Background <p>Childbirth is a complex process, and midwives involved in assisting or witnessing it often experience psychological trauma, which can impact their well-being and professional performance. Psychological trauma in midwives is under-researched, despite its implications for their mental health and the quality of childbirth services. Addressing this issue is critical for ensuring safe and compassionate care. This study aimed to explore the psychological trauma experienced by midwives during childbirth and identify key influencing factors to enhance the safety and humanization of childbirth services.</p> Methods <p>This descriptive qualitative study involved in-depth interviews with 13 midwives selected based on preset criteria. Data were analyzed using a qualitative content analysis framework, and thematic analysis was applied to identify recurring themes from the data.</p> Results <p>Four primary themes emerged from the data. First, midwives reported persistent emotional trauma, including ongoing fear, guilt, and self-blame associated with traumatic childbirth experiences. Second, they faced multifaceted professional challenges, including high expectations and systemic pressures. Emotional exhaustion was more closely associated with persistent trauma and vicarious exposure, as reflected in other themes. Third, participants described feelings of helplessness and powerlessness when managing critical or life-threatening situations. Fourth, vicarious trauma was common, stemming from deep empathy and emotional engagement with laboring women and their families.</p> Conclusion <p>Strategies to address these challenges include strengthening midwives’ psychological resilience and professional competencies, optimizing team collaboration, and enhancing psychological and emotional support. Implementing these measures can safeguard the mental health of midwives, promote humanistic care, and improve childbirth safety.</p> Trial registration <p>ChiCTR2400088104 August 12th, 2024.</p>