TRAUMA-RESPONSIVE CARE DURING PROCEDURES
Adapted from RHAP Contraceptive Pearl: Trauma Informed Pelvic Exams 2015
- If a person has never experienced a speculum or bimanual exam, take extra time and care to explain what will happen, what a speculum is, how it is inserted, and how to best position their body for comfort. Take into consideration a person’s age, mobility, and size during exams, and use the smallest appropriate speculum.
- Routinely provide trauma-responsive care, and not only with those who disclose a trauma history. Pelvic exams can trigger responses related to past trauma (Gorfinkel 2021), and many people will not disclose previous trauma to their healthcare providers.
- Consider how each person wants to be assisted in transferring and positioning on the exam table.
- Ensure that staff are adequately trained in safe transfers with different types of bodies and abilities.
| TRY TO | |
| Establish rapport | Introduce yourself and take a seat to demonstrate respect and ease anxiety. |
| Invest in people’s experience | Prioritize a person’s experience by asking for preferences, observing reactions, taking requested breaks, and adjusting for comfort. |
| Allow a support person | Allow a support person (partner, friend, family member, or doula). Those receiving doula support are less likely to require additional health center support resources, although pain and satisfaction are unchanged (Chor 2015). |
| Support the person’s comfort | Keep a person’s body covered, except areas being examined. Use the smallest appropriate speculum with lubricant. Say “table” instead of “bed.” Consider saying “footrests” instead of “stirrups” and offering alternative pelvic exam positions (see Ch 3). |
| Discuss relaxation techniques | Include non-pharmacological options, such as breathing, music, mindfulness etc. (see Ch 5) when discussing other pain management approaches |
| Invite the person to take control | Ask what would make the exam more comfortable. Assure control over the pace and pause if uncomfortable. Ask permission to place a speculum or intracavitary US probe, or offer self-placement. |
| Keep the abortion seeker informed | Ask about preferences for the level of detail provided. It can be helpful to say “We’re about two-thirds through” or “This part takes about one minute.” |
| Use your intuition | Assess what is helpful and follow the person’s lead. Use quiet, humor, or ask about what is important to them (such as work, kids, school or goals). |
| Go at the person’s pace | If asked to stop, do so (if safe), adding “Do you need a break now? Let’s try taking some deep breaths. Let me know when you’re ready to proceed.” |
| Check in | Check in about whether they want physical and/or emotional support during the procedure, offering an assistant’s reassurance or hand to squeeze. |
| Use supportive statements | Say “The procedure is progressing smoothly” or “Keep focusing on your breath.” |