Novel Perinatal Program Provides Support, Reassurance to Survivors of Trauma and Sexual Abuse

For women with a history of sexual assault or abuse, childbirth can trigger strong emotions associated with previous traumatic events. Although one-quarter of patients who give birth report enduring significant personal trauma at some point in their life, little clinical guidance exists on how to best support these survivors during the birthing process.

In her 20-year career as a labor and delivery nurse, Cleveland Clinic nurse Patricia Gilbert, BSN, RN, became intrigued by patients with difficult backgrounds. Recognizing an opportunity to improve the care of survivors during the perinatal period, she approached Dusty Burke, MSN, RNC, Director of Nursing Operations, about developing a trauma-informed care program. Burke embraced the innovative idea, which involves identifying survivors prior to delivery and providing them with a supportive birth experience, and the M-POWER program began to take shape.

The team began by diving into the nursing literature and was surprised by what it found. “There were plenty of statistics on how many women have been affected by childhood sexual assault and abuse, but we discovered very little information about how those experiences can affect the childbearing years of life,” explains Gilbert, M-POWER’s nursing coordinator.

What’s more, Gilbert says that although many authors mentioned the need to develop a standardized protocol for managing perinatal patients with a history of trauma, nothing had been done about it. She and Burke took the news as a call to action. “We were confident that we could fill that gap,” she says.

Identifying at-risk patients

Gilbert notes that some trauma survivors exhibit extreme anxiety and a need for control – traits that can be heightened during pregnancy.

“The sudden focus on intimate areas of a pregnant patient’s body can elicit a powerful gut response,” she says. “In particular, the physiological changes and repeat, potentially invasive physical examinations that accompany pregnancy can cause significant stress in patients who have endured previous abuse or injury.”

“M-POWER is designed to identify survivors before they give birth, address their concerns and work with them to develop a holistic care plan based on safety and trust. We want to make sure these patients feel fully supported and heard by their caregivers,” Gilbert explains.

Calming the emotional storm

The M-POWER process begins with a referral, which can be initiated by the patient or her provider. Gilbert and Burke worked with their multidisciplinary steering committee to create a three-question screening tool to assist with the referral process.

“Patients with a significant history of abuse are often uncomfortable disclosing details about their past, so we’ve created a specialized screening protocol that takes the patient’s privacy and potential apprehension into account,” says Burke.

Women who meet the criteria for enrollment in the M-POWER program are given the opportunity to tour the labor and delivery unit and work with a specially trained resource nurse to create an individualized plan of care. Each patient’s medical record includes specific care notes that outline optimal strategies for meeting their individual needs.

Although details of past trauma are not required to provide this level of care, Burke emphasizes the importance of documenting each patient’s needs before they are admitted to the labor and delivery unit. “When a patient arrives to give birth, the staff can respond appropriately because they have already been briefed on that individual’s unique concerns, triggers and personal preferences,” says Burke.

Gilbert adds, “Many of these women arrive with potential triggers related to touch, exposure and unfamiliar procedures. Some may become uncomfortable when strangers are involved in their care. In other cases, the patient’s chief concern is pain. We’ve learned to diffuse these fears by providing specific details about what to expect during labor and childbirth, thoroughly discussing options for managing their symptoms and even describing the physical sensations they may feel during each step of the process.”

Preparation is key

Gilbert emphasizes that the success of M-POWER is largely dependent on caregiver education. “It is essential that every clinician involved in the birthing process has the tools needed to best support these patients, many of whom arrive in ‘fight or flight’ mode,” she says.

A recent Cleveland Clinic Caregiver Catalyst Grant has allowed M-POWER leaders to further develop the novel program. After nearly a year of training development with a certified When Survivors Give Birth instructor, the team has created a custom-tailored education protocol for Cleveland Clinic caregivers. The training also allowed the team to provide a two-day symposium on trauma-informed care for obstetrical caregivers and M-POWER resource nurses.

After a full year of planning, M-POWER went live on August 1 in all six Cleveland Clinic Ohio locations that provide obstetrical services. Burke says they plan to expand the program to other Cleveland Clinic hospitals next year.

In the meantime, the team is focused on further developing relationships with local community centers, rape crisis centers and other outreach programs.

Looking ahead

Although it is too early to assess whether M-POWER will have a measureable effect on maternal outcomes, Gilbert and Burke are confident the program has provided a more supportive birthing experience for both trauma survivors and delivery room staff.

“We are enormously grateful for the support that has allowed us to bring this program to fruition,” says Burke. “We’re aware that recent changes to reproductive healthcare laws may affect the demand for this specialized service, but we’re prepared to do what it takes to meet the needs of our most vulnerable patients.”