Support and Prevention of Midwives as Second Victims

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Midwifery work often includes exposure to traumatic events. For example, intrapartum emergencies, terminal diagnoses, and maternal or perinatal death may occur. The trauma associated with these events impact providers as well as patients and their family. Second victims have been identified as healthcare providers who are involved in an unanticipated adverse patient event, medical error, and/or patient related injury and become victimized in the sense that the provider is traumatized by the event.” (Scott, et al, 2009)

The emotional and intimate nature of the midwife-birthing person relationship makes midwives particularly susceptible to the effects associated with second victim phenomenon (Schrøder, et al, 2016). These effects may manifest as flashbacks, nightmares, or insomnia. Feelings of guilt, shame, blame, isolation, helplessness, and hopelessness similar to post traumatic stress disorder may also occur (McDaniel & Morris, 2020). Further, a fear of litigation and the associated stress can amplify the emotional impact of the experience for the midwife (Alexander & Bogossian, 2018). For these reasons, midwifery organizations must work to help prepare and support their members as they experience traumatic events.

The Professional Liability Committee (PLC) of the American College of Nurse-Midwives (ACNM) aims to bring this phenomenon to light with a Midwives as Second Victims Project. The project goals include raising awareness for ACNM members about the nature of second victim trauma in midwifery, building a supportive environment to facilitate trauma reduction or elimination, and ending shame and blame culture within midwifery following adverse events, disciplinary action, or litigation. The PLC aims to accomplish these goals through a three-pronged approach. 

First, the committee will support the development of online resources on ACNM’s website for individuals to read and download for personal or institutional use. These resources will increase visibility and awareness of second victim phenomena in midwifery. Links to existing web-based resources for physical and emotional support will also be made accessible. Second, the PLC is exploring the creation of a toolkit for practices, institutions, affiliates, or regions. Several hospital institutions have programs to support employees after adverse events. These programs can be adapted for midwives practicing in home or birth centers, community hospitals, or small health systems who may not have such resources readily available. Third, the PLC is exploring the potential for ACNM to develop a peer support program. Following adverse events, midwives often desire to talk with other midwives (Alexander & Bogossian, 2018). This program will include the training and infrastructure to make the first ACNM Peer Support Post Adverse Events Program. Such a program may give midwives the option of talking with each other for support after post traumatic events. We are in the beginning phase of all of these efforts and are excited about the progress, development, and opportunities to partner and collaborate with other committees, organizations, and midwives. 

Midwives must widely support each other after a traumatic event. The PLC is starting the process. These resources and programs will increase awareness of the second victim phenomenon, provide aid to midwives suffering from it, and destigmatize the topic of trauma in midwifery.

References

  • Alexander, C. R., & Bogossian, F. (2018). Midwives and clinical investigation: A review of the literature. Women and Birth, 31(6), 442-452.
  • Beck, C. T., LoGiudice, J., & Gable, R. K. (2015). A mixed‐methods study of secondary traumatic stress in certified nurse‐midwives: shaken belief in the birth process. Journal of midwifery & women’s health, 60(1), 16-23. 
  • Lane, M. A., Newman, B. M., Taylor, M. Z., O’Neill, M., Ghetti, C., Woltman, R. M., & Waterman, A. D. (2018). Supporting clinicians after adverse events: development of a clinician peer support program. Journal of patient safety, 14(3), e56. 
  • McDaniel, L. R., & Morris, C. (2020). The second victim phenomenon: how are midwives affected?. Journal of Midwifery & Women’s Health.
  • Scott, S. D., Hirschinger, L. E., Cox, K. R., McCoig, M., Brandt, J., & Hall, L. W. (2009). The natural history of recovery for the healthcare provider “second victim” after adverse patient events. BMJ Quality & Safety, 18(5), 325-330.
  • Schrøder, K., Larsen, P. V., Jørgensen, J. S., vB Hjelmborg, J., Lamont, R. F., & Hvidt, N. C. (2016). Psychosocial health and well-being among obstetricians and midwives involved in traumatic childbirth. Midwifery, 41, 45-53.