Trauma informed care in the perinatal period. Dr Elsa Montgomery Head of the Department of Midwifery

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1 Trauma informed care in the perinatal period Dr Elsa Montgomery Head of the Department of Midwifery

2 Trauma informed care Realizes the widespread impact of trauma and understands potential paths for recovery Recognizes signs and symptoms of trauma in clients, families, staff, and others involved with the system Responds by fully integrating knowledge about trauma into policies, procedures, and practices Resists re-traumatization. 2

3 How did the study come about? 1:5 women have experienced some form of childhood sexual abuse Anecdotal accounts testify to emotional trauma caused by childbirth There is very little research on the maternity care experiences of women who were sexually abused in childhood 3

4 Use of health care professionals in last 24 months

5 Thematic analysis 5

6 Feeling invisible you just wanna curl up and be part of the wallpaper. You just don t want to make a fuss or anything. (Sue) because I feel that I sort of retracted in to myself, it meant that I was easier to be ignored yeah? So then I feel invisible and that makes me feel really, really, really angry because I m thinking well, I m here, you know, everyone else is getting a better deal than me, I m still here but no one s noticing me. (Sam) 6

7 Screaming inside when someone s um either like um threatening my personal like intimate spaces or hurting me, or telling me to do stuff and I m like feeling threatened, I will do exactly what they say. I will be the best patient they can possibly have. I ll be that star patient. But I m not. I m actually screaming inside. I m like absolutely terrified. I m expecting them to hurt me. I m being good because I don t want them to hurt me anymore. (Sam) 7

8 Silently screaming Inside I was just silently screaming. Wanting it to be something it wasn t. And I was thinking this isn t what I expected, I didn t expect to have this fear, I didn t expect to have this (sniffs) feeling of not being able to cope. (Linda) 8

9 I-poems I don t have control I start panicking I try to make I had tried to I wanted things a certain way I wanted to be listened to I wanted people to pay attention I felt I think I felt so I, I felt almost like an animal I had everyone just looking at me I felt embarrassed I felt degraded I felt dirty I felt horrible! Horrible! I just wanted to run away I couldn t

10 In collaboration with King s Cultural Institute. Produced by 10

11 Elizabeth - I poems I don t have control I start panicking I try to make I had tried to I wanted things a certain way I wanted to be listened to I wanted people to pay attention I felt I think I felt so I felt almost like an animal I had everyone just looking at me I felt embarrassed I felt degraded I felt dirty I felt horrible! Horrible! I just wanted to run away I couldn t 11 I m gonna have to say something to somebody I think if I d asked for help I suppose knowing I felt I won t let it I won t let it spiral out of control I will insist I will if people think I m difficult then so be it I will keep going on I won t do it on my own this time

12 Re-enactment of abuse in maternity care my whole childhood was about everyone doing stuff to me. Never asking, just doing stuff to me and now someone s taken my baby and they ve not even asked. (Elizabeth) 12

13 Feeling safe I m completely scared of the dark and to lie there with someone walking into your little curtain bit and turn the light off was horrible because you can hear the footsteps coming footsteps have a real big meaning when you ve been treated not well as a child. (Sue) 13

14 Are we really listening? I mean I never discussed it with the midwives or anything maybe I should have they didn t I mean there was a question why I didn t want a m any male doctors or any male midwives (Sally) And you feel like, you know that they re like so busy and you can see that and you re thinking well, I m not gonna say anything, I ll just sit there and put up with it and just be good, you know, cos they ll let me out soon. You know, if I don t bother them or like make too much fuss, they ll just think I m alright and I can go home and then I ll sort out any problems when I m at home. (Sam) 15

15 Silenced by society and I can t afford to tell you because you ll take my kid away; y know, if you really knew how bad because you the way that society deals with someone who s in that sort of state is to lock em up. (Sam) I was absolutely terrified that at some point someone was gonna find out that I d been abused and that they were going to put this label on me and watch me and look out for the signs that I was somehow dodgy. (Linda) 16

16 Voicing the silence Most women do not disclose Disclosure and sensitive care do not prevent re-enactment of abuse Women need to have their distress acknowledged What unspoken messages are the women trying to convey? 17

17 The women want us to hear I hoped that somebody would just just say one thing and make me think they actually will want to listen every time that I went to my midwife appointment I d think oh please let her notice that something s not right and just ask that one small question and then I can get some help (Elizabeth) if somebody actually dared to say is it what you expected? people might give an honest answer. But if people say Are you OK? the natural response is to say yes, I m fine. (Linda) 18

18 Key points All health & social care professionals will encounter women who have experienced childhood sexual abuse Most of those women will not disclose Women want to feel safe We must listen for unspoken messages and respond with sensitivity 19

19 I am extremely grateful to: The women who were prepared to talk to me Staff who took part in interviews The Iolanthe Trust for an award to fund training courses in interviewing skills Supervisors Professor Catherine Pope & Dr Jane Rogers King s Cultural Institute & JMotion Healthwatch Hampshire

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