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Women and Birth xxx (xxxx) xxx Community perspectives on delivering trauma-aware and culturally safe perinatal care for Aboriginal and Torres Strait Islander parents

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Abstract

Background Since colonisation, Aboriginal and Torres Strait Islander peoples have experienced violence, loss of land, ongoing discrimination and increased exposure to traumatic events. These include adverse childhood experiences which can lead to complex trauma, and are associated with increased incidence of high-risk pregnancies, birth complications and emergence of post-traumatic symptoms during the perinatal period, potentially impacting parenting and leading to intergenerational trauma. The perinatal period offers unique opportunities for processing experiences of trauma and healing yet can also be a time when parents experience complex trauma-related distress. Therefore, it is essential that trauma-aware culturally safe perinatal care is accessible to Aboriginal and Torres Strait Islander parents. Aim This study aimed to understand community perspectives of what ‘trauma-aware culturally safe perinatal care’ would look like for Aboriginal and Torres Strait Islander parents. Methods Data were collected during a workshop held with predominantly Aboriginal and Torres Strait Islander key stakeholders to co-design strategies to foster trauma-aware culturally safe perinatal care. Data were thematically analysed. Findings Four overarching themes represent proposed goals for trauma-aware culturally safe care: Authentic partnerships that are nurtured and invested in to provide the foundations of care; a skilled workforce educated in trauma awareness; empowering and compassionate care for building trust; and safe and accessible environments to facilitate parent engagement. Conclusions Provision of trauma-aware culturally safe care achieving these goals is likely to enable parents experiencing complex trauma to access appropriate support and care to foster healing in the critical perinatal period.

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Aims and objectives: To report an analysis of the concept of perinatal posttraumatic stress disorder (PPTSD). Background: Prevalence of PPTSD is rising in the United States, with 9% of the U.S. perinatal population diagnosed with the disorder and an additional 18% being at risk for the condition. Left untreated, adverse maternal-child outcomes result in increased morbidity, mortality, and healthcare costs. Design: Concept analysis via Walker and Avant's approach. Methods: The databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Academic Search Premier, and PsychINFO were searched for articles, written in English, published between 2006 and 2015, containing the terms perinatal and PTSD. Results: PPTSD owns unique attributes, antecedents, and outcomes when compared to PTSD in other contexts, and may be defined as a disorder arising after a traumatic experience; diagnosed any time from conception to 6 months postpartum; lasting longer than 1 month; leading to specific negative maternal symptoms, and poor maternal-infant outcomes. Attributes include a diagnostic time frame (conception to 6 months postpartum), harmful prior or current trauma, and specific diagnostic symptomatology defined in the Diagnostic and Statistical Manual of Mental Disorders, 5(th) Edition. Antecedents were identified as trauma (perinatal complications and abuse), postpartum depression, and previous psychiatric history. Consequences comprised adverse maternal-infant outcomes. Conclusions: Further research on PPTSD antecedents, attributes and outcomes in ethnically diverse populations may provide clinicians a more comprehensive framework for identifying and treating PPTSD. Relevance to clinical practice: Nurses are encouraged to increase their awareness of PPTSD for early assessment and intervention, and prevention of adverse maternal-infant outcomes. This article is protected by copyright. All rights reserved.
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Objective: Given the high prevalence of chronic disease, it is of concern that access to and sustained engagement with primary healthcare services by Aboriginal and Torres Strait Islander Australians is often far lower than would be expected. This study sought to explore ways in which relationships can support sustained engagement with healthcare services. Methods: Semi-structured interviews were conducted with 126 Aboriginal and Torres Strait Islander participants with and without chronic disease and 97 Aboriginal and Torres Strait Islander and non-Indigenous healthcare providers, healthcare service managers or administrative staff. Results: Our findings indicate that when faced with acute health issues, Aboriginal and Torres Strait Islander participants did prioritise care, provided that the service was both physically and emotionally welcoming. Trustworthiness of healthcare providers and strong relationships with patients were the most important factors for encouraging sustained engagement overtime. Conclusions: Responsibility for sustaining relationships does not rest solely with Aboriginal and Torres Strait Islander patients. Rather, healthcare providers need to commit to the process of building and maintaining relationships. Implications: First and foremost healthcare providers should take time to establish and then maintain relationships. Healthcare services can also contribute by ensuring facilities are welcoming for Aboriginal and Torres Strait Islander peoples.
Article
This paper reviews the evidence for the existence of a complex form of post-traumatic disorder in survivors of prolonged, repeated trauma. This syndrome is currently under consideration for inclusion in DSM-IV under the name of DESNOS (Disorders of Extreme Stress Not Otherwise Specified). The current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events. This formulation fails to capture the protean sequelae of prolonged, repeated trauma. In contrast to a single traumatic event, prolonged, repeated trauma can occur only where the victim is in a state of captivity, under the control of the perpetrator. The psychological impact of subordination to coercive control has many common features, whether it occurs within the public sphere of politics or within the private sphere of sexual and domestic relations.
Article
The saying “violence begets violence” is an apt descriptor of the cycle of family violence, as children who witness parental violence are at high risk for repeating family violence in their own adult intimate relationships. Neuroscience research suggests that emotional regulation may be an important link in the heritability of family violence, and promotes awareness of the importance of internalizing as well as externalizing responses to stress, neglect, and abuse. This study argues for a trauma-informed approach to identifying children and parents whose symptoms of emotional dysregulation may be otherwise overlooked, and for an expanded approach to treatment that incorporates family systems and emotional regulation strategies. El dicho “la violencia genera más violencia” es un descriptor apropiado del ciclo de violencia familiar, ya que los niños que son testigos de violencia entre los padres tienen un alto riesgo de repetir la violencia familiar en sus propias relaciones íntimas como adultos. Investigaciones neurocientíficas sugieren que la regulación emocional puede ser un vínculo importante en la heredabilidad de la violencia familiar, y promueven la concienciación sobre la importancia de la internalización y la externalización de las respuestas al estrés, el abandono y el abuso. Este artículo argumenta a favor de un enfoque informado del trauma orientado a la identificación de niños y padres cuyos síntomas de desregulación emocional pueden pasarse por alto así como a favor de un enfoque ampliado de un tratamiento que incorpore estrategias de regulación emocional y sistemas familiares. “暴力滋生暴力”这一说法是对家庭暴力循环的恰当描述,因为目睹过父母暴力(WPV)的孩子在自己成人亲密关系中有重复家庭暴力的高风险。神经科学研究表明,情绪调节可能是家庭暴力遗传性上的重要一环,并增强对应激、忽视与虐待的内化与外化反映重要性的意识。本文提出用基于创伤的方法识别情绪失调症状可能被忽视的孩子与家长,并提出将扩展方法用于整合了家庭系统和情绪调节策略的治疗。
Article
Objective: to describe the experiences of women, midwives and others during the establishment of a new model of maternity care for remote dwelling Aboriginal women transferred to a regional centre in northern Australia for maternity care and birth. Design: a mixed method design within a Participatory Action Research approach was used. Qualitative findings are presented here. Data for this paper were collected from semi-structured interviews, field notes and observations and analysed thematically. Setting: the 'top end' of the Northern Territory of Australia. Participants: a total of 66 participants included six MGP midwives, two Aboriginal Health Workers and one Senior Aboriginal Woman working in the new model; eight hospital midwives; 34 Department of Health staff, three staff from other agencies; and 12 remote dwelling Aboriginal women who used the service. Findings: the study generated one overarching theme, it's not a perfect system but it's changing. This encompassed improvements to the services evident to all participants. Core themes related to the previous maternity service which was described as the arduous journey, the new model was seen as a new way of working and a resultant very different journey occurred for Aboriginal women using the service. Key conclusions and implications for practice: there was a dissonance between the previous culture of maternity services and the woman centred focus of the new model. Over 12 months initial resistance to the new model diminished and it became highly valued. The transfer of information between the regional service and remote community health centres improved as did the safety and quality of care. Aboriginal women can access continuity of carer in the regional centre for the first time and reported a more positive experience with maternity services. The new model appears to have changed the cultural responsiveness of the regional maternity service; and care provided for remote dwelling women within this service. The qualitative findings inform others seeking to implement a similar model of care for remote dwelling women transferred to a regional centre for birth.
Article
The power to promote wellness, resist oppression, and foster liberation is grounded in psychological and political dynamics. Hitherto, these two sources of power have been treated in isolation, both for descriptive and prescriptive purposes. As a result, we lack an integrative theory that explains the role of power in promoting human welfare and preventing suffering, and we lack a framework for combining psychological and political power for the purpose of social change. In this article, the author puts forth a psychopolitical conceptualization of power, wellness, oppression, and liberation. Furthermore, he introduces the concept of psychopolitical validity, which is designed to help community psychologists to put power issues at the forefront of research and action. Two types of psychopolitical validity are introduced: type I—epistemic, and type II—transformative. Whereas the former demands that psychological and political power be incorporated into community psychology studies; the latter requires that interventions move beyond ameliorative efforts and towards structural change. © 2008 Wiley Periodicals, Inc.
Article
Theoretical models for health care practice are important both as tools for guiding daily practice and for explaining the philosophical basis for care. The aim of this study was to define and develop an evidence-based midwifery model of woman-centred care in Sweden and Iceland. Using a hermeneutic approach we developed a model based on a synthesis of findings from 12 of our own published qualitative studies about women's and/or midwives' experiences of childbirth. For validity testing, the model was assessed in six focus group interviews with 30 practising midwives in Iceland and Sweden. The model includes five main themes. Three central intertwined themes are: a reciprocal relationship; a birthing atmosphere; and grounded knowledge. The remaining two themes, which likewise influence care, are the cultural context (with hindering and promoting norms); and the balancing act involved in facilitating woman-centred care. The model shows that midwifery care in this era of modern medical technology entails a balancing act for enhancing the culture of care based on midwifery philosophies. The next step will be to implement the model in midwifery programmes and in clinical practice, and to evaluate its applicability.
Article
Advances in fields of inquiry as diverse as neuroscience, molecular biology, genomics, developmental psychology, epidemiology, sociology, and economics are catalyzing an important paradigm shift in our understanding of health and disease across the lifespan. This converging, multidisciplinary science of human development has profound implications for our ability to enhance the life prospects of children and to strengthen the social and economic fabric of society. Drawing on these multiple streams of investigation, this report presents an ecobiodevelopmental framework that illustrates how early experiences and environmental influences can leave a lasting signature on the genetic predispositions that affect emerging brain architecture and long-term health. The report also examines extensive evidence of the disruptive impacts of toxic stress, offering intriguing insights into causal mechanisms that link early adversity to later impairments in learning, behavior, and both physical and mental well-being. The implications of this framework for the practice of medicine, in general, and pediatrics, specifically, are potentially transformational. They suggest that many adult diseases should be viewed as developmental disorders that begin early in life and that persistent health disparities associated with poverty, discrimination, or maltreatment could be reduced by the alleviation of toxic stress in childhood. An ecobiodevelopmental framework also underscores the need for new thinking about the focus and boundaries of pediatric practice. It calls for pediatricians to serve as both front-line guardians of healthy child development and strategically positioned, community leaders to inform new science-based strategies that build strong foundations for educational achievement, economic productivity, responsible citizenship, and lifelong health.
Article
The earliest relationship does not begin with birth. Pregnant women construct mental representations of the fetus, and feelings of affiliation or "maternal-fetal attachment" generally increase over the course of gestation. While there is a fairly substantial literature on the development and moderation of psychological features of the maternal-fetal relationship, including the role of ultrasound imaging, relatively little is known about the manner in which maternal psychological functioning influences the fetus. Dispositional levels of maternal stress and anxiety are modestly associated with aspects of fetal heart rate and motor activity. Both induced maternal arousal and relaxation generate fairly immediate alterations to fetal neurobehaviors; the most consistently observed fetal response to changes in maternal psychological state involves suppression of motor activity. These effects may be mediated, in part, by an orienting response of the fetus to changes in the intrauterine environment. Conversely, there is evidence that fetal behaviors elicit maternal physiological responses. Integration of this finding into a more dynamic model of the maternal-fetal dyad, and implications for the postnatal relationship are discussed. Research on the period before birth affords tremendous opportunity for developmental scientists to advance understanding of the origins of human attachment.
Article
Stories appear to provide an indirect way of confronting the inherent conflict between the concepts of disease and wellness and assisting in the transition to a new concept of living well with the disease. This new concept may engender feelings of acceptance and hope that can facilitate application of knowledge and behavior change. In addition, culturally appropriate stories allow people to draw from their own personal beliefs and values to interpret and apply new information to their own lives. A good story takes listeners on a collective journey with many paths; each path is uniquely suited to the needs of the individual, with wisdom gained that is uniquely suited to their own life.
Bringing Them Home. National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families
  • Australian Government
Australian Government, in: H. Rights, E.O. Commission. (Eds.), Bringing Them Home. National Inquiry into the Separation of Aboriginal and Torres Strait Islander Children from their Families, Human Rights and Equal Opportunity Commission, Canberra, 1997.
Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice
  • J Atkinson
  • J Nelson
  • C Atkinson
J. Atkinson, J. Nelson, C. Atkinson, Trauma, transgenerational transfer and effects on community wellbeing, in: N. Purdie, P. Dudgeon, R. Walker (Eds.), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, Dulwich Centre Publications, Adelaide, 2010, pp. 135-144.
Trauma, grief and loss: the vulnerability of Aboriginal families in the child protection system
  • Bessarab
D. Bessarab, F. Crawford, Trauma, grief and loss: the vulnerability of Aboriginal families in the child protection system, in: B. Bennett, S. Green, S. Gilbert, D. Bessarab (Eds.), Our Voices: Aboriginal and Torres Strait Islander Social Work, Palgrave Macmillan, South Yarra, 2013, pp. 93-113.
Decolonising identity stories: narrative practice through Aboriginal eyes
  • Drahm-Butler
T. Drahm-Butler, Decolonising identity stories: narrative practice through Aboriginal eyes, in: B. Wingard, C. Johnson, T. Drahm-Butler (Eds.), Aboriginal Narrative Practice: Honouring Storylines of Pride, Strength and Creativity, Dulwich Centre Publications, Adelaide, 2015, pp. 25-47.
Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, 2nd, Australian Government Department of the Prime Minister and Cabinet/Telethon …
  • R Marriott
  • S Ferguson-Hill
R. Marriott, S. Ferguson-Hill, Perinatal and infant mental health and wellbeing, in: P. Dudgeon, H. Milroy, R. Walker (Eds.), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice, 2nd, Australian Government Department of the Prime Minister and Cabinet/Telethon …, 2014, pp. 337-353.
Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice
  • G Gee
  • P Dudgeon
  • C Schultz
  • A Hart
  • K Kelly
G. Gee, P. Dudgeon, C. Schultz, A. Hart, K. Kelly, Aboriginal and Torres Strait Islander social and emotional wellbeing, in: P. Dudgeon, H. Milroy, R. Walker (Eds.), Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice. 2, Commonwealth of Australia, Canberra, 2014, pp. 55-68.
  • C Kezelman
  • P Stavropoulos
C. Kezelman, P. Stavropoulos, Organisational Guidelines for Trauma-Informed Service Delivery (Updated 2020), Blue Knot Foundation, 2020.