Many obstetric providers are just beginning to understand the impact that a traumatic birth experience can have on the physical and psychological health of the mother-baby dyad and the extent to which a history of previous sexual trauma can affect the birth experience.
As providers, we are well trained to identify risks, diagnose signs and symptoms of physical disease processes, and to implement the best evidence-based therapies. Unfortunately, many of us are ill equipped to identify the risks, signs and symptoms for psychological disease processes such as PTSD. As a consequence of these shortcomings in our training, we may misdiagnose these patients and unintentionally place them at an increased risk of “re-traumatization” resulting in a negative birth experience, post-partum depression, or impaired neonatal bonding.1
Trauma-informed care focuses on four basic principles:
1. Realize the impact of the trauma
2. Recognize the signs and symptoms of trauma
3. Respond by integrating trauma knowledge into policies, procedures, and practices, and
4. Resist re-traumatizing individuals.2
Below are some helpful resources for providers to learn about the benefits of implementing trauma informed care, and to assist in the development of multidisciplinary care plans that allow for optimal understanding and respect for the patient’s situation.
As providers, we are well trained to identify risks, diagnose signs and symptoms of physical disease processes, and to implement the best evidence-based therapies. Unfortunately, many of us are ill equipped to identify the risks, signs and symptoms for psychological disease processes such as PTSD. As a consequence of these shortcomings in our training, we may misdiagnose these patients and unintentionally place them at an increased risk of “re-traumatization” resulting in a negative birth experience, post-partum depression, or impaired neonatal bonding.1
Trauma-informed care focuses on four basic principles:
1. Realize the impact of the trauma
2. Recognize the signs and symptoms of trauma
3. Respond by integrating trauma knowledge into policies, procedures, and practices, and
4. Resist re-traumatizing individuals.2
Below are some helpful resources for providers to learn about the benefits of implementing trauma informed care, and to assist in the development of multidisciplinary care plans that allow for optimal understanding and respect for the patient’s situation.
Dr. Vogel gives in-person and virtual trainings for a variety of providers.
Application of Trauma Informed Care Principles
In this 8 minute video, you'll see an example of how Trauma Informed Care principles can be used to ensure bodily integrity for patients and reduce risk of psychological harm.
Helpful Readings
Click to view a PDF of all the sources listed below.
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CHILDBIRTH INDUCED POSTTRAUMATIC STRESS SYNDROME
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By Dekel, Steube, Dishy.
"Many people think of childbirth as a uniformly happy event. This belief may be responsible for the paucity of research into its possible deleterious outcomes. As unpleasant as it may be to face this, such research as exists indicates that childbirth may have negative (as well as positive) psychological effects. Postpartum women may experience psychological distress, and some may even develop mental disorders."
"Many people think of childbirth as a uniformly happy event. This belief may be responsible for the paucity of research into its possible deleterious outcomes. As unpleasant as it may be to face this, such research as exists indicates that childbirth may have negative (as well as positive) psychological effects. Postpartum women may experience psychological distress, and some may even develop mental disorders."
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DIFFERENT LABOUR OUTCOMES IN PRIMIPAROUS WOMEN WHO HAVE BEEN SUBJECTED TO ABUSE OR RAPE
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By Nerum, Halvorsen, et al.
"Sexual abuse leads to extensive injurious health effects. Several studies have shown that childhood sexual abuse (CSA) and rape in adulthood (RA) lead to problems such as sexual dysfunction, anxiety, depression, post-traumatic stress disorder, eating and sleep disturbances, functional gastrointestinal disorders and chronic pain, such as headaches, fibromyalgia and pelvic pain."
"Sexual abuse leads to extensive injurious health effects. Several studies have shown that childhood sexual abuse (CSA) and rape in adulthood (RA) lead to problems such as sexual dysfunction, anxiety, depression, post-traumatic stress disorder, eating and sleep disturbances, functional gastrointestinal disorders and chronic pain, such as headaches, fibromyalgia and pelvic pain."
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CHILDHOOD ABUSE HISTORY, PTSD, POSTPARTUM MENTAL HEALTH AND BONDING
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By Seng, Sperlich, Low, Ronis, Muzik, Liberzon.
"Research is needed that prospectively characterizes the intergenerational pattern of effects of childhood maltreatment and lifetime posttraumatic stress disorder (PTSD) on women's mental health in pregnancy and on postpartum mental health and bonding outcomes. This prospective study included 566 nulliparous women in 3 cohorts: PTSD-positive, trauma-exposed resilient, and not exposed to trauma."
*institutional access or payment may be required to see full article
"Research is needed that prospectively characterizes the intergenerational pattern of effects of childhood maltreatment and lifetime posttraumatic stress disorder (PTSD) on women's mental health in pregnancy and on postpartum mental health and bonding outcomes. This prospective study included 566 nulliparous women in 3 cohorts: PTSD-positive, trauma-exposed resilient, and not exposed to trauma."
*institutional access or payment may be required to see full article
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ANTEPARTUM AND INTRAPARTUM RISK FACTORS AND THE IMPACT OF PTSD ON MOTHER AND CHILD
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By Vogel, Homitsky.
"Trauma has been defined as an event that overwhelms one's ability to maintain a sense of control, to assign meaning to the experience and to maintain connection with others. Psychological trauma that manifests any time in the peripartum period can have significant implications for maternal, fetal and neonatal health. Up to 44% of women perceive their childbirth experience as traumatic."
"Trauma has been defined as an event that overwhelms one's ability to maintain a sense of control, to assign meaning to the experience and to maintain connection with others. Psychological trauma that manifests any time in the peripartum period can have significant implications for maternal, fetal and neonatal health. Up to 44% of women perceive their childbirth experience as traumatic."
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WHEN SURVIVORS GIVE BIRTH: UNDERSTANDING AND HEALING THE EFFECTS OF EARLY SEXUAL ABUSE ON CHILDBEARING WOMEN
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By Simkin, Klaus.
When Survivors Give Birth is written for a mixed audience of maternity care professionals and para-professionals, mental health therapists and counselors, and women survivors and their families. The authors expertly and compassionately address the unusual and distressing challenges that arise for abuse survivors during the childbirth experience.
When Survivors Give Birth is written for a mixed audience of maternity care professionals and para-professionals, mental health therapists and counselors, and women survivors and their families. The authors expertly and compassionately address the unusual and distressing challenges that arise for abuse survivors during the childbirth experience.
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