Trauma, relational trust and the effects on the midwife : a thesis presented in fulfillment of the requirements for the degree of Doctor of Philosophy, School of Health and Social Sciences, Massey University, Palmerston North, New Zealand
This qualitative thesis uses a method of narrative research to explore the effects of a
traumatic practice experience on the 16 midwives interviewed for this project. It is
an investigation of relationships at play influenced by power games and their
consequences creating conflict. The issues of partnership and autonomous
midwifery practice are the key drivers that make New Zealand midwives more
likely to be blamed and their competence in practice challenged. Partnership
negates domination for collaboration and as a result challenges the beliefs of the
dominant groups of medicine and management. Midwives questioned why when
they had coped with similar situations in the past was this incident ‘the straw that
broke the camels back’. The investigation uncovers that the trauma experienced
was prolonged due to a breakdown of relational trust in organisations, management,
colleagues, women and self. The breach of trust altered the meaning of the
traumatic event for the midwives which impacted on their personal and professional
identities creating biographical disruption and exacerbating the initial stress
reaction. Loss of personal and professional identities elicited grief which in most
cases was disenfranchised and therefore not supported. Grief associated with
maternal death was supported. As a result of the increase of emotional stress some
of the midwives suffered illness such as anxiety, post traumatic stress disorder and
chronic back pain implying that the aetiology of the disease could be emotions.
These illnesses experienced by the midwives contributed to workforce attrition.
Midwifery has an oral history whereby relationships are built and experiences
shared, making narrative research an ideal method for this personal topic. The
analysis of the study data draws upon the narrative concepts of Margaret Somers
(1994), Arthur Frank (2005) and Davis and Harre (1990) and Bourdieu (1982)
theory of economic practice to facilitate an understanding of the effects of these
traumatic practice experiences for the midwife participants. Midwives in New
Zealand are legally required to provide care to childbearing women using a
partnership model of care based on trust and mutual respect (MCNZ,2004).
Consideration was given to the influence of the model on the effects experienced by
the midwives. Substantive chapters explore the effects of biographical disruption,
grief, support, violence in the workplace, destroyed relationships and disrupted
lives, trust and dysfunctional organisations.
In the text gathered from this study I have developed two theoretical models; one
explains how the trauma is exacerbated rather than supported; the other outlines the
effects of the trauma. The study adds to the literature by providing evidence that
biographical disruption occurring as a result of a traumatic practice experience can
lead to a chronic illness. My research has addressed gaps in midwifery,
biographical disruption, grief, workplace violence and trauma literature.