Trauma-Informed Maternity Care

Abstract

Pregnancy and childbirth are often difficult experiences for women who have experienced trauma. Exposure to interpersonal trauma is common in the US population, women experience high lifetime rates of child abuse, sexual assault, and intimate partner violence and these, in turn, may impact reproductive health. The data on sexual abuse in childhood, alone, indicate that at least one in four expectant women will have a history of sexual abuse. The Centers for Disease Control and Prevention (CDC) recently estimated that one in five adult women experience completed or attempted rape. Many women experience multiple forms of trauma, and some subsequently develop posttraumatic stress disorder (PTSD). When present prior to pregnancy and childbirth, PTSD can impact pregnancy outcomes and subsequent parenting, contributing to enduring intergenerational effects of trauma. Routine screening and inquiry for interpersonal trauma is critical because providers of maternity care may not always be aware of a woman’s history. Even if a patient does not wish to disclose, the care team has communicated to her that this is an important issue that can impact birth experience and outcomes. The birth experience itself can be traumatic, even for women with no antecedent trauma history. This chapter provides practical recommendations for implementing trauma-informed care (TIC) in maternity settings and discusses examples of programs that employ principles of TIC.