Editor’s Note: The opinions expressed in this blog post are solely those of the author.

We hear a lot about trauma-informed care these days, and for good reason. When a clinician provides trauma-informed care, they are acknowledging that people (many people) have a history of trauma in their lives that affects their general health, disease processes, the way that they respond to wellness as well as disease, and illness, and the encounters that they have with those in health care. To give trauma-informed care is to be cognizant of those signs and symptoms exhibited by survivors of trauma and approach their care from a stance of sensitivity, compassion, and empathy. An additional critical tenet of trauma-informed care is that the client is not re-traumatized

The suffering that Mrs. Gupta related she had suffered as a 5-year-old child on a train during the time of the British takeover of India, and separation of India from Pakistan, was horrific. Her constant scrubbing and cleaning of her apartment were the manifestation of the pervasive thoughts she endured constantly about the dirty train floor where her aunt lost her own baby. No matter how hard she scrubbed, that severe trauma she experienced as a child was never going to leave her consciousness until appropriately dealt with.

There are five guiding principles to the provision of trauma-informed care which include: safety, choice, collaboration, trustworthiness, and empowerment (1). Ensuring that the physical and emotional safety of an individual is addressed is the first crucial step to providing trauma-informed care. After ensuring safety, the individual needs to know that the provider is trustworthy. Trustworthiness can be proven via the establishment and consistent use of boundaries and the clarity of expectations. Additionally, the more empowered the individual feels, and the more control they have over their experience (via collaboration with their providers), the more likely they will participate and be invested in the care offered by their providers. (2)

A vital component of trauma-informed care is that there is an avoidance of re-traumatization. Re-traumatization involves exposing people to anything that either resembles that which originally caused the trauma, or anything that triggers feelings associated with the original trauma which may cause the person to “re-live” the trauma. Re-traumatization does not encompass only words – sights, sounds, even smells can be a trigger. For women who have been sexually assaulted and undergone the subsequent examination, for example, just going for an annual gynecologic exam and seeing the speculum, being on the table and putting feet in stirrups, hearing the sounds that are made during the exam – all those things can bring them right back to the original incident. (2)

Women who have traumatic birth experiences often unfortunately have that trauma revisited in subsequent births. Giving birth is such a powerful, visceral experience; its memory is woven into our muscles and tissue. There have been many studies done on women’s memories from the births that they have had. In interviewing elderly women, they may not have great recall of some events in their lives, yet when asked about the births that they have experienced, they can often remember vivid and minute details, good and bad. I try to hold that truth front and center when I am caring for a laboring woman; this is an experience that she will hold in her heart the rest of her days; it is my responsibility, as her midwife, to do everything in my power to ensure that she remembers her experience as one wherein she felt safe, empowered, and most of all, heard.

References

1. Harris, M. & Fallot, R. D. (Eds.) (2001). Using Trauma Theory to Design Service Systems. New Directions for Mental Health Services. San Francisco: Jossey-Bass.

2. Buffalo Center for Social Research. What is Trauma-Informed Care? - University at Buffalo School of Social Work - University at Buffalo (Accessed 11/5/2021)