Power, Trauma, and Care: How Systems of Power Shape the Lived Experience of Women and Children in Healthcare
“Care can never thrive where control is the goal. True healing happens when power is shared, voices are honored, and humanity is seen.” - Mary Coughlin
Power, Trauma, and Care: How Systems of Power Shape the Lived Experience of Women and Children in Healthcare
How Power Shapes the Experience of Trauma in Healthcare
Power in Institutional Policies
Power in Systems of Reproductive Control
How Do We Disrupt Systems of Power?
When a mother walks into a healthcare setting with her child, she’s often reassured they’re in "good hands." But whose hands are they, really? Whose needs are those hands serving? And who holds the power to decide what "good care" actually looks like?
For many women and children — especially in spaces like NICUs, pediatric wards, and maternal health clinics — healthcare is a place where healing and harm coexist. While the people providing care may be compassionate and well-intentioned, the systems governing care delivery often work against them. These systems, built on hierarchy, policy, and bureaucracy, shape every aspect of the care experience.
Power is not inherently harmful. When shared, power heals. But when power is hoarded, unchecked, or invisible, it becomes a source of control, exclusion, and trauma. For parents, it can feel like being locked out of decisions about their baby’s care. For clinicians, it feels like being asked to "follow the rules" even when it goes against their professional instincts. For babies, it shows up as a loss of belonging and co-regulation — the very experiences that foster healthy development.
These experiences aren’t isolated. They are systemic. They happen because of policies, hierarchies, and norms that privilege control over care. But they don't have to. We can disrupt these systems by recognizing the power dynamics at play and creating spaces where care is relational, healing, and human.
How Power Shapes the Experience of Trauma in Healthcare
Trauma is often seen as a singular event — an injury, a crisis, a moment of rupture. But in healthcare, trauma is often the result of power imbalances that occur over time, subtly and repeatedly. It's the parent who is told, "You can't visit right now." It's the nurse who knows skin-to-skin care is essential but is overruled by a physician. It's the woman experiencing a miscarriage in a Catholic hospital, forced to "wait and watch" for the fetus to have no cardiac activity before receiving care.
These moments are not isolated. They are part of a larger pattern of systemic power. Here are three of the most pervasive ways power shapes trauma in healthcare:
Power in Medical Hierarchies
In most healthcare systems, doctors hold the highest authority, followed by nurses, with parents and patients at the bottom of the chain. While this chain of command can ensure quick decision-making in emergencies, it often works against the relational care that families need.
How This Power Imbalance Shows Up
For Parents: Parents, especially mothers, may feel dismissed, belittled, or "talked over" in care decisions for their child. Their instincts, questions, and suggestions are often seen as "emotional" rather than credible contributions to the care plan.
For Clinicians: Nurses, social workers, and other caregivers are often asked to enforce rules they do not believe in, like denying parental presence during NICU rounds or telling a mother she cannot hold her baby.
For Babies: Babies are deeply attuned to their parents' emotional states. When parents are disempowered or disconnected from their role, babies lose access to the emotional co-regulation they need for brain development.
Narrative Moment One NICU nurse shared this story:
“A mother asked me if she could hold her baby skin-to-skin, and I knew it was exactly what the baby needed. But the physician said it wasn’t the right time. I had to tell her no. The look on her face — that moment stays with me. I knew it wasn't right, but I didn’t have the power to say yes. I felt like I betrayed both of them.”
Reflection Prompt
For Clinicians: Have you ever experienced a moment where you were asked to "follow the rules" even when it felt wrong? How did that moment affect you?
For Parents: Have you ever felt dismissed, silenced, or ignored during your child’s care experience? What did that experience leave you feeling about your role as a parent?
Power in Institutional Policies
Policies are often framed as "safety measures," but too often, they prioritize efficiency over human connection. This was made painfully clear during the COVID-19 pandemic, when hospitals imposed rigid visitation policies in NICUs. The goal was infection control, but the result was emotional devastation.
How This Power Imbalance Shows Up
For Parents: Parents were banned from visiting their newborns in the NICU during COVID-19. For weeks or months, they were separated from their babies during the most formative period of attachment.
For Clinicians: Nurses were forced to enforce these policies, which often meant turning parents away at the door, knowing it would cause pain.
For Babies: Babies in NICUs rely on skin-to-skin contact to stabilize heart rate, sleep cycles, and emotional regulation. Depriving them of their parents during this critical period can have long-term developmental consequences.
Narrative Moment
“One mother called every day, begging to see her baby. She sobbed into the phone, saying, ‘I just want to hold him.’ But hospital policy was clear — only one parent could visit, and her husband had already been there that week. I had to tell her no. I will never forget her voice.” — NICU Nurse
Reflection Prompt
For Parents: How did COVID-era hospital policies affect your connection with your baby? How do you continue to heal from that experience?
For Clinicians: Have you ever had to enforce a policy you didn't agree with? How did it affect your sense of purpose as a caregiver?
Power in Systems of Reproductive Control
In Catholic hospitals, miscarriage care is sometimes delayed because policies require waiting for "cardiac activity to cease" before intervention. This often means patients are sent home to wait for their miscarriage to "progress," leaving them to endure days of unnecessary pain and uncertainty.
How This Power Imbalance Shows Up
For Patients: Women experiencing miscarriage at Catholic hospitals report being left in limbo, unable to access the care they need.
For Care Providers: Nurses and physicians are often bound by institutional religious doctrine, even when they know it violates best medical practice.
For Family Members: Partners and support people feel helpless as they watch their loved one suffer, unable to advocate for better care.
Narrative Moment
“I was already grieving the miscarriage, but being forced to stay in that state for days — in pain and in limbo — felt like punishment. It wasn’t medical care. It was control.” — Patient at a Catholic Hospital
Reflection Prompt
For Parents: Have you experienced a medical decision that felt like it was rooted in policy or power, rather than care and compassion? How did that experience impact your sense of agency?
How Do We Disrupt Systems of Power?
Disrupting systems of power doesn’t require dismantling entire institutions. It starts with small shifts in perspective and practice. Trauma-Informed Developmental Care (TIDC) offers a pathway forward.
Shifts That Disrupt Power in Healthcare
Honor Family Voice and Choice: Stop making decisions for families. Make decisions with them.
Flatten Hierarchies: Invite nurses, parents, and caregivers to be active co-creators of care, not passive participants.
Center Relational Authority: Relational authority is about earning trust through authentic relationships, not through titles or credentials.
Reflection Prompt
For Everyone: Where do I have power in this system, and how am I using it? Am I using it to control or to connect?
Call to Action
The systems of power that shape healthcare aren't inevitable. They were designed — and what is designed can be redesigned.
Every time we center care, connection, and co-creation, we resist systems of power that seek to control. We move from isolation to belonging. From silence to shared humanity. From trauma to healing.
If you’re a parent, your voice matters. If you’re a nurse, your agency matters. If you’re a clinician, your compassion matters.
Care is greater than control. Let’s start there.
Take care,
Mary
