Second Victims in Swedish Obstetrics

Sammanfattning: The term “second victim” implies that healthcare providers can be pro-foundly affected by severe events in which a patient is badly injured or dies. The patient is the first victim. This thesis investigates the magnitude, riskfactors and consequences of becoming a second victim in Swedish delivery care.We examined self-reported exposure to severe events in a survey among 1459 midwives and 706 obstetricians. A severe event was defined as severe injury or death to a mother or child or other stressful events, such as threats or violence, during delivery. Of the midwives and obstetricians who responded, 71% and 84%, respectively, had experienced one or several severe events during their career. Post-traumatic stress symptoms following the perceived worst event were measured. Fifteen percent of the midwives and obstetricians reported symptoms equivalent to partial post-traumatic stress disorder (PTSD), and 5% of the midwives and 7% of the obstetricians reported symptoms commensurable with PTSD. Increased risk was correlated with emotions of guilt, and negative experience or support from friends. Professionals with partial PTSD left delivery care significantly more often than their less traumatised colleagues.Experiences of severe events were, furthermore, investigated, using qualitative content analysis, leading to an overarching theme “acting in an illusory system of control and safety”. This reflected how midwives and obstetricians retrospectively identified factors that had contributed to the course of events leading to such detrimental consequences. The process that the midwives and obstetricians followed in the aftermath of a severe event, were investigated using a Grounded Theory analysis. A core category, “regaining of a professional self-image”, was constructed. Six main categories illustrated an erratic pathway which might lead to full regaining, reconsidering, reconstructing professional self-image or deciding to leave the profession, depending on level of regained professional self-image.In summary, the majority of midwives and obstetricians will experience severe obstetric events that might affect them, sometimes severely. The vulnerability that healthcare professionals are exposed to should not be underestimated and preparedness in terms of collegial support, as well as an awareness in the workplace of how badly affected employees might be, is important.