Perinatal Care Through a Trauma Informed Lens Lecture Pack

The art of trauma informed intake is more than just including a couple of questions on your intake history. When the right questions are asked in a non-threatening way, you can become the trusted recipient of sensitive information that is vital to the quality of care that you provide. This class will enable you to plan and create a trauma-safe environment at the very first patient visit. You will develop written and verbal forms of inquiry that cover a broad range of trauma history and will learn to facilitate patient disclosures in a compassionate, effective way. You will be able to identify indicators of trauma history in the absence of patient disclosure and learn to connect the coping mechanisms your patient exhibits to the type and duration of their trauma history. You will learn how to elicit your patient’s self-identified strengths and resources which you can use to develop an effective treatment plan. Your individualized approach will positively influence patient trust, safety, health and emotional well-being. Most importantly, it will avoid the re-traumatization that so often happens in medical settings which erode the success of future healthcare encounters.

Trauma affects at least one third of childbearing women. Although a common experience, many breastfeeding counselors do not feel confident in working with trauma survivors. Should they ask about it? How do you stay within your scope of practice? This session will provide an overview of the types of trauma women are most likely to experience (childhood abuse, birth trauma, sexual assault, partner violence, natural disaster, and combat), and provide strategies for working effectively and comfortably with trauma survivors. This session also provides an overview of research showing that breastfeeding actually helps trauma survivors cope and lessens the risk of intergenerational trauma.

Maternity practice in the United States has come under scrutiny over the past year due to the increase in maternal mortality. Data also show that maternal and infant morbidity are big concerns for prenatal and perinatal practitioners; for every woman who dies during, labor and delivery 70-80,000 more report almost dying. The news reports “obstetrical violence” and birth trauma as common for women all over the world. Infants are also affected by birth trauma, especially neonatal intensive care and separations from their mothers. The trauma-informed care model is starting to be integrated into maternity care as many providers are screening for perinatal mood disorders and childhood maltreatment sometimes referred to as Adverse Childhood Experiences. This presentation will review how current psychological, somatic psychological and mental health approaches include the autonomic nervous system responses to threat and overwhelm, or the science of safety, and processes to help patients feel resilient, or acknowledge their capacity to cope in the face of adversity. Then, a new five point process will be outlined that may improve perinatal outcomes, refine the care of mother-baby dyad, and support birth and maternity professionals of all kinds.

Maternal mortality rates are improving around the world but preventable deaths remain unacceptably high, such as in the US where rates are the highest of any developed country, continue to increase, and are associated with severe racial disparities.

Adverse babyhood experiences (ABEs) are a new construct identifying 10 categories of adversity that increase risk for complications and death in mothers and infants. In this emerging era of trauma-informed care, ABEs provide opportunities to optimize resilience through practical strategies for prevention, treatment and repair. ABEs serve as indicators of risk for low birth weight, preterm birth, neonatal intensive care, and chronic illness later in life, among other poor outcomes for infants; and for miscarriage, still birth, other complications and negative outcomes for mothers, including postpartum depression, which is a leading cause of maternal death. ABEs further the science of adverse childhood experiences to highlight a distinct group of risk factors occurring prior to a child’s 3rd birthday.

Attendees will be able to identify early indicators of risk in babies and parents; understand how effects of trauma occur through epigenetics and are not psychological; learn of practices for reducing risk in the sensitive periods before and after birth, and for repairing effects of ABEs later in life; and part with knowledge to inform choices in management and treatment interventions that optimize clinical outcomes.

Human infants expect to engage and connect to their adult care providers to feel safe, secure, and thrive. The autonomic or unconscious nervous system alerts us whether we feel safe, in danger, or in a life-threatening situation. When we feel safe, we are open, calm and ready to engage. When we feel in danger, our sympathetic nervous system is activated; our hearts race, and we may either lash out or leave. Finally, if we feel our lives are endangered, we may collapse, shut down or dissociate. Neuroscientist Stephen Porges calls the unconscious awareness of our safety, danger, or life threat, neuroception.

When babies are hospitalized in a newborn intensive care unit. (NICU), their biological expectancies of physical and emotional proximity to their caregivers are disrupted. Both hospitalized babies and their families may have neuroceptions of danger or even life threat reflected in their behaviors and vital signs. Supporting parasympathetic vagal tone through the continuous presence of families, skin to skin care, and forming strong relationships can mitigate the trauma of a hospitalization in the NICU.

Trauma-informed care in the NICU supports babies and their families to remain together, supports parents as the primary relationship for their babies and builds safety, security, and connectedness among babies, families, and staff.