Pink stickers to identify vulnerable women – smart thinking or stigmatising trauma?

Some women have risk factors for PTSD after birth. Women who have been sexually abused, for example, may have their previous trauma reignited by giving birth, particularly if they experience intrusive examinations my medical professionals. But other women are at risk too: those who have had a previous traumatic birth experience, who have a needle phobia or who suffer from anxiety or mental health problems.

At risk women may need extra support during labour. And so, with this in mind, a trial was carried out at Warwick Hospital in which a bright pink sticker was put on the maternity notes of at-risk women.

The pink sticker went on the front of the notes, along with a page number indicating where to find information about the woman’s particular condition. The introduction of the pink sticker was combined with mandatory training for the trust’s midwives in psychological health.

The scheme seems to have worked well: 85% of the women interviewed after they’d given birth reported positive feelings, saying the system had made them feel cared for and understood. A handful of women, however, felt worried about the stigma implied by the pink sticker, while a few felt that staff had been too busy to read their notes properly.

So is it a good way of identifying and supporting vulnerable women? Or should we be focusing on providing better care all round?

I asked a friend, Gemma, who herself suffered a traumatic birth, what she thought of the system. Gemma’s maternity notes mentioned her problems with anxiety, but this was ignored during a difficult labour that was handled insensitively.

Gemma writes:

“I think that system may well have helped me avoid the trauma I suffer. But I’m in two minds. ALL women should be afforded the same level of care to avoid trauma. What about the women who’ve previously suffered abuse and either dealt with it or thought they were ‘over it’ and don’t even realise they are predisposed to suffer trauma if not supported properly? They should get a pink sticker, but they wouldn’t realise it.

“I think ALL women should receive the same level of care, kindness and compassion and staff need not be reminded of this with a pink sticker, but I guess as a temporary measure maybe, if it’s working and saving people it shouldn’t be written off. It really is like sticking a plaster over a massive point blank range shot gun wound. And I suppose it boils down to sticking to the huge battle of raising awareness and increasing our knowledge of how the little things matter so much during vulnerable situations.”

I share Gemma’s feelings of unease. But perhaps the most interesting finding of the study was that midwives themselves were positive about the system, enabling them to provide better care. The authors of the article write:

“…the pink sticker system has affected the whole service in positive ways. It was acknowledged that the system works well, and the emotional understanding provided to women giving birth at Warwick Hospital has been enhanced above the usual care.”

So the system helped the midwives provide better emotional support for all women in labour, not just those with the pink sticker. Perhaps, after all, it was the training that was key to the good outcomes rather than the sticker.

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