Blame and guilt – a mixed methods study of obstetricians' and midwives' experiences and existential considerations after involvement in traumatic childbirth

Abstract

Introduction. When complications arise in the delivery room, midwives and obstetricians operate at the interface of life and death, and in rare cases the infant or the mother suffers severe and possibly fatal injuries related to the birth. This descriptive study investigated the numbers and proportions of obstetricians and midwives involved in such traumatic childbirth and explored their experiences with guilt, blame, shame and existential concerns. Material and methods. A mixed methods study comprising a national survey of Danish obstetricians and midwives and a qualitative interview study with selected survey participants. Results. The response rate was 59% (1237/2098), of which 85% stated that they had been involved in a traumatic childbirth. We formed five categories during the comparative mixed methods analysis: the patient, clinical peers, official complaints, guilt, and existential considerations. Although blame from patients, peers or official authorities was feared (and sometimes experienced), the inner struggles with guilt and existential considerations were dominant. Feelings of guilt were reported by 36-49%, and 50% agreed that the traumatic childbirth had made them think more about the meaning of life. Sixty-five percent felt that they had become a better midwife or doctor due to the traumatic incident. Conclusions. The results of this large, exploratory study suggest that obstetricians and midwives struggle with issues of blame, guilt and existential concerns in the aftermath of a traumatic childbirth.

A meta‐ethnographic synthesis of midwives’ and nurses’ experiences of adverse labour and birth events

“…Midwives and nurses witnessing such events are predisposed to a higher degree of emotional and psychological trauma (Schroder, Jorgensen, Lamont, & Hvidt, ; Sheen et al., ; Sheen, Spiby, & Slade, ). In a recent survey of Australian midwives, more than two‐thirds of respondents (67.2%) reported having witnessed a traumatic birth, with 74.8% experiencing feelings of horror and 65.3% guilt (Leinweber, Creedy, Rowe, & Gamble, ).…”

The case for developing an online intervention to support midwives in work-related psychological distress

“…Additionally, some midwives can become self-judgemental when targeting the high standards they aspire to, be left to their own devices when dealing with the emotional labour of caring for women, or left to cope with their distress by swallowing their emotions in cultures of service and sacrifice (Davies, Coldridge 2015, Beaumont, Durkin et al 2016, Schrøder, Jørgensen et al 2016. Should midwives continue to use persistence and avoidance as maladaptive coping strategies for dealing with distress, their dysfunctional endurance may not enable them to recognise ill health in either themselves or their colleagues.…”

Second victims need emotional support after adverse events: even in a just safety culture

“…In a national study on how Danish midwives and obstetricians ( n = 1237) experience adverse events in childbirth, we found that fear of being blamed by the patient, clinical peers or through official complaints was of considerable concern to obstetricians and midwives, although few had experiences of such blame. Feelings of guilt were reported by 50% of the respondents, which in the interview study was described as a psychological burden, even in cases where no blame was attached . These reports of feeling guilt without being at fault or experiencing blame indicate that a blame‐free culture per se does not relieve the HCPs of distress and guilt feelings that they may experience following an adverse event.…”

“…Feelings of guilt were reported by 50% of the respondents, which in the interview study was described as a psychological burden, even in cases where no blame was attached. 5 Commentary that a blame-free culture per se does not relieve the HCPs of distress and guilt feelings that they may experience following an adverse event. Zinck Pedersen 6 characterises the current Danish safety programme as training HCPs in 'appropriate' blame-free attitudes and in approaching adverse events as systemic.…”