This PATTCh Webinar is focused on the maternity care team and their experiences of witnessing or providing care during a traumatic birth. Nurses’, midwives’ and doulas’ experiences are the focus here. The need to remain calm and effective in a frightening or dangerous situation may cause the care provider symptoms similar to PTSD symptoms – nightmares, preoccupation, self-blame, reliving the experience, and many more. This is called Secondary Traumatic Stress Disorder, and it can be debilitating or very troubling. Yet these caregivers are often expected to carry on in their jobs, unaffected by the traumatic experience. This presentation examines research findings on the condition and on possible solutions to the lack of institutional assistance for staff members to recover from the trauma.
Closely related to trauma relating to dangerous or frightening births is another type of trauma experienced in some hospital settings – horizontal violence (HV), or, as the British describe it, “workplace uncivility,” in which nursing or other co-workers are cruel to one another. Bullying and undermining are not unusual among hospital staff, and cause psychological harm to the victims, sometimes leading them to quit their jobs. HV sometimes results after a bad outcome of a birth, when blame, criticism, and lack of support prevail when the incident is investigated. This presentation will discuss HV, its damaging effects on staff morale, quality of care, and individual mental health. Solutions will also be discussed.
At the end of this session, the learner will be able to:
1. Differentiate Posttraumatic Stress Disorder (PTSD) from Secondary Traumatic Stress Disorder (STSD) and Posttraumatic Stress Effects (PTSE) or Posttraumatic Stress Symptoms (PTSS).
2. Describe risk factors that increase the chances of STDS in one who witnesses a traumatic birth.
3. Review research findings on the long-term impact of STDS on birth workers’ self-images and ability to carry on their work
4. Explain the impact of horizontal violence (“workplace incivility”) among coworkers, especially on a person who has assisted at a traumatic birth.
5. Give examples of behaviors in the workplace that constitute “horizontal violence.”
6. Describe employer services that can help prevent or assist healing from STSD among birth workers.
7. List self-help and group activities that reduce symptoms of STSD after birth or experiences of HV.
A. Review of the presentation
B. Differentiate among birth-related Posttraumatic Stress Disorder (PTSD), Secondary Traumatic Stress
Disorder (STSD), and Posttraumatic Stress Effects (PTSE) (also known as Posttraumatic Stress Symptoms (PTSS)).
1. Definitions, symptoms, pre-existing risk factors, and incidence
2. People who are most likely to experience STSD (their personalities, early and current life events, support network)
II. Review of research findings on Secondary Traumatic Stress among Partners, Labor Nurses, Midwives, Physicians, and Doulas
2. Differences in impact of STSD on the affected groups, especially those with and without a supportive network and employer.
III. Horizontal violence (or “workplace incivility”): a common aftermath of a traumatic birth, near miss, or serious or fatal injury:
1. Definition, with examples of behaviors that qualify as horizontal violence
2. Changing the culture of the workplace to eliminate horizontal violence to encourage compassion and respect for one with STSD
3. May also be perpetrated when there is no traumatic event (a workplace culture of horizontal violence).
IV. Prevention and healing of STDS
1. Workplace commitment to prevention with policies for handling situations in which staff are exposed to traumatic events.
A. Recognition that STSD is not a sign of weakness or lack of professionalism.
B. Understanding of the detrimental effects of accumulated unresolved trauma.
2. Personal healing activities
3. Counseling or therapy with a trauma counselor
1. STSD is a real phenomenon and can be as harmful as PTSD.
2. Health professionals need and deserve acknowledgment and support through their trauma.
VI. Questions and discussion
Kathy Spring, BSN, RNC has 37 years of experience in Maternal Child Health, including many years in level 2 and 3 Neonatal Intensive Care Nurseries as staff nurse, charge nurse and manager. In addition, she has several years’ experience as Manager in Antepartum, Postpartum, Labor & Delivery departments, and Neonatal Intensive Care Unit and Intermediate Care Nursery in a Level 2 single-room maternity care birthing facility, caring for families across the perinatal continuum. Most recently, Kathy serves as a staff nurse in a large tertiary facility caring for low- and high-risk antepartum, laboring and postpartum families. Kathy has witnessed the changes in nursing practice and clinical responsibility as we care for perinatal patients, their families and their infants. She is admired in the Seattle community as a highly skilled, wise and compassionate nurse who is also a mentor to newer nurses and a caring colleague to her fellow nurses.
Penny Simkin, PT, is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates she has prepared over 13,000 women, couples, and siblings for childbirth. She has assisted hundreds of women and couples through childbirth as a doula. She is author or co-author of books for both parents and professionals, including “The Labor Progress Handbook,” “Pregnancy, Childbirth, and the Newborn: The Complete Guide,” “When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women,” “The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions,” She has developed teaching materials for birth classes and produced several videos for educators, doulas, and families , the latest of which is for siblings-to-be, “There’s a Baby.” She is co-founder of DONA International (formerly Doulas of North America) and PATTCh (Prevention and Treatment of Traumatic Childbirth). Currently, she serves on the editorial board of the journal, Birth: Issues in Perinatal Care,and serves on the senior faculty of the Simkin Center for Allied Birth Vocations at Bastyr University, which was named in her honor. Today, her practice consists of childbirth education, birth counseling, combined with a busy schedule of conferences and workshops. Find out more about Penny at her website: www.pennysimkin.com.