title: Responses to birth trauma and prevalence of posttraumatic stress among Australian midwives.
abstract: BACKGROUND
  Midwives frequently witness traumatic birth events. Little is known about responses to birth trauma and prevalence of posttraumatic stress among Australian midwives.
  
  
  OBJECTIVE
  To assess exposure to different types of birth trauma, peritraumatic reactions and prevalence of posttraumatic stress.
  
  
  METHODS
  Members of the Australian College of Midwives completed an online survey. A standardised measure assessed posttraumatic stress symptoms.
  
  
  RESULTS
  More than two-thirds of midwives (67.2%) reported having witnessed a traumatic birth event that included interpersonal care-related trauma features. Midwives recalled strong emotions during or shortly after witnessing the traumatic birth event, such as feelings of horror (74.8%) and guilt (65.3%) about what happened to the woman. Midwives who witnessed birth trauma that included care-related features were significantly more likely to recall peritraumatic distress including feelings of horror (OR=3.89, 95% CI [2.71, 5.59]) and guilt (OR=1.90, 95% CI [1.36, 2.65]) than midwives who witnessed non-interpersonal birth trauma. 17% of midwives met criteria for probable posttraumatic stress disorder (95% CI [14.2, 20.0]). Witnessing abusive care was associated with more severe posttraumatic stress than other types of trauma.
  
  
  CONCLUSIONS
  Witnessing care-related birth trauma was common. Midwives experience strong emotional reactions in response to witnessing birth trauma, in particular, care-related birth trauma. Almost one-fifth of midwives met criteria for probable posttraumatic stress disorder.
  
  
  CONCLUSIONS
  Midwives carry a high psychological burden related to witnessing birth trauma. Posttraumatic stress should be acknowledged as an occupational stress for midwives. The incidence of traumatic birth events experienced by women and witnessed by midwives needs to be reduced.
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia. Electronic address: julia.leinweber@griffithuni.edu.au.
authors.forename: Julia
authors.initials: J
authors.lastname: Leinweber
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia. Electronic address: d.creedy@griffith.edu.au.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Creedy
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, The Alfred Campus, Level 1 549 St Kilda Road, Melbourne, VIC 3004, Australia. Electronic address: heather.rowe@monash.edu.
authors.forename: Heather
authors.initials: H
authors.lastname: Rowe
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Logan Campus, University Drive, Meadowbrook, QLD 4131, Australia. Electronic address: j.gamble@griffith.edu.au.
authors.forename: Jenny
authors.initials: J
authors.lastname: Gamble
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008016:Life Change Events; D008875:Middle Aged; D008880:Midwifery; D009721:Nurse Midwives / Q000523:psychology*; D007744:Obstetric Labor Complications / Q000451:nursing / Q000523:psychology; D036801:Parturition / Q000523:psychology; D011247:Pregnancy; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: Midwives; Obstetric violence; Occupational health; Peritraumatic distress; Posttraumatic stress