‘No Man׳s Land’: An exploration of the traumatic experiences of student midwives in practice
Introduction
The role of the midwife is to attend and support the childbearing woman on her individual journey to motherhood. Dealing with trauma and loss is a fundamental aspect of the role of the midwife (NMC, 2009) which can be extremely distressing (Kenworthy and Kirkham, 2011). The role of being ‘with woman’ during traumatic birth has been identified as having an emotional cost for midwives (Leinweber and Rowe, 2010). In helping contexts, caring roles have been associated with a range of trauma-related stress syndromes including secondary traumatic stress syndrome, PTSD, compassion fatigue and burnout and ‘vicarious traumatisation’ (McCann and Pearlman, 1990, Figley, 2002, Laposa et al., 2003, Mealer et al., 2007, Sabo, 2006). Repeated exposure to ‘sad situations’ has been identified by nurses as a factor in compassion fatigue and burnout (Maytum et al., 2004, Abendroth and Flannery, 2006).
The student midwife is in a liminal state of transition (van Gennep, 1960) from lay person to certified midwife. Because the role of midwife includes being an expert in the normal physiological process, most midwifery curricula begin with a focus on normal birth; yet many student midwives experience traumatic births early in their clinical experience (Davies, 1999, McKenna and Rolls, 2011). Studies on student midwife attrition suggest that they often witness events for which they are not prepared and that, for some, this stress is a factor in their decision to leave (Cavanagh and Snape, 1997, Green and Baird, 2009). It is also recognised that adult learners in health-care settings are vulnerable to feelings of lack of confidence and disempowerment as they face the challenges of clinical environments (Jones and Wylie, 2008, McCleland and Williams, 2002). Thus issues related to powerlessness or lack of control, central to the experience of PTSD and other traumatic stress disorders, may arise for the student midwife at any point. Exploration of the experiences of learners is important because experiences during socialisation into the profession have a lasting impact and shape the future professional (Page, 2005).
To avoid prejudging what students might find traumatic, this research did not set criteria for trauma, or use measurements to determine what was considered traumatic. This approach to trauma acknowledges that the stimuli which may give rise to traumatic stress can be major or minor events (Collins, 2006, Kershaw, 2008, Vaithilingam et al., 2008). It is consonant with Beck׳s (2004) construct that childbirth trauma is ‘in the eye of the beholder’. Thus when we use the term ‘traumatic’ in this paper it relates to the students’ perceptions of what was traumatic for them and for the women in their care.
The aim of the research was:
To explore student midwives׳ perceptions of what was traumatic for them and how they were supported with such events.
Section snippets
Methods
A qualitative approach appropriate for an open exploration of the topic was utilised (Crotty, 1998). Two researchers, a midwife and a psychotherapist, interviewed 11 student midwives within a university setting. Semi-structured interviews explored their training experiences from the perspective of what has been traumatic for them.
Discussion
It is a statutory body requirement for UK midwifery programmes to ensure students experience providing continuity of care for a group of women in order to give insight into the impact of pregnancy and birth on the woman and her family (NMC, 2009:20). Students in the study exhibited an intense mirroring relationship with women, particularly those they had come to know through providing continuity of care through individual caseloading. In the absence of the professional skills and knowledge
Conclusion and implications for research/practice
The limitations of this study include the self-selecting nature of student participation and the fact that participants were drawn from a single academic institution (although students were practising in various different clinical settings). Nonetheless, this is the first study to address this important and sensitive terrain and it builds upon previous work which recognises the emotionally demanding nature of midwifery work (Hughes and Fraser, 2011, Hunter, 2004, Hunter, 2010, Leinweber and
Acknowledgements
We would like to thank the students who participated in the study, and the two anonymous reviewers of this article.
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In this paper we refer to the student midwife as female, because all the participants were women.