Midwives are vulnerable to PTSD. What can we do about it?

Australian midwives experience a higher rate of PTSD than the general population. As facilitators of the birth rite of passage, midwives can be exposed to painful and confronting scenarios. Many of us soldier on and put on a brave front despite our inner turmoil.   

“Midwives may carry on working in distress, and use this persistence as a maladaptive coping strategy. This dysfunctional endurance may not allow them to recognise psychological ill health in themselves. Long hours, the introduction of new technologies in healthcare, job security, emotion work, trauma exposure, dysfunctional working cultures and a lack of career progression have clearly become strong predictors of work-related psychological distress in midwives.” — Pezaro et al., Midwives Overboard!

Let’s examine why midwives are vulnerable to PTSD, and what we can do about it.

As midwives we develop close relationships with those we care for. Our capacity for feeling empathy is a core feature of good midwifery care, but it can also result in secondary traumatic stress.

Around 43% of Australian women experience childbirth as traumatic. Exposure to women’s birth trauma may leave midwives susceptible to secondary traumatic stress, otherwise known as vicarious trauma. 

 “I was involved in a shoulder dystocia and subsequent deposition. It has taken me 8 years not to think about this woman and her child every day.” — Clinical nurse midwife, A mixed-methods study of secondary traumatic stress in certified nurse-midwives: shaken belief in the birth process

Exposure to trauma and secondary traumatic stress can lead to PTSD. Midwives and their employers can work to minimise this risk.

After experiencing trauma, you may feel grief, sadness, anxiety, numbness, detachment, flashbacks, agitation, anger, confusion, withdrawal, grief and/or guilt. Many midwives who witness birth trauma report feelings of guilt and responsibility.

To avoid these painful feelings, midwives may: 

• shield themselves from anything that reminds them of the incident
• avoid activities they usually enjoy
• feel less connected to colleagues and loved ones 
• lose focus and concentration or
• turn to substances.

Midwives are more likely to develop PTSD if they experience feelings of guilt or a strong reaction to a traumatic birth.

We also know that PTSD is more common in:

• women than men
• midwives who experience their own birth trauma
• junior midwivesand
• midwives who don’t have supportive relationships at work.

When we are asked to compromise our professional integrity, beliefs and values, it may cause fear, trauma and distress.

A study of responses to birth trauma in Australian midwives found that midwives who witness situations where other health professionals ‘did not listen to women’, ‘provided little choice’, ‘pressured women to comply’, ‘did not gain consent’ or ‘used inappropriate language’ can experience moral distress and trauma. Student midwives, due to their inexperience and junior position, may have an even stronger reaction. 

Our sense of professional purpose and confidence in what we do is undermined if we cannot provide high-quality, woman-centred (or patient-centred) care. This is a main reason midwives leave the profession. 

We can all reduce the chance of our stress becoming PTSD. Here are some strategies:

• Accessing clinical supervision to enable reflection on our clinical practice, assisting us to understand our role and reduce our feelings of responsibility and guilt for trauma. Check out our podcast with Julie Sharrock to learn more about the benefits of supervision.
• Debriefing in a timely manner after potentially traumatic or stressful incidents.
• Being aware of our abilities, capabilities and limits to build realistic expectations and boundaries.
• Protecting ourselves by anticipating stress, recognising triggers and warning signs and taking steps to reduce stress and overwhelm. Check out our podcast with Sam Eddy to learn how to take your stress temperature even in a crisis.
• Building assertiveness skills — being able to speak up for yourself helps with job satisfaction and stress management.
• Seeking professional assistance through an EAP, doctor, psychologist or our counselling team — we’re here 24/7 on 1800 667 877 or by email.
• Taking care of ourselves by making time for self-care.Check out our Wellbeing Portal for support to prioritise your health and wellbeing.  
• Maintaining good sleeping habits.
• Building resilience with ‘mood changers’:
• switching off after work with activities such as listening to music, warm baths, or exercise,
• finding outside interests or hobbies to separate work from your personal life,
• spending time with pets or keeping up positive social connections.

Employers can do more to ensure the psychosocial safety of midwives and other healthcare workers. A review of interventions to reduce PTSD in healthcare professionals outlines the following suggestions:

• Offering a safe forum or platform to debrief and share experiences.
• Normalising support and compassion towards ourselves and others as a buffer against the effects of trauma.
• Providing training in emotional regulation and relaxation.
• Raising awareness about the impact and management of trauma.
• Establishing hospital PTSD management and support policies.
• Providing peer support programs moderated by people who have proper clinical experience and fully understand the experience of midwives.

If you’d like to encourage your workplace to do more to prevent PTSD but you’re not sure how to go about it, we’re always here to help you strategise.

Accepting help and support is critical to preventing and overcoming PTSD.

It can be hard to reach out when you’re feeling vulnerable. We know that many midwives have told us they feel ashamed and are concerned they will be judged or stigmatised. In our experience, finally talking to someone about what you’re feeling is a relief. Feeling overwhelmed by trauma is scary but more common than most people realise.

We are here to help — call us on 1800 667 877 or email us.

Celeste is a midwife who has worked in the profession for ten years across many areas of midwifery including birthing, postnatal, antenatal and fertility. Celeste still works clinically as a midwife and also works as a senior clinician for the Nurse and Midwife Health Program of Victoria. Celeste is passionate about providing support to nurses and midwives in need. Celeste has a strong interest in health specifically relating to sleep, nutrition, exercise and stress. Celeste sings in a women’s community choir and loves weight lifting, being out in nature, dancing and Japanese food.