New guidance from the American College of Obstetrics and Gynecologists (ACOG) calls on ob/gyns to recognize the prevalence of trauma and its impact on patients and health care teams and outlines the importance of trauma-informed approaches to delivery of care.
Committee Opinion No. 825 notes that, although trauma spans all races, ages and socioeconomic statuses, certain populations experience it at higher rates and with greater frequency of repeated victimization than others.
Signs and symptoms of trauma are seen frequently in ob/gyn, including chronic pelvic pain, sexually transmitted infections, unintended pregnancy, conflicted opinions on pregnancy and sexuality, and a struggle with infant attachment postpartum. Behavioral signs of trauma include agitation, irritability, being easily startled by noise or touch, heart palpitations and self-blame.
A trauma-informed approach should be implemented throughout all levels of the ob/gyn’s practice, taking care to prioritize resiliency and avoid stigmatization. Clinicians and staff also should be trained on how to be trauma-informed, as the feeling of physical and psychological safety is critical to provide effective care to trauma survivors.
The committee opinion identifies the important skills in trauma-informed care as the Four C’s: calm, contain, care, and cope.
Calm: Notice how you are feeling while caring for the patient. Take a breath and focus on promoting a calm environment.
Contain: When asking about potential trauma history, ask the level of detail that will allow the patient to maintain a sense of emotional and physical safety.
Care: Promote self-care and compassion.
Cope: Offer coping skills that promote strength, resiliency and hope.
Multiple interviews and examinations may negatively affect and retraumatize the patient, which should be included in the trainee experience in the medical education system.