When the Work Gets To You: Traumatic Stress, Burnout, and Grief Among Healthcare Providers

Written By Jess Coleman, Ph.D.

Table of Contents

You chose this work because it matters. Because you wanted to be present for people during some of the most profound moments of their lives — delivering babies, supporting families through crisis, helping people navigate frightening diagnoses and treatments, sitting with them through loss. The meaning in this work is real, and the cost to well-being can be great.

If you work in obstetrics, midwifery, labor and delivery nursing, maternal fetal medicine, neonatal or pediatric intensive care, gynecologic or breast oncology, or as a birth doula — or in any other role that keeps you close to people in their most vulnerable moments — you are working in one of the most psychologically demanding environments in healthcare. The exposure is relentless. The stakes are extraordinarily high. The losses accumulate. And the system you work within often makes it harder, not easier, to do the work you trained to do with the care and integrity you intended to bring to it.

Research confirms what many providers experience but rarely name: secondary traumatic stress, moral injury, burnout, and grief are significant and pervasive occupational hazards in medicine. They are not signs of weakness or insufficient training. They are predictable responses to sustained exposure to trauma, loss, and ethical impossibility in a professional culture that has historically expected providers to absorb all of it without showing the strain. This post is for you.

Who this post is for

This post is written for medical professionals and allied health providers who work in all settings, with a focus on reproductive, perinatal, and gynecologic care settings. This includes OB/GYNs, maternal fetal medicine specialists, labor and delivery nurses, certified nurse midwives, NICU and PICU nurses and physicians, neonatologists, gynecologic and breast oncology teams, birth doulas, perinatal social workers, and anyone else whose work keeps them close to birthing people, infants, and families navigating medical crisis, loss, or serious illness.

The experiences described in this post — secondary traumatic stress, moral injury, grief, and burnout — are not unique to any one role or setting. They exist across the spectrum of medical care, and they exist in people who are deeply committed to their work and their patients. In fact, commitment is often a risk factor: the more you care, the more the weight of what you witness, absorb, and cannot change tends to accumulate.

If you recognize yourself in these descriptions, or recognize a colleague, this post is for you.

Secondary traumatic stress and vicarious trauma: when patients' experiences become yours

Secondary traumatic stress (STS) refers to the psychological symptoms that can develop from exposure to traumatic events: from knowing about, witnessing, or being present for what others go through. It was first described in the context of therapists working with trauma survivors, but research has since established it as a significant concern across healthcare professions, particularly those with sustained, high-intensity exposure to patient trauma.

In reproductive and perinatal medicine, the exposure is both frequent and intense. Research finds that approximately 24 to 29 percent of maternal-newborn nurses, including certified nurse-midwives, labor and delivery nurses, and NICU nurses, report secondary trauma symptoms, with intrusive symptoms being the most common. A 2025 study of OB/GYN faculty and certified nurse midwives found that more than 91 percent had experienced a traumatic work event, and that adverse events negatively impacted professional self-efficacy across all provider groups.

Secondary traumatic stress symptoms can include:

  • Intrusive, unwanted memories or flashbacks to traumatic patient events
  • Difficulty separating from patient experiences at the end of a shift
  • Hypervigilance or increased anxiety in clinical situations that resemble prior traumatic events
  • Avoidance of certain patient populations, procedures, or clinical areas
  • Emotional numbing or detachment that creeps into both professional and personal life
  • Difficulty sleeping, including nightmares related to clinical events
  • A felt sense that you are carrying things that do not belong to you, and cannot put them down

Qualitative research characterizes healthcare providers in reproductive and perinatal settings as "second victims" of traumatic birth events and patient losses, a framing that acknowledges the real psychological impact of this work without pathologizing it. What you experience when a birth goes catastrophically wrong, when a baby does not survive, when a patient receives a devastating diagnosis — that is not just occupational stress. It is a genuine trauma response, and it deserves to be named as such.

Moral injury: when the system prevents you from doing right by your patients

Moral injury is distinct from secondary traumatic stress. Moral injury is increasingly recognized as a source of distress among healthcare professionals, emerging from structural constraints on the ability to deliver optimal care and stand up for patients, their professional oaths, and their professions. It is not simply stress from a difficult job. It is the psychological and spiritual wound that can occur when you know what the right thing to do is, and the system, the hierarchy, the protocol, or the resource shortage prevents you from doing it.

Repeated experiences of moral distress can lead to moral injury, which is a profound sense that you have betrayed your own ethical code, or that people you trusted have betrayed some fundamental obligation.

In reproductive and perinatal medicine, moral injury has specific and familiar shapes. It may look like:

  • Knowing that a patient is not receiving the standard of care they deserve because of systemic failures, understaffing, or institutional pressure, and being unable to change it
  • Being asked to participate in care decisions that feel ethically wrong and having no avenue for meaningful dissent
  • Witnessing racial disparities in maternal care outcomes and feeling the weight of a system you are embedded in but did not design
  • Carrying the aftermath of a preventable loss while the institution moves on without acknowledgment
  • Working in a doula role where your advocacy for a patient is overridden or dismissed and you bear witness to care that was not centered on her

Research on moral injury in maternity care highlights hierarchical structures, particularly those based on gender, as significant mediators, meaning that the power dynamics within healthcare teams can compound the injury, particularly for nurses, midwives, and doulas who may have less institutional authority than physicians even when they are closest to the patient.

Moral injury tends to be more resistant to standard self-care interventions than burnout or secondary traumatic stress because it is rooted in a perceived ethical violation, not simply in exhaustion or overexposure. Addressing it requires space to process what happened, to examine what it means, and often to grieve the version of the profession you entered that may feel increasingly distant from the one you are practicing in.

Cumulative grief: the losses that don't have a place to go

Grief is an expected companion in reproductive and perinatal medicine. Stillbirth, neonatal death, pregnancy loss, devastating diagnoses, the deaths of patients undergoing gynecologic or breast cancer treatment are part of the landscape of this work. What is less often acknowledged is the cumulative weight of that grief across a career, and the particular way it accumulates when there is no structured space to process it.

Individual losses are significant, and the grief that builds up across years of clinical practice — across dozens or hundreds of losses, each of which was experienced at least partly in isolation, each of which had to be set aside before the next patient arrived — is something different. It compounds. And it can eventually make it difficult to access the emotional availability that this work, and these patients, require.

Providers in perinatal and reproductive settings often describe a particular kind of grief that is hard to name because it does not fit the standard frameworks. It is not always about a specific patient. It is the accumulated weight of proximity to profound human suffering, repeated over time, without adequate ritual, acknowledgment, or release. It is grief about what could not be done, about what the system failed to provide, about the gap between the care you wanted to give and the care that was possible.

This grief is also often invisible to others. The people in providers' personal lives may not understand what it is like to witness a traumatic birth or complication, attend a fetal demise, to care for a critically ill neonate, or to accompany a patient through the end of a gynecologic cancer treatment that has stopped working. The absence of a shared framework, combined with the professional culture of not showing distress, can leave providers carrying losses that have no external witness and no protected space for processing.

Burnout and compassion fatigue: when the well runs dry

Burnout and compassion fatigue are the terms most commonly used in conversations about healthcare provider wellbeing, and while they are distinct from secondary traumatic stress and moral injury, they frequently coexist with both.

Burnout is a state of chronic exhaustion resulting from a sustained mismatch between the demands of work and the resources available to meet them. It is characterized by emotional exhaustion, depersonalization — a detachment from patients that can feel at odds with why you entered the profession — and a reduced sense of personal accomplishment. Burnout is not a personal failing. It is a predictable outcome of working in systems that consistently demand more than they support.

Compassion fatigue refers more specifically to the erosion of the full capacity for empathy and care that can develop from sustained exposure to the suffering of others. It is sometimes described as the cost of caring — the way that the emotional attunement required for this work can gradually deplete the reservoir that makes it possible.

In reproductive and perinatal medicine, burnout and compassion fatigue often develop in the context of secondary traumatic stress and moral injury. A provider who is carrying unprocessed trauma, accumulated grief, or repeated ethical violations is a provider whose resources are being depleted from multiple directions simultaneously, and who may be running on empty long before any formal burnout measure would flag them as a concern.

The warning signs are often subtle at first: a growing sense of dread before certain shifts, difficulty caring about outcomes that previously felt urgent, a creeping cynicism that feels foreign to your earlier sense of professional identity, increased irritability at home, or a persistent flatness that does not resolve with rest. These are signals worth paying attention to — not because they indicate something is wrong with you, but because they indicate something is happening that deserves a response.

How these experiences overlap — and why the distinctions matter

Secondary traumatic stress, moral injury, grief, and burnout are related but meaningfully different — and the distinction matters because the response to each is different.

Secondary traumatic stress responds to trauma-focused interventions: creating distance from the traumatic material, processing what happened, and regulating a nervous system that has been conditioned to expect crisis. Moral injury requires something more like ethical processing: making meaning of what happened, locating responsibility accurately, and finding a way to integrate an experience that violated something fundamental about your professional identity and values. Grief requires witness, space, and the kind of non-linear, non-rushed processing that structured acknowledgment can provide. Burnout requires systemic change and individual replenishment: rest, boundary restoration, and often a renegotiation of the relationship between the work and the self.

The culture of silence in healthcare

One of the most consistent findings in research on healthcare provider well-being is the degree to which professional culture suppresses help-seeking. Providers across specialties and roles report feeling that acknowledging distress is professionally risky, that they should be able to handle the demands of the work without support, and that seeking mental health care would be perceived as weakness or unfitness.

In reproductive and perinatal medicine, the stakes of the work are high and visible. The expectation of competence, composure, and emotional availability is built into the professional role. Providers who are struggling may work alongside colleagues who appear to be managing fine, without knowing that those colleagues are carrying the same weight in the same silence.

This culture of silence is not accidental. It is produced and maintained by institutional structures that do not build in adequate space for processing and support, by professional training that models emotional suppression, and by liability concerns that can make honest conversation about adverse events feel dangerous. The result is that providers who are struggling often wait far too long before seeking support, and when they do seek it, they may not have words for what is happening because the professional language available to them was never designed to describe it.

Comments from colleagues, supervisors, or institutions that can deepen this isolation include:

  • "This is just part of the job."
  • "You need to learn to leave it at the door."
  • "If you can't handle it, maybe this isn't the right field for you."
  • "We all go through this. You'll toughen up."

These responses are not always unkind in intention. But they communicate that the distress is not legitimate, not worth addressing, and not the institution's concern, which leaves providers exactly where they started, only more alone.

What therapy support can look like

Therapy for reproductive and perinatal healthcare providers is not about teaching you to care less or to build thicker walls. It is about creating a space to honestly examine what this work has cost you and to develop the internal resources to sustain a career that matters to you.

I work with medical providers across all medical specialties, and particularly in reproductive and perinatal medicine: OB/GYNs, midwives, labor and delivery nurses, NICU and PICU staff, maternal fetal medicine teams, gynecologic and breast oncology providers, and birth doulas. I also understand the systems you are working within — the structural factors that generate moral injury, the cultural pressures that suppress help-seeking, and the specific clinical realities of work in these settings. You should not have to explain what a fetal demise is, or what it costs to attend one, before we can begin the real conversation.

In my work with providers, we often focus on:

  • Processing specific traumatic clinical events that have stayed with you — through intrusive and unwanted memories, avoidance, or a persistent emotional shift
  • Understanding and naming the distinction between secondary traumatic stress, moral injury, grief, and burnout and addressing what is actually present rather than a generic category of "provider stress"
  • Making meaning of moral injury experiences: locating responsibility accurately, processing the ethical violation, and finding a sustainable relationship with the profession you chose
  • Creating space for cumulative grief — the losses across a career that have not had adequate witness or processing
  • Examining what the work has cost in terms of identity, relationships, and connection to the original values that brought you into this field
  • Developing more sustainable practices for managing ongoing exposure without suppression or numbing
  • Reconnecting with the values and meaning that make this work worth doing — not as a bypass of the difficulty, but as an anchor alongside it

The therapy modalities that I use are particularly well-suited to this population because they do not ask you to feel differently about what you have witnessed. They support you in developing the capacity to hold what you carry with more flexibility and less suffering, and to stay connected to what matters most about your work and identity even when the system makes that harder than it should be.

Consultation and support for provider teams and organizations

In addition to individual therapy, I offer consultation to provider teams and healthcare organizations navigating secondary traumatic stress, moral injury, and provider wellbeing in reproductive and perinatal care settings. This work may include:

  • Consultation with clinical leadership or administrative teams about the psychological impact of specific adverse events or patterns of care and preventing severe prolonged psychological consequences among staff
  • Psychoeducation for provider teams about secondary traumatic stress, moral injury, grief, and burnout — helping staff develop shared language for what they are experiencing
  • Guidance for organizations on building structures that support provider wellbeing in a sustained rather than reactive way

This work is grounded in the understanding that individual therapy, while meaningful, is not sufficient to address the systemic factors that contribute to provider distress. Organizations that want to support their providers effectively need both individual resources and systemic ones. I work at both levels.

If you are in a leadership role and are concerned about the wellbeing of your team, or if you are a provider who thinks your organization might benefit from this kind of support, I would be glad to connect. You can reach me through the contact form on this site or at contact@drjesscoleman.com.

When to seek support

Mental health support may be helpful when distress from clinical work is interfering with sleep, relationships, personal life, or the capacity to continue practicing in a way that feels sustainable or aligned with your values. Therapy is also valuable when specific clinical events have stayed with you in ways that feel unresolved — through intrusive and unwanted memories, avoidance, or persistent emotional weight — or when a growing sense of detachment, cynicism, or dread is becoming difficult to ignore.

You do not need to be in crisis to seek support. You do not need to have had a single catastrophic event. The accumulation itself is sufficient. Many providers find that beginning therapy before they are fully depleted, before the detachment has become entrenched or the grief has compounded beyond what feels manageable, makes the work more accessible and outcomes more durable.

If someone is experiencing thoughts of self-harm or suicide, immediate support is needed. In the U.S., calling or texting 988 connects to the Suicide and Crisis Lifeline. If there is imminent danger, call 911 or go to the nearest emergency room.

If any of this resonates, I would be glad to connect. You can reach me through my contact form or at contact@drjesscoleman.com.

Telehealth therapy for healthcare providers

I provide telehealth therapy to adults in North Carolina, California, and 40+ PSYPACT states. I specialize in reproductive and perinatal mental health, medical trauma, and the specific occupational experiences of providers working in OB/GYN, midwifery, labor and delivery, NICU and PICU, maternal fetal medicine, and gynecologic and breast oncology settings. Telehealth is often a meaningful fit for providers whose schedules make in-person therapy logistically difficult, and who benefit from being able to access support without navigating the clinical environment they are already spending significant time in. You can reach me through the contact form on this site or by emailing contact@drjesscoleman.com.

Frequently Asked Questions

Is secondary traumatic stress the same as PTSD?

Secondary traumatic stress and PTSD share overlapping symptoms including intrusive re-experiencing, avoidance, and hyperarousal. Secondary traumatic stress can meet the diagnostic threshold for PTSD in some individuals. The key distinction is in the mechanism: PTSD develops from direct traumatic experiences, while secondary traumatic stress develops from exposure through witnessing or knowing about another person's trauma. Both are real, both respond to evidence-based treatment, and both are significantly underdiagnosed in healthcare providers.

Is what I am experiencing burnout or something else?

Burnout and secondary traumatic stress are related but distinct. Burnout is primarily a response to chronic work overload and resource depletion — it develops gradually and tends to be characterized by exhaustion, detachment, dread, cynicism, and reduced efficacy. Secondary traumatic stress develops specifically from exposure to patient trauma and can emerge more acutely. Moral injury involves a perceived ethical violation and tends to involve more specific guilt, shame, or loss of meaning than burnout alone. Many providers are experiencing some combination of all of these, and identifying which is most prominent can help clarify what kind of support is most likely to help.

What is moral injury and why is it different from burnout?

Moral injury refers to the psychological and spiritual wound that results from participating in, witnessing, or failing to prevent actions that violate one's moral code — or from having one's moral code violated by the actions of others or the constraints of a system. It goes beyond the resource-demand mismatch of burnout to implicate something more fundamental: a sense that something wrong occurred, that integrity was compromised, and that the professional self has been damaged in a way that ordinary rest will not repair. Addressing moral injury typically requires more than self-care — it requires processing, meaning-making, and often a renegotiation of one's relationship to the institution or the profession.

Can therapy really help with this, or is the problem too systemic?

The systemic factors that produce secondary traumatic stress, moral injury, and burnout in healthcare are real and require systemic responses — which individual therapy alone cannot provide. At the same time, individual therapy can meaningfully address what the system has put into you: the traumatic memories, the accumulated grief, the moral wounds, and the depletion that make it harder to continue the work. Therapy and systemic change are not competing solutions. Both are needed. Individual therapy gives you the internal resources to sustain yourself within an imperfect system and often, to be more present and effective in advocating for that system to change.

Is it appropriate to seek therapy during a period when I am still actively working in a demanding clinical environment?

Yes. In fact, for most providers, therapy during active clinical work is more useful than waiting until they have left or significantly reduced their exposure. Therapy can provide real-time support for processing what is happening now — rather than waiting until the accumulation has reached a crisis point. The work of therapy is not contingent on having left the situation; it is about building the capacity to be in the situation with more resources.

Further Reading

Jess Coleman, Ph.D.
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