May Research Update

‘No Man׳s Land’: An exploration of the traumatic experiences of student midwives in practice.

Davies, S., Coldridge, L.

BACKGROUND: The role of being ‘with woman’ during traumatic birth has been identified as having an emotional cost for midwives, but to date no research has explored traumatic experiences of student midwives.
AIM: To explore student midwives׳ perceptions of what was traumatic for them and how they were supported with such events.
DESIGN: A qualitative descriptive approach, using semi structured interviews.
SETTING: One university in the North West of England.
PARTICIPANTS: 11 student midwives recruited by poster campaign.
FINDINGS: Five main themes emerged from the analysis. Wearing your Blues depicted what participants described as the ‘bleak’ landscape of practice. No Man’s Land was concerned with traumatic tensions in the student role. ‘Get the Red Box!’ and The Aftermath concerned traumatic events in practice and the impact of these on students. Learning to cope related to the way students coped with such incidents, as well as other stresses in the role.
KEY CONCLUSIONS: The student midwife inhabits a vulnerable position in the ‘No Man’s Land’ of hospital practice. Her strong identification with the woman renders her potentially more vulnerable in traumatic situations. The study revealed a paradigmatic clash between the manualised care of a busy obstetric unit and the individualised woman-led approach they were expecting.
IMPLICATIONS FOR PRACTICE: It seems important for the profession to recognise that distressing events are not always the obvious critical incidents in care, and that a culture of support and/or debriefing after adverse events may assist students to articulate their needs and develop resilience. Educators may need to appreciate that the student midwife role in an emergency may heighten her vulnerability. This study also highlighted the potential alienation of students when placed in the maelstrom of a busy obstetric unit.

Empathy and spiritual care in midwifery practice: Contributing to women’s enhanced birth experiences.

Moloney, S., Gair, S.

Background: Research has identified empathy as a crucial ingredient in effective practice for health professionals, including midwifery. Equally, the role of spirituality has been recognised as enhancing the quality of the birth experience through the care, compassion and presence of the midwife. Yet literature discussing birthing women’s lived experiences of caregiver empathy and spiritual care appears uncommon.
Aim: The aim of this article is to highlight women’s stories about midwives’ empathy and spiritual care or lack thereof during birth, in order to contribute to the promotion of more empathic, spiritually aware midwifery practice.
Methods: Ten interviews and seven focus groups were conducted with forty-eight women, including mothers, midwives and staff from a women’s service. A secondary analysis of the data was conducted examining women’s descriptions and reflections on midwives’ levels of empathy and spiritual care.
Findings: When midwives’ empathy and spiritual care were evident, women’s birth experiences appeared enhanced, providing a solid foundation for confident mothering. Conversely, participants appeared to link a lack of caregiver empathy, compassion or spiritual care with more enduring consequences, birth trauma and difficulty bonding with their babies.
Conclusion: Midwives’ empathy and spiritual care can play a key role in creating positive birth and mothering experiences. More research into the role of empathy and spiritual care in enhancing midwifery practice in all birth settings is recommended, as is the increased embeddedness of empathic regard and the notion of ‘birth as sacred’ into midwifery curricula.

Narratives of traumatic birth: Quality and changes over time.

Ayers, S., Radoš, S. N., Balouch, S.

Childbirth is a highly emotive event that can involve complications. Around 1% of births in the United Kingdom involve life-threatening complications to the mother (Waterstone, Bewley, & Wolfe, 2001) and 0.8% result in stillbirth or perinatal death (Confidential Enquiry into Maternal and Child Health [CEMACH], 2009). A review found that 3.1% of women report posttraumatic stress disorder (PTSD) after birth (Grekin & O’Hara, 2014). The aim of this study was to examine whether narrative characteristics of traumatic birth were specific to women with PTSD or observed in all women who experience a highly emotive and potentially traumatic birth. Parturient women were matched for birth events, but either had severe PTSD symptoms (n = 22) or no, or very low, PTSD symptoms (n = 22). Women were interviewed about the birth 3 and 6 months postpartum, and their birth narratives were examined for content, coherence, and cognitive and perceptual processing. Results showed birth narratives became shorter and more coherent over time. Consistent with PTSD literature, birth memories were more likely to be recalled and involuntarily triggered in women with PTSD symptoms. However, women with PTSD symptoms had more coherent narratives, used more causal and fewer tentative words. These latter findings are inconsistent with research finding that PTSD is associated with fragmented or incoherent memories but are consistent with the view that highly emotive events result in improved memory (e.g., Berntsen, Willert, & Rubin, 2003). Possible reasons for this are discussed.

Exploring the process of writing about and sharing traumatic birth experiences online.

Blainey, S. H. & Slade, P.

Objective: This study aimed to explore the experience of writing about a traumatic birth experience and sharing it online.
Method: Twelve women who had submitted their stories about traumatic birth experiences to the Birth Trauma Association for online publication were interviewed about their experiences. Women were interviewed shortly after writing but before posting and again 1 month after the story was posted online. All participants completed both interviews. These were transcribed and analysed using template analysis.
Results: Women described varied reasons for writing and sharing their stories, including wanting to help themselves and others. The process of writing was described as emotional, however was generally seen as a positive thing. Aspects of writing that were identified as helpful included organizing their experiences into a narrative, and distancing themselves from the experience.
Conclusion: Writing and posting online about a traumatic birth is experienced positively by women. It may be a useful self-help intervention and is worthy of systematic evaluation. The mechanisms through which writing is reported to have impacted as described in the interviews link to the mechanisms of change in cognitive-behavioural approaches to post-traumatic symptoms.