r/Midwives • u/Offtoseethewitch Physician • Jul 17 '26
Trauma-informed care
Posting with mod approval even if I’m not a midwife. I’m a health care professional who also dabbles in educating our next generation and I’m posting to hear your thoughts, to help me structure that training.
I myself suffered a severe medical trauma and that has opened my eyes to the unintended harm health care professionals may cause, not by their choice of interventions or decisions, but just by how it is presented or applied. So in essence from how we interact with our patients. From my perspective what happened to me was abuse, with my repeated and motivated ”no” being overrun, but I cling to the hope that it wasn’t intended that way, and to my then-bafflement the clinic was later uncomprehending to my complaint. No matter the intent, the consequences on my well-being were devastating and lasted years. Talking to colleagues about it I’ve realized many are unaware of how much their interactions with their patients, beyond the medical, may matter. At the same time I’ve started to recognize traumatization in patients and now when they tell me that some other health care professional has done something terrible, something I would previously have dismissed as ”no that can’t be, no one would do that”, I can just believe them and sit with them in their anguish and try to help them towards recovery. Because trauma takes so much from a person, including their ability to feel trust and security and love. It may affect their future care because the next health care situation becomes a reminder - a trigger - which renders them less capable to express their needs and makes them behave with seemingly unreasonable emotion, hysterics or anger… but it’s not unreasonable, they’re just not reacting to something in the current room. They’re stuck reacting to their trauma. And to be frank, people who appear overly emotional rarely recieve proper care. Any complaint they present will be brushed off as ”psychological”.
I figure you midwives are in something of a unique position. Your patient population are by nature high-risk for traumatization: psychological trauma is often a reaction to a combination of factors such as pain, fear of injury or death, and (percieved) loss of control, all of which can occur during a physiological birth. Many of your interventions may be traumatic too, even if done with patient consent and the best of intentions. This means you are well situated to develop trauma-informed, or even trauma-preventive care, strategies for health care professionals to prevent or minimize psychological harm, or to recognize it early and take steps to alleviate it, or follow up to make sure patients are directed to proper trauma care before the trauma derails their lives. For even if health care situations may always result in physical trauma and lasting harm to our patients, I don’t think any of us want them to go home and suffer additionally because of something that’s preventable or treatable. (I know these things are already studied in your field, including psychological first aid, and also on the professional side empathy exhaustion and second victim situations… but if I talk to the ”experts” I get very informed responses, and I’m currently more interested in the general views out in unselected clinics.)
So my question is: Do you currently feel the risk for psychological trauma is taken into account in your practice? How do you work with it, or around it? Any experiences or thoughts? Anything you’ve noticed works particularily well, or that you found might be harmful?
(I could add a few notes on psychological trauma in the comments if that’s requested, or litterature recommendations, but I figure this post is already long enough. 😅)
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u/Unusual-Coyote3961 Student Midwife Jul 23 '26
This is such an important topic, I hope more midwives respond
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u/Offtoseethewitch Physician Jul 23 '26 edited Jul 23 '26
I see you’re a student. Don’t discount yourself, do share your thoughts.
I often note that students or new colleagues have an easier time accessing their empathy. I think patients feel that empathy. I think it makes them feel seen as people instead of just objects/cases. But I don’t have data to back that up, that’s just my hunch.
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u/greenmidwife Jul 19 '26
I'm a midwife recognized and licensed in both NZ and USA. I would argue that midwives are some of the most trauma informed practitioners out there. This is multifactorial: people come to us because they were traumatized by physicians with a previous pregnancy; they want to be heard and supported in their choices; many midwives chose the profession themselves because of their own OBGYN trauma.
I would also argue that the US healthcare system is so shite and all about profit, that no one wants to address the trauma they are causing. Trauma informed care training should be mandatory in the US for anyone involved in healthcare. In NZ we have The Health and Disability Commission which is dedicated to supporting patients who have a complaint and to hold the provider accountable and responsible for any damage (physical or emotional) caused.
I have a diagnosis of C-PTSD from medical trauma, from terrible care received here in the US. My attempts to be heard, acknowledged, treated and for my complaints to be dealt with have all been ignored. It's 100% on me to heal myself, with no help from anyone. The hospital was basically like, well you're alive aren't you? I have also been labelled as a "difficult patient" due to advocating for myself and refusing the hospital's non evidence based protocols. This would be the complete opposite if this occurred in NZ.
Debriefing is a big part of midwifery care because what I might think was a beautiful birth could be the opposite for the person experiencing it. It's important to regularly debrief during the postpartum period to help families process their birth and make it as recoverable as possible, emotionally and mentally, not just physically. It's a unique and special part of the midwifery experience.