Trauma-Informed Care in the Perinatal Period

Trauma-Informed Care in the Perinatal Period

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‍What is Trauma?

  • Trauma is an event, series of events, or set of circumstances experienced as physically or emotionally harmful or life-threatening, with lasting adverse effects on mental, physical, social, emotional, or spiritual well-being. (SAMHSA, 2024)

Key Perinatal Effects of Trauma:

Mental Health Effects:

  • Dissociation
  • Avoiding care/missed appointments
  • Difficulty connecting with baby
  • Substance use, depression, PTSD, suicidality
     

Physical Effects:

  • Preterm birth
  • Low birthweight
  • Pelvic pain
  • Gestational hypertension
  • Traumatic birth/ re-traumatization

Barriers to Perinatal Care for Trauma Survivors:

  • Frequency of exams and intrusive touch
  • Lack of privacy and control
  • Fear of speaking up
  • Experiences of invalidation

Disparities in Trauma Effects:

Black pregnant sexual violence survivors are:

     
  • 5x more likely to experience PTSD
  • 2x more likely to experience depression and anxiety
  • Less likely to experience depression and anxiety
  • Less likely to receive adequate mental health services
  • Interpersonal racism linked to very low birth weight
       

Trauma-Informed Care (TIC) Overview:

  • Reduces re-traumatization and promotes resilience by following key principles.

Four R's of TIC: (SAMHSA, 2014)

  1. Realize the impact of trauma.
  2. Recognize signs and symptoms
  3. Respond by integrating trauma knowledge
  4. Resist re-traumatization

Basic Assumptions of TIC: (NTIC, 2017)

  • Safety: Create a safe, supportive environment.
  • Trustworthiness & Transparency: Encourage honest communication.
  • Peer Support: Promote connections with supportive networks.
  • Empowerment, Voice, & Choice: Give patients control over their care.
  • Cultural, Racial, Historical, and Gender Considerations: Be aware of biases and systemic issues.

Universal Precautions for TIC:

  • Assume every patient may have experienced trauma.
  • Approach "difficult: behavior with compassion and understanding.
  • Key actions:
    • Ask permission before entering the exam room.
    • Follow through on promises and encourage feedback.
    • Insert choice whenever possible.
    • Consider cultural perspectives and potential power imbalances.
       

Support Strategies:

  • Provide emotional validation.
  • Adjust pace of care to patient comfort.
  • Invite the patient to set their goals and lead their treatment plan.
  • Be mindful of potential activators in medical settings.