Why all clinicians need to learn trauma-informed care

Clinicians have long known that women who misuse drugs and alcohol, experience domestic violence, or have a history of trauma, are considered ‘vulnerable’ along the child-bearing continuum, but a striking proportion have not yet received training on how to care for this patient cohort.

Clinical Midwifery Consultant, Louise Everitt, says trauma-informed care is crucial in the maternity space, as some of the lesser-known signs of vulnerability often go unnoticed.

Additionally, some of the traditional ways clinicians have been taught to care for peri- and post-natal women might be falling short for those who are vulnerable.

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 ahead of the Obstetrics Medico-Legal Conference.

“Simple things like a clinician standing over a pregnant woman as she lays down in bed can make her feel less safe or comfortable when having personal conversations. As can being too formal in note-taking sessions.”

Neglecting these subtleties can impact trust building and cause women to withhold important information, including mental health disclosures.

“We have heard multiple accounts of women not being truthful when asked about thoughts of self-harm, as they were terrified of the stigma and clinicians taking their baby away from them. This was particularly pronounced in migrant and Indigenous women, with difficulties in understanding English.

“Of course, this is a major concern, as there are a whole range of tragic consequences for the woman and their family when a diagnosis gets missed.”

Subtleties may even surprise experienced clinicians

Ms Everitt, who recently acquired commonwealth funding to design trauma informed care training as part of her PhD, says the insights from those with lived experience can be eye-opening.

“As part of the training course I designed, we have had a number of women stand up and describe their experience of the health system whilst managing issues like postnatal psychosis. They have talked about what clinicians did (and did not) do or say, and the profound impact it had on them.

“I have worked as a midwife for more than three decades, but have still been surprised to hear their perspective. It is definitely a different way of learning than just listening to statistics.”

Gaps in the system

Another key finding from the personal accounts was that some women escaped any form of professional help with their mental health throughout their childbearing journey.

“Some women were transferred from one unit to another and had their condition mismanaged as a result. This led to serious consequences for them and their child,” Ms Everitt said.

“This is surprisingly common, as the National Perinatal Mental Health guidelines mean that basic screening is primarily done by child and family health nurses or midwives. If the patient misses out on those sessions, they could go through their whole pregnancy, without anyone addressing their mental health.”

Mental health should not be about box ticking

Ms Everitt says mental health should never be an afterthought for clinicians, with trauma linked to serious lifelong health consequences.

“We know that mental health and domestic violence has a really big impact on women’s health, as does any type of adverse event during pregnancy and beyond. These events can cause diabetes, heart problems, obesity, you name it.

“If we turn mental health management into a box ticking exercise, not only does it not give adequate attention to the issue, but it is unlikely women will respond to it properly.”

Driving home the message

The augmented reality aspect of Ms Everitt’s course has helped clinicians recognise gaps in their own understanding, in a way traditional training methods often cannot.

“We get clinicians to watch a patient-practitioner interaction in the maternal healthcare space, twice. The first time the video does not include any thought captions for the patient. The second time it does, revealing some of the stark things women might be thinking during those sessions.

“This approach has really helped clinicians recognise how good people can be at hiding their problems and where their own care approach might be lacking. Many of our participants (who are experienced clinicians) were not able to identify issues when watching the clip first time around and were alarmed to see what they missed in round two.”

All round tick of approval

After the training was designed, Ms Everitt and team surveyed the women with lived experience of perinatal mental health issues to see if it was adequate. The feedback was exceptional.

“The women told us that they could (metaphorically) hear their own voices and see their own stories in the augmented reality component; and it was gratifying for them to see their experience played out in this way.”

Feedback from participants has also been positive, with many relishing the insight on how other healthcare disciplines operate.

“Many social workers have been surprised to see how women are dealt with before being referred to them by a clinician; and vice versa. It is strange because, even though mental health management is multi-disciplinary, rarely do these different disciplines sit down together to discuss what is happening with a single person.”

The course has also earned formal recognition, in the form of high profile consortium partners. The Royal College of Obstetricians and Gynaecologists, mental health charity PANDA, and the Clinical Excellence Commission are just a few of the organisations that have come on board to support the training.

Protection for clinicians who have lived experience

Given the confrontational nature of the course content, Ms Everitt and team have had to take measures to protect their participants and gain national ethics approval.

“It is possible – and indeed likely – that clinicians have their own lived experience of perinatal mental health issues, so we have taken care to keep them safe during the training process.

“As well as providing referrals links, we regularly check in with those in the room to make sure they are handling the material okay.

“Maternal mental health is a pervasive issue and any attempts to address it through enhanced training must also consider the mental health of staff.”

Louise Everitt is Clinical Midwifery Consultant in Complex Pregnancy Care at St George’s hospital in NSW. She has worked as a midwife for 35 years and is trained as a nurse and child and family health nurse. Her clinical passion for vulnerable families was behind her drive to undertake a research PhD in perinatal mental health – a project that has since attracted commonwealth funding and led to a nationwide training effort.

Sharing more details of her work and findings, Ms Everitt is due to present at the Obstetrics Medico-Legal Conference, hosted by Informa Connect.

This year’s event will be held 7-8 August at the Rendezvous Hotel, Melbourne.

Learn more and register.