Mixed-Methods Study of the Impact of Interpersonal Trauma on Midwives' Professional Practice: "Of Course It Affects...

In the United States, there is a high prevalence of sexual violence, with more than half of women and nearly one in 3 men affected. Individuals who have experienced such interpersonal trauma (IPT), one or more adverse childhood experiences (ACEs), or discrimination have higher rates of chronic and mental health concerns. Midwifery care hinges on connection, and midwives may themselves be survivors or be currently experiencing IPT. The purpose of this study is to understand the lived experiences of midwives who are survivors of IPT or discrimination and how these experiences impact their professional work.

A convergent mixed-methods approach was followed. Certified nurse-midwives (CNMs), certified midwives, and certified professional midwives (CPMs) practicing in the United States were recruited and asked to respond to an open-ended prompt via Research Electronic Data Capture, describing and providing specific examples of how being a survivor impacts their midwifery practice. Validated scales to measure ACEs, posttraumatic stress disorder (PTSD), and everyday discrimination were administered. Colaizzi's descriptive phenomenology and descriptive statistics were used for data analysis.

Forty-nine midwives (n = 38 CNMs; n = 11 CPMs) with an average of 15.6 years' experience completed the study. Over 50% experienced 4 or more ACEs, and 55.1% experienced adult sexual assault. Six qualitative themes emerged: (1) shaped me-"My trauma is a significant part of what called me to midwifery"; (2) the arc of healing matters-"Memories will come up"; (3) allows me to identify survivors and empathize-"I feel I can enter into that space with them"; (4) trauma-informed care-"I am particularly mindful about consent and putting the power in the patients' hands"; (5) layers of discrimination-"Is there anyone who is a midwife in our country who has not experienced discrimination?"; and (6) working within broken systems and lacking supports-"What's the point of asking the question and not addressing the issue?"

Results from this study indicate that midwives are also survivors of ACEs and adult traumas and suffer from PTSD. For some, the decision to become a midwife was influenced by their past traumas. Midwives' professional work continues to shape their trauma recovery and the care they provide throughout their career. Supportive work environments are essential for midwife trauma survivors so they can provide the highest level of patient care while also attending to their own well-being.