Birth Trauma Research Articles

Termination for fetal anomaly in the UK – Women's views on termination method in the second trimester

The majority of individuals in the UK opting to terminate a pregnancy complicated by fetal anomaly have a medical rather than a surgical termination. This study provides context, understanding and evidence of the value that they attach to having the option to choose a termination method following a diagnosis of fetal anomaly. Ten women attending a fetal medicine unit participated in qualitative interviews by telephone and in person, explaining decision-making processes for their choice of method, their views on having this choice, and their perception of the value and acceptability of this choice. Important factors included the opportunity to confirm the fetal anomaly, hospitalisation, waiting time, and duration of the process. The emotional effort of carrying the pregnancy was foremost for many women, as was the need for self-preservation from birth trauma. Choice of termination method was felt to be a right for an individual facing a fetal anomaly.

Effect of early postpartum EMDR on reducing psychological complaints in women with a traumatic childbirth experience

This pilot study investigated the feasibility of postpartum Eye Movement Desensitization and Reprocessing (EMDR) for improving posttraumatic stress disorder (PTSD) symptoms, and its association with work absence, relationship difficulties, and development of psychiatric disorders in women with a traumatic childbirth experience who do not meet all criteria for PTSD. A randomized controlled study was conducted among 20 women (EMDR (N=11) vs. care as usual (CAU) (N=9)) who reported a traumatic birth. Outcomes were measured by questionnaires and a semi-structured interview. The results showed improvement of trauma-related psychological complaints for all women. EMDR appears to be more effective in reducing PTSD symptoms than CAU. Moreover, EMDR showed a small positive effect on work absence due to factors related to the traumatic childbirth experience. Results from the questionnaires were substantiated by interviews. However, due to the small size of the study, no statistically significant differences were found. In addition, no differences were found for relationship difficulties and development of psychiatric disorders. In conclusion, women with a traumatic birth experience may benefit from EMDR, even if they do not qualify for a diagnosis of PTSD. This study could be a starting point for future research aimed at early treatment that reduces trauma-related psychological complaints in postpartum women.

Bilateral Vocal Fold Paralysis in a Patient With Congenital MYOD1 Myopathy.

Congenital bilateral vocal fold paralysis (BVFP) is a rare but significant cause of morbidity in pediatric otolaryngology. The differential diagnosis is expansive, with common etiologies including birth trauma, brainstem neoplasms, and neurologic disorders. There are few known genetic causes of the condition. This report details the first known case of BVFP secondary to a genetic deficiency in MYOD1, a master transcriptional regulator of skeletal muscle cell specification. Genetics consultation and testing may be a useful adjunct in the workup of congenital BVFP and may help guide prognostication, additional workup, counseling, and clinical decision-making.

Study of Metformin as first line therapy for control of gestational diabetes in Independent University Hospital.

Objective: To assess the control of gestational diabetes with metformin and to study maternal and fetal outcome in patients using metformin. Study Design: Cross Sectional study. Setting: Department of Obs & Gynae, Independent University Hospital. Period: September 2019 to July 2021. Material & Methods: Eighty six patient diagnosed as having gestational diabetes mellitus by oral glucose tolerance test included in study and Metformin used as first line therapy along with diet for control of blood sugar levels. While patients with insulin dependent diabetes and type 2 DM were excluded from study. Results: It was observed in study, that with metformin use glycemic control was excellent in 70 (81.3%) of patients. Maternal outcome like risk of maternal weight gain>10kg, preeclampsia, and premature births were low in patient usung metformin in pregnancy and as well as neonatal risk of macrosomia, prematurity, neonatal hypoglycemia and need for hospital admission were low with the use of metformin in patients suffering from gestational diabetes. Conclusion: GDM associated adverse outcome for mother like maternal weight gain, pregnancy induced hypertension operative delivery and neonate like macrosomia, birth trauma, neonatal hypoglycemia are well controlled by the use of life style modification and metformin use in almost >80 % of cases only in few cases there is additional need of insulin therapy. Maternal and fetal outcome found to be satisfactory with the use of metformin. Further studies are required to build a more confidence.

Experiences of workplace adversity among midwives in labour wards of tertiary hospitals in northern Nigeria

Background/Aims Midwifery has been described as an emotionally charged profession. It can be even more demanding as a result of the staff shortages and lack of resources often encountered in low- and middle-income countries. In Nigeria, there are high maternal and infant mortality rates, shortages in the midwifery workforce and a high prevalence of stress among midwives. The aim of this study was to explore midwives' experiences of workplace adversity and resilience in tertiary hospitals in northern Nigeria. Methods This study used a constructivist grounded theory approach. Data were collected via in-depth face-to-face interviews and field notes. A total of 34 interviews were conducted in two phases, with purposive and theoretical samples of midwives across two tertiary institutions in northern Nigeria. The iterative process of grounded theory methodology was used for data analysis. Results Significant adversity was caused by a severe lack of human and material resources, leading to an excessive workload. The nature of the work was characterised by high numbers of obstetric emergencies and attending to traumatic births. Conclusions Midwives working in tertiary hospitals in northern Nigeria experience workplace adversity fuelled by high caseloads, workforce shortages, a lack of basic equipment and consumables, an unsupportive working atmosphere and attending traumatic births. More investment in Nigerian maternity services is needed to improve quality of care provision, reduce adversity in the midwifery workforce and enhance staff retention.

Birth Trauma Debriefing: A Specialist Midwife’s Perspective

In the UK, 4 in 100 women and birthing people develop post-traumatic stress disorder (PTSD) postnatally.1 In addition, up to 30% of maternity service users experience childbirth as a traumatic event. Factors leading to birth trauma are numerous, and support for parents affected by birth trauma must be provided in a timely, sensitive and individualised manner.2,3 Midwife and writer Illiyin Morrison is blazing the trail for midwife-led support for birth trauma in the UK. Here she shares her insights with the authors on birth trauma, debriefing and the role of student midwives.

Team Approach: The Care of Children with Hand and Upper Limb Differences

» Pediatric hand and upper limb differences include a wide range of conditions that may be genetic, part of a syndrome, or arise from birth trauma or an unknown cause.» Because of the variety of conditions and complexity of care requiring professionals from multiple disciplines, the Pediatric Hand Team is similar in purpose to the coordinated multidisciplinary care provided by Craniofacial Panels for children with craniofacial anomalies. Pediatric hand surgeons are trained to lead and coordinate the care of children with these differences, and the Pediatric Hand Team includes occupational and/or certified hand therapists, child life specialists, geneticists and genetic counselors, prosthetists and orthotists, pediatric physical medicine and rehabilitation physicians, pediatric orthopaedic surgeons, pediatric anesthesiologists, and social workers and psychologists. The Team must also have access to pediatric imaging, including ultrasound and magnetic resonance imaging.» Treatment of hand differences may include observation, splinting/bracing, therapy, reconstructive surgery, or a combination of these, and indications vary with development, age, associated conditions, and child and family preference. Children who have challenges coping with the stigma of their difference may benefit from programs such as Hand Camp and the Lucky Fin Project.» Multiple online and print resources are available to support the Pediatric Hand Team and the child's family and other caregivers.» A well-coordinated team-based approach meets the physical and psychosocial needs of the child with hand and upper limb differences from birth to adulthood.

Post-traumatic stress syndromes following childbirth influenced by birth mode—is an emergency cesarean section worst?

PurposeThe experience of birth is an emotional challenge for women. Traumatic birth experiences can cause psychological stress symptoms up to post-traumatic stress disorders (PTSD), with impact on women’s wellbeing. Primarily unplanned interventions can trigger birth-mode-related traumatization. The aim of the study was to evaluate whether an emergency cesarean section (ECS) is the most traumatizing.MethodsA retrospective case–control study was undertaken. Therefore, data were collected by standardized questionnaires (Impact of Event Scale-Revised and City Birth Trauma Scale) that were sent to women with singleton pregnancies > 34 weeks of gestation who either give birth by ECS (case group, n = 139), unplanned cesarean section (UCS), operative vaginal birth (OVB), or natural birth (NB) (three control groups, n = 139 each). The investigation period was 5 years.ResultsOverall, 126 of 556 (22%) sent questionnaires were returned and could be analyzed (32 ECS, 38 UCS, 36 OVB, and 20 NB). In comparison to other birth modes, women with ECS were associated with a higher degree of traumatization as revealed by statistically significant differences regarding the DSM-5 criteria intrusion and stressor. In addition, women who underwent ECS declared more frequently a demand for professional debriefing compared to other birth modes.DiscussionECS is associated with more post-traumatic stress symptoms compared to other birth modes. Therefore, early interventions are recommended to reduce long-term psychological stress reactions. In addition, outpatient follow-ups by midwives or emotional support programs should be implemented as an integral component of postpartum debriefings.

Glycemic control and neonatal outcomes in twin pregnancies with gestational diabetes mellitus

Preliminary data suggest that strict glycemic control in twin pregnancies with gestational diabetes mellitus may not improve outcomes but might increase the risk of fetal growth restriction. This study aimed to investigate the association of maternal glycemic control with the risk of gestational diabetes mellitus-related complications and small for gestational age in twin pregnancies complicated by gestational diabetes mellitus. This was a retrospective cohort study of all patients with a twin pregnancy complicated by gestational diabetes mellitus in a single tertiary center between 2011 and 2020, and a matched control group of patients with a twin pregnancy without gestational diabetes mellitus in a 1:3 ratio. The exposure was the level of glycemic control, described as the proportion of fasting, postprandial, and overall glucose values within target. Good glycemic control was defined as a proportion of values within target above the 50th percentile. The first coprimary outcome was a composite variable of neonatal morbidity, defined as at least 1 of the following: birthweight >90th centile for gestational age, hypoglycemia requiring treatment, jaundice requiring phototherapy, birth trauma, or admission to the neonatal intensive care unit at term. A second coprimary outcome was small for gestational age, defined as birthweight <10th centile or <3rd centile for gestational age. Associations between the level of glycemic control and the study outcomes were estimated using logistic regression analysis and were expressed as adjusted odds ratio with 95% confidence interval. A total of 105 patients with gestational diabetes mellitus in a twin pregnancy met the study criteria. The overall rate of the primary outcome was 32.4% (34/105), and the overall proportion of pregnancies with a small for gestational age newborn at birth was 43.8% (46/105). Good glycemic control was not associated with a reduction in the risk of composite neonatal morbidity when compared with suboptimal glycemic control (32.1% vs 32.7%; adjusted odds ratio, 2.06 [95% confidence interval, 0.77-5.49]). However, good glycemic control was associated with higher odds of small for gestational age compared with nongestational diabetes mellitus pregnancies, especially in the subgroup of diet-treated gestational diabetes mellitus (65.5% vs 34.0%, respectively; adjusted odds ratio, 4.17 [95% confidence interval, 1.74-10.01] for small for gestational age <10th centile; and 24.1% vs 7.0%, respectively; adjusted odds ratio, 3.97 [95% confidence interval, 1.42-11.10] for small for gestational age <3rd centile). In contrast, the rate of small for gestational age in gestational diabetes mellitus pregnancies with suboptimal control was not considerably different when compared with non-gestational diabetes mellitus pregnancies. In addition, in cases of diet-treated gestational diabetes mellitus, good glycemic control was associated with a left-shift of the distribution of birthweight centiles, whereas the distribution of birthweight centiles among gestational diabetes mellitus pregnancies with suboptimal control was similar to that of nongestational diabetes mellitus pregnancies. In patients with gestational diabetes mellitus in a twin pregnancy, good glycemic control is not associated with a reduction in the risk of gestational diabetes mellitus-related complications but may increase the risk of a small for gestational age newborn in the subgroup of patients with mild (diet-treated) gestational diabetes mellitus. These findings further question whether the gestational diabetes mellitus glycemic targets used in singleton pregnancies also apply to twin pregnancies and support the concern that applying the same diagnostic criteria and glycemic targets in twin pregnancies may result in overdiagnosis and overtreatment of gestational diabetes mellitus and potential neonatal harm.

Innovator from Novatorovs` street: the life of a scientist, the fate of a devotee

Innovator from Novatorovs` street: the life of a scientist, the fate of a devotee

PA11 Congenital erosive and vesicular dermatosis healing with reticulated supple scarring and comedome-like lesions

Abstract A 23 + 4-week gestational age female infant was born via spontaneous vaginal delivery following a premature spontaneous rupture of membranes (SROM). Pregnancy had been uneventful and antenatal scans were normal. After SROM, her mother was treated with intravenous antibiotics for septicaemia secondary to Escherichia coli infection. A vaginal swab 4 days prior to delivery grew group B streptococcus. The infant was subsequently prescribed benzylpenicillin and gentamicin for suspected chorioamnionitis. At 8 days old, she developed a vesicular eruption on her right shoulder, initially described as linear, which subsequently spread to affect both upper arms, back and buttocks. An older sibling was reported to have microcephaly and multiple developmental issues. Genetic testing for incontinentia pigmenti was negative, and the lesions subsequently evolved to form reticulate supple scarring-associated clusters of comedones. She was treated with adapalene 0.1% cream to aid remodelling of the epidermis. Congenital erosive and vesicular dermatitis (CEVD) is a rare disorder characterized by widespread superficial erosions and vesicles on the torso and limbs, with relative sparing of the face, palms and soles (Tlougan BE, Paller AS, Schaffer JV et al. Congenital erosive and vesicular dermatosis with reticulated supple scarring: unifying clinical features. J Am Acad Dermatol 2013; 69:909–15). The lesions typically heal within months to form supple dyspigmented scarring in a reticulate pattern. The CEVD can be associated with neurological abnormalities, ocular defects, hypoplastic or absent nails, cicatricial alopecia and hypohidrosis in areas of scarring with subsequent heat intolerance (Kong BY, Mancini AJ. Congenital erosive and vesicular dermatosis with reticulated supple scarring. Arch Dis Child Fetal Neonatal Ed 2018; 103:F78). The pathogenesis of CEVD is unclear, but proposed aetiologies include intrauterine infections, amniotic adhesions and birth trauma (Tlougan et al.). It is strongly associated with prematurity and being small for gestational age. This case is unique as the patient developed comedones, which has not been reported in other cases of CEVD. This adds to the wide clinical spectrum of CEVD. It is important for dermatologists to be aware of this condition as a differential diagnosis of vesicular eruption in neonates.

Perinatal palliative care in sub-Saharan Africa: recommendations for practice, future research, and guideline development.

Worldwide, sub-Saharan Africa has the highest burden of global neonatal mortality (43%) and neonatal mortality rate (NMR): 27 deaths per 1,000 live births. The WHO recognizes palliative care (PC) as an integral, yet underutilized, component of perinatal care for pregnancies at risk of stillbirth or early neonatal death, and for neonates with severe prematurity, birth trauma or congenital anomalies. Despite bearing a disproportionate burden of neonatal mortality, many strategies to care for dying newborns and support their families employed in high-income countries (HICs) are not available in low-and-middle-income countries (LMICs). Many institutions and professional societies in LMICs lack guidelines or recommendations to standardize care, and existing guidelines may have limited adherence due to lack of space, equipment, supplies, trained professionals, and high patient load. In this narrative review, we compare perinatal/neonatal PC in HICs and LMICs in sub-Saharan Africa to identify key areas for future, research-informed, interventions that might be tailored to the local sociocultural contexts and propose actionable recommendations for these resource-deprived environments that may support clinical care and inform future professional guideline development.

Three-dimensional reconstruction of the pelvic bones on MRI scans

BACKGROUND: Pelvimetry is an important part of the obstetric examination for predicting a mismatch between the size of the fetus and the mothers pelvis, which leads to difficulty or impossibility of vaginal delivery. Contracted pelvis is one of the main causes of maternal birth trauma and perinatal morbidity and mortality.&#x0D; AIM: To create a computer vision model for automatic segmentation and three-dimensional (3D) reconstruction of the pelvic bones.&#x0D; METHODS: A 3D U-Net-based neural network was used and trained on T2 weighted images in frontal projection (repetition time, 7500; echo time, 130; slice thickness, 4mm; field-of-view, 4039; matrix, 256256). The sample size covered 49 patients. The training and test samples included 42 and 7 examinations, respectively. The segmentation of areas of interest was done manually and verified by a specialist. The sample size was justified by achieving representativeness of the data for obtaining a qualitative model (according to the SorensenDice coefficient).&#x0D; RESULTS: 3D reconstructions of the pelvic bones were obtained. The average Sorensen-Dice coefficient on the accuracy of pelvic bone segmentation in the test sample was 0.86. The result justified the use of a 3D U-Net-based neural network as a tool capable of perceiving a 3D structure of images and conducting qualitative segmentation. The results allow further work on automating the determination of key points at reconstructions.&#x0D; CONCLUSIONS: A computer vision model for automatic segmentation of the pelvic bones to obtain 3D reconstruction of images was created. This enabled the next stage of the study, i.e. the development of a model for determining the key points in the images and the distances between the points.

The Soviet colonialism: conscious and unconscious coding of meanings in the The Well novel by Abish Kekilbayev

Abish Kekilbayev’s story The Well was first published in 1978 in the Kazakh language book Belaya Aruana. The story is one of the most striking works of Kazakh literature of the Soviet period and it has been translated into many languages of the world. It has been the subject of research by literary and cultural critics in Kazakhstan, Russia, Germany, the United States, Bulgaria and other countries, and it is still of interest for analysis and interpretation. In 2018, a feature film based on the novel was produced in Kazakhstan. This article examines the work as an example of coding during the ideological censorship of the Soviets and, from a psychoanalytical perspective, as a derivative of birth trauma. During the Soviet colonial period, ethnic myths acquired particular significance for Central Asian writers; they became a natural extension of the traditional folk epic and a way out of the situation: by engaging the mythical consciousness, they could encode meanings, presenting them in the form of socialist realism.

Incidence and risk factors for postpartum mood and anxiety disorders among women veterans

BackgroundOur aim was to determine rates of postpartum mood and anxiety disorders (PMADs) among U.S. women Veterans and the overlap among PMADs. We further sought to identify PMAD risk factors, including those unique to military service. MethodsA national sample of women Veterans completed a computer-assisted telephone interview (N = 1414). Eligible participants were aged 20–45 and had separated from service within the last 10 years. Self-report measures included demographics, general health, reproductive health, military exposures, sexual assault, childhood trauma, and posttraumatic stress disorder (PTSD). The PMADs of interest were postpartum depression (PPD), postpartum anxiety (PPA) and postpartum PTSD (PPPTSD). This analysis included 1039 women Veterans who had ever been pregnant and who answered questions about PPMDs related to their most recent pregnancy. ResultsA third (340/1039, 32.7%) of participants were diagnosed with at least one PMAD and one-fifth (215/1039, 20.7%) with two or more. Risk factors common for developing a PMAD included: a mental health diagnosis prior to pregnancy, a self-report of ever having had a traumatic birth experience, and most recent pregnancy occurring during military service. Additional risk factors were found for PPD and PPPTSD. ConclusionWomen Veterans may be at an increased risk for developing PMADs due to high rates of lifetime sexual assault, mental health disorders, and military-specific factors including giving birth during military service and military combat deployment exposures.

184-LB: The Effect of Early Screening and Intervention for Gestational Diabetes Mellitus on Pregnancy Outcomes—The TESGO Randomized Controlled Trial

Background: Women with gestational diabetes mellitus (GDM) have excessive fetus growth weeks earlier than the recommended screening period, suggesting that earlier screening and intervention may improve pregnancy outcomes and the health of the offspring. This trial aimed to investigate if early screening and intervention could alter pregnancy outcomes, compared to the standard group. Methods: We conducted an open-label randomized controlled trial in singleton pregnant women at National Taiwan University Hospital from 2018 to 2021. GDM is diagnosed by 75g 2-hour oral glucose tolerance tests at 18-20 weeks of gestational age for the early-screening group and at 24-28 weeks for the standard-screening group. The diagnostic cutoffs are according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. The primary outcome is a composite measure of pregnancy outcomes, including primary cesarean section, birth weight &amp;gt;90th percentile, neonatal hypoglycemia, cord serum C-peptide &amp;gt;90th percentile, gestational hypertension, preeclampsia and birth trauma. Results: Total 967 subjects were enrolled, including 483 subjects in the early-screening group and 484 subjects in the standard-screening group. Primary outcome was not statistically different between the two groups (early-screening group, 34.74%; standard-screening group 30.75%, p=0.20). There was also no significant difference in each individual outcome of the primary outcome between two groups except neonatal hypoglycemia, which was significantly higher in the standard-screening group than in the early-screening group (4.14% vs. 1.71%, p=0.0278). Conclusions: Early screening and intervention of GDM by the one-step method does not improve pregnancy outcomes as compared to standard practice. Disclosure C. Kuo: None. S. Lin: None. M. Lin: None. C. Lee: None. C. Chang: None. Y. Chang: None. Y. Tai: None. S. Chen: None. I. Yen: None. K. Fan: None. C. Hsu: None. K. Huang: None. W. Hsu: None. J. Kang: None. H. Li: None.

The latent factor structure and assessment of childbirth-related PTSD: psychometric characteristics of the City Birth Trauma Scale-Persian version (City-BiTS-P).

There is no validated Persian questionnaire to measure childbirth-related PTSD (CB-PTSD) symptoms. To cover this gap, the present study aimed to provide a Persian version of the City Birth Trauma Scale (CityBiTS-Pr) and to determine its psychometric properties. Since this is a cross-sectional study, sampling was done using a convenient sampling method. In total, 300 Persian-speaking women took part in this study and completed the City Birth Trauma Scale (CityBiTS-Pr), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Edinburgh Postnatal Depression Scale (EPDS), the Anxiety Subscale of the Depression, and the Anxiety and Stress Scale (DASS-21). In addition, sociodemographic information was completed. A confirmatory factor analysis of two- and four-factor models and a bi-factor model with a general factor and two specific factors were tested. Fit indices were calculated for all three models. Reliability, convergent, divergent, and discriminant validity also were examined. R v4.2.1 and SPSS v23 were used for data analysis. The four-factor model comprised intrusion, avoidance, negative cognitions and mood, and hyper-arousal showed a poor fit. The two-factor model composed of "birth-related symptoms" and "general symptoms" provided the best results based on all fit indices. The bi-factor result was relatively good, but the loadings indicated that the general symptoms factor is not well defined. The Persian version of the City Birth Trauma Scale (CityBiTS-Pr) is a valid and reliable questionnaire for evaluating postpartum PTSD.

The psychosocial experience of traumatic birth in couples: an interpretative phenomenological study

ABSTRACT Background One-third of women report a psychologically traumatic event during birth; limited research exists on how couples experience and process self-reported traumatic birth. Aims and objectives This study aimed to examine the lived experience and psychosocial impact of traumatic birth in couples. Methods Interpretative Phenomenological Analysis was used to explore in-depth participants’ lived experience during and after traumatic childbirth. Four couples were recruited, from women experiencing vaginal deliveries in the public hospital system in Australia during the past 5 years. Women and men were interviewed individually. Results Three superordinate themes were identified: ‘Compassionless care’ (experiences of being dismissed, devalued and degraded by care providers), ‘Violation and subjugation’ (women’s bodies and birthing experiences being violated) and ‘Parenting after birth trauma’ (challenges in caring for a newborn following trauma and recovery from trauma). Discussion Couples described care providers’ actions as a major contributing factor to trauma experiences. Couples contextualised care in terms of under-resourced wards and perceived women were treated as a means to an end. Women and men both described feeling fearful, distressed and devalued. Following birth trauma, individual cognitive factors, such as negative self-evaluations and avoidance of the trauma memory interacted with family system to shape trauma-related distress. Conclusions Future research would benefit from highlighting the systemic context in which compassionless care occurs, and the family system in which trauma is experienced and processed. Findings reinforce that psychosocial safety must be considered in addition to physical safety for both women and men in maternity care practices.

Reducing Trauma on the Labor and Delivery Unit Through Education and Trauma-Informed Care

The lasting effects of birth trauma after it has occurred is well-documented. However, research dedicated to the effects of respectful maternal and trauma-informed care (TIC) on primary prevention of birth trauma does not exist to date.

Labor and Delivery Clinician Perspectives on Impact of Traumatic Clinical Experiences and Need for Systemic Supports.

Few studies have elucidated the impact of work-related trauma on labor and delivery clinician or considered whether it may be a cause of burnout. This study aims to elicit labor and delivery clinician perspectives on the impact of exposure to traumatic births on their professional quality of life. Labor and delivery clinicians (physicians, midwives, nurse practitioners, and nurses; n = 165) were recruited to complete an online questionnaire on experiences with traumatic births. The questionnaire contained measures from the Maslach Burnout Inventory and the professional quality of life scale version 5. Some participants completed an optional free-text prompt to recommend ways to support clinicians after traumatic births (n = 115). Others opted into a semi-structured phone interview (n = 8). Qualitative data was analyzed using a modified grounded theory approach. Self-reported adequate institutional support for clinicians after a traumatic birth was positively correlated with compassion satisfaction (r = 0.21, p < 0.01) and negatively correlated with secondary traumatic stress (r = -0.27, p < 0.01), and burnout (r = -0.26, p < 0.01). Qualitative themes included lack of system-wide and leadership support, lack of access to mental health resources, and suboptimal workplace culture as contributors toward secondary traumatic stress and burnout. Participants recommended proactive leadership, consistent debriefing protocols, trauma education, and improved access to counseling. Multi-level barriers prevented labor and delivery clinicians from accessing needed mental health support after exposure to traumatic births. Proactive investment in healthcare system supports for clinicians may improve clinician professional quality of life.