April 8, 2021
3 min reading
A new board opinion issued by the American College of Obstetricians and Gynecologists encourages women health professionals to recognize that trauma occurs and its effect on their patients and colleagues.
The opinion also recommends that women health professionals use a trauma-based approach to care at all levels of their practice.
There are a number of health effects that can often be seen in obstetrics and gynecology that could be related to trauma, according to the authors of the American College of Obstetricians and Gynecologists (ACOG) board. These include sexually transmitted infections, chronic pelvic pain, unwanted pregnancies, conflicting feelings about pregnancy, and challenges with postpartum attachment.
“The prevalence of trauma is sobering,” the authors say wrote.
One study found that nearly 64% of mostly non-Hispanic whites who had some high school education had experienced at least one adverse childhood experience.
“A study of a more diverse sample of high school graduates confirmed these findings, with 83.2% of respondents reporting at least one community or community problem, and 37.3% reporting four or more,” the authors wrote. “Although trauma encompasses all races, ages, and socioeconomic statuses, some populations are exposed to trauma at higher rates and with a higher frequency of repeated victimization.”
For example, the authors noted that trauma disproportionately affects families affected by substance use disorders, chronic economic stress, poverty, or homelessness. They were also disproportionately affected, they added. One survey found that 41% of female veterans experienced some form of sexual trauma while in the military.
The trauma-based approach to care described in the ACOG opinion applies to all women, not just those listed in the data, and to other girls and women who have experienced traumatic acts such as intimate partner violence, rape or incest, Colleen McNicholas, DO, MSCI, lead author and chief medical officer in Planned Parenthood of the St. Louis and southwestern Missouri, told Healio Primary Care.
“To really provide people with the best care, we need to recognize that our patients and our staff have these histories that can be traumatic and affect the way they communicate with us and our meetings with them and the way they make decisions about their health and well-being “, she said.
- The trauma-based model consists of the “four Rs” previously highlighted by the Directorate for Substance Abuse and Mental Health, which are:
- “Understand” the widespread effects of trauma and understand potential ways to recover;
- “Recognize” the signs and symptoms of trauma in patients, families, staff and others involved in the system;
- “Respond” by fully integrating trauma knowledge into policies, procedures and practices; i
- they try to actively resist “again–traumatization. “
ACOG recommends that healthcare professionals become familiar with the trauma-based model of care, as well as:
- implement the model in all parts of your practice to avoid stigmatization and emphasize resilience;
- create a trauma-informed workforce by educating other clinicians and office staff on how to be informed about trauma;
- Recognize that feelings of ‘physical and psychological security’ are vital to effective relationships with trauma survivors, and OB-GYNs should create a safe physical and emotional environment for patients and staff;
- conduct a universal review of current trauma and trauma history; i
- recognize that the benefits of traumatic training must be weighed against the possible re-traumatization of patients who undergo several interviews and examinations.
McNicholas said in an interview that clinicians should also strive to establish a “relationship of trust” with their patients.
“Patients need to feel both physically and psychologically safe in our presence and under our care,” she said. “The only real way to do that is to understand and acknowledge that some of our patients have a traumatic past and experiences, or maybe even traumatic recurring experiences, and we need to adjust to those experiences.”
It will take time to develop these relationships, McNicholas said.
“This is not necessarily a conversation. It’s part of repeated conversations with patients over time, ”she said. “The way to encourage that open communication is from the very beginning, admit that many people in the past have had traumatic experiences that affect the way people exist in the world and in the health care system.”
ACOG. Caring for patients who have experienced trauma. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/04/caring-for-patients-who-have-experienced-trauma. Retrieved April 1, 2021.
ACOG: It is important for obstetricians-gynecologists to adopt a trauma care model. https://www.acog.org/news/news-releases/2021/03/important-obstetrician-gynecologists-adopt-trauma-informed-model-of-care. Retrieved April 1, 2021.