Interventions needed to address trauma in obstetric care

Interventions needed to address trauma in obstetric care | Image Credit: © kishivan – © kishivan – stock.adobe.com.

Obstetric patients often face trauma and traumatic stress, indicating a need for interventions that enhance patient-centered care, according to a recent study published in Pregnancy.¹

Experts have noted a broad range of sources for trauma, including emotional abuse, neglect, loss, and systemic abuses of power. Trauma-informed care (TIC) encourages providers to recognize signs of trauma in their patients and respond with empathy to avoid re-traumatization.

“In obstetrics and gynecology (OB/GYN), TIC is especially relevant, as much of this care occurs in intimate and vulnerable settings where physical exposure and examinations may trigger traumatic memories, or emergent scenarios may impair a patient’s sense of autonomy,” wrote investigators.

Effects of trauma and chronic stress

Experiences of trauma have been linked to the release of cortisol and catecholamines.² These stress hormones may lead to long-term adverse outcomes if chronically elevated, including increased inflammation, worse emotional regulation, impaired communication, and complications in interpersonal relationships.¹

The most common examples of traumatic experiences include adverse childhood experiences (ACEs) such as neglect, abuse, and household dysfunction occurring when an individual is aged under 18 years. Increased ACEs have been linked to higher odds of chronic diseases, psychiatric illness, and harmful behaviors.

TIC has been highlighted as beneficial to reduce racial health disparities, especially the significant differences in maternal and neonatal morbidity and mortality. Traumatic life events (TLEs) are more common in Black patients vs White patients, and these events are often heightened by racial discrimination, highlighting a need for TIC to improve health equity.

Pregnancy and childbirth as trauma triggers

Challenges toward an individual’s sense of control and body autonomy make pregnancy and childbirth traumatizing in many patients as well. In those with traumatic stressors, there is also a risk of re-traumatization, especially for marginalized populations. Traumatic events such as stillbirth and pregnancy loss may also occur in pregnant women.

These concerns have led investigators to recommend TIC during patient encounters. Therefore, the review was conducted to provide guidelines for TIC implementation into obstetric practice.

Articles were identified through searches of the PubMed and OVID databases. Investigators screened 482 PubMed articles and 167 OVID articles, excluding 319 and 91, respectively. Context and recommendations were based on current TIC curricula and key society guidelines.

Disparities and risks from trauma

Approximately 1 in 3 pregnant patients report at least 1 TLE, with many reporting multiple. The data highlighted significant increases in trauma risk among non-Hispanic Black patients vs non-Hispanic White patients, with an odds ratio (OR) for post-traumatic stress disorder (PTSD) of 1.22. However, an OR of 0.3 was reported for seeking mental health treatment, highlighting reduced odds.

An association between childhood trauma and intimate partner violence risk during pregnancy was also reported, with an adjusted OR (aOR) of 2.48. Additionally, the aOR was 4.40 in patients with 3 or more ACEs, highlighting a greater risk. These patients were also more likely to distrust providers and inadequately utilize prenatal care.

A survey found that trauma history was also linked to increased odds of postpartum mood disorders. Of patients hospitalized for severe postpartum mood disorders, 76% had a history of trauma, and 24% qualified for a complex PTSD diagnosis. In comparison, rates among the general population were 22.7% and 0.5%, respectively.

Adverse pregnancy and perinatal outcomes

Perinatal adverse outcomes linked to traumatic stress include pregnancy loss and infertility, with relative risks of 1.96 and 2.75, respectively, among patients with multiple ACEs. Pregnancy complications such as substance use, decreased sleep quality, gestational diabetes, and hypertensive disorders were also more common in these patients.

Adverse effects in offspring were also reported. This included children of mothers with PTSD having a mean increase of 3.6 points in their Ages and Stages Questionnaire: Social-Emotional score. Attention-deficit-hyperactivity disorder, PTSD, and other psychological disorders were also more common in these children.

This data highlighted the prevalence of trauma and traumatic stress in OB/GYN patients. Investigators concluded that TIC is vital to reduce these adverse outcomes.

“Recognizing and responding to trauma is not only essential for clinical excellence but also for advancing health equity and reducing the disparities that drive maternal morbidity and mortality in vulnerable populations,” wrote investigators.

References

1. Schroeder BE, Kuller JA, Dotters-Katz SK. Reframing obstetric care through a trauma-informed lens: A narrative review of trauma-informed principles and clinical applications. Pregnancy. 2025;1(5). doi:10.1002/pmf2.70081
2. Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019;15(9):525-534. doi:10.1038/s41574-019-0228-0