Posted by Amy Sarcevic on 29 June 2023
Why all clinicians need to learn trauma-informed care
Clinicians have long recognized that women who misuse drugs and alcohol, experience domestic violence, or have a history of trauma are vulnerable along the childbearing continuum. However, many health professionals lack training on how to care for this patient cohort effectively, says Clinical Midwifery Consultant Louise Everitt.
Ms. Everitt emphasizes that trauma-informed care is essential in maternity settings, as subtle signs of vulnerability often go unnoticed. Additionally, traditional approaches to peri- and post-natal care may fall short for vulnerable women.
The Impact of Neglecting Subtleties
"As clinicians, we often think we know how to identify and handle red flags in women. But our research with those who have lived experience of perinatal mental health issues has revealed that some important subtleties are missing," Ms. Everitt said.
Examples include:
- Body Language: Standing over a pregnant woman during personal conversations can make her feel unsafe.
- Formality: Overly formal note-taking can hinder trust-building.
Neglecting these subtleties can lead to women withholding critical information, such as mental health disclosures. This is particularly pronounced in migrant and Indigenous women, who may face language barriers.
"We’ve heard multiple accounts of women not being truthful about thoughts of self-harm due to fear of stigma or losing their baby. This can have tragic consequences for the woman and her family."
Eye-Opening Insights for Clinicians
Ms. Everitt, who has worked as a midwife for over 35 years, says the insights from women with lived experience have been transformative.
"Hearing women describe their experiences of the health system while managing issues like postnatal psychosis has been eye-opening, even for experienced clinicians. It’s a different way of learning than just listening to statistics."
Gaps in the System
Ms. Everitt highlights systemic gaps that leave some women without mental health support during their childbearing journey:
- Missed Screenings: Basic mental health screenings are often conducted by child and family health nurses or midwives. If a woman misses these sessions, her mental health may go unaddressed throughout her pregnancy.
- Mismanagement: Women transferred between units may experience mismanagement, leading to serious consequences for both mother and child.
Mental Health: Beyond Box-Ticking
Ms. Everitt stresses that mental health management should not be reduced to a box-ticking exercise:
"Adverse events during pregnancy can lead to lifelong health issues, including diabetes, heart problems, and obesity. Turning mental health into a box-ticking exercise doesn’t give the issue the attention it deserves."
Augmented Reality Training: A New Approach
Ms. Everitt’s trauma-informed care training incorporates augmented reality to help clinicians recognize gaps in their understanding. Participants watch a patient-practitioner interaction twice:
- First Viewing: No thought captions for the patient.
- Second Viewing: Thought captions reveal the patient’s internal struggles.
"This approach has helped clinicians see how good people can be at hiding their problems and where their own care approach might be lacking."
Positive Feedback and Recognition
The training has received exceptional feedback from women with lived experience and participating clinicians:
- Women’s Feedback: Many felt their voices and stories were accurately represented in the augmented reality component.
- Clinicians’ Feedback: Participants appreciated the insight into how other healthcare disciplines operate, fostering a more collaborative approach to care.
The course has also earned formal recognition, with support from organizations like the Royal College of Obstetricians and Gynaecologists, PANDA, and the Clinical Excellence Commission.
Protecting Clinicians with Lived Experience
Given the sensitive nature of the training, Ms. Everitt and her team have implemented measures to protect participants who may have their own lived experience of perinatal mental health issues. These include:
- Referral Links: Providing access to support services.
- Regular Check-Ins: Ensuring participants are coping with the material.
"Maternal mental health is a pervasive issue, and any training must also consider the mental health of staff."
Join the Discussion
Louise Everitt will share more about her work and findings at the upcoming Obstetrics Medico-Legal Conference, hosted by Informa Connect. The event will take place on 7-8 August at the Rendezvous Hotel, Melbourne.
About Louise Everitt
Louise Everitt is a Clinical Midwifery Consultant in Complex Pregnancy Care at St George’s Hospital in NSW. With over 35 years of experience as a midwife, nurse, and child and family health nurse, she is passionate about supporting vulnerable families. Her PhD research in perinatal mental health has attracted commonwealth funding and led to a nationwide training initiative.