Midwifery Practice Policy for Trauma Informed Care

My mission is to provide competent and compassionate Trauma-Informed Care (TIC) to clients by seeing them as unique individuals with their own lived experiences, multigenerational histories, and cultural experiences. With the understanding that trauma impacts us all, I promise to care for each client with dignity and respect by promoting an environment of safety, trustworthiness, and choice free from re-traumatization, and will offer support and guidance through appropriate TIC resources and referrals.

- Meagan Flaherty

Realize

Trauma cannot be defined as any singular event and is subjective to the individual who experiences it. Most of the individuals who will seek care with my practice will have likely experienced some sort and/or degree of trauma in their lifetime. The effects of this trauma can impact an individual’s health and well-being as well as having possible impact/s to their family, community, and to future generations.

Recognize

Trauma can impact individuals in various ways and is not limited to the type or frequency of the trauma/s experienced. As such, it is important not to limit or anticipate the way/s in which an individual may respond to trauma, only to be aware that the spectrum of response/s are as unique as the individual themselves.

Respond

Knowing that trauma is something that impacts us all, to include future generations, it is of critical importance to treat every person as if they have experienced trauma and to provide each individual with a safe, respectful, trustworthy, and supportive environment.

Resist Re-Traumatization - My Promise to My Clients

I will never make assumptions about a person’s trauma history. This means treating every individual as if they have experienced trauma as well as not making assumptions about how that individual may or may not experience or respond to their trauma/s.

I will always ask permission prior to touching a client, even if they have given me permission before.

I will always obtain informed consent prior to performing any exam or procedure.

Example: We can try and confirm if your water broke earlier this morning a couple of different ways …. The risks and benefits of knowing if your water has broken are …. Which method of confirming the presence of amniotic fluid would you like to use, or would you prefer not to test for that right now?

I will explain every exam/procedure prior to performing them, as they are being done, and provide alternatives.

Example: To do the GBS swab I will need to use a cotton swab in and around your genital area, and on and around your anus. If you would prefer, I can hand you the swab and you can go into the bathroom and do it yourself.

I will use inclusive, non-judgmental language.

I respect and support the client’s autonomy and trust that they are the expert in themselves.

I will offer support and provide referrals to Trauma-Informed Care perinatal care providers (lactation consultants, doulas, social workers, therapists, counselors, community resources etc.)

1. Treat all clients and staff as though they have experienced trauma.

2. Make no assumptions. Treat each person as a unique individual who is the expert in their own lived experience.

3. Provide regular, routine trauma and Intimate Partner Violence (IPV) screening on all clients who enter into care.

4. Be open and honest about client confidentiality and state required reporting laws before disclosures.

5. Provide a safe, welcoming environment with private areas for exams and confidential discussions/conversations.

6. Provide brochures and safety cards outlining the impacts and warning signs of IVP in waiting areas and bathrooms.

7. Provide shoe cards in secure, private locations that are accessible to the clients (bathrooms/exam rooms).

8. Utilize SAVE technique when individuals appear to have been triggered.

9. Always obtain consent before performing any physical examination or touching a client/staff-member, even if consent has been granted before.

What is trauma and why is it relevant to midwifery care?

Trauma is a multifaceted event that has long-term impacts not only on an individual’s physical, mental, emotional, and behavioral health but also on those around them. Trauma cannot be defined as a single, static event in time nor is it something that can be weighed or measured. Trauma is unique to the individual who has experienced it and while one person may go through the same or similar trauma as another and may not feel any lasting harm was done, another may experience debilitating and life-altering impacts. The healing from trauma is not linear, rather it is a timeless and cyclical process.

Pregnant persons who have experienced trauma are at a higher risk for preterm birth, low birth weight, failed chest/breastfeeding, and poor bonding with their infant/s. As such, pregnant persons who have experienced trauma may need extra support and resources during their pregnancies to feel safe and secure. Additionally, parent’s that experienced maltreatment as children may need extra guidance, encouragement, and support as they navigate life with a newborn. It is critical to understand that trauma is a multigenerational event which has the ability to create cycles of maltreatment and trauma for future generations unless otherwise halted.

Midwives are poised to be able to help interrupt these generational cycles of trauma by providing high-quality, safe, and effective Trauma Informed Care to all of their clients. My mission is to provide competent and compassionate Trauma-Informed Care (TIC) to clients by seeing them as unique individuals with their own lived experiences, multigenerational histories, and cultural experiences. With the understanding that trauma impacts us all, I promise to care for each client with dignity and respect by promoting an environment of safety, trustworthiness, and choice free from re-traumatization, and will offer support and guidance through appropriate TIC resources and referrals.

Goals, Tools, & Parameters for Universal Screening

• The goal is to provide each and every client that comes into care with appropriate trauma screening at the following intervals:

• Full screening at the onset of care (ACES or PEARLS dependant on age of client, PLC-C screening tool, client history)

  • Explain my commitment to confidentiality and any legal/state reporting requirements for client confidentiality, and explain that I do routine screenings with all clients at certain intervals during their care

• At initial visit, provide client education on IPV and the impacts on health and pregnancy

• • This may be delayed to another visit if the partner or family is present

  • "I go over this information with all clients so that you can be informed about IPV and its impacts, and so that you can help others."

• Provide client handouts/brochures/educational tools

• Check-ins at each monthly appointment from onset of care through week 24

• Safety cards and Shoe Cards will be placed in the office restroom

• Rescreening between 24 and 28 weeks (verbal inquiries/discussion) along with client education and information about IPV

• Check-ins at each biweekly visit until week 36

• Rescreening between 36 and 37 weeks

• Full rescreening (PCL-C/verbal) at the 1 week postpartum home visit along with PPMD screening (Edinburgh)

  • Trauma rescreening may be delayed to the 6 week office visit if the partner or family does not provide the opportunity for a private conversation

Response to Disclosure

If a disclosure occurs:

Thank client for their trust/sharing

Validate their experience/s and discuss prevalence

Remind them of any reporting requirements (if applicable)

Ask what is needed for support and discuss self-care plan

Provide warm referrals and community resources

Review plan moving forward and what was discussed

Thank client again for disclosing

Ask about previous disclosure/s

Document as appropriate in client’s chart, respecting privacy and confidentiality of client if they have requested details of the disclosure to be omitted from their records.

Response to Signs That a Client Has Been Triggered

SAVE the situation:

STOP everything. No matter what is happening, stop immediately.

Appreciate the experience that the client is living though. Express empathy (sincere) and acknowledge that they have been triggered. That must have felt very uncomfortable for you. I can see that you are tense and shaking right now.

Validate their experience. (If disclosure has occurred) Many individuals who have experienced trauma are triggered by internal exams. It is a normal response. (If no disclosure) Many individuals experience very intense sensations and emotional responses during internal exams. They can bring up a lot of memories and it is a normal response.

Explore how you can best support the client. I know that was a really intense experience for you. How can I best support you right now?

Warm Referrals

A list of warm referrals and community resources will be provided on the business website and as a handout with the initial Welcome Packet. Warm referrals will be given as appropriately through care after disclosures or if there are signs that the client may have been triggered.

Note: While many of these services are available regardless of physical location, in-person and local area resources and referrals are for individuals who reside in the Hampton Roads area of Southeastern Virginia.

Crisis Hotline Numbers

• National Crisis Hotline (handles any type of crisis): Text HOME to 741741 anywhere in the United States

• National Suicide Preventions Hotline: 1-800-273-8255

• National Domestic Violence Hotline: 1-800-799-SAFE (7233); TTY 1-800-787-3224

• Childhelp National Child Abuse Hotline: 1-800-4-A-CHILD (422-4453)

• Shaken Baby Task Force 24 Hour Crying Baby Helpline: 1-866-243-BABY (2229)

• Postpartum Support Virginia *NOTE THIS IS A WARM LINE AND NOT A 24/7 HOTLINE*: 703-829-7152

• Transitions Family Violence Services 24hr Crisis Hotline (Hampton Roads VA): 757-723-7774

Family Support

• Partners to Parents: partnerstoparents.org

Online resource covering topics ranging from preparing for parenthood, newborn care, how to maintain a healthy relationship during the postpartum period, and postpartum mood concerns/warning signs for partners and parents. Resource is inclusive and evidence-based.

• Virginia Peninsula Doulas: peninsuladoulas.com

Online listing of local area birth and postpartum doulas. Postpartum doula support can help families - both seasoned and new - adjust to life with a newborn.

Infant and Parent Bonding

• Babywearing of Hampton Roads: babywearinghamptonroads.org

Peer support, information, and education about babywearing. Free monthly in-person meet-ups available.

• Kids Priority One: kidspriorityone.org/parenting-prenatal.php

Support, information, and resources for pregnant persons and new parents on proper infant care.

757-CHILDREN (244-5373)

Local Shelters/Support Programs

• Transitions Family Violence Services: transitionsfvs.org

Online and in-person resources for the Hampton Roads VA area for adult and child victims of abuse. Transitions’ Housing Program provides emergency housing services for adults and children fleeing violence.

• Samaritan House: samaritanhouseva.org

Online and in-person services and resources for victims of sexual and domestic violence, stalking, sex trafficking, or homelessness.

Call the 24hr hotline for immediate help: 757-430-2120.

For an appointment for counseling services or information about their programs call: 757-631-0710.

Local Therapists

• Partners In Women’s Mental Health: partnersinwomensmh.com

Specializing in perinatal and postpartum mental health. Has the ability to prescribe medications if needed. Office is located in Norfolk, VA with virtual services offered.

757-828-3816

Postpartum Mood Disorders

• Postpartum Support Virginia: postpartumva.org

Online, virtual, and in-person local area resources for postpartum mood disorders, partner support, mom groups, and grief/loss.

• Postpartum Support International: postpartum.net

Online resource providing information, education, and support for postpartum depression and other postpartum mood disorders.

Resources for Miscarriage, Stillbirth, and Early Infant Loss

• Star Legacy Foundation: starlegacyfoundation.org

Online resource for parents who have experienced a stillbirth, infant death, or pregnancy loss. Provides information, education, support, peer support groups, and local chapters/resources.

• Caroline Tripp with Bella Vita Doula Services: bellavitadoulava.com

Caroline is a birth, postpartum, and bereavement doula who serves all of the 757 area and Peninsula. She is also the area’s Star Legacy Foundation Chapter Leader.

• Weighted Angels: weightedangels.com

Non-profit organization that provides support to pregnancy and infant loss families on the Virginia Peninsula. Weighted Angels offers free weighted stuffed animals that match the birth weight of your baby.

Social Support Services

• Women, Infants, and Children (WIC) Nutrition Program: vdh.virginia.gov/hampton/women-infants-and-children-wic-nutrition-program

State run program that provides supplemental food and nutritional counseling for infants, children 5yrs and under, pregnant persons, lactating persons, and biological females with a baby under five years old who live in Virginia and meet certain income guidelines.

LaSalle Center: 757-727-1140, press 4

Wilsondale Center: 757-224-5007

WIC Program Manager Angela Prioleau: 757-727-2562

• Hampton Redevelopment and Housing Authority: hamptonrha.com

Public housing for eligible low-income families and Section 8 housing (currently there is no availability for new applications for Section 8 Housing 4/2021). Provides information, applications, waitlist, programs, information, resources, and support for low-income families looking for safe, affordable housing.

757-727-6337

• Virginia Department of Medical Assistance Services (Medicaid): dmas.virginia.gov/#/index

Online resource that provides information about eligibility, education, programs and services, and support and resources for Virginia residents.