Trauma-informed Approach
What is trauma-informed?
Be trauma-informed is to recognize that trauma is very common in people's lives. Simply put,
“There's a story behind every person. There's a reason why they are the way they are. They aren't just like that because they want to be. Something in the past created them, and sometimes it is impossible to fix... ― Hanny Quinn
Center for Disease Control and Prevention stated that one in four women has experienced domestic violence in the US, and one in five women younger than 10 was raped (Tober, 2018). In addition, discrimination, neglect, and abuse account for much more trauma. Approximately 70% of people have been exposed to at least one traumatic event during the course of their lifetime, and from that, 8% developed Post-traumatic Stress Disorder (Bellenbaum et al., 2018). In other words, many people have experienced serious trauma at some point in their lives. There is a story behind each person.
Childbirth is one of the life events that are stressful for most birthing individuals; however, one group of individuals that is more vulnerable to experience distress are the ones that have been a victim of sexual abuse.
Can we tell who has trauma?
Trauma comes in different shapes and forms. There is no unified way to identify what trauma looks like. People who had physical, sexual, or emotional abuse may exhibit differently in different ways. Some may seem to have “recovered fully” on the outside, or perhaps they are just better at hiding their scars inside. These negative thoughts may resurface depending on their life circumstances, for instance, pregnancy, childbirth, breastfeeding, or transitioning to parenthood.
About one-third of women experience trauma while giving birth, and that is often associated with Perinatal Mood Disorder, postpartum depression, generalized anxiety, substance abuse, or post-traumatic stress disorder (Reed, 2017). These individuals are four times more likely to be depressed during pregnancy and have many complications, including preterm labour (Kendall-Tackett, 2017). These negative experiences can alter the birthing persons' sense of self, disrupt their family relationships, mother and baby bonding, and subsequently the child's social, emotional, and mental development.
What are the effects of trauma?
This video by Dr. Cruz summarised the effects of trauma and its consequences.
Source: Centre for Health Care Strategies
So, trauma does not just affect the birth individual but also the growth and development of the next generation as well.
The World Health Organization in 2014 issued a statement calling for "respectful care for birthing women." The way the birthing individuals are treated prenatally will impact whether or not they will be successful in breastfeeding. WHO further stated that “if we want to increase breastfeeding rates, gentle care can make all the difference.” (Kendall-Tackett et al., 2017).
Childbirth can be another trauma for individuals who had been sexually abused (Harris, 2018). The process of pregnancy and childbirth is often associated with unwanted touching and internal examination, which can trigger anxiety and flashback from past sexual trauma (Reed et al., 2017). These negative intrusive memories amplify their emotional and physical distress. They are on high alert, they have a hard time sleeping or concentrating, and they tried to avoid being reminded of traumatic events. 3% of prenatal and 4% of postpartum individuals are diagnosed with PTSD during this transition into parenthood (Bellenbaum et al., 2018).
What are we going to do about that?
The Trauma-Informed Approach (TIA) is designed to address the impact of trauma so that care providers can work collaboratively to help individuals heal. This approach teaches us to shift the question from “What's wrong with you?” to “What happened to you?” to try and understand the stories behind the person, and to remove the stigma or blame from trauma survivors. The goal here is to avoid retraumatization.
The 4 Rs
Substance Abuse and Mental Health Services Administration (SAMHSA) suggests the 4Rs:
Realize that trauma is a widespread issue that affects many people. We have to acknowledge that every person may have had some sort of trauma in the past. The better approach is the “universal approach". We assume everybody had trauma, and we have to handle every single person with care. We do not necessarily have to question their past experience. We just assume that they have some sort of undisclosed history, and we must respond carefully.
Recognize trauma and its effects. Pregnancy is a window of opportunity for change; pregnant individuals are more open to new beginnings, new chapters. As birth workers, we will grasp this golden opportunity to help them take the first step toward healing.
Respond by integrating various policies and staff training to complement the principles of the trauma-informed approach. Organizations need to adopt the trauma-informed approach as their standard of practice.
Resist retraumatization. We will do everything we can to avoid retraumatization.
5 guiding principles
The 5 guiding principles of trauma-informed care are Safety, Choices, Collaboration, Trustworthiness, and Empowerment.
Ensure Safety. Make the pregnant individuals feel safe, both physically and emotionally.
Offer Choices. Educate individuals about their choices during pregnancy and childbirth.
Collaborate with healthcare providers. Build bridges and work in partnerships toward common goals.
Demonstrate trustworthiness. Build a trusting relationship - what we say is what we do, and be trustworthy!
Empowerment. Focus on building their strengths. Empowering them to establish stronger coping skills to move beyond their past experience and avoid retraumatization.
We need to understand and try to change the way we think. Remember, sometimes we only know their name, not their story.” ― Hanny Quinn
Childbirth educators, labour doulas, postpartum doulas, lactation educators, and new parent educators, let the Trauma-informed Approach be our Standard of Care. Let TIA be the engine of our train!
References:
Bellenbaum, P., & Bellenbaum, P. (2018). Trauma-Informed Care (TIC) in the Perinatal Period — The Motherhood Center of New York. Retrieved 28 February 2021, from https://www.themotherhoodcenter.com/blogindex/2018/8/9/trauma-informed-care-in-the-perinatal-period
Harris, A. (2020, Feb 7). Childbirth can be another source of trauma for women who were abused. Retrieved 28 February 2021, from https://www.irishtimes.com/life-and-style/health-family/childbirth-can-be-another-source-of-trauma-for-women-who-were-abused-1.4141804
Menschner, D., & Maul, A(2021). Key ingredients for successful trauma-informed care implementation - Centre for Health Care Strategies. Retrieved 28 February 2021, from https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf
Mosley, E., & Lanning, R. (2020). Evidence and guidelines for trauma-informed doula care. Midwifery, 83, 102643. doi: 10.1016/j.midw.2020.102643
Reed, R., Sharman, R., & Inglis, C. (2017). Women’s descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy And Childbirth, 17(1). doi: 10.1186/s12884-016-1197-0
Tello, M. (2018). Trauma-informed care: What it is, and why it’s important - Harvard Health Blog. Retrieved 28 February 2021, from https://www.health.harvard.edu/blog/trauma-informed-care-what-it-is-and-why-its-important-2018101613562
What is Trauma-Informed Care? - Trauma-Informed Care Implementation Resource Center. (2018). Retrieved 28 February 2021, from https://www.traumainformedcare.chcs.org/what-is-trauma-informed-care/
Why Trauma-Informed Care Needs to be Our Standard. (2017). Retrieved 28 February 2021, from https://womenshealthtoday.blog/2017/08/24/why-trauma-informed-care-needs-to-be-our-standard/