Midwives’ and obstetricians’ lived experiences of maternal near-miss events in Italy: a qualitative study using reflexive thematic analysis

Introduction: Maternal near-miss (MNM) events impose substantial emotional and professional strain on midwives and obstetricians, yet clinicians' experiences remain underexplored in Italy. This study explored how maternity clinicians experience and make sense of MNM events. Methods: We conducted a qualitative interview study underpinned by a contextualist epistemological position and analysed data using contextualist reflexive thematic analysis. Semi-structured interviews were undertaken with 13 clinicians (9 midwives, 4 obstetricians) in a level II maternity unit in Northern Italy between February and September 2024. Interviews were audio-recorded, transcribed verbatim, and analysed iteratively alongside data collection. Trustworthiness was supported through reflexive journaling/memos, iterative team discussions, and end-of-interview participant validation (summary checking). Results: Four interrelated themes were developed: (1) Barriers to trauma processing, including judgmental audit cultures, limited formal support, and fragmented communication, with perceptions consistent with institutional betrayal; (2) Clinical confidence-building and largely informal emotional recovery, including teamwork, mentoring, and informal debriefing, highlighting peer solidarity as a key buffer; (3) Communication challenges, particularly delivering bad news to women and families and navigating interprofessional communication under pressure; and (4) Emotional complexity, characterised by guilt, responsibility, and enduring personal and professional impact. A central interpretive insight was emotional reciprocity, a bidirectional relationship between clinicians' "second victim" distress and perceived women's recovery trajectories. Conclusion: MNM events can have lasting psychological and occupational effects on maternity clinicians. Findings underscore the need for structured organisational responses alongside peer-based support to mitigate second-victim impacts and support workforce wellbeing.