Trauma Informed Care in Pelvic Acupuncture

If you’ve taken my practical or my ethics class, you’ve probably heard me reference this study before and I’m going to do it again, here in writing, because it’s a good one.

In 2006, Pallavi Latthe and her colleagues at the University of Birmingham published a systematic review in the BMJ that pooled data from 122 studies and over 94,000 women. They were trying to understand what predisposes women to chronic pelvic pain. What they found, across dysmenorrhea, across dyspareunia, across non-cyclical pelvic pain, was a pattern so consistent it could not be set aside. Sexual abuse. Childhood abuse. Anxiety. Depression. Psychological comorbidity. These were not minor risk factors. They were named, study after study, alongside the gynecological and the inflammatory and the structural, as central to the picture of who ends up living with pelvic pain.

What this means in practice is this. If you are seeing pelvic patients, you are seeing trauma. Not occasionally. Not in a few sensitive cases. Consistently. The pelvic bowl is one of the places the body keeps the score, and when a patient walks into your room with pelvic symptoms, the odds are very high that some part of what she is carrying has been carried for a long time.

This is the room we are working in. So we need to be the practitioners the room requires.

What trauma informed care actually means

Trauma informed care is not a curriculum or a certificate. It is a posture. It is the assumption, made in advance of any conversation, that the body in front of you has a history you do not fully know. Some of that history may have been spoken. Some may never be. Some may not even be conscious to the patient herself.

The work is not to extract the history. The work is to make the room safe enough that the body does not have to defend itself while you are trying to treat it.

Safety is not a feeling we can promise. It is an environment we can build.

Building the environment

What follows is a set of practices for emotional and physical safety in a pelvic acupuncture session. Some of these are clinical. Some are spatial. Some are relational. All of them communicate to the patient, often before a single word is spoken, that she is in the hands of a practitioner who takes her body seriously. This has to be your mindset.

Before the session

The conversation about safety begins before the patient is on the table. Set expectations in plain language. Tell her what you will do. Tell her what you will not do without her consent. Tell her she can stop the session at any point, for any reason, without explanation, and that there will be no questions and no judgment. Ask her if there is anything about her body, her history or her preferences that would help you serve her well. Let the silence be okay if she does not have an answer.

Then leave the room while she gets on the table.

The environment itself

Create a room she can settle into.

A private space with a door that closes. A pillow for her head, a pillow between her knees, and sometimes a pillow she can hold against her chest if that helps her ground. A top sheet and a bottom sheet, never just one, and a blanket she can pull up. A temperature that is warm enough that the body does not have to brace.

When you re-enter the room, approach her face before you approach her pelvis. This is paramount. It matters more than it sounds like it should.

During the session

Describe each step before you take it. I am going to lift the sheet to expose this area. I am going to palpate here. I am going to insert a needle near this point. Don’t rush. Pause between sentences. Watch her breath. If her breath changes, name it gently and offer her a moment.

Practice precise draping. Expose only what you need to expose, only for as long as you need to expose it. Cover the rest. The patient should never feel more uncovered than the clinical work requires.

Keep physical contact with the client.

Stay with her during the first pelvic session. Do not leave the room. Trust takes time and the first session is not the time to test how much she can hold on her own.

Clinical hygiene as relational care

Some of what we call sterile technique is also emotional language. The patient is watching how you handle her body. She is noticing whether you washed your hands. Whether you put on gloves before approaching her pelvis. Whether the area was cleaned. Whether each needle came from a single sealed package or was discarded into a blister pack if not used. Whether you palpated carefully before inserting, alert to vessels and nerves and lymph channels. Whether you spread the tissue with attention before the needle went in.

These are clinical practices. They are also messages.

The pacing of treatment itself

I want to say something about the rhythm of the work.

You do not have to needle the pain on the first visit. In fact, I would gently suggest that you not. Give the patient a session or two of gentle constitutional work, of distal points, of light palpation, of building familiarity with your touch and your room and your voice before you take a needle anywhere near the pelvic floor. Let her nervous system meet you in the easier places first.

When the body knows you, the pelvis will let you in.

After the session

Be mindful of her emotions before, during and after. Some patients leave a pelvic session with tears they cannot quite explain. Some leave with a stillness that takes them days to metabolize. Some leave talking too quickly, joking, brushing it off. All of these are normal nervous system responses to having a held part of the body finally attended to.

Check in. Not with intensity, but with care. Ask how she is. Honor what she says. Honor what she does not.

The deeper invitation

Trauma informed care is not a separate offering from our medicine. It is our medicine, practiced with the full understanding of what a pelvic body has often had to carry.

The patients who walk into your room with pelvic pain have, statistically and clinically, been carrying more than the symptom on the intake form. The Latthe review is one of dozens that confirm what most of us already sense when we sit across from these patients. The body knows. The body has been waiting for someone to meet it carefully.

Be that practitioner.

Be the acu who knows how.

References

Latthe, P., Mignini, L., Gray, R., Hills, R., & Khan, K. (2006). Factors predisposing women to chronic pelvic pain: Systematic review. BMJ, 332(7544), 749–755. https://doi.org/10.1136/bmj.38748.697465.55