Post-Traumatic Stress Disorder among midwives after exposure to maternal death and stillbirth in Khomas Region of Namibia

Abstract

Objective: Despite global efforts to decrease maternal death and stillbirths worldwide, maternal mortality rate and stillbirth remain high in the global south countries. These deaths often have immediate and long-lasting effects on midwives who care for these women.Methods: This paper explores the effects of maternal death and stillbirth on midwives in Namibia. A qualitative approach was adopted using a descriptive, exploratory and contextual design. The objective of this study was to explore the Post-Traumatic Stress Disorder (PTSD) related feelings among midwives after exposure to maternal death and stillbirth. Data was collected using Focus Group Discussions (FGD) and individual interviews. Four FGDs and four individual interviews were conducted with midwives from two state hospitals in Windhoek. Midwives were purposively selected, and a total of 29 midwives participated in the study. Individual interviews and FGDs were audiotaped and transcribed verbatim. Data were analysed using content analysis and coded using Tech’s steps of open-coding.Results: The researcher identified one central theme with six sub-themes. The study showed that the midwives experienced PTSD related feelings such as insomnia and nightmares, recollection of the event (flashbacks), sense of self-blame, guilt, anger, shame, and being haunted/tormented.Conclusions: It is concluded that maternal death and fresh stillbirth can lead to PTSD effects on midwives, hence addressing these challenges. Therefore, the researchers recommend that hospitals in the Khomas Region develop and implement the wellness programmes in the workplace, such as the Employee Assistance Programme, to support midwives who experienced these traumatic events to prevent and manage these effects in the future. Equally, further research is needed to evaluate the impact of the wellness programme on midwives who experienced MDs and FSBs in Namibia.

Psychological Experiences of Midwives Regarding Maternal Deaths at Two Selected Public Hospitals in Lesotho

“…They further stated that the duration of those nightmares of re-living the trauma differs with the individual as well. The findings are also consistent with those of Amukugo and Nghitanwa (2021), who affirmed that the mind normally brings to consciousness what was suppressed or forced to go to the unconscious mind. The midwives who witnessed maternal death often encounter episodes of disturbing dreams as their minds retrieve and reflect on their experiences.…”

“…They mentioned psychological effects and insomnia as their experience. These findings are similar to those of Amukugo and Nghitanwa (2021), who stated that often, the midwives responded to experiencing maternal death by experiencing flashbacks, nightmares, anger, a sense of self-blame or guilt, and denial. However, Levin et al (2021) in their study argued that for midwives who have experienced trauma as a result of witnessing a maternal death for the first time, as well as those who experienced it several times, the impact, together with the intensity of nightmares and insomnia are equally experienced.…”

“…Most of the participants demonstrated that they experienced trauma following the incidence of maternal death. The findings conformed to Amukugo and Nghitanwa (2021), who concluded that the occurrences of trauma, depression, stress, and hopelessness responses are time-bound and intensified with duration; hence, they could lead to post-traumatic stress disorders (PTSD). Levin et al (2021) in their study reiterated that trauma may persist until the midwives advance to clinically qualifying to fit the diagnostic criteria for PTSD, depression, and other stress-related conditions.…”

“…It remains unclear why the experiences of midwives were not researched in the past decades as in African countries, mostly in rural areas, midwives, who are based in the delivering health facilities, often experience maternal deaths because of the scarcity of resources (Amukugo & Nghitanwa, 2021). Research exploring the experiences of midwives regarding maternal deaths remains very limited, especially in rural health facilities where the majority of deaths occur (Amukugo & Nghitanwa, 2021). The midwives' continuous exposure to incidents such as maternal deaths interferes with their mental well-being, thus impacting their ability to cope (Dartey et al, 2017).…”

“…Dartey et al (2017) further appeal that exposure of midwives to maternal deaths has led to low performance and lack of mental attentiveness, thereby interfering with the services provided to other pregnant women. Amukugo and Nghitanwa (2021) stated that often, the midwives responded to experiencing maternal death through flashbacks, nightmares, anger, a sense of selfblame or guilt, and denial. The extent of the impact of trauma on midwives has led developed countries to develop a stress-prevention manual to guide coping with stress, grief, anxiety, and depression experienced by midwives post-experiencing trauma secondary to being exposed to maternal death (Dartey et al, 2017).…”