Secondary traumatic stress in iranian midwives: stimuli factors, outcomes and risk management

Abstract

Background The present qualitative study was conducted to explain the experiences of secondary traumatic stress (STS) and its related factors in midwives working in maternity wards. Methods Data were collected using semi-structured interviews with 11 midwives working in the maternity wards of hospitals in Urmia, Iran, through in-depth interviews with open-ended questions. Data were analyzed using the conventional content analysis approach. Results The results of data analysis led to the extraction of three themes, seven main categories, and 18 subcategories. The first theme was “STS stimuli,” with the two categories of “Discriminatory approach to midwifery” and “The nature of the midwifery profession”. The second theme was “Traumatic outcomes”, which included the subcategories of “Psychological-emotional trauma”, “Physical trauma” and “Social trauma”. The third theme was “Risk management”, which had the two subcategories of “Reactive approach” and “Proactive approach”. Conclusions The results showed that, in addition to the traumatic nature of events that midwives experience during work as the secondhand victims, factors such as governance-organizational structure, unbalanced distribution of power, and poor supportive laws undermine their professional role and provide conditions conducive to STS. Therefore, avoiding traumatic situations and scientific and skill self-empowerment were the most important strategies adopted by the midwives in this study to prevent risky situations and cope with the consequences of STS. The participation of midwifery stakeholders in policy-making and adopting supportive legislation in redefining the position and role of midwives can play a major role in reducing STS and sustaining their role and position in maternal care.

Determinants of secondary traumatic stress in midwives: The role of workplace related factors

“…Sohrabzadeh et al reported some of the reasons for not reporting violence, such as the belief in the futility of reporting, repetition of more than one case of violence, not having enough time to follow up, forgetting due to busy work, and considering the matter unimportant [54]. In a qualitative study of STS among midwives in Iran, Hajiesmaello et al found that verbal harassment by doctors, department o cials, shift o cials, or even colleagues of midwives had caused severe psychological damage to midwives [30].…”

“…Job stress can occur when employees face more work than they can handle, leading to inappropriate work environments, high workloads and pressure, and organizational factors such as policies, structures, and role ambiguity [45]. Midwives experience signi cant job stress due to the burden of caring for maternal and fetal/newborn health, limited functional independence, a high volume and variety of tasks, and role con icts in their work environment [30].…”

“…Given the sensitive nature of the midwifery profession, it is likely that many midwives are exposed to chronic or sudden professional stress. However, studies on the consequences of childbirth injuries and midwives' professional experiences in Iran are limited [30]. Although several studies in Iran have investigated burnout and occupational stress in the midwifery profession [31,32], there has yet to be research on STS and the role of work environment factors in its occurrence.…”

Explaining Midwives’ Experiences in Adjusting to the Role of Healthcare Providers in Health Transformation Plan in Iran: A Qualitative Study

“…In Urmia, a study on secondary traumatic stress disorder in Iranian midwives con rmed that high workload and pressure, insu cient time, and the need for speeding up task accomplishment maximally contributed to perceived occupational stress and explained high belongingness to the midwifery profession as an element resisting this occupational stress. It reported that factors such as organizational-governmental structure, unbalanced distribution of power, and weakness of supportive rules enfeebled midwives' professional roles and led to emotional fatigue and occupational burnout (59). Due to the workload associated with caring for pregnant mothers, HPMs expectedly experience limited functional independence, organizational bias, task diversity, role con ict, and occupational stress.…”

The Impact of the Workload and Traumatic Stress on the Presenteeism of Midwives: The Mediating Effect of Psychological Detachment

“…In addition, delivery room as a special medical unit, maternal or foetal death, neonatal resuscitation, postpartum haemorrhage, and other traumatic workplace events have become major causes of job stress for midwives [18,19]. Traumatic stress in midwives usually refers to the psychological stress response to an adverse birth event directly experienced or witnessed in the workplace [20,21].…”