The Support Service took part in the Society of Obstetricians and Gynecologists of Canada’s 2024 Maternal Mortality Summit. Over the past four years, the Support Service has contributed to training health professionals on ways to avoid re-victimizing patients who may have a history of sexual assault. Through partnerships with McGill University, the Université de Montréal, and Sainte-Justine hospital, the support service has helped to run simulations and provide training that uncovers the impact of sexual violence on future medical intervention. In applying treatment that is sensitive to trauma and to victimized individuals, all physicians can better support their patients and improve health outcomes.

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In recognition of this work, the Society of Obstetricians and Gynecologists of Canada (SOGC) invited Gabrielle Arthurs, the Support Service’s Medico-Social Interventions Coordinator, to give a presentation at the SOGC’s Annual Clinical and Scientific Conference in connection with its Summit on the Prevention of Maternal Mortality.

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The presentation, titled ‘A Balancing Act: Reflections on Listening, Consent and Collaboration in Caregiving’ took the form of an informal discussion between Dr. Diane Francoeur, Cathie Barker Pinsent, SW, and Gabrielle Arthurs (the Support Service’s Medico-Social Interventions Coordinator). The objective was to highlight the impact of maternal mortality on medical professionals, especially in cases where a person giving birth has died, and to determine how trauma-informed care can not only help to prevent some of these deaths, but also instigate treatment strategies that protect medical professionals from emotional exhaustion.

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According to the WHO’s 2010 report, maternal mortality in Canada is on the rise.[1] The spectrum of maternal health encompasses both physical and mental wellness, while a range of social and economic factors significantly improve access to and quality of maternal healthcare. Factors such as obesity, age, hypertension, carrying multiple fetuses, prior pregnancy complications, lifestyle choices, and pre-existing medical comorbidities all impact maternal health.

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(1) Socioeconomic factors such as education, ethnicity, financial barriers, income inequality, a lack of health insurance, a lack of paid family leave, residing in racially segregated communities, and shortages of healthcare providers all influence access to maternal healthcare, which we know is important for achieving better health outcomes. (2) Finally, it is well known that mental health (3) and consumption of psychoactive substances (4) appear as critical factors that contribute to adverse developments in the maternal experience.[2]

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Past and current experiences of sexual violence are also important factors in the assessment of maternal health during pregnancy, and even more so after delivery.

During the roundtable, Dr. Diane Francoeur presented various scenarios in which physicians must inform family members of the death of a loved one, naturally having had an impact on the healthcare professional. Gabrielle’s role was to establish connections between improving patient care and improving care for professionals, using the trauma-informed approach. Strategies applied to patients can also be applied to healthcare professionals. This is true for workers in the field of sexual assault as well as any other field in which professionals must take into consideration any traumatic events in their patients’ pasts.

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Receiving and relaying traumatic information (such as hearing about a past sexual assault or informing family members of the death of their loved one) can be traumatic by itself, and during the SOGC’s Maternal Mortality Summit, our panel asked the physicians present to acknowledge and validate their own feelings concerning their practice. 

During the question-and-answer period, participants reported feeling seen and validated by the panel’s presented content. While overall, the Summit was a day predicated on science and statistics-based, many expressed that including a panel on trauma-informed care was a crucial element in making progress on the issue of maternal mortality. Participants related how cases have affected them in their careers and personal lives and concluded that physicians’ emotional health is an often-disregarded issue that requires consideration in the development of patient-centred medicine.  

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The Support Service’s Medico-Social Interventions Coordinator, Gabrielle Arthurs, was happy to be able to provide this space for this group of physicians, while the parallels between the unappreciated emotional needs of these physicians and the physicians associated with medico-social intervention cannot be emphasized enough. There exists little or no infrastructure for responding to the emotional and professional needs of physicians who are tasked with receiving and communicating traumatic information.

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The Support Service’s mission is to provide support to all members of medico-social teams. This support can take the form of individual consultations, team meetings that address questions and concerns, or helping centres and regions to develop supportive resources when sexual assault cases induce emotional distress for medico-social personnel.

The Summit was a prime example of what can be achieved when professionals who are engaged and dedicated to a cause come together. The personnel find solutions, establish common ground and a receptive and supportive environment, and are restored in their energy when it is time to return to work.

After Gabrielle’s presentation, Dr. Francoeur gave her own, during which she provided examples of encounters with family members after a maternal death.

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Thank you, Diane [… Dr. Diane Francoeur…], for sharing these experiences. 

Even given one’s naturally strong resilience, training, practice, and institutional support, the kinds of interactions Diane describes will never be easy.

Because we are human beings present to other human beings’ agony and distress, and this harms us.  

All relations between people have the potential for wounds and upset. But when we are completely closed off to the ties that connect us as healthcare providers and as patients, we lose the essential structures that would minimize the negative impacts on health.

Fear of distress and, more commonly, discomfort, prevents health professionals and their patients from addressing the complex issues that can lead to maternal mortality.

As healthcare providers, we need to ask ourselves if we have the adaptability, training, practice, and necessary support to ask our patients difficult or sensitive questions, such as:

‘Have you experienced violence, sexual or otherwise, in your past?’

‘Does this pregnancy result from a consensual or non-consensual act?’ or, a milder, but still-tricky question, ‘What do you feel is the role of a health professional in your pregnancy?’

 ‘When sharing your concerns with health professionals in the past, did you feel that your concerns were taken seriously?’

 

Are we willing to hear the answer, to show compassion, to validate our patients’ feelings and reactions and, ultimately, to adapt services or a treatment plan that takes their experiences into account? 

I think these questions bring us back to the idea of consent. If a healthcare provider doesn’t have basic information about the patient’s life and feelings about her pregnancy, are we really providing the patient with the right content to ensure informed consent? It’s somewhat of a house of cards for establishing consent.

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If we come back to the experience described by Diane, when announcing to family members the death of the mother and perhaps also the child, recourse to preparation and prevention strategies also applies to us. We need to recognize that discomfort and distress are natural. And we need to face them, to prepare ourselves for what we are likely to feel and how we are going to care for ourselves. Is there someone I can call? A team member or mentor? If there are no other options, can I take 5 minutes to validate my own experiences by writing a note to myself? Gabrielle, that was hard. It’s normal to be sad after what happened. That could affect you later. 

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I’d like to tell you a little story: when I was having contractions during my first delivery, my healthcare professional told me to think of the contractions as a wave and, instead of fighting them, to let myself be carried along by them. It was still a major and overwhelming experience, but it took a lot less energy, energy that we might have a need for later. Let’s not forget that health professionals are also people with a history, with feelings, traumas, and complex mental health.  

So, throughout today’s program, which focusses on solving the crisis of maternal mortality and on finding solutions, I would like for this panel’s content to be like a little engine turning in the background of your mind. What strategies do I have for taking care of myself? What can I do to ensure that the systems I work in take responsibility for my personal care and training? How does my avoidance of pain and sadness affect my interventions with patients, and am I missing important information because of this avoidance strategy?  

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Presenters:

• Diane Francoeur, MD, FRCSC

• Gabrielle Arthurs, BSW, MSW

• Moderator: Cathie Barker Pinsent, SW

 

[1] WHO: Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization, Geneva2023https://iris.who.int/bitstream/handle/10665/366225/9789240068759-eng.pdf?sequence=1

[2] Cook JL, Sprague AE; members of the Society of Obstetricians and Gynaecologists of Canada’s Maternal Mortality Pilot Project. Measuring Maternal Mortality in Canada: An Update on the Establishment of a Confidential Enquiry System for Preventing Maternal Deaths #savingmoms #savingbabies. J Obstet Gynaecol Can. 2019 Dec;41 (12):1768-1771. doi: 10.1016/j.jogc.2019.07.018. Epub 2019 Oct 4. PMID: 31591055.

 

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The Support Service team
Allied with designated centres across Québec

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