School of Nursing and Midwifery

What is Birth trauma and vicarious trauma?

The Australian Institute of Health and Welfare ⁽¹⁾ estimates that 3 – 5 % of women experience Perinatal Post Traumatic Stress Disorder but other sources suggest birth trauma is as high as one third of birthing women ^(1-7). Antecedents of birth trauma may include complex birth, extreme pain, loss of control and fear of death for themselves or their baby but also low-quality care provider interactions, disrespectful care and obstetric violence ^{(1 -7)}.

Second victims are healthcare providers who are involved in an unanticipated adverse patient event, a medical error and/or a patient related injury and become victimised in the sense that the provider is traumatised by the event. Frequently, these individuals feel personally responsible for the outcomes. Many feel as though they have failed the person in their care, and consequently second guess their clinical skills and knowledge which may lead to changes in their future practice ^{(8 - 12)}. Midwives who encounter traumatic events at childbirth (9) may be negatively affected emotionally by these traumatic events ^{(9 – 13)}. Between 67.2% and 93.6% of midwives in Australia have witnessed traumatic childbirth ^(11-12) and in the United Kingdom it was estimated that midwives would, on average, experience seven traumatic perinatal events throughout their career ⁽¹⁴⁾.

Why are midwifery students at risk?

Midwifery students experience clinical placements in a supernumerary capacity, for learning and skill acquisition, and because of this status, have little control over the care provided and thus become more vulnerable to trauma. Midwifery students’ who witnessed traumatic events at childbirth, may be psychologically affected, have an increase in stress levels, altered education experience, have increased childbirth fear, which may affect decisions around caregiving and may change the course of their future professional life ^(9,15). Midwifery students who witness traumatic events at childbirth need increased and specific support to help overcome the negative consequences.

What did our study find?

We asked our midwifery students what they did when they witnessed a difficult or traumatic birth, and they told us they talked to each other to help them process difficult feelings and learn from the experiences ⁽¹⁶⁾. They chose to debrief with a peer, as opposed to a clinical facilitator or lecturer. They explained that a midwifery student peer understood the vulnerability of being supernumerary, witnessing events that they had no control over and understanding that they had knowledge gaps all of which contributed to feelings of distress. The students explained that they had also wanted to learn from their peers’ similar experiences and hear how they had coped, which together built a better understanding of midwifery practice. We implemented an adapted Midwifery Student Peer Debriefing Guide to help midwifery students help each other ⁽¹⁶⁾.

What skills do I need to debrief a peer?

The skills you acquire and require in preparation for your role as a midwife in debriefing a birth person post birth, are the same skills you would you with your peer.

1. Positive regard for others – Demonstrate care, warmth and genuine concern for others is crucial to letting the debriefed know you accept them as a person without judgment ⁽¹⁸⁾.
2. Active listening – Being present, concentrate on your peer, looking for body language that may tell more of the story, reading between the lines. If the peer says, “no but I’m fine” but their body language displays crying you may say “It sounds like you are trying to stay strong but there are moments when sadness overwhelms you?” ^(19,20)
3. Use Open ended questions – Asking questions helps fill in the gaps when the peer is telling you their experience, by delving deeper into the problem it helps them process the difficult feelings and helps them problem solve as they are explaining the scenario to you, in a way finding their own solutions. You may say “Can you tell me more about what aspect made you feel upset?”  ⁽²¹⁾
4. Paraphrasing – Reflect on what the peer has told you and paraphrase what you understand they have said. They may say - “I’m so overwhelmed by this I’m thinking about it all the time no matter how much I do,” The debriefer reflects, “It sounds like you’re feeling really distressed by this and thinking about it all the time – is taking up a lot of your mental space “.
5. Validate feelings – Allow space for emotions, event he difficult ones like anger, validate that it emotions are normally responses, the body telling you this means something to you. For example, you may say “It sounds like you’re feeling really angry about how the woman was treated – that must be disheartening especially after all the care you gave – anyone would feel similarly” OR ‘Seeing such a significant emergency, can bring up so many scary emotions – its normal to feel fear and anxiety about the future of the mother and baby ^(23,24)
6. Offer a new perspective – reinforce positive approaches to coping, challenge negative self-talk, encourage self-care strategies. They may say “So, it’s just a mess, and I don’t know what to do, I’m just not finding ways to get past this” The debriefer may ask “It seems like this has left you feeling confused and overwhelmed, unsure about what steps to take next, what do you do normally do to make yourself feel better? Shall we go for a walk after work, or shall we do some mindful breathing now?” ⁽²⁵⁾
7. Make a plan – Closure after talking about difficult experiences is important, you want to know the peer has found solutions or you may suggest referral. You may take her to the clinical facilitator or ward manager if you feel you need more help or ask her to ring the helpline in Australia if she wants to explore more counselling help (see below)⁽²⁶⁾