title: A socioecological model of posttraumatic stress among Australian midwives.
abstract: OBJECTIVE
  to develop a comprehensive model of personal, trauma event-related and workplace-related risk factors for posttraumatic stress subsequent to witnessing birth trauma among Australian midwives.
  
  
  METHODS
  a descriptive, cross-sectional design was used.
  
  
  METHODS
  members of the Australian College of Midwives were invited to complete an online survey.
  
  
  METHODS
  the survey included items about witnessing a traumatic birth event and previous experiences of life trauma. Trauma symptoms were assessed with the Posttraumatic Stress Disorder Symptom Scale Self-Report measure. Empathy was assessed with the Interpersonal Reactivity Index. Decision authority and psychological demand in the workplace were measured with the Job Content Questionnaire. Variables that showed a significant univariate association with probable posttraumatic stress disorder were entered into a multivariate logistic regression model.
  
  
  RESULTS
  601 completed survey responses were analysed. The multivariable model was statistically significant and explained 27.7% (Nagelkerke R square) of the variance in posttraumatic stress symptoms and correctly classified 84.1% of cases. Odds ratios indicated that intention to leave the profession, a peritraumatic reaction of horror, peritraumatic feelings of guilt, and a personal traumatic birth experience were strongly associated with probable Posttraumatic Stress Disorder.
  
  
  CONCLUSIONS
  risk factors for posttraumatic stress following professional exposure to traumatic birth events among midwives are complex and multi-factorial. Posttraumatic stress may contribute to attrition in midwifery. Trauma-informed care and practice may reduce the incidence of traumatic births and subsequent posttraumatic stress reactions in women and midwives providing care.
authors.affiliation: Protestant University of Applied Sciences Berlin, Teltower Damm 118, 14167 Berlin, Germany. Electronic address: leinweber@eh-berlin.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Leinweber
authors.affiliation: Menzies Health Institute Queensland, Griffith University, Logan campus, University Drive, Meadowbrook, QLD 4131 Brisbane, Queensland, 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 Melbourne, Victoria, 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 Brisbane, Queensland, Australia. Electronic address: j.gamble@griffith.edu.au.
authors.forename: Jenny
authors.initials: J
authors.lastname: Gamble
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009721:Nurse Midwives / Q000523:psychology*; D011247:Pregnancy; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology; D011795:Surveys and Questionnaires; D017132:Workplace / Q000523:psychology
keywords: Midwives; Obstetric violence; Occupational health; Posttraumatic stress; Trauma; Workforce attrition