Universal precautions: the case for consistently trauma-informed reproductive healthcare

Owens, Lauren; Terrell, Stephanie M.; Low, Lisa Kane; Loder, Charisse; Rhizal, Deb; Scheiman, Lisa; Seng, Julia S.

doi:10.1016/j.ajog.2021.08.012

Cited by 43 publications

(47 citation statements)

References 23 publications

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“…These barriers are not traditionally addressed during contraceptive counselling. 27 While they are clearly important issues to address in every age group, it could be seen as particularly pertinent for women over 40 years who are more likely to have been through traumatic births and invasive gynaecological investigations. Enquiring about these types of experiences when initiating or switching contraception would be a positive step in making the consultation more tailored and holistic.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting contraceptive choice in women over 40: a qualitative study

Burgin

Bailey

2022

BMJ Open

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ObjectiveTo explore the views of women over 40 years in choosing and using contraception, and to inform how contraceptive counselling for this age group could be improved.Design, setting and participantsFourteen women aged 40–52 years were recruited through social media platforms to take part in online, semistructured, in-depth interviews. Transcripts were analysed using a qualitative thematic approach.Results(1) Participants were anxious about unplanned pregnancy, and still highly motivated to avoid this. (2) Changes of contraceptive method over the lifecourse were occasionally precipitated by emergent health conditions, but healthcare providers often recommended a change in method on the basis of age alone. (3) Participants were experiencing perimenopausal symptoms but were largely unaware of how hormonal contraception could be used to treat these symptoms. (4) Prior negative experiences with contraceptive methods, coercive experiences with healthcare providers, and traumatic life events all contributed to a narrowing of contraceptive preference in later life.ConclusionWomen over 40 years may be highly motivated to avoid pregnancy. This age group may have complex contraceptive histories with emerging perimenopausal symptoms. Women over 40 years may have accumulated adverse experiences which impact their contraceptive choices. These factors need to be explored by clinicians, to facilitate shared decision-making.

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Section: Discussionmentioning

confidence: 99%

Factors affecting contraceptive choice in women over 40: a qualitative study

Burgin

Bailey

2022

BMJ Open

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“…It is important to note that these universal precautions do not aim to provide psychotherapy or "traumaspecific" mental health interventions, as such interventions would likely be outside the scope of the postpartum care provider's training and expertise. 25 Furthermore, it could be logistically and ethically problematic to screen patients for birth-related psychological trauma during a postpartum encounter without the appropriate time and resources to listen attentively, respond empathically, and link patients to services as warranted. 28 TIC practices that focus on universal precautions rather than screening for patients who have experienced trauma are within the scope of any postpartum caregiver's expertise, feasible to integrate into routine care both in the birth and outpatient setting, and a critical component of supporting patients and families through the pregnancy, birth, postpartum continuum, and transition to primary care.…”

Section: Trauma-informed Universal Precautionsmentioning

confidence: 99%

“…Moving from principles to implementation and sustained prioritization of TIC requires not only individual commitment of providers but also the system-level investment of health care institutions and all associated personnel. The 4 essential practices SAMHSA has outlined for TIC implementation include: (1) realizing the widespread impact of trauma and potential paths for recovery, (2) recognizing the signs and symptoms of trauma in patients, families, staff, and others (including the potential lack of visible signs), (3) responding by integrating knowledge about trauma into policies, procedures, and practices, and (4) seeking to actively avoid retraumatization 22,25. In short, it involves delivering respectful, patient-centered, trauma-informed, and antiracist services in every patient encounter regardless of trauma disclosure.…”

Section: A Trauma-informed Approach To Postpartum Carementioning

confidence: 99%

A Trauma-informed Approach to Postpartum Care

White

Saxer

Raja

et al. 2022

Clinical Obstetrics &Amp; Gynecology

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Distressing or traumatic perinatal experiences and adverse health outcomes can lead to particularly challenging postpartum experiences for patients and families. By adopting a trauma-informed care approach, the health care team can provide much-needed support, prevent additional harm, and promote healing. We propose practical communication, behavioral, and procedural considerations for integrating trauma-informed care principles into routine postpartum care, with attention to populations that have been marginalized. We see postpartum care as a critical component of holistic patient recovery and an opportunity to facilitate posttraumatic growth so that all families can thrive.

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“…The absence of protocols and policies surrounding sexual assault screening presents a de ciency within obstetrics and gynecological and primary care settings, and it is important to understand how healthcare professionals navigate these insu ciencies. Further, there is a need for trauma-informed care approaches within obstetrics and gynecological healthcare [45,49,50,57,58] that go beyond the immediate care after an act of violence and extend to the long-term medical consequences, especially those impacting sexual and reproductive health [57,59].…”

Section: Introductionmentioning

confidence: 99%

“…Trauma-informed care has two components: universal trauma precautions and trauma-speci c care [50]. Universal trauma precautions are implemented in all settings regardless of patient trauma history [57]. Utilizing this strategy and its precautionary measures may help build trust with patients [50].…”

Section: Introductionmentioning

confidence: 99%

The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments

DeMaria

Meier

King

et al. 2022

Preprint

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Background Nearly half of adult women in the US report experiencing sexual assault, with almost one-fifth reporting rape. For many victims of sexual assault, healthcare professionals are the first point of contact and disclosure. The purpose of this study was to understand how healthcare professionals working in community settings perceived their role in discussing sexual violence experiences with women during obstetrics and gynecological healthcare appointments. The secondary purpose was to compare healthcare professionals’ perspectives with those of the patient to determine how sexual violence conversations should occur in these environments. Methods Data were collected in two phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18–45 (n = 22) living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using thematic analyses. HyperRESEARCH assisted in data management and organization. Results There were three resulting themes: (1) healthcare professionals’ approaches to screening for a history of sexual violence varied depending on how they ask, what setting they work in, and type of professional is doing the asking; (2) healthcare experiences can compound traumatic experiences and create distrust with survivors; and (3) sexual violence impacts patient healthcare experiences through what services they seek, how professionals may interact with them, and what professionals they are willing to utilize. Conclusions Findings offered insight into actionable and practical strategies for enhancing sexual violence screening and discussions in community-based women’s reproductive health settings. The findings offer strategies to improve by addressing barriers and facilitators among community healthcare professionals and the people they serve. Incorporating healthcare professionals’ and patient experiences and preferences for violence-related discussions during obstetrics and gynecological healthcare appointments can assist in violence prevention efforts, improve patient-professional rapport, and yield better health outcomes.

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Universal precautions: the case for consistently trauma-informed reproductive healthcare

Cited by 43 publications

References 23 publications

Factors affecting contraceptive choice in women over 40: a qualitative study

Factors affecting contraceptive choice in women over 40: a qualitative study

A Trauma-informed Approach to Postpartum Care

The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments

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