What is Trauma-Informed?

When a mother calls the arrival of her baby "birth rape" we know something drastic needs to change. Trauma-informed care is not the same as trauma-specific treatment. Trauma-informed care is a learned skill set that approaches client care based on a set of principles that guides the professional's understanding, communication, interactions, and care for the client. Trauma specific treatment or interventions, on the other hand, are those evidence-based therapeutic treatment practices that focus on the effects of trauma and seeks to facilitate recovery from trauma. Trauma-informed care recognises the signs of trauma in their clients, the client's supporters, and their community. It understands the impact of trauma on the client's biology, psychological health, and social and relational interactions. Trauma informed care helps to build the client's resilience and well-being while avoiding re-traumatising them. Trauma informed care,

• Acknowledges that trauma is pervasive and may result from developmental, complex, historical, inter-generational, or single-incident events.
• Realises that trauma has a significant impact on the individual's physical, social, emotional, relational, sexual, and spiritual health. Trauma-informed care moves past intrinsic biases to support at-risk clients in building wellness.
• Recognises the signs and symptoms of trauma in a client, their community, and their supporters. Trauma survivors can develop strategies for survival that may seem mal-adaptive in the non-traumatised individual. Trauma-informed care builds on these strategies to increase resilience and well-being. 
• Respects the culture, history, dignity, vulnerability, and coping strategies of the client.
• Responds with affective empathy and compassionate communication and practices.
• Works to ensure the client is not re-traumatised by offering client-centred care where the client participates in decision-making and determines what is safe for them in a supportive collaboration with their care provider.

Both individual providers and systems can become trauma-informed. Trauma-informed systems, such as clinics, practices, and hospitals, implement those strategies that ensure their staff are all working from the same compassionate client-centred perspective where the skills of trauma-informed care are the universally applied across the organisation. Not only do clients benefit, but everyone in the organisation benefits from improved clinical accuracy, reduced burnout, increased client satisfaction, and increased wellness in the client and the clinician.

The principles of trauma-informed care are comprised of the following tenets:

• Safety, this is the guiding principle for both clients and clinicians. Staff must be safe from client, hierarchical, and lateral abuse. Clients define for themselves what is "safe" depending on their prior experiences and their history with medical services. Marginalised and disenfranchised persons must be safe to seek medical services where their culture, identity, dignity, sexual safety, and autonomy are respected.
• Trustworthiness and transparency, means that clinicians are open and honest about the limitations of their practice and develop a relationship of trust through honesty and compassion. Clients will know that their care won't be dependent on who is on call that day, but rather based on their needs. Clients are free to seek alternatives and are supported in their search to find the best options for themselves.
• Peer support and mutual self-help, acknowledges the power in peer support for both clients and clinicians. 
• Collaboration and mutuality, the client and the clinician form a relationship that is built on mutual respect and collaboration where the client is at the centre of their own care. Power dynamics are addressed so that clients are safe to explore options without threat of retaliation or reprisals.
• Empowerment, voice, and choice, recognises and validates the client's strengths and inherent knowledge. Clients are encouraged to build upon existing strengths and explore new skills to become empowered in their own healthcare.
• Cultural, historical, and gender issues, are recognised and honoured. Cultural humility seeks to understand the the lens through which clients view their circumstances and their healthcare options. Obstetric violence is recognised as sex-based violence and works to protect the sexual dignity of the client. Resilience-based strategies are consistent with the client's history and culture. 

While many clinicians and systems assume they are trauma-informed, they lack the evidence based education, training, and skills to effectively interact with their clientele in a way that builds trust, confidence, and resilience-based healing. A trauma-informed approach takes no more time in terms of clinical care than a non-trauma-informed approach. In fact, in the long run, it preserves significant resources as there is greater clinical accuracy, greater client participation in their own healthcare, and reduced professional burnout and its consequences.

A client who perceives their care as disrespectful during the perinatal experience is much less likely to access medical services for herself or her child. She is also much less likely to seek regulated care for a subsequent pregnancy or birth (UNPA, 2004). In fact, the rise of "unassisted" births can be traced to a response to disrespectful care, loss of autonomy, and obstetric violence (Holten & de Miranda, 2016). Unfortunately, the response of many within the medical industry is to "punish" the mother when she does seek medical services for making choices they didn't agree with, further driving her away from medical support for herself and her family (Vedam et al., 2017).

Trauma-informed care providers have the opportunity to meet these clients with understanding and compassion. As they build a trusting relationship with the client, where the client's prior trauma and coping strategies are recognised and accepted, they have the opportunity to participate in halting the epigenetic expression of trauma and changing the course of previous generations.

Birth Trauma Ontario provides scientifically sound education and skills development for healthcare providers and allied professionals who work with birthing families. Physicians, nurses, midwives, lactation consultants, doulas, and allied healthcare providers will benefit with a solid foundation in the elements of trauma-informed care that will transform your practice and halt the global pandemic of birth trauma.

You can review the references for the above information here.