A Mixed Methods Study of Secondary Traumatic Stress in Labor and Delivery Nurses


  • The authors report no conflict of interest or relevant financial relationships.


Cheryl Tatano Beck, DNSc, CNM, FAAN, University of Connecticut, School of Nursing, 231 Glenbrook Road, Storrs, CT 06269-2026. cheryl.beck@uconn.edu



To determine the prevalence and severity of secondary traumatic stress in labor and delivery (L&D) nurses and to explore nurses’ descriptions of their experiences attending traumatic births.


A mixed methods convergent parallel design was used.


A random sample of 464 L&D nurses obtained from the membership list of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) participated in this mail survey.


In the quantitative approach of this mixed methods study, participants completed the Secondary Traumatic Stress Scale. For the qualitative approach, the nurses were asked to describe their experiences being present at a traumatic childbirth.


In this sample, 35% of the L&D nurses reported moderate to severe levels of secondary traumatic stress. Content analysis of the participants’ descriptions of being present at traumatic births revealed six themes: (a) magnifying the exposure to traumatic births, (b) struggling to maintain a professional role while with traumatized patients, (c) agonizing over what should have been, (d) mitigating the aftermath of exposure to traumatic births, (e) haunted by secondary traumatic stress symptoms, and (f) considering foregoing careers in L&D to survive.


With 35% of this sample of L&D nurses reporting at least moderate secondary traumatic stress, nurses need to consider the possible impact their work may be having on them and take preventative measures to address their current symptoms.