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Perceptions and experiences of patient birth trauma among maternity healthcare professionals: an exploratory study

Salter, Cynthia (2020) Perceptions and experiences of patient birth trauma among maternity healthcare professionals: an exploratory study. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Each year 3.79 million U.S. women give birth, and more than 98% of births take place in hospitals. Yet the U.S. maternal mortality ratio is increasing and is four to five times higher for women of color than for white women. Besides poor physical health outcomes, many women experience lasting psychological trauma symptoms after giving birth, even in the absence of obstetric emergencies.
This dissertation research uses semi-structured interviews with 28 maternity healthcare professionals including labor and delivery nurses (n=14), midwives (n=8) and physicians (n=6) to explore their perceptions and experiences of patient birth trauma. Findings include reports of potential secondary trauma, compassion fatigue, burnout and moral distress among participants, associated with providing maternity care. Participants identified system drivers with patient birth trauma, including lack of provider training in responding to patient emotional needs, lack of structure for processing their own emotional response to trauma, and inadequate nursing staff. Other contextual factors that participants associated with patient birth trauma included lack of patient birth preparation, lack of continuity of care, lack of informed consent, lack of patient-centered care and poor communication. It is noteworthy that some contextual factors that participants associated with increased risk of patient birth trauma are the same factors that interfered with provider ability to manage their own responses to trauma.
Additionally, participants’ descriptions of birth trauma were mapped onto the Bohren et al. 2015 “Typology of Mistreatment of Women During Childbirth,” with participant narratives fitting into six of the seven mistreatment categories. The greatest number of participant statements mapped onto the category “Failure to meet professional standards of care,” followed by “Poor rapport between women and providers.” These findings demonstrate that some providers use the phrase “birth trauma” as a euphemism for patient mistreatment.
This research contributes to understanding system factors associated with birth trauma, respectful patient-centered maternity care and mistreatment, all issues of public health significance. Findings reinforce the need to address systemic mistreatment and racism and to provide adequate support for clinicians in addressing their own emotional responses to birth trauma as well as training in the psychological and emotional components of birth.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Salter, Cynthiacys6@pitt.educys6
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBurke, Jessicajgburke@pitt.edujgburke
Committee MemberChang, Judyjcc61@pitt.edujcc61
Committee MemberDocumet, Patriciapdocumet@pitt.edupdocumet
Committee MemberMendez, Daraddm11@pitt.eduddm11
Committee MemberTerry, Marthamaterry@pitt.edymaterry
Date: 29 January 2020
Date Type: Publication
Defense Date: 15 November 2019
Approval Date: 29 January 2020
Submission Date: 19 November 2019
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 164
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: birth trauma, mistreatment, respectful maternity care
Date Deposited: 29 Jan 2020 21:43
Last Modified: 01 Jan 2022 06:15

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