‘Sobering’ data: ACOG encourages trauma-informed approach to care for women
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A new committee opinion issued by the American College of Obstetricians and Gynecologists encourages women’s health professionals to acknowledge that trauma occurs and the effect it has on their patients and colleagues.
The opinion also recommends that women’s health professionals utilize a trauma-informed approach to care across all levels of their practice.
There are a number of health effects that are often seen in obstetrics and gynecology that could be linked to trauma, according to the authors of the American College of Obstetricians and Gynecologists (ACOG) committee opinion. These include sexually transmitted infections, chronic pelvic pain, unintended pregnancy, conflicted feelings about being pregnant and challenges with infant attachment postpartum.
“The prevalence of trauma is sobering,” the authors wrote.
One survey showed that nearly 64% of mostly white, non-Hispanic individuals who had some post-secondary schooling experienced at least one adverse childhood experience.
“A survey of a more diverse sample of adults who had completed high school confirmed those findings, with 83.2% of respondents reporting at least one standard or community-level adversity and 37.3% reported four or more,” the authors wrote. “Although trauma spans all races, ages and socioeconomic statuses, some populations are exposed to trauma at higher rates and with greater frequency of repeated victimization.”
For example, the authors noted that trauma disproportionately impacts families affected by substance use disorder, chronic economic stress, poverty or homelessness. Military families are also disproportionately affected, they added. One poll showed that 41% of female veterans had experienced some sort of sexual trauma while in the military.
The trauma-based approach to care outlined in the ACOG committee opinion applies to all women, not just those cited in the data and other girls and women who have experienced traumatic acts such as intimate partner violence, rape or incest, Colleen McNicholas, DO, MSCI, lead author of the opinion and chief medical officer at Planned Parenthood of the St. Louis Region and Southwest Missouri, told Healio Primary Care.
“In order to really provide the best care to folks, we have to recognize that our patients and our staff present with these histories that can be traumatic and impact the way they interact with us and our appointments with them and how they make decisions about their health and well-being,” she said.
- The trauma-informed model consists of “the four R’s” previously outlined by the Substance Abuse and Mental Health Services Administration, which are:
- “realize” the widespread effect of trauma and understand potential paths for recovery;
- “recognize” the signs and symptoms of trauma in patients, families, staff and others involved with the system;
- “respond” by fully integrating knowledge about trauma into policies, procedures and practices; and
- seek to actively resist “re-traumatization.”
ACOG recommends that health care professionals familiarize themselves with the trauma-informed model of care, as well as:
- implement the model across all parts of their practice to avoid stigmatization and emphasize resilience;
- create a trauma-informed workforce by educating other clinicians and staff in the office on how to be trauma-informed;
- recognize that feelings of “physical and psychological safety” are vital to effective care relationships with trauma survivors, and OB-GYNs should create a safe physical and emotional environment for patients and staff;
- implement universal screening for current trauma and history of trauma; and
- recognize that the advantages of trauma training must be weighed against the possible re-traumatization of patients who go through several interviews and examinations.
McNicholas said in the interview that clinicians should also strive to establish “a trusted relationship” 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 do have traumatic pasts and experiences, or maybe even recurring traumatic experiences, and we have to adapt to those experiences.”
These relationships will take time to develop, McNicholas said.
“This isn’t necessarily a single conversation. It’s part of repeated conversations with patients over time,” she said. “The way to foster that open communication is from the very beginning, acknowledge that lots of people have had traumatic experiences in the past that impact the way that people exist in the world and in the health care system.”
References:
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. Accessed April 1, 2021.
ACOG: Important for obstetrician-gynecologists to adopt trauma-informed model of care. https://www.acog.org/news/news-releases/2021/03/important-obstetrician-gynecologists-adopt-trauma-informed-model-of-care. Accessed April 1, 2021.
Perspective
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This is an extremely important issue that needs to be addressed. OB-GYNs commonly address difficult, challenging issues with their patients. We interact with women during some of the most positive as well as the most negative, challenging times of their lives. As a result of this interaction, women often have much closer relationships with their OB-GYN than they do with their other health care providers. Patients often tell us things that they won’t tell anyone else.
As physicians, we need to be sensitive and able to help patients allow themselves to comfortably discuss their issues I personally always ask patients, “Do you feel safe at home?” “Have you ever been physically or sexually abused?” “Do you feel safe with your partner?” “Do you feel that your children are safe?” These are some of the questions that we as physicians really need to ask.
This ACOG committee opinion is very important and I am very proud of ACOG for putting it together. This committee opinion should be read by every single member of ACOG as well as physicians across the globe.
Professor, Oakland University William Beaumont School of Medicine
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