„Wer kümmert sich um uns?“ Ergebnisse einer Querschnittsuntersuchung zur psychosozialen Gesundheit von Geburtshelfer*innen und Hebammen nach traumatischen Geburtserlebnissen

Zusammenfassung

Hintergrund: Traumatische Geburten führen nicht nur zu emotionalem Stress für die werdenden Eltern, sondern können auch die psychosoziale Gesundheit von Hebammen und Geburtshelfer*innen aufgrund ihrer beruflichen Anforderungen beeinträchtigen.

Ziel der Studie: Evaluation des Einflusses traumatischer Geburtserlebnisse auf die psychosoziale Gesundheit von geburtshilflichem Gesundheitspersonal.

Methodik: Querschnittsuntersuchung unter Anwendung validierter Messinstrumente (Impact of Event Scale Revised IES-R, Copenhagen Burnout Inventory CBI) und Erhebung des posttraumatischen Wachstums (PGI-SF) durch eine Online-Befragung von Hebammen und Geburtshelfer*innen im deutschsprachigen Raum.

Ergebnisse: Die Studie umfasst 700 Teilnehmer*innen mit peripartalen und/oder persönlichen Traumata. Die 33 Teilnehmer*innen (6,3% der 528 Teilnehmer*innen mit ausgefülltem IES-R ) mit einer posttraumatische Belastungsstörung (PTBS) erhielten seltener Unterstützung durch Kolleg*innen (p=0,007) und zogen häufiger Konsequenzen am Arbeitsplatz (p<0,001) als Teilnehmer*innen ohne PTBS. Ein moderates bis hohes Burnout-Level ergab sich für 66,2% der 542 Teilnehmer*innen mit ausgefülltem CBI. Bei 75,9% der 528 Teilnehmer*innen mit ausgefülltem PGI-SF zeigte sich durch das Erleben eines Traumas ein persönliches Wachstum.

Schlussfolgerung: Die psychosoziale Gesundheit von Hebammen und Geburtshelfern ist durch traumatische Geburtserlebnisse gefährdet. Screening-Untersuchungen und das Angebot kollegialer und professioneller Nachbesprechungen zur Stärkung der Resilienz sind wesentliche präventive Maßnahmen.

Abstract

Background: Traumatic births not only cause emotional stress for expectant parents but can also affect the psychosocial health of midwives and obstetricians due to their professional demands.

Aim: To evaluate the impact of traumatic birth experiences on the psychosocial health of obstetric healthcare professionals.

Methods: A cross-sectional study using validated measurement tools (Impact of Event Scale Revised IES-R, Copenhagen Burnout Inventory CBI) and assessing post-traumatic growth (PGI-SF) through an online survey of midwives and obstetricians in German-speaking areas.

Results: The study included 700 participants with peripartum and/or personal traumas. Of the 528 participants who completed the IES-R, 33 (6.3%) with post-traumatic stress disorder (PTSD) received less support from colleagues (p = 0.007) and were more likely to experience workplace consequences (p < 0.001) than participants without PTSD. A moderate to high level of burnout was found in 66.2% of the 542 participants who completed the CBI. Personal growth through experiencing trauma was reported by 75.9% of the 528 participants who completed the PGI-SF.

Conclusion: The psychosocial health of midwives and obstetricians is at risk due to traumatic birth experiences. Screening tests and the provision of collegial and professional debriefings to strengthen resilience are essential preventive interventions.

Schlüsselwörter

Gesundheitspersonal - Traumatische Geburt - Burnout - Posttraumatische Belastungsstörung - Kommunikation

keywords

healthcare workers - traumatic childbirth - post-traumatic stress disorder - communication

Publikationsverlauf

Eingereicht: 24. Februar 2024

Angenommen nach Revision: 27. Juni 2024

Artikel online veröffentlicht:
09. August 2024

• Literatur

• 1 Baumeister RF, Bratslavsky E, Finkenauer C. et al. Bad is Stronger than Good. Review of General Psychology 2001; 5: 323-370
• 2 Williams SE, Ford JH, Kensinger EA. The power of negative and positive episodic memories. Cogn Affect Behav Neurosci 2022; 22: 869-903
• 3 M K, K B, R P, et al. Saving Lives, Improving Mothers’ Care Core Report – Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2018-20. Oxford: National Perinatal Epidemiology Unit; 2022
• 4 Aibar L, Rabanaque MJ, Aibar C. et al. Patient safety and adverse events related with obstetric care. Arch Gynecol Obstet 2015; 291: 825-830
• 5 Weigl T, Garthus-Niegel S. [Questionnaires for the Assessment of Birth Expectancy and Birth Experience (Part 2 of a series on psychological assessment during the peripartum period)]. Z Geburtshilfe Neonatol 2021; 225: 392-396
• 6 McKelvin G, Thomson G, Downe S. The childbirth experience: A systematic review of predictors and outcomes. Women Birth 2021; 34: 407-416
• 7 Ertan D, Hingray C, Burlacu E. et al. Post-traumatic stress disorder following childbirth. BMC Psychiatry 2021; 21: 155
• 8 Sheen K, Slade P, Spiby H. An integrative review of the impact of indirect trauma exposure in health professionals and potential issues of salience for midwives. J Adv Nurs 2014; 70: 729-743
• 9 Schrøder K, Larsen PV, Jørgensen JS. et al. Psychosocial health and well-being among obstetricians and midwives involved in traumatic childbirth. Midwifery 2016; 41: 45-53
• 10 Slade P, Balling K, Sheen K. et al. Work-related post-traumatic stress symptoms in obstetricians and gynaecologists: findings from INDIGO, a mixed-methods study with a cross-sectional survey and in-depth interviews. BJOG 2020; 127: 600-608
• 11 Walker AL, Gamble J, Creedy DK. et al. Impact of traumatic birth on Australian obstetricians: A pilot feasibility study. Aust N Z J Obstet Gynaecol 2020; 60: 555-560
• 12 Wahlberg Å, Andreen Sachs M, Johannesson K. et al. Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross-sectional retrospective survey. BJOG 2017; 124: 1264-1271
• 13 Schrøder K, Jørgensen JS, Lamont RF. et al. Blame and guilt – a mixed methods study of obstetricians’ and midwives’ experiences and existential considerations after involvement in traumatic childbirth. Acta Obstetricia et Gynecologica Scandinavica 2016; 95: 735-745
• 14 APA PsycNet. Diagnostic and statistical manual of mental disorders: DSM-5^TM, 5th ed. Arlington, VA, US: American Psychiatric Publishing, Inc; 2013
• 15 Beck CT, LoGiudice J, Gable RK. A mixed-methods study of secondary traumatic stress in certified nurse-midwives: shaken belief in the birth process. J Midwifery Womens Health 2015; 60: 16-23
• 16 Leinweber J, Creedy DK, Rowe H. et al. Responses to birth trauma and prevalence of posttraumatic stress among Australian midwives. Women Birth 2017; 30: 40-45
• 17 Sheen K, Spiby H, Slade P. Exposure to traumatic perinatal experiences and posttraumatic stress symptoms in midwives: prevalence and association with burnout. Int J Nurs Stud 2015; 52: 578-587
• 18 Creedy DK, Sidebotham M, Gamble J. et al. Prevalence of burnout, depression, anxiety and stress in Australian midwives: a cross-sectional survey. BMC Pregnancy Childbirth 2017; 17: 13
• 19 Bourne T, Shah H, Falconieri N. et al. Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study. BMJ Open 2019; 9: e030968
• 20 Iorga M, Socolov V, Muraru D. et al. Factors Influencing Burnout Syndrome in Obstetrics and Gynecology Physicians. Biomed Res Int 2017; 2017: 9318534
• 21 Dewa CS, Loong D, Bonato S. et al. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res 2014; 14: 325
• 22 Schwappach DL, Boluarte TA. The emotional impact of medical error involvement on physicians: a call for leadership and organisational accountability. Swiss Med Wkly 2009; 139: 9-15
• 23 Ruitenburg MM, Frings-Dresen MHW, Sluiter JK. The prevalence of common mental disorders among hospital physicians and their association with self-reported work ability: a cross-sectional study. BMC Health Serv Res 2012; 12: 292-298
• 24 Cann A, Calhoun LG, Tedeschi RG. et al. A short form of the Posttraumatic Growth Inventory. Anxiety Stress Coping 2010; 23: 127-137
• 25 Beck CT, Eaton CM, Gable RK. Vicarious Posttraumatic Growth in Labor and Delivery Nurses. J Obstet Gynecol Neonatal Nurs 2016; 45: 801-812
• 26 Gold KJ, Kuznia AL, Hayward RA. How physicians cope with stillbirth or neonatal death: a national survey of obstetricians. Obstet Gynecol 2008; 112: 29-34
• 27 Schrøder K, Larsen PV, Jørgensen JS. et al. Psychosocial health and well-being among obstetricians and midwives involved in traumatic childbirth. Midwifery 2016; 41: 45-53
• 28 Baas MAM, Scheepstra KWF, Stramrood CAI. et al. Work-related adverse events leaving their mark: a cross-sectional study among Dutch gynecologists. BMC Psychiatry 2018; 18: 73
• 29 Zeidenstein L. Breaking the silence. Finding a voice for loss. J Nurse Midwifery 1995; 40: 317-319
• 30 Weiss DS, Marmar CR. The Impact of Event Scale – Revised. JP Wilson & TM Keane (eds) Assessing psychological trauma and PTSD. New York: Guilford; 1996: 399-411
• 31 Exenberger S, Kumnig M, Juen B. et al. Dimensions of posttraumatic growth in a German-speaking sample using mixed methods. Eur J Psychotraumatol 2019; 10: 1701258
• 32 Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress 1996; 9: 455-471
• 33 Kristensen TS, Borritz M, Villadsen E. et al. The Copenhagen Burnout Inventory: A new tool for the assessment of burnout. Work & Stress 2005; 19: 192-207
• 34 Wahlberg Å, Andreen Sachs M, Bergh Johannesson K. et al. Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study. International Journal of Nursing Studies 2017; 65: 8-16
• 35 Toohill J, Fenwick J, Sidebotham M. et al. Trauma and fear in Australian midwives. Women Birth 2019; 32: 64-71
• 36 Uddin N, Ayers S, Khine R. et al. The perceived impact of birth trauma witnessed by maternity health professionals: A systematic review. Midwifery 2022; 114: 103460
• 37 Mills TA, Ayebare E, Mweteise J. et al. „There is trauma all round“: A qualitative study of health workers’ experiences of caring for parents after stillbirth in Kenya and Uganda. Women Birth 2023; 36: 56-62
• 38 Becker J, Becker C, Abeysekera R. et al. Silent Tears of Midwives: ’I Want Every Mother Who Gives Birth to Have Her Baby Alive’-A Narrative Inquiry of Midwives Experiences of Very Early Neonatal Death from Tanzania. Children (Basel) 2023; 10: 705
• 39 Sheehy A, Baird K. A qualitative study of early career Australian midwives’ encounters with perinatal grief, loss and trauma. Women Birth 2022; 35: e539-e548
• 40 Ravaldi C, Carelli E, Frontini A. et al. The BLOSSoM study: Burnout after perinatal LOSS in Midwifery. Results of a nation-wide investigation in Italy. Women Birth 2022; 35: 48-58
• 41 Fontein-Kuipers Y, Duivis H, Schamper V. et al. Reports of work-related traumatic events: A mixedmethods study. Eur J Midwifery 2018; 2: 18
• 42 Dietl JE, Derksen C, Keller FM. et al. Psychosocial Processes in Healthcare Workers: How Individuals’ Perceptions of Interpersonal Communication Is Related to Patient Safety Threats and Higher-Quality Care. Int J Environ Res Public Health 2023; 20: 5698
• 43 Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ 2000; 320: 726-727
• 44 Annborn A, Finnbogadóttir HR. Obstetric violence a qualitative interview study. Midwifery 2022; 105: 103212
• 45 Batram-Zantvoort S, Wandschneider L, Razum O. et al Violation of maternal integrity during childbirth: a micro-, meso- and macrostructural perspective. European Journal of Public Health 2019; 29 ckz185.747
• 46 Tyler V, Aggar C, Grace S. et al. Nurses and midwives reporting of workplace violence and aggression: an integrative review. Contemp Nurse 2022; 58: 113-124
• 47 Böhle S, David M, Breckenkamp J. et al. [Violence Against Staff in Delivery Rooms – Results of an Online-Survey and Structured Interviews in Obstetric Clinics in Berlin]. Z Geburtshilfe Neonatol 2022; 226: 121-128
• 48 Capper TS, Thorn M, Muurlink OT. Workplace violence in the Australian and New Zealand midwifery workforce: A scoping review. J Nurs Manag 2022; 30: 1831-1842
• 49 Frommberger U, Angenendt J, Berger M. Post-Traumatic Stress Disorder – a Diagnostic and Therapeutic Challenge. Dtsch Arztebl Int 2014; 111: 59-65
• 50 Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000; 68: 748-766
• 51 Paul N, Limprecht-Heusner M, Eichenauer J. et al. Burnout among midwives and attitudes toward midwifery: A cross-sectional study from Baden-Württemberg, Germany. Eur J Midwifery 2022; 6: 46
• 52 Suleiman-Martos N, Albendín-García L, Gómez-Urquiza JL. et al. Prevalence and Predictors of Burnout in Midwives: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2020; 17: E641
• 53 Wahlberg Å, Högberg U, Emmelin M. The erratic pathway to regaining a professional self-image after an obstetric work-related trauma: A grounded theory study. Int J Nurs Stud 2019; 89: 53-61
• 54 Puia DM, Lewis L, Beck CT. Experiences of obstetric nurses who are present for a perinatal loss. J Obstet Gynecol Neonatal Nurs 2013; 42: 321-331
• 55 Goldbort J, Knepp A, Mueller C. et al. Intrapartum nurses’ lived experience in a traumatic birthing process. MCN Am J Matern Child Nurs 2011; 36: 373-380