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CW/TW: Sexual Assault, Trauma, Abuse, Specific Medical Examinations or Situations  –  Bringing new life into the world can be a profound and transformative experience, one that defines the very essence of human existence. Obstetricians and Gynecologists (OB-GYNs) are often the custodians of this journey, guiding individuals through the intricate web of pregnancy, childbirth, and postpartum health. Yet, in the pursuit of ensuring the physical well-being of their patients, the emotional and psychological aspects of care can often be overshadowed or outright ignored. This is where the framework of trauma-informed care steps in – as a vital and necessary shift in the world of pregnancy care.

Trauma-informed care recognizes that every individual carries a unique story, one that may bear the weight of past traumas, experiences, and hardships. By acknowledging this, OB-GYNs can revolutionize the way they provide care, fostering an environment of empathy, safety, and understanding.

In this blog post, we will discuss the necessity of trauma-informed care within the field of obstetrics and gynecology. We will explore the impact it has on patients, practitioners, and the entire healthcare ecosystem, shedding light on why it’s not just an option but an imperative for those who are committed to the well-being of birthers and their reproductive journeys.

 What Is Trauma-Informed Care?

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Trauma-informed care is a framework that recognizes the prevalence of trauma in our society and seeks to create an environment that fosters healing and recovery. In the context of obstetrics, it acknowledges that many birthers may have experienced trauma in their lives, including but not limited to sexual abuse, domestic violence, or previous traumatic birth experiences.

So, how does this translate into the OB-GYN office? It means creating an atmosphere of safety, trust, and respect. Every interaction and decision, from scheduling appointments to conducting examinations, is approached with sensitivity to the potential impact on survivors of trauma.

Trauma informed care provides principles instead of strict practices or procedures so that they may be applied to any field. The Five Guiding Principles are; safety, trustworthiness & transparency, peer support, collaboration and mutuality, empowerment voice and choice, cultural, historical, and gender issues.

This excerpt from the Buffalo Center Center for Social Research, does a great job at explaining how these principles improve care. 

“Ensuring that the physical and emotional safety of an individual is addressed is the first important step to providing Trauma-Informed Care. Next, the individual needs to know that the provider is trustworthy. Trustworthiness can be evident in the establishment and consistency of boundaries and the clarity of what is expected in regards to tasks.

Additionally, the more choice an individual has and the more control they have over their experience through a collaborative effort with providers, the more likely the individual will participate in services and the more effective the services may be. Finally, focusing on an individual’s strengths and empowering them to build on those strengths while developing stronger coping skills provides a healthy foundation for individuals to fall back on.”

Trauma informed care is a vital, OB-GYNs guide us through pregnancy, birth & postpartum health but emotional & psychological care is ignored.

The Positive Impact on Birthers

Implementing trauma-informed care in the OB-GYN office can have profound positive effects on birthers.

Here’s why it’s worth the effort:

Reduced Retraumatization: Trauma-informed care minimizes the risk of retraumatizing birthers.

It recognizes that questions, statements, and procedures can trigger distressing memories and seeks to avoid or handle them with utmost care. For example, if a birther has experienced sexual trauma, a trauma-informed OB-GYN might explain each step of an examination in detail and ask for explicit consent before proceeding. If consent is given, the examination happens in privacy and possibly with an additional staff or support person present.

Improved Mental Health: When birthers feel safe and respected, it can significantly enhance their mental well-being during pregnancy, childbirth, and postpartum.

This can reduce the risk of developing post-traumatic stress disorder (PTSD) related to their birthing experience.(SOURCE). PubMed Trauma informed interventions: A systematic review) A trauma-informed approach may involve regular check-ins about emotional well-being, providing resources for therapy, and creating a judgment-free zone for discussing mental health concerns.

Better Maternal-Child Outcomes: Studies have shown that a supportive, trauma-informed approach can lead to better maternal and child outcomes (SOURCE).

Integrating TIC in Maternal Care Practices) When birthers feel heard and cared for, it positively affects the birthing process and the newborn’s health. This might mean offering additional support for chest feeding, encouraging skin-to-skin contact, and ensuring that birthers are well-informed about postpartum care for both themselves and their infants.

Empowerment and Informed Choices: Trauma-informed care empowers birthers to make informed decisions about their care.

It fosters open communication, ensuring that birthers are actively involved in their own healthcare journey. Obstetricians practicing trauma-informed care take the time to explain all available options, potential risks, and benefits of each decision, allowing birthers to make choices aligned with their preferences and values.

How Can OBs Learn More About Trauma-Informed Care?

Now that we’ve established the benefits, let’s discuss how OBs can become champions of trauma-informed care:

Education and Training: Obstetricians and their staff should undergo comprehensive training on trauma-informed care.

Organizations like the American College of Obstetricians and Gynecologists (ACOG) and Substance Abuse and Mental Health Services Administration (SAMHSA) as well as many other independent trainers offer resources and workshops on this topic.

Training covers topics such as recognizing trauma, understanding its impact, and implementing trauma-informed practices.

Patient-Centered Approach: Shift the focus from a medical-centric approach to a patient-centered one. Encourage birthers to share their preferences, concerns, and trauma history, and actively listen to their responses. Establishing trust and a collaborative relationship is fundamental to trauma-informed care.

Creating a Safe Environment: Redesign the physical space of the office to be welcoming and comfortable. Ensure privacy and provide calming elements like soothing colors, soft lighting, and comfortable furniture. Ensure administration staff refrain from asking personal questions or require a patient to retell personal details.

Review Policies and Procedures: Evaluate existing policies and procedures to identify areas where a trauma-informed approach can be integrated. For example, revising intake forms to avoid triggering questions and ensuring that all staff members are aware of and trained in trauma-informed practices.

Build a Supportive Team: Foster a culture of empathy and understanding among your staff. Everyone from receptionists to nurses plays a crucial role in creating a trauma-informed environment. Regular team meetings can be used to discuss challenges and successes in implementing trauma-informed care.

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    Changing OB Practices: Practical Examples

    Let’s get down to the nitty-gritty. How can OBs put trauma-informed care into action? Here are some practical examples:

    Mindful Language: Choose words carefully. Instead of asking, “Have you had any previous traumatic experiences?” try, “Is there anything you’d like to share about your medical history that may affect your care?” Sensitivity in language can make birthers feel more comfortable and understood.

    Informed Consent: Prioritize informed consent. Clearly explain procedures, potential discomfort, and alternative options. Give birthers the autonomy to make decisions about their care. This may involve providing information both verbally and in writing, allowing time for questions, and respecting a birther’s right to refuse any part of the care plan.

    Pain Management: Pain management is a sensitive issue for survivors of trauma. Discuss pain relief options early, explore non-pharmacological methods such as relaxation techniques, hydrotherapy, or massage, and involve birthers in the decision-making process. Always ask about and respect a birther’s pain threshold and preferences.

    Physical Examinations: Always explain the purpose of a physical examination and ask for consent. Provide support, such as allowing birthers to have a trusted person present during exams, and offering choices about positions or clothing during examinations.

    Postpartum Care: Extend trauma-informed care into postpartum visits. Acknowledge the potential emotional impact of childbirth and offer resources for mental health support. This may involve providing information on local therapists or support groups, inquiring about postpartum mental health during check-ups, and ensuring that birthers have access to timely postpartum care.

    How Birthers Can Assess a Trauma-Informed Space

    As birthers, you have the right to choose a healthcare provider who respects and understands your unique needs. Here’s how you can assess if a space is trauma-informed:

    Research: Start by researching potential OB-GYN practices or midwives. Look for testimonials, reviews, and any mention of trauma-informed care in their approach. Websites and social media can also provide insight into the practice’s philosophy.

    Ask Questions: During your initial consultation, don’t be afraid to ask questions. Inquire about their approach to trauma-informed care and how they handle sensitive topics. A trauma-informed provider should be willing to discuss their practices openly.

    Gut Feeling: Trust your instincts. Pay attention to how you feel during your interactions. Do you feel heard, respected, and safe? Your gut feeling can be a powerful indicator of whether the space is truly trauma-informed.

    Communication: Evaluate how they communicate. Do they actively listen to your concerns and preferences? Do they use language that fosters trust and empowerment? A trauma-informed provider should make you feel valued and understood.

    Supportive Environment: Observe the physical environment of the office. Is it welcoming, private, and designed with your comfort in mind? Some trauma-informed spaces may have resources available in waiting rooms, such as pamphlets on trauma recovery or local support services

    Trauma-informed care is necessary. It recognizes the importance of creating safe spaces for survivors in the OB-GYN office and empowers birthers to take an active role in their healthcare journey. OBs, by embracing this approach, can transform their practices and provide compassionate and understanding care that makes a world of difference in the lives of their patients.

    Remember, birthers, you deserve care that acknowledges your experiences and respects your choices. So, go forth and advocate for your well-being, because your health and happiness matter, always. With trauma-informed care, we can create a future where birthing experiences are empowering, healing, and nurturing for all.

    Sources:

    Han, H. R., Miller, H. N., Nkimbeng, M., Budhathoki, C., Mikhael, T., Rivers, E., Gray, J., Trimble, K., Chow, S., & Wilson, P. (2021). Trauma informed interventions: A systematic review. PloS one, 16(6), e0252747. https://doi.org/10.1371/journal.pone.0252747

    Sperlich, M., Seng, J. S., Li, Y., Taylor, J., & Bradbury-Jones, C. (2017). Integrating Trauma-Informed Care Into Maternity Care Practice: Conceptual and Practical Issues. Journal of midwifery & women’s health, 62(6), 661–672. https://doi.org/10.1111/jmwh.12674

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