title: What are the characteristics of perinatal events perceived to be traumatic by midwives?
abstract: OBJECTIVE
  there is potential for midwives to indirectly experience events whilst providing clinical care that fulfil criteria for trauma. This research aimed to investigate the characteristics of events perceived as traumatic by UK midwives.
  
  
  METHODS
  as part of a postal questionnaire survey conducted between December 2011 and April 2012, midwives (n=421) who had witnessed and/or listened to an account of an event and perceived this as traumatic for themselves provided a written description of their experience. A traumatic perinatal event was defined as occurring during labour or shortly after birth where the midwife perceived the mother or her infant to be at risk, and they (the midwife) had experienced fear, helplessness or horror in response. Descriptions of events were analysed using thematic analysis. Witnessed (W; n=299) and listened to (H; n=383) events were analysed separately and collated to identify common and distinct themes across both types of exposure.
  
  
  RESULTS
  six themes were identified, each with subthemes. Five themes were identified in both witnessed and listened to accounts and one was salient to witnessed accounts only. Themes indicated that events were characterised as severe, unexpected and complex. They involved aspects relating to the organisational context; typically limited or delayed access to resources or personnel. There were aspects relating to parents, such as having an existing relationship with the parents, and negative perceptions of the conduct of colleagues. Traumatic events had a common theme of generating feelings of responsibility and blame Finally for witnessed events those that were perceived as traumatic sometimes held personal salience, so resonated in some way with the midwife's own life experience
  
  
  CONCLUSIONS
  midwives are exposed to events as part of their work that they may find traumatic. Understanding the characteristics of the events that may trigger this perception may facilitate prevention of any associated distress and inform the development of supportive interventions.
authors.affiliation: Institute of Psychology, Health and Society, 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, United Kingdom; School of Nursing and Midwifery, University of Queensland, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Spiby
authors.affiliation: Institute of Psychology, Health and Society, University of Liverpool, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Slade
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D009721:Nurse Midwives / Q000523:psychology*; D010465:Perception; D018743:Perinatal Care / Q000592:standards; D011247:Pregnancy; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000523:psychology*
keywords: Indirect trauma; Maternity workforce; Midwives; Posttraumatic stress