It’s hard to absorb the research that points to how the mother was treated or that it’s a breakdown in the relationship between the birthing client and her care providers that most predicts a traumatic experience. We understand that you have challenges that are specific to your work environment, the limitations of your practice, and also face the risk of professional burnout.
Secondary or Vicarious Trauma
Doctors, nurses, midwives, and doulas are all at high risk for secondary or vicarious trauma. Secondary trauma is the emotional duress that results when an individual is exposed to people who have been traumatised, or observe others or participate in inflicting cruelty on another person. It can happen quite suddenly, whereas vicarious trauma is the result of an accumulation of exposure to the pain of others. When it comes to birth, this kind of trauma results when professionals observe or participate in the cruel or inhumane treatment of a birthing parent or baby. Some of what they observe or participate in might be part of an effort to save the mother or baby, but witnessing it, or participating in it, is so disturbing that it overwhelms their coping strategies over time. About one third of midwives and obstetrical nurses exhibit symptoms of trauma. And doulas who receive the least professional regard in the birth setting report very high rates of vicarious trauma.
Burnout is defined by these three characterisitcs:
- Emotional exhaustion and a lack of enthusiasm for work
- Depersonalization of the patient and cynicism towards patients and peers
- Low sense of accomplishment at work
Just over half of obstetricians report burnout. Midwives and nurses report burnout, sometimes called compassion fatigue, at about the same rate.
When a care provider is dealing with burnout, they employ depersonalization as a coping strategy. It’s a means of not becoming too invested in the person they’re treating, however, it’s a significant risk factor for a traumatic experience for the client. Burnout and compassion fatigue also make the care provider less effective and it contributes to poorer quality of care. When a doula burns out, she generally leaves the profession, meaning that few doulas are able to work long enough to become highly skilled in their profession. It’s a lose-lose situation for professionals and clients.
Burnout isn’t just a personal issue, it’s a facility-based issue. How the hospital runs their units is highly predictive of provider burnout. And while it’s great when a practitioner can engage in mindfulness and self-care to lessen personal burnout, without a facility-wide approach to trauma-informed care, the patient is still at risk. Fortunately institutions can employ effective strategies to further reduce burnout and improve patient care.
You can do a self-assessment for possible burnout here.
Most practitioners start their medical training with the same or higher levels of empathy than a control group. However, the practitioner’s empathy declines over the course of their medical school training as they are taught to objectify the patient, they are overloaded with work, experience mistreatment from supervisors, and are not given emotional support. It’s not the individual, but how they learn to survive their training.
Empathy for the client is at the core of trauma-informed care. Empathy is client-centred and benefits both the practitioner and the client. It not only reduces burnout, but it increases clinical accuracy and patient wellness!
Care providers often wonder if they’ve got they’ve got more time in the day or anything left to give to offer empathy to their clients. The good news is that it’s a simple learned skill that reaps great rewards and barely takes more time in their day. Cognitive empathy is how most practitioners are taught to approach their clients. This is an emotionally detached concern for the client where the practitioner recognises and understands the client’s experience. However, affective empathy is achieving emotional resonance with the client and improves cognitive accuracy, improves client disclosure, improves the effectiveness of a treatment, and improves both the client’s and the practitioner’s wellbeing! A client that believes their care provider has empathy for them is much less likely to experience trauma.
You can do a self-assessment on your level of empathy here.
Working with at-risk clients
Fortunately, not everyone that experiences a traumatic event will develop post-traumatic stress disorder. There are certain risk factors that make some individuals more susceptible. As a trauma-informed professional you can enhance those skills that build resilience and wellness in your clients.
Prior sexual violation is a significant risk factor for trauma. Although the reported incidence of sexual assault is about 1 in 4 for female-presenting individuals, we know that this is grossly underreported and that far many more have been the victims of assault, objectification, sexual harassment, and much more. The likelihood is that most of your clients have already been subject to some form of sexual violation. And if they are part of a marginalised group, then they are even more likely to have experienced sexual violation. That means that how they interpret routine clinical care may be quite different than you intend. In fact, for some rape survivors, their births feel like they are “back in the rape“. Careful attention to how you deliver your care to pregnant and birthing clients can make the difference in how they emerge from the experience.
Adverse childhood experiences (ACEs) are those traumatic events that occur before an individual’s 18th birthday. These adverse experiences may be the result of childhood abuse or neglect, or experiences that were part of household dysfunction, such as domestic violence, substance abuse, or mental illness. Clients that have a high score for ACEs are more likely to have accompanying health concerns. The corollary to that is that a client with altered coping strategies, such as substance abuse, impaired cognition, dysfunctional relationships, poor decision-making skills, etc., is more likely dealing with the effects of ACEs. The birth suite could be one of the first places where this individual is regarded with respect in a resilience-based paradigm where their existing coping strategies are acknowledged and built upon. You can review the WHO’s Adverse Childhood Experiences International Questionnaire here.
Becoming a trauma-informed professional
Learn more about how to support at-risk clients and offer resilience-based health care and complementary services by becoming a certified trauma-informed professional. A trauma-informed professional will have information that comes from almost 450 studies and references. You will have the knowledge you need to work with clients that are presenting with the consequences of complex, situational, developmental, cultural, or historical trauma. You will develop skills in a resilience-based approach that builds wellness and competence in your clients. You will understand the benefits of affective empathy and how it helps you and your clients to recover from secondary trauma and burnout. And you will see health improvements in your clients and in yourself that really make a difference!
You can review the references for the above information here.