Midwife Connection

by: Walker Karraa, MFA, MA

In reading Cheryl Tatano Beck’s, CNM, DNSc, latest study, "A Mixed Methods Study of Secondary Traumatic Stress in Labor and Delivery Nurses"(Beck & Gable, 2012) the words of a labor and delivery nurse shook me to the core:

Each traumatic birth adds another scar to my soul. Sometimes I tell my husband that I feel like the picture of Dorian Gray. Somewhere my real face is in a closet and it reveals the awful things I’ve seen during my labor and delivery career. The face I show the world is of an aging woman who works in this lovely place called a delivery room where happy things happen. (Beck & Gable, 2012, p. 10)

Clearly, experiencing a traumatic birth can have devastating effects for care providers. When left unaddressed, symptoms of Secondary Traumatic Stress (STS), or compassion fatigue (Figley, 1995) may lead to providers suffering psychological distress, and perhaps considering leaving the field altogether.

STS was defined as “a syndrome of symptoms the same as those of PTSD (post-traumatic stress disorder), and the symptoms parallel those experienced in persons directly exposed to the traumatic event” (Beck & Gable, 2012, p. 1). Symptoms of STS in providers have been demonstrated in literature, but to date this is the first study examining prevalence and severity of STS in labor and delivery nurses. Of a random sample of 464 L&D nurses, recruited through the membership of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), 35% reported moderate to severe levels of STS as a result of being present at a traumatic birth—the definition of which included both instances of inappropriate or abusive care, as well as bad outcomes for the mother and/or baby (Beck & Gable, 2012).

The qualitative data gathered through written response evoked vivid recounts of traumatic births, contributing to a deeper understanding of the power of traumatic birth to negatively impact care providers: “The list seemed endless of the distressing emotions nurses experienced during traumatic births” (Beck & Gable, p. 9). Intrusive memories of the event, irritability, and difficulty sleeping plagued providers years later. Infant demise, maternal demise, and shoulder dystocia were reported as the top three traumatic births in order of frequency. Being a new nurse, abusive deliveries, patients with a language barrier, and adolescent clients were found to “intensify nurses’ exposure to a traumatic birth” (Beck & Gable, 2012, p. 7).

The long-term impact of these experiences truly struck me. One participant shared: “I feel like I will never get these sounds/images out of my head even though they occurred more than 10 years ago.” Still another noted: “Physically and mentally, I knew I would never be able to work that area for another 30 years," and still another, “I feel as sick to my stomach thinking about it today as I did 40 years ago when it was fresh.”

How might these experiences be presenting in the work of midwives? While traumatic birth ending in infant/maternal mortality is rare, when it does occur, it can have deep psychological impact on care providers. Beck and Gable noted the need to protect providers and employ continuing education regarding vulnerability to STS, particularly for nurses in their first year working in L&D. Moreover, they noted the need for research such as this in all aspects of maternal care.

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Walker would like to thank Cheryl Beck and Robert K. Gable for permission to review this study.

References:

Beck, CT, & Gable, RK (2012). A mixed methods study of secondary traumatic stress in labor and delivery nurses. Journal of Obstetric Gynecological and Neonatal Nursing, 00(00), 1-14. doi:10.1111/j.1552-6909.2012.01386.x

Figley, CR (1995). Compassion fatigue: Toward a new understanding of the costs of caring. In B. H. Stamm (Ed.), Secondary traumatic stress: Self-care issues for clinicians, researchers, and educators (pp. 3-28). Lutherville, MD: Sidran Press.

Walker Karraa is a doctoral student at the Institute of Transpersonal Psychology/Sofia University where she is researching transformational dimensions of postpartum depression. Walker holds an MA degree in Clinical Psychology from Antioch University/Seattle. Walker is a contributor for Lamaze International's Science and Sensibility, and Giving Birth With Confidence. She is co-authoring a book on PTSD following childbirth with Kathleen Kendall-Tackett, PhD, IBCLC, FAPA.