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Aim: We aimed to describe the aim, data collection and content from a survey completed among pregnant women during the first peak of the COVID-19 pandemic in Denmark. Methods: The declaration of the COVID-19 pandemic in early 2020 challenged pregnant women’s mental well-being due to a concern for their unborn child and their need for healthcare services through pregnancy and birth. To explore how the COVID-19 pandemic and the intensified measures such as the lockdown of Denmark impacted pregnant women’s well-being and mental health, we conducted a questionnaire survey in the spring of 2020 when the COVID-19 pandemic was at its first peak, and the consequences for pregnant women and the unborn child were very uncertain. All women residing in Denmark and registered with an ongoing pregnancy on 24 April 2020 were invited to participate. The questionnaire included background information, variables on COVID-19 symptoms and validated batteries of questions on loneliness, anxiety, stress, quality of life, meditation and prayers. Additional questions were included to examine concerns related to pregnancy and childbirth during the pandemic. Cohort characteristics: Almost 18,000 women answered the questionnaire, which represents 60% of all invited women who experienced a national lockdown for the first time. Their median age was 30 years, and they were more likely to be multiparous. Conclusions: Data from the COVIDPregDK Study will enable us to gain valuable knowledge on how the pandemic, the intensified measures from the health authorities and the national lockdown affected pregnant women’s mental health and their concerns during the COVID-19 pandemic.

Background: Poor mental health is considered a major health challenge globally, not least for young people, who will form families within forthcoming years. Research related to childbirth and parenthood transition has focused on how to promote good mental health by preventing mental illness. Aim: We discuss how a salutogenetic approach to mental health in parenthood transition is beneficial, and specifically how the component of meaningfulness in Sense of Coherence (SoC), could be investigated to optimize good mental health during parenthood transition. Discussion: In more recent understandings of meaningfulness, ideas from existential philosophy and psychology have been included. We discuss how, from an existential psychological perspective, open and explorative questioning of life conditions and dilemmas may help to regain one's footing and get in touch with one's driving force – meaningfulness. Such questioning implies that someone, a professional or a friend, actively and relationally helps explore existential aspects of life. Conclusion: We believe that investigating and asking research questions pointing at optimizing a salutogenetic perspective, specifically focusing on the component of meaningfulness and its embedded existential aspects of life, could lead to new knowledge on how to promote good mental health in maternity care.

Objective: Health-care professionals (HCPs) who are involved in an unanticipated adverse patient event, a medical error or a patient-related injury can become second victims. Being a second victim can lead to various symptoms, affecting the well-being of HCPs and possible turnover intentions or absenteeism. An increasing number of hospitals have implemented a second-victim support programme. To achieve unique insights into what works and what does not work in second-victim support programmes, HCPs’ perceptions are needed. The aim of this study was to translate the Second Victim Experience and Support Tool (SVEST) into Danish and test the psychometric properties of the Danish version (D-SVEST). Methods: The SVEST self-administered questionnaire was translated into Danish following the World Health Organization’s guidelines. Assessments of the content validity, construct validity and internal consistency were performed based on 171 participants. Results: The study demonstrated that the D-SVEST is content valid and fits the a priori defined structure. Yet, four items revealed unacceptable factor loadings (Conclusions: In conclusion, the D-SVEST is considered relevant and valid for measuring second-victim experiences and the adequacy of support resources. However, we recommend a modification of items 9 and 25 to enhance the measurement scale in a Danish context. The D-SVEST can be used by health-care management at Danish hospitals.

Som sundhedsprofessionel foretager man hver dag kliniske skøn, der er baseret på videnskabelig viden, egen klinisk erfaring og i fælles beslutningstagning med den enkelte patient. Selv de dygtigste sundhedsprofessionelle kan foretage et fejlskøn eller komme til at begå en decideret fejl, ofte med ingen eller ringe betydning. Men i nogle tilfælde fører det til, at der sker alvorlig skade på patienten, måske endda med fatale konsekvenser. I dette kapitel vil jeg gøre rede for, hvordan sundhedsprofessionelle oplever at være en del af denne type forløb. Jeg vil kort beskrive den danske patientsikkerhedskultur omkring håndtering af fejl og utilsigtede hændelser, og jeg vil argumentere for, at kollegiale relationer har en ofte overset betydning for den sundhedsprofessionelles reaktioner og oplevelsen af følelsesmæssig belastning i efterforløbet. Jeg har forsket i sundhedsprofessionelles oplevelser af traumatiske og utilsigtede hændelsesforløb gennem det seneste årti, og jeg trækker i kapitlet på indsigter fra formelle forskningsinterviews og uformelle samtaler med klinikere, samt dele af litteraturen på området. Desuden inddrages erfaringer fra et igangværende forskningsprojekt om et kollegialt støtteprogram. Der indledes med en case, som vil blive anvendt som gennemgående illustrativt eksempel gennem hele kapitlet.

Healthcare professionals are socialized into a tacit, professional identity of competences and skills - to save lives, repair trauma and facilitate good and trustful relational care. When severe adverse events happen, healthcare professionals may struggle to accept their own fallibility, and the event may pose a threat to the selfdeclared 'superior' or 'infallible' professional identity. The consequences of a sudden identity shift between the 'potentially infallible HCP' and 'potentially fallible HC P' caused by an adverse event is the analytical object of this study. The aim of the paper is to derive new understandings of how HCPs in maternity services experience adverse events by using Arnold van Gennep's and Victor Turner's 'rites of passage' theorizations and the concept of liminality to explain the process of transition between the two professional identities. Through five focus groups conducted in June 2018 with midwives and obstetricians-gynecologists, we have examined i) how second victim experiences can be understood using theories of transition and liminality, and ii) how the organizational procedures in a Danish university hospital may serve as a ritual for the involved HCPs in the aftermath of adverse events. The findings suggest that the inconsistency in the level of support contributes to the chaos that may be experienced by the healthcare professional. The organizational structure does not provide rites of transition or any other ritual processes, except for debriefings that, in many cases, are experienced as deficient. Since liminal states suggest danger and threat, because the previous professional identity is replaced by ambiguity and separation, the lack of clear rituals and support may put further strain on the HCP adding to the associated psychological and social distress. Considering the liminality and the need for structured transition rites within the work environment may prove useful when constructing adequate second victim support programs.

When a life is lost or severely impaired during childbirth, the midwife and obstetrician involved may experience feelings of guilt in the aftermath. Through three empirical cases, the paper examines the sense of guilt in the context of the current patient safety culture in healthcare where a blame-free approach is promoted in the aftermath of adverse events. The purpose is to illustrate how healthcare professionals may experience guilt without being at fault after adverse events, and Gamlund's theory on forgiveness without blame is used as the theoretical framework for this analysis. Philosophical insight has proven to be a useful resource in dealing with psychological issues of guilt and Gamlund's view on error and forgiveness elucidates an interesting dilemma in the field of traumatic events and medical harm in healthcare, where healthcare professionals experience that well-intended actions may cause injury, harm or even death to their patients. Failing to recognise and acknowledge guilt or guilty feelings may preclude self-forgiveness, which could have a negative impact on the recovery of midwives and obstetricians after adverse events. Developing and improving support systems for healthcare professionals is a multi-factorial task, and the authors suggest that the narrow focus on medico-legal and patient safety perspectives is complemented with moral philosophical perspectives to promote non-judgemental recognition and acknowledgement of guilt and of the fallible nature of medicine.

Objective: To describe midwives' and obstetricians' experiences on the level of support from colleagues and managers in Danish labor wards following adverse events.Design, setting and participants: A 2012 National survey of Danish obstetricians and midwives was conducted to assess the level of support received in the workplace.Main outcome measures: Scales on social community at work, social support from colleagues and immediate superiors, and use of support mechanisms on labor wards after serious adverse events were assessed.Results: 2098 midwives and obstetricians were invited to complete the survey (response rate 59%), and the analyses were carried out on the 593 respondents who had been involved in at least one traumatic childbirth at their current place of work. Respondents experienced high levels of social support from colleagues and social community at work, midwives significantly higher than obstetricians, and 95% of respondents had talked to colleagues about an adverse event. Respondents generally experienced low levels of social support and feedback from immediate superiors, and only 49% had talked to their immediate superior about an adverse event. Fifty% believed that the hospital had a clear process through which they could report adverse events, and 44% knew how to access the necessary confidential emotional support at work.Conclusions: Midwives and obstetricians experienced high levels of social support and feedback from colleagues who are the most frequent individuals to consult after adverse events. We strongly suggest developing second victim support programmes with a focus on offering peer support from qualified and trained peers.

Objective this study investigates the self-reported psychosocial health and well-being of obstetricians and midwives in Denmark during the most recent four weeks as well as their recall of their health and well-being immediately following their exposure to a traumatic childbirth. Material and methods a 2012 national survey of all Danish obstetricians and midwives ( n =2098). The response rate was 59% of which 85% ( n =1027) stated that they had been involved in a traumatic childbirth. The psychosocial health and well-being of the participants was investigated using six scales from the Copenhagen Psychosocial Questionnaire (COPSOQII). Responses were assessed on six scales: burnout, sleep disorders, general stress, depressive symptoms, somatic stress and cognitive stress. Associations between COPSOQII scales and participant characteristics were analysed using linear regression. Results midwives reported significantly higher scores than obstetricians, to a minor extent during the most recent four weeks and to a greater extent immediately following a traumatic childbirth scale, indicating higher levels of self-reported psychosocial health problems. Sub-group analyses showed that this difference might be gender related. Respondents who had left the labour ward partly or primarily because they felt that the responsibility was too great a burden to carry reported significantly higher scores on all scales in the aftermath of the traumatic birth than did the group who still worked on the labour ward. None of the scales were associated with age or seniority in the time after the traumatic birth indicating that both junior and senior staff may experience similar levels of psychosocial health and well-being in the aftermath. Key conclusions and implications this study shows an association between profession (midwife or obstetrician) and self-reported psychosocial health and well-being both within the most recent four weeks and immediately following a traumatic childbirth. The association may partly be explained by gender. This knowledge may lead to better awareness of the possibility of differences related to profession and gender when conducting debriefings and offering support to HCPs in the aftermath of traumatic childbirth. As many as 85% of the respondents in this national study stated that they had been involved in at least one traumatic childbirth, suggesting that the handling of the aftermath of these events is important when caring for the psychosocial health and well-being of obstetric and midwifery staff.

We would like to thank Cauldwell and Bewley (1) for their encouraging comments regarding our recent manuscript 'Blame and guilt - a mixed methods study of obstetricians' and midwives' experiences and existential considerations after involvement in traumatic childbirth' (2). The manuscript is the first publication from a large interdisciplinary study, and more data and analyses will follow. While we agree that it is an important finding that 87% agreed with 'Memories of what happened to the patient kept troubling me for a long time after the event', we do not share the authors' interpretation of the item to be representative of intrusive memories. We would like to thank Cauldwell and Bewley (1) for their encouraging comments regarding our recent manuscript 'Blame and guilt - a mixed methods study of obstetricians' and midwives' experiences and existential considerations after involvement in traumatic childbirth' (2). The manuscript is the first publication from a large interdisciplinary study, and more data and analyses will follow. While we agree that it is an important finding that 87% agreed with 'Memories of what happened to the patient kept troubling me for a long time after the event', we do not share the authors' interpretation of the item to be representative of intrusive memories. This article is protected by copyright. All rights reserved.

Det længe ventede svenske randomiserede studie SWEPIS*, der én gang for alle skulle undersøge, om igangsættelse i uge 41+0 forbedrer perinatale og maternelle udfald fremfor at afvente til uge 42+0, måtte afbrydes efter, at man havde inkluderet ca. 25% af den ønskede studiepopulation. Seks børn døde perinatalt i den afventende gruppe i forhold til ingen børn i interventionsgruppen. Dansk Jordemoderfagligt Selskab (DJS) og Jordemoderforeningen beskriver her studiet og gennemgår efterfølgende overvejelserne omkring dette.