PONE-D-24-17808MATernity care providers’ experiences of work-related serious EventS (MATES): An International surveyPLOS ONE

Dear Dr. Healy,

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Dear Dr Healy,

Your submission requires minor revisions. Both reviewers have recommended minor revisions. Therefore, I invite you to respond to the reviewers' comments and submit your revised your manuscript.

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Academic Editor

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is a useful survey and provides important information on the experiences of maternity care providers. Just some issues to address:

L 98 -100 The term 'positive experience' comes from the WHO (2018) which states that childbirth should be a positive life event to optimize the experience of childbirth for women and their babies while recognising that adverse events can and do occur. The context of this statement should be clarified which could be followed by the Beck reference.

If this is an international study, perhaps the authors could present international data on adverse events (morbidity/mortality) – these are expectations for MCPs globally.

L178. I presume that informed consent was by means of a check box to proceed with the online study, did the participants also submit a 'written consent'? Also, explain what is meant by the term 'sufficient reflective time' for an online survey.

L 201. Were the 180 incomplete surveys included in the analysis?

Provide more information on the 33 countries? Europe, Asia, Africa, Americas?

Also a breakdown of the 353 participants would be helpful, numbers of midwives, nurses, physicians, obstetricians, neonatologists, GPs, and mental health care providers. It seems most respondents nurse/midwives or physicians.

Consider the limitations - survey in English excluded potential participants, also bias in relation to publications in English (US, Australia, UK, Ireland, Nordic countries).

Reviewer #2: The aim of this international study was to examine the factors related to the impact of

maternity care providers’ involvement in traumatic events. An anonymised online survey relating to MATernity serious EventS (MATES) was developed utilising validated instruments and hosted on QualtricsXM across 33 countries between 1st July and 31st December 2022 via social

media and the COST Action network. In total, 579 MCPs responded with a wide age range and years of experience.

Findings suggest that MCPs are exposed to a large variation of serious events and

continue to be intensely affected, up to the present day. Events ranged from stillbirth,

neonatal death, maternal death, severe or life-threatening maternal or infant incidents and

violence and aggression from women or family member. Institutional support for staff is

limited, and when available, seldom used. Family and friends were relied on for support,

but this does not appear to be associated with MCPs experiencing less secondary traumatic stress. Subsequently MCPs were absence from work through sickness (22%),

changed their professional allocation (19%) and seriously considered leaving (42%).

Moreover, many reported low to moderate compassion satisfaction and burnout (65-

80%). With international scarcity of MCPs, the impact of these events seem to contribute to this

shortage. Effective support for MCPs is required if staff are to be recruited and retained.

This is an important study and the strengths and limitations of the method have been described.

It is an important finding that nearly 65% of respondents indicated that they had been exposed to violence or aggression by the woman or her family on one or more occasion.

It is also important that respondents reported that they relied mainly on their partner, family, or friends for support after a serious event, and that Institutional support programs were not available for almost 60% of the respondents and if available, were only used by 37%. The reasons for lack of access needs to be explored in the future.

Table 7 is complex and worth explaining in words the key relationships and implications from the table. In terms of future actions the authors may wish to inform themselves of the Trauma Risk Management (TRiM) TRIM programme which is being piloted in healthcare as a potential action to provide early support for colleagues.

D. Whybrow, N. Jones, N. Greenberg, Promoting organizational well-being: a comprehensive review of Trauma Risk Management, Occupational Medicine, Volume 65, Issue 4, June 2015, Pages 331–336, https://doi.org/10.1093/occmed/kqv024

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Reviewer #1: No

Reviewer #2: Yes:  Jane Sandall

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MATernity care providers’ experiences of work-related serious EventS (MATES): An International survey

PONE-D-24-17808R1

Dear Dr. Healy,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Sunita Panda, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All recommendations have been adequately addressed by the authors, it is important that this paper is published.

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Reviewer #1: No

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