General News Research — 12 April 2016

Managing a traumatic childbirth can leave midwives and obstetricians struggling with stress and feelings of guilt and blame, according to research published in the journal Acta Obstetricia et Gynecologica Scandinavica

At the same time, health care workers say that complications in the delivery room can make them reflect more on the meaning of life and help them to become better professionals.

Medical mistakes can cause trauma for patients and relatives, but when things go wrong, whether due to errors or not, health professionals can be profoundly affected.

Even negative outcomes that result from unavoidable circumstances can leave clinicians feeling personally responsible.

In 2000, the Institute of Medicine (IOM) produced a report, “To Err Is Human,” which initiated a move away from a blame culture toward one that would encourage disclosure and learning after adverse events.

Promotion of this approach has included perinatal audits, obstetric skills training and debriefings aimed at improving procedures and preventing future incidents.

49% feel guilt, 65% learn from the experience

Katja Schrøder, of the University of Southern Denmark, and colleagues wanted to learn more about the impact of traumatic childbirth on clinicians’ mental health and their professional and personal identities.

They invited Danish obstetricians and midwives to complete a questionnaire and participate in interviews.

Of 1,237 respondents, 85% had been involved in a traumatic childbirth, in which severe and possibly fatal injuries resulting from labor and delivery were experienced by the mother or the infant.

While employees feared, and sometimes experienced, blame by patients, peers or official authorities, greater still were their personal struggles with guilt and existential issues.

The traumatic delivery induced feelings of guilt in 49% of respondents, 50% said that it made them think more about the meaning of life, while 65% felt that they had become a better professional as a result.

To at least some extent, 87% of respondents felt troubled for a long time by what happened to the patient, and 36% agreed or strongly agreed with the statement, “I will always feel some sort of guilt when thinking about the event.”

The results were consistent, regardless of how much time had passed since the event.

The researchers believe this is the largest study to investigate this issue, and the first to consider existential considerations and personal, spiritual or emotional development.

Schrøder says: “Self-blame and guilt appear to dominate when midwives and obstetricians struggle to cope with the aftermath of a traumatic childbirth […]. Although the current patient safety programs have promoted a more just and learning culture with less blaming and shaming after adverse events, the personal feeling of guilt remains a burden for the individual healthcare professional.”

She suggests that the existential, emotional and spiritual aspects may play a profound role in the aftermath of these events.

Limitations include the 59% response rate, which could have given rise to selection bias, and the fact that 60% of the events occurred over 3 years previously, which could affect the memory and the responses.

The authors believe these findings might help in the provision of support to health care professionals after being present at a traumatic childbirth.

This, they say, would also benefit patients, because the physical and emotional state of clinicians has a knock-on effect on the quality and the safety of patient care.

This article first appeared on ‘Medical News Today’ on 12 April 2016.


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