feeling 'out of a comfort zone.' Emotional upset, self-blame and feelings of vulnerability to investigative procedures were reported. High distress midwives were more likely to report being personally upset by events and to perceive all aspects of personal and professional lives to be affected. Both groups valued talking about the event with peers, but perceived support from senior colleagues and supervisors to be either absent or inappropriate following their experience; however, those with high distress were more likely to endorse this view and report a perceived need to seek external input.
  
  
  CONCLUSIONS
  Findings indicate a need to consider effective ways of promoting and facilitating access to support, at both a personal and organisational level, for midwives following the experience of a traumatic perinatal event.
authors.affiliation: University of Liverpool, UK. Electronic address: kayleigh.sheen@liverpool.ac.uk.
authors.forename: Kayleigh
authors.initials: K
authors.lastname: Sheen
authors.affiliation: University of Nottingham, UK; University of Queensland, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Spiby
authors.affiliation: University of Liverpool, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Slade
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006167:Guilt; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008880:Midwifery; D036801:Parturition; D011247:Pregnancy; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D013315:Stress, Psychological; D011795:Surveys and Questionnaires
keywords: Indirect exposure to trauma; Midwives; Posttraumatic stress; Template analysis