Compassion fatigue impacted by traumatic birth and psychological resilience among midwives in mainland China: an explanatory sequential mixed-methods

Abstract Background Compassion fatigue (CF) among midwives threatens both their well-being and the quality of maternal care. This study examined how traumatic birth exposure, psychological resilience, and work-family factors influence CF among midwives in mainland China. Methods An explanatory sequential mixed-methods design was employed. Phase 1 involved a cross-sectional survey of 227 midwives from eight public hospitals in Guangzhou, using the Professional Quality of Life Scale (ProQOL) and Connor-Davidson Resilience Scale (CD-RISC). Multivariable ordinal logistic regression identified predictors of CF. Phase 2 included 15 in-depth interviews to contextualize quantitative findings, with data analyzed thematically. Results Nearly all participants (98.7%) reported some degree of CF, with over half experiencing moderate or higher levels. Higher psychological resilience significantly reduced CF severity (OR = 0.888, 95% CI: 0.851–0.926, p < 0.001), while sole childcare responsibility (OR = 4.442, 95% CI: 1.439–13.722, p = 0.010), longer professional experience, extended shifts, and frequent traumatic birth exposure (≥ 3 events/month) increased CF risk. Moderate traumatic exposure (1–2 events/month) was protective compared to no exposure. Qualitative data revealed mechanisms such as emotional burden, recovery needs, and organizational support. Conclusions CF is prevalent among Chinese midwives and influenced by traumatic birth exposure, resilience, and work-family demands. Interventions should integrate organizational reforms (e.g., shorter shifts, debriefing) with resilience training and peer support to mitigate CF and sustain care quality.