gms | German Medical Science

Background: Midwifery students may experience violence in their practical work in the delivery room. Obstetric violence involves violence by obstetricians against women during childbirth in the form of “physical, sexual and verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers and health system conditions and constraints” (Bohren et al. 2015, S.7). Midwifery students experience this violence indirectly by observing it. At the same time, they are exposed to direct violence against themselves or workplace aggression by midwives during their vocational training. Violence against midwifery students can occur through physical, verbal, and emotional violence as well as inadequate communication by obstetric staff.

The research question of this study is: How do midwifery students cope with experiencing violence or workplace aggression?

Methods: An interview-based grounded theory study was conducted with midwifery students and young midwives (<2 years of professional experience) from Germany (n=23) who have experienced violence in the field. This methods were chosen to capture the phenomenon of experiencing violence. Theoretical sampling was used for data collection. Data were analyzed using open, axial, and selective coding procedures using MAXQDA.

Results: The study participants recognized obstetric violence and workplace aggression in their vocational training. They were affected and shocked by their experiences of violence in the clinical setting and articulated specific desires for change. Additionally, they developed coping strategies for self-care. To do this, they used a belief system that helped them maintain a perspective of hope for relief from obstetric violence and workplace aggression. The study participants recognized the system of violence maintains itself. A tension between midwifery students who want to change their experience and obstetric staff who cling to inherited structures became visible. Student midwives were afraid to conform to this system and normalize their experiences. Supporters were located in practice, theory, and in the linkage of these two sites.

Relevancy: The results show that implementing a fundamental culture change in the delivery room is challenging. Midwifery students need support not to subordinate themselves to the system of violence. Rather, their goal is respectful learning and midwifery to promote the health of women and their families. Challenges and opportunities to help through theoretical teaching and from people in the field are revealed.

Conclusion: The present study can serve midwifery teaching and practice sites of midwifery science to build a structure of sustainable support for future generations of midwifery students and strengthen change processes.

Ethics and conflicts of interest: An ethical clearing from the University of Lübeck was obtained. The research was financed by own resources. There are no conflicts of interest.