Tuesday, October 18, 2022

Trauma-Informed OB Care Can Help Pregnant Women, Their Children

A history of trauma in pregnant women can negatively impact the experience of pregnancy, postpartum, and parenting. Psychiatrists caring for women in the perinatal period are in an ideal position to screen for trauma and work with obstetrical (OB) clinical care teams to respond to the trauma-related challenges that can arise during obstetric care, according to the authors of a review article in the Journal of Consultation-Liaison Psychiatry.

“Women are specifically vulnerable to gender-related traumatic events such as unwanted pregnancy, reproductive loss, traumatic birth, childhood sexual abuse, sexual assault, rape, and intimate partner violence,” wrote Jyoti Sachdeva, M.D., an associate professor of psychiatry and obstetrics and gynecology at the University of Cincinnati, and colleagues. “Perinatal care, given its somewhat invasive nature, has the potential to traumatize or cause re-traumatization.”

The literature review by Sachdeva and colleagues summarizes research showing how a mother’s experience with trauma can impact everything from birth outcomes (such as preterm birth) to the way a mother bonds and interacts with her child.

The authors described several instruments (such as the Adverse Child Experiences Score and the Trauma Screening Questionnaire) that can be used to routinely screen women in the perinatal period for trauma history. They also outlined what the authors termed “physical, behavioral, and emotional warning signs” that suggest that a patient may have a history of trauma (including unexplained somatic symptoms; delayed or absence of prenatal care; and/or panic attacks, flashbacks, and dissociation triggered by pelvic exams). Lastly, they described how women who experienced trauma might benefit from psychotherapy and/or pharmacotherapy.

“Psychiatrists working in collaboration with obstetrical colleagues have the opportunity to positively impact systems of care by facilitating the implementation of trauma-informed, patient-centered care,” Sachdeva and colleagues concluded. “This opportunity requires expertise in recognizing the sequelae of trauma in perinatal populations and engaging our obstetrical colleagues to sensitively screen for trauma and involving patients in universal TIC [trauma-informed care]. By raising the awareness of obstetrical teams to the importance of gathering an accurate trauma history and providing TIC, patients will be empowered to communicate their choices and exert control through their perinatal course, decreasing the likelihood for re-traumatization and mitigating trauma-related symptoms.”

For related information, see the Psychiatric News special report “Women’s Reproductive Mental Health—A Clinical Framework.”

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