How Stress and Trauma Impact Maternity Care

I often find myself in conversations about maternity services where frustrations surface—about mistakes made, about unnecessary interventions, or sometimes about moments where action was needed but delayed. It’s easy to see why emotions run high when we talk about birth and the care women receive. For many, it feels personal because it is personal. But this isn’t about making excuses for midwives, obstetricians, or anyone else working in maternity care. It’s about digging deeper to understand why things are the way they are. Because without understanding, we can’t hope to change anything.

At the heart of it all lies a troubling truth: the way maternity care is currently structured often sets professionals up to fail. They are tasked with navigating complex situations under extraordinary pressure, with the constant fear of mistakes hanging over their heads. What’s particularly fascinating—and heart-breaking—is that the very act of focusing on not making mistakes can make mistakes more likely. This isn’t conjecture or anecdote; it’s how the brain works.

Let’s take a closer look at the psychology behind this. The human brain, brilliant as it is, operates in ways that are sometimes counterintuitive. When you tell yourself, “Don’t make a mistake” what your brain hears loudest isn’t the “don’t”—it’s “make a mistake”. This phenomenon is well-documented in psychology and is often explored in Neuro-Linguistic Programming (NLP). The subconscious mind struggles to process negatives. If I say to you, “Don’t imagine a blue tree” chances are you’ve already pictured one, even though the instruction was to avoid it. The brain latches onto the key image or idea, and in doing so, inadvertently amplifies it.

Research supports this. Studies on cognitive function under stress show that negative self-talk can impair focus and decision-making, particularly in high-pressure situations. For example, a study published in ScienceDirect, the researchers found that individuals who engage in negative self-talk experience increased anxiety and decreased working memory capacity, leading to impaired decision-making and performance.

Now imagine being a midwife in the birth room or an obstetrician handling a complex situation. They’re under pressure, perhaps recalling a past incident where something went wrong, and their internal dialogue is a loop of, “Don’t mess this up”. Their focus is so fixed on avoiding error that their ability to think clearly and respond flexibly is compromised. Anxiety spikes, decision-making narrows, and what they feared most becomes more likely.

This isn’t just theoretical. Studies have shown that stress impairs cognitive performance, especially when combined with fear-based thinking. In high-pressure environments like maternity care, where every decision carries weight, the stakes are even higher. It’s not just about individual moments of doubt or hesitation—it’s about the cumulative impact of working in a system that reinforces this kind of fear.

But the problem doesn’t stop at the mental strain caused by negative thinking. There’s another layer: the emotional toll of the job itself. Midwives and obstetricians witness trauma more often than we might like to admit. They see births go wrong, hear heart-stopping alarms, and sometimes, despite their best efforts, lose mothers or babies. Even when things go right, the ever-present anticipation of disaster takes a toll. Over time, this constant exposure to stress and trauma leaves scars—ones that can manifest as PTSD, burnout, or even physical health issues.

PTSD among maternity care providers is a growing concern. Research highlights that midwives and obstetricians are at significantly higher risk of PTSD compared to other healthcare professionals. A study published in The European Journal of Midwifery in 2021, found that midwives who witnessed traumatic births were significantly emotionally affected, often losing self-confidence and considering leaving the profession. Unlike other medical professionals, maternity staff are not only responsible for health outcomes but are also deeply entwined in one of the most emotional moments of a family’s life. The stakes feel deeply personal for everyone involved, and that weight is hard to carry.

What happens when professionals are overwhelmed by stress and trauma? They become more likely to either overreact or underreact in critical moments. Fear of litigation or being blamed for poor outcomes often drives unnecessary interventions, such as inductions or caesareans that might not be needed. On the flip side, the same fear can cause paralysis—delaying decisions when swift action is necessary. It’s not a lack of skill or competence but the sheer weight of the circumstances they’re operating under.

Adding to this complexity is the tendency to assign blame. It doesn’t help to blame mothers for their outcomes, as was highlighted in a recent BBC investigation into maternity care. Nor does it help to scapegoat other professionals like doulas or independent midwives. Data has shown that doulas were present in less than 1% of neonatal deaths, despite recent attempts to link them to poor outcomes. In other words, the overwhelming majority of tragic cases involve other factors and other professionals. Blame distracts from the bigger picture—the structural failings and systemic pressures that shape every decision and outcome. Instead of pointing fingers, we need to focus on building a system where collaboration and accountability go hand in hand.

When mistakes happen, there’s little room for grace, for understanding, or for addressing the deeper issues at play. In many maternity settings, the culture around error is one of shame and fear rather than learning and growth. Professionals know that a single mistake could define their career, and this creates an atmosphere where no one wants to speak up or ask for help. It’s not just damaging for the individuals involved; it’s a missed opportunity for the entire system to improve.

If we want to create meaningful change in maternity care, we need to start with the people providing the care. We need to understand that their mistakes are not just theirs—they are the result of a system that doesn’t support them properly. This isn’t about excusing errors but about creating an environment where fewer errors happen in the first place.

One way to start is by rethinking how we talk about mistakes. The constant drumbeat of “don’t mess this up” must be replaced with something more constructive. Imagine a culture where midwives and obstetricians felt safe to say, “This is where I struggled”, or “Here’s a mistake I made and what I learned from it”. Normalising these conversations would help to break down the fear of failure and turn it into a learning experience. It would also reduce the internal pressure that makes errors more likely.

But we can’t stop at changing the narrative. Maternity care providers need tangible, practical support for their mental health. This means offering regular access to counselling, not just after traumatic births but as an ongoing resource. It means building peer networks where midwives and obstetricians can talk openly with others who understand their challenges. And it means creating workplaces where asking for help is seen as a strength, not a weakness.

Of course, none of this will succeed if we don’t address the structural issues. Chronic understaffing, long shifts, and inadequate resources are all too common in maternity care, and they exacerbate every other problem. A burnt-out midwife who hasn’t slept properly in days is more likely to make mistakes, no matter how well-trained or experienced they are. The system needs to prioritise sustainable staffing levels and workloads—not just for the sake of professionals but for the families they care for.

Trauma-informed care is another piece of the puzzle. This concept is often discussed in the context of patients, but it applies just as much to those providing the care. Trauma-informed workplaces recognise that many professionals carry their own emotional scars and ensure that policies and practices reflect this understanding. A trauma-informed approach might include debriefing after difficult births, offering flexibility for those struggling with burnout, or simply fostering a culture of compassion rather than criticism.

The language we use matters, too. Not just in how maternity professionals talk to themselves but in how the wider system communicates with them. Too often, the focus is on what went wrong, rather than celebrating what went right. Imagine how much more empowered midwives and obstetricians would feel if their good work was regularly acknowledged—if they were reminded of the many lives they’ve touched and the countless moments they’ve made better.

Maternity care is about more than clinical outcomes. It’s about creating an environment where mothers, babies, and families feel safe and supported. But that’s impossible if the people providing the care don’t feel safe and supported themselves. This isn’t just a matter of fairness or kindness; it’s a practical necessity. The better we take care of obstetricians and midwives, the better care they can provide.

We’re quick to criticise when things go wrong, and of course, accountability matters. But if we don’t also examine the system that allowed those mistakes to happen, we’re missing the point. This is about more than finding fault. It’s about asking better questions: How do we create a maternity care system where mistakes are less likely? How do we support professionals so they can make clear, confident decisions? And how do we build a culture where everyone involved feels valued, respected, and understood?

There are no quick fixes, but that doesn’t mean we should settle for the way things are. Obstetricians and midwives enter this work because they care deeply about mothers and babies. They want to make a difference, to be a positive presence at one of life’s most transformative moments. If we give them the tools, the support, and the understanding they need, they can do exactly that. And that’s a change worth fighting for.