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Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
LIME/Medical Management Centre, Karolinska Institute, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Gynecological endocrinology.
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2017 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 65, p. 8-16, article id S0020-7489(16)30199-7Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence).

OBJECTIVE: To assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints.

DESIGN: Cross-sectional survey.

PARTICIPANTS: Members of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG).

METHODS: A questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression.

RESULTS: The response rate was 39.9% (n=1459) for midwives and 47.1% (n=706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient.

CONCLUSIONS: A considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.

Place, publisher, year, edition, pages
2017. Vol. 65, p. 8-16, article id S0020-7489(16)30199-7
Keywords [en]
Event, Midwives, Obstetricians, Occupational exposure, Traumatic
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-344013DOI: 10.1016/j.ijnurstu.2016.10.009PubMedID: 27815987OAI: oai:DiVA.org:uu-344013DiVA, id: diva2:1187496
Available from: 2018-03-05 Created: 2018-03-05 Last updated: 2018-04-11
In thesis
1. Second Victims in Swedish Obstetrics
Open this publication in new window or tab >>Second Victims in Swedish Obstetrics
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The term “second victim” implies that healthcare providers can be pro-foundly affected by severe events in which a patient is badly injured or dies. The patient is the first victim. This thesis investigates the magnitude, riskfactors and consequences of becoming a second victim in Swedish delivery care.

We examined self-reported exposure to severe events in a survey among 1459 midwives and 706 obstetricians. A severe event was defined as severe injury or death to a mother or child or other stressful events, such as threats or violence, during delivery. Of the midwives and obstetricians who responded, 71% and 84%, respectively, had experienced one or several severe events during their career. Post-traumatic stress symptoms following the perceived worst event were measured. Fifteen percent of the midwives and obstetricians reported symptoms equivalent to partial post-traumatic stress disorder (PTSD), and 5% of the midwives and 7% of the obstetricians reported symptoms commensurable with PTSD. Increased risk was correlated with emotions of guilt, and negative experience or support from friends. Professionals with partial PTSD left delivery care significantly more often than their less traumatised colleagues.

Experiences of severe events were, furthermore, investigated, using qualitative content analysis, leading to an overarching theme “acting in an illusory system of control and safety”. This reflected how midwives and obstetricians retrospectively identified factors that had contributed to the course of events leading to such detrimental consequences. The process that the midwives and obstetricians followed in the aftermath of a severe event, were investigated using a Grounded Theory analysis. A core category, “regaining of a professional self-image”, was constructed. Six main categories illustrated an erratic pathway which might lead to full regaining, reconsidering, reconstructing professional self-image or deciding to leave the profession, depending on level of regained professional self-image.

In summary, the majority of midwives and obstetricians will experience severe obstetric events that might affect them, sometimes severely. The vulnerability that healthcare professionals are exposed to should not be underestimated and preparedness in terms of collegial support, as well as an awareness in the workplace of how badly affected employees might be, is important.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 94
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1446
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-344021 (URN)978-91-513-0284-3 (ISBN)
Public defence
2018-05-08, Auditorium minus, Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2018-04-17 Created: 2018-03-05 Last updated: 2018-04-17

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