After a night of emergency caesarean sections and one unexpected neonatal death, a consultant leaves the theatre and sits in the on-call room, not from exhaustion, but from the aftermath of the trauma and intrusive memories.
Such scenes unfold quietly across hospitals worldwide. Obstetric emergencies are emotionally charged events where decisions made in seconds can determine life or loss. Yet while systems focus on patient survival, the psychological toll on the clinicians involved often goes unaddressed. Research shows that nearly half of obstetric nurses experience what is known as “second-victim” distress at some point in their careers — an invisible burden that affects not only individual well-being but also patient safety.
The “Second Victim” and Its Psychological Fallout
The term “second victim” was first introduced by Dr Albert Wu in 2000 to describe healthcare providers traumatised by an unanticipated adverse patient event, medical error, or death. The emotional impact can range from shock and guilt to long-lasting post-traumatic stress symptoms.
In obstetrics, this phenomenon is particularly pronounced. A U.S. study found that 47.8% of obstetric nurses reported feeling like a second victim at least once in their career. A survey in Spain reported over 60% of obstetricians and midwives had similar experiences.
Closer to home, a 2025 study at Sarawak General Hospital found that 46.1% of Malaysian healthcare professionals had experienced second-victim distress following a patient safety incident.
Typical symptoms include intrusive memories, insomnia, self-doubt, and avoidance of clinical duties. For some, the trauma persists for months, mirroring post-traumatic stress disorder (PTSD).
Why It Matters for Patient Care and Systems
Clinician distress does not exist in isolation. Studies have link unaddressed second-victim trauma to impaired concentration, reduced teamwork, defensive practice, and attrition. These ripple effects compromise safety culture and increase costs associated with burnout and staff turnover.
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What Clinicians Can Do: Practical Actions During and After Emergencies
Immediate (During the Emergency)
In the thick of a crisis, clear communication and compassion can protect both patients and teams.
- Use psychological first aid: short, grounded phrases such as “You are safe, we’re doing everything we can” help families anchor amid chaos.
- Apply closed-loop communication: give clear instructions, have them repeated back, and confirm, minimising confusion and cognitive overload.
- Assign a senior staff member to update the family once stabilisation occurs; consistent communication prevents escalation and mistrust.
Early Follow-Up (24–72 Hours)
- Structured debrief: Hold short, facilitated discussions focused first on clinical facts, then emotional impact.
- Peer check-ins: Encourage a trained colleague or “buddy” to reach out. Programmes like RISE or forYOU Team (University of Missouri Health) demonstrate that peer conversations normalise help-seeking and shorten recovery.
Medium Term (1–8 Weeks)
Supervisors should follow up to assess how staff are coping and offer confidential referrals to occupational health or counselling if needed. Track return-to-work readiness and provide graded re-exposure to the clinical setting if symptoms persist.
When Symptoms Persist (Beyond 4 Weeks)
If distress continues or worsens, a formal mental-health assessment is warranted. Seeking professional pscycogical services, both within and outside the hospital, is highly encouraged to help cope with the long-term effects of repeated trauma.
System-Level Fixes Hospitals Can Implement
- Peer-Support Programmes: Hospitals can adapt 24/7 peer-response models, training selected staff to provide first-line psychological first aid after adverse events.
- Structured Debrief Frameworks: Short, facilitated models like STOP5 or TALK have been shown to improve teamwork and emotional processing.
- Measurement and Monitoring: Validated tools like the Second Victim Experience and Support Tool (SVEST) help institutions assess prevalence and gaps in support.
- Emotional Simulation Training: Incorporating emotional management and family-communication scenarios into obstetric simulation fosters both technical and psychological readiness.
- Culture of Psychological Safety: Leadership must ensure staff can seek help without fear of blame or career repercussions, aligning with patient-safety frameworks that value transparency and continuous learning.
Building Mental Resilience with Training
At the Intensive Course for Obstetric Emergencies (ICOE), simulation-based training recognises that preparedness is both technical and emotional. Every scenario is crafted to mirror the high-stakes complexity of real emergencies, from swift decision-making and teamwork under pressure to managing communication with anxious families.
Embedding structured debriefs and reflective discussions into its modules makes sure the ICOE framework helps participants not only refine their clinical responses but also learn to process the emotional aftermath of critical events. In doing so, it champions a more holistic approach to obstetric care — one that equips healthcare professionals to respond with skill, composure and compassion, even in the most challenging moments.
