Parents' experiences of seeking health care and encountering allegations of shaken baby syndrome: A qualitative study.

OBJECTIVES: To explore parents' experiences of seeking health care for their children and instead being accused by healthcare professionals of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT), being reported to Social Services, undergoing judiciary processing, and the impact of these events on family (dis)integration. METHODS: Design: A qualitative study based on qualitative content analysis. Participants: Twelve parents in Sweden, mothers and fathers, seeking health care for their infants, encountering allegations of SBS/AHT, losing custody of their infants, and being subjected to a judiciary process, and finally regaining custody of their children. Data collection: In-depth interviews. RESULTS: An overarching theme 'Fighting for protection of their child after being trapped by doctors' and four sub-themes were developed to reflect the parents' experiences, reactions and interpretations. The first sub-theme, 'Being accused of injuring the child', illuminated the shock experienced when seeking care and instead being accused of being a perpetrator. The second, 'Chaos and powerlessness', refers to the emotions experienced when losing custody of the child and being caught in the enforcement of legislation by the authorities. The third, ´The unified fight against the doctors' verdict´, illustrates the parents' fight for innocence, their worry for the lost child, and their support and resistance. The fourth, 'The wounded posttraumatic growth', describes the emotions, grief, panic, anxiety, and challenges in reuniting the family, but also the parents' reflections on personal growth. Unanimously, they had experienced the authorities' inability to reconsider, and expressed a deep mistrust of paediatric care. CONCLUSIONS: Being wrongly accused of child abuse and alleged SBS/AHT evoked emotions of intense stress, but parents endured because of a successful fight to regain custody of their child. However, the trauma had a long-term impact on their lives with residual posttraumatic stress symptoms and mistrust towards healthcare services and the authorities. The results provide important inferences for restoring system failures within child protection services.

Left alone with the emotional surge - A qualitative study of midwives' and obstetricians' experiences of severe events on the labour ward.

BACKGROUND: Working on the labour ward entails being responsible for severe events during which a mother or baby may be injured or may die. Such events might affect decision-making, team-working, capacity for empathy, and patient safety. AIM: To explore midwives' and obstetricians' experiences, reactions and interpretations of being part of a severe event on the labour ward. DESIGN: A qualitative study using content analysis of in-depth interviews. PARTICIPANTS: Fourteen Swedish healthcare providers: seven midwives, and seven obstetricians. METHODS: Qualitative content analysis was used to describe and interpret the manifest and latent meaning of the interview text, while remaining close to participants' lived experiences. RESULTS: The overarching theme "Left alone with the emotional surge" was developed around three subthemes, supported by categories and subcategories. Professionals identified factors that had contributed to the course of events that made them perceive that they had been "acting within an illusory system of control and safety". When the severity of the situation became clear, "cognitive and emotional discordance was experienced", and, in the aftermath, the professionals described a "search for internal and external redemption" related to strong emotions of being left alone. CONCLUSIONS: Facing severe obstetric events entails exposure to emotionally demanding situations and hence joint vulnerability. Midwives and obstetricians described a sense of loneliness and perceptions of insecurity regarding the organisational system, managers and colleagues, following a complex, severe event with a woman or her baby during childbirth.

The erratic pathway to regaining a professional self-image after an obstetric work-related trauma: A grounded theory study.

BACKGROUND: It is known that healthcare providers might be affected by severe medical events in which patients are badly hurt. In birth care, escalating situations can result in death or injury to a mother or new-born child. OBJECTIVE: To explore the process that Swedish midwives and obstetricians go through after a severe event in the maternity unit. DESIGN: A modified Constructivist Grounded Theory analysis, based on fourteen in-depth interviews with birth care professionals. PARTICIPANTS: Seven midwives and seven obstetricians. RESULTS: A core category, 'regaining of a professional self-image', was constructed and interpreted as being constituted of six main categories illustrating a frequently erratic pathway to the regaining of a professional self-image. The process included a search for external acceptance for the re-establishment of belongingness by obtaining corroboration from the woman, work colleagues and manager, and the medico-legal system. Media exposure was invariably seen as something negative. Internal processes involved coping with emotions of guilt and shame and the vulnerability that the work entails, as well as contemplating future work. The possibility to fully regain one's professional self-image depended on having a sense of confidence and an urge to support others in similar situations by sharing gained insights. However, the process could also result in reconsidering one's professional self-image by setting up boundaries, creating a better work-life balance, or creating mental back-up plans in case of similar recurrences. For others, the process led to a change of professional identity and a search for roles away from emergency obstetrics or the specialty as such. CONCLUSIONS: Many 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. Growth as well as leaving birth care can be the results of the process following a severe event.

Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study.

BACKGROUND: The process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence). OBJECTIVE: To assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints. DESIGN: Cross-sectional survey. PARTICIPANTS: Members of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG). METHODS: A questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression. RESULTS: The response rate was 39.9% (n=1459) for midwives and 47.1% (n=706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient. CONCLUSIONS: A considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.