The stress of the midwife: Experiences of advanced midwives working in obstetric emergency units in Johannesburg, South Africa

Obstetric emergencies account for the majority of causes of maternal deaths. The major causes of maternal and neonatal deaths in obstetric emergencies include bleeding, pregnancy-induced hypertension, cord prolapse, shoulder dystocia, poor progress, placenta abruptio, placenta praevia and amniotic fluid embolism. These adverse labour and birth events cause emergency situations and trauma for the nursing staff involved. A qualitative, descriptive phenomenological research design was used to explore and describe the lived experiences of advanced midwives regarding the management of obstetric emergencies in Midwife Obstetric Units (MOUs) of Gauteng Province, South Africa. An interview guide was prepared with a major question which was followed by probing questions based on the participant's responses. Semi-structured, face-to-face individual interviews were used to collect data from thirteen (13) advanced midwives who were purposively selected and had been working in the Midwife Obstetric Units for two years or more after obtaining their qualifications. The Midwife Obstetric Units were selected based on the records of their birth statistics. The seven Collaizi's procedural steps were utilised for data analysis. Measures to ensure the trustworthiness of the study were observed within the naturalistic paradigm comprising criteria of credibility; transferability; dependability; and confirmability. Three themes with sub-themes emerged from the current study, namely: psychosocial stress; advanced midwives' workload; and lack of professionalism. In conclusion, it was evident that advanced midwives experience psychosocial stress because of unconducive working environments which are not adequately resourced, and high expectations from patients and their families. Management should support advanced midwives with the necessary resources that will enable them to perform their duties effectively and minimise their levels of stress and trauma.