STAR-OB Trauma-informed Obstetric Care

About the STAR-OB Initiative

The STAR-OB initiative aims to support the integration of evidence-based trauma-informed care practices into routine obstetric care by fostering:

  • Safe and supportive environments for patients and staff,
  • Trauma awareness and sensitivity,
  • Advocacy and empowerment,
  • and Respectful care and Relationship building (STAR-OB).

The STAR-OB toolkit includes clinical tools, training materials, implementation guides, and patient facing resources designed to feasibly integrate trauma-informed care into existing clinical practices.

STAR OB was developed by research team based on guidance from birthing people, obstetric clinicians, and experts in the field. Some of the toolkit content was sourced from existing evidence-based resources, while other content was developed specifically for STAR OB based on information collected from clinicians and birthing people.

The STAR-OB toolkit is composed of 4 primary components:

What is trauma-informed care, and why is it important for obstetrics?

"...There's such a significant amount of violence we’re exposed to in this culture…being trauma informed sort of is being aware that there are many triggers for everyone you are taking care of and doing your best to eliminate or mitigate things that might incite a fear or trauma response in the person you're caring for."
- OB Clinician

Many pregnant people have experienced trauma, which can make perinatal care stressful and increase the risk of pregnancy-related health conditions. However, everyone who interacts with patients has the opportunity to reduce re-traumatization and promote resilience.  

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as physical, sexual, and emotional abuse or neglect in childhood and/or adulthood and systemic violence including racism and community violence4. For pregnant people with histories of trauma, perinatal care, birth, and postpartum care can be re-traumatizing8; however, slight modifications to procedures, communication, and the care environment can enhance patients’ sense of safety and improve the patient-provider relationship22, 23.

SAMHSA has pioneered a general Trauma-Informed Care (TIC) framework, which provides scaffolding for services to enhance patients’ sense of trust and safety, empower patients by working collaboratively, encouraging peer support, and acknowledging contextual factors such as gender and race4. Estimates of lifetime trauma exposure among pregnant women range from 39%24 to 87%25, yet most obstetric clinicians and clinical staff have not received training in TIC to prevent re-traumatization from routine care practices. Given frequent clinical contact during the perinatal period, obstetric clinical teams are uniquely situated to bolster resilience during this vulnerable period by providing care that is responsive to the needs of trauma survivors.

"[Trauma informed care] is a huge thing for me, as far as my care of women, there's lots of things that neither myself nor the women have control over. But whatever things that I can give control back to people, is a huge part of what I would say I try to do, being trauma-informed."
– Obstetric Clinician

What does trauma-informed care mean for patients

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Check out the STAR-OB Toolkit Topics:

In order to provide the best care possible, it is important that providers check in with themselves and also take care of their wellness.

Patient perspectives on care are essential to informing and improving quality of clinical care. Integrating the lived experiences of birthing people with obstetric provider knowledge and awareness leads to a stronger clinical alliance, especially within the context of trauma-informed care.

It is important that obstetric care teams, from clinicians to admin to support staff, have the necessary skills to facilitate an environment where birthing people can feel safe, empowered, and trusting of the care they receive.

It is important that providers use effective communication skills to establish trust with the birthing person in a way that acknowledges that they are dealing with a human being in the exam room.