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Secondary Traumatic Stress Caused by Witnessing a Traumatic Birth or Experiencing Horizontal Violence:
Impact on Nurses, Midwives, and Doulas (3.0 hrs.)

A presentation by Penny Simkin, PT and Kathy Spring, BSN, RNC

Thursday, November 17, 2016, 9AM – Noon PST Co-sponsored by the Praeclarus Press and Prevention and Treatment of Traumatic Childbirth (PATTCh). $49 Early bird registration

This PATTCh Webinar is focused on the maternity care team and their experiences of witnessing or providing care during a traumatic birth. Nurses’, midwives’ and doulas’ experiences are the focus here. The need to remain calm and effective in a frightening or dangerous situation may cause the care provider symptoms similar to PTSD symptoms – nightmares, preoccupation, self-blame, reliving the experience, and many more. This is called Secondary Traumatic Stress Disorder, and it can be debilitating or very troubling. Yet these caregivers are often expected to carry on in their jobs, unaffected by the traumatic experience. This presentation examines research findings on the condition and on possible solutions to the lack of institutional assistance for staff members to recover from the trauma.

Closely related to trauma relating to dangerous or frightening births is another type of trauma experienced in some hospital settings – horizontal violence (HV), or, as the British describe it, “workplace uncivility,” in which nursing or other co-workers are cruel to one another. Bullying and undermining are not unusual among hospital staff, and cause psychological harm to the victims, sometimes leading them to quit their jobs. HV sometimes results after a bad outcome of a birth, when blame, criticism, and lack of support prevail when the incident is investigated. This presentation will discuss HV, its damaging effects on staff morale, quality of care, and individual mental health. Solutions will also be discussed.
Learner Objectives

At the end of this session, the learner will be able to:

1. Differentiate Posttraumatic Stress Disorder (PTSD) from Secondary Traumatic Stress Disorder (STSD) and Posttraumatic Stress Effects (PTSE) or Posttraumatic Stress Symptoms (PTSS).

2. Describe risk factors that increase the chances of STDS in one who witnesses a traumatic birth.

3. Review research findings on the long-term impact of STDS on birth workers’ self-images and ability to carry on their work

4. Explain the impact of horizontal violence (“workplace incivility”) among coworkers, especially on a person who has assisted at a traumatic birth.

5. Give examples of behaviors in the workplace that constitute “horizontal violence.”

6. Describe employer services that can help prevent or assist healing from STSD among birth workers.

7. List self-help and group activities that reduce symptoms of STSD after birth or experiences of HV.


Kathy Spring, BSN, RNC has 37 years of experience in Maternal Child Health, including many years in level 2 and 3 Neonatal Intensive Care Nurseries as staff nurse, charge nurse and manager. In addition, she has several years’ experience as Manager in Antepartum, Postpartum, Labor & Delivery departments, and Neonatal Intensive Care Unit and Intermediate Care Nursery in a Level 2 single-room maternity care birthing facility, caring for families across the perinatal continuum. Most recently, Kathy serves as a staff nurse in a large tertiary facility caring for low- and high-risk antepartum, laboring and postpartum families. Kathy has witnessed the changes in nursing practice and clinical responsibility as we care for perinatal patients, their families and their infants. She is admired in the Seattle community as a highly skilled, wise and compassionate nurse who is also a mentor to newer nurses and a caring colleague to her fellow nurses.

Penny Simkin, PT, is a physical therapist who has specialized in childbirth education and labor support since 1968. She estimates she has prepared over 13,000 women, couples, and siblings for childbirth. She has assisted hundreds of women and couples through childbirth as a doula. She is author or co-author of books for both parents and professionals, including “The Labor Progress Handbook,” “Pregnancy, Childbirth, and the Newborn: The Complete Guide,” “When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women,” “The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions,” She has developed teaching materials for birth classes and produced several videos for educators, doulas, and families , the latest of which is for siblings-to-be, “There’s a Baby.” She is co-founder of DONA International (formerly Doulas of North America) and PATTCh (Prevention and Treatment of Traumatic Childbirth). Currently, she serves on the editorial board of the journal, Birth: Issues in Perinatal Care, and serves on the senior faculty of the Simkin Center for Allied Birth Vocations at Bastyr University, which was named in her honor. Today, her practice consists of childbirth education, birth counseling, combined with a busy schedule of conferences and workshops. Find out more about Penny at her website: