Intimate partner violence cuts across all racial, social, cultural, economic, political and religious backgrounds. Behind the abuse is the desire to exercise power and control over a person. There are many types of abuse. They include physical, emotional, verbal, psychological, sexual, and financial abuse. Some of the telltale signs for concern are threats, intimidation, manipulation, stalking, economic control, using children and isolation. Children often witness abuse, which negatively impacts their mental health and physical well-being directly and indirectly. Children’s exposure to IPV is a form of child maltreatment. All of this is family violence. 

According to Canadian doctor and author Gabor Maté, “trauma is not what happens to you, it is what happens inside you.” In fact, trauma can change the way a person perceives and experiences the world.  

Trauma-informed practices recognize that trauma is pervasive in society. Practitioners adapt their approaches to better account for trauma and avoid practices that can re-traumatize people. 

For midwives, trauma-informed care should be practiced at all stages of the client-midwife relationship: intake, pre-natal, parturition and post-partum. Throughout each stage, always strive to meet clients where they are, let them take the lead, and don’t push them to do anything out of their comfort zone.  

Regardless of what stage in the pregnancy, trauma-informed care means: 

• Learning about your client and their community/family 
• Understanding the impact of cultural, historical and gender issues 
• Checking your own implicit biases 
• Collaborating with your client 
• Being transparent and keeping things confidential 
• Providing informed choices  
• Being non-judgemental 
• Creating a safe(r) space

Truth and reconciliation are about recognizing the harms of Canada’s colonial history and building respectful relationships with Indigenous Peoples. The painful legacy of residential schools, forced sterilizations, disappeared and murdered Indigenous women and girls, and the destruction of Indigenous lands continue to leave their marks. It’s important to understand how the mass removal of children from families into the child welfare system has caused unspeakable harm. One of the consequences is ongoing intergenerational trauma. As midwives support clients who may be experiencing abuse, they should take special care to avoid re-traumatizing pregnant people. Actively listen, offer support and meet people where they are. Supporting the restoration of Indigenous midwifery and birth to First Nations, Metis and Inuit communities is another way we can work together to redress the harms of colonialism. 

Do your homework. Find out about the communities you are working with. Find out about the resources in your community. And if you don’t feel like you have enough knowledge – speak to a colleague or another health or social service professional. 

You are not expected to be an expert on family violence. You are expected to know the signs, symptoms, and risk factors as well as follow-up protocols to keep you and your client safe. 

• Have you done your homework about signs and symptoms, asking about family violence, and assessing immediate risk? 
• Are you following documentation guidelines?  
• Do you have safety protocols – for home visits and visits in-clinic? 
• Do you have client safety planning tools and resources on hand? 

It’s complicated. Clients may disclose a situation of ongoing violence that doesn’t require you to report but does require you to support your client to receive the care they need. But when you suspect child maltreatment, you have a duty to report. Get informed about the difference between disclosure and reporting, and where there may be grey areas. This is part of practicing trauma-informed care and can avoid creating more harm.  

This is hard work. Midwives often go the extra mile and get burned out in the process. Midwives can also experience moral injury when they do something in a clinical context that may inadvertently harm a client. Self-care is about a lot more than taking downtime, it’s about taking care of your physical, mental and spiritual health. Take the time to map out what that means to you.