Exploring safety aspects of maternity care through the lens of midwifery students’ clinical experiences in Belgium, Czech republic, Estonia, Norway, Slovakia: A qualitative study.

Abstract

Background Meeting the safety needs of women and newborns is crucial in preventing harm in maternity care. Recent recommendations suggest that childbirth needs to be understood through a broader framework, since maternal and newborn mortality/morbidity remain a global challenge. The unique role of midwifery students in clinical environment can provide and contribute to such understanding. This paper explores aspects of maternity care services impacting patient safety as identified by midwifery students in five European countries.

Methods A 2-stage qualitative design employed an interpretivist approach. Thirty-five midwifery students (Belgium, Czech Republic, Estonia, Norway, Slovakia) were recruited through purposive sampling to engage students with an Erasmus + experience. Stage 1 (2022–2023): Thirty-five written narratives were collected anonymously via an online ‘Sharing LearnIng from Practice for Patient Safety‘ Learning Event Recording Tool. The dataset captured care in antenatal, maternity and postnatal wards. Stage 2 (2024): Three focus group discussions verified and added to the initial findings. Audio recordings were transcribed, NVivo software was utilised to assist reflexive thematic analysis in both stages.

Results Three themes emerged from the analyses. ‘Treat me well’ theme captured the communication gaps and dehumanised assembly-line approach leading to compromised safety, obstetric violence and trauma. The second theme describes the paralysing impact of specific team members in ‘Team dynamics and accountability’, reducing a sense of agency among staff to advocate for patient safety. Theme ‘Traumatised team-members’ reveals the secondary trauma impact on emotional fatigue and defensive practices.

Conclusions Midwifery students emphasised the importance of individualised, well-communicated, and respectful care, with language barriers being addressed. Ensuring that patients feel safe seems equally relevant to physical safety. Collaborative teams prevent errors/hazards through interdisciplinary simulations, debriefings and students’ continuous mentoring. By fostering a psychologically safe environment and implementing whistleblowing policies, the paralysing bystander effect among staff might be mitigated, and obstetric mistreatment, violence, and trauma could be addressed. Unresolved secondary trauma appears to increase unnecessary interventions and reduce the emotional availability of staff for patients in maternity care. Hence, effective recovery needs to be supported by management, and emotional resilience training should be incorporated into midwifery curricula to indirectly improve patient safety.