Designing a Trauma-Informed Maternal Mental Health Intervention for Acute Stress Events

Background and purpose: Perinatal mood and anxiety disorders (PMADs) address the spectrum of perinatal mental health challenges, including depression, anxiety, post traumatic stress disorder (PTSD), obsessive compulsive disorder, and postpartum psychosis during and after pregnancy. Anywhere between 7% to 63% of mothers will experience PPD globally. Currently, the main cause of maternal death after birth of a child is suicide relating to PMADs. Previous studies have indicated postpartum care that is not trauma-informed or culturally sensitive can contribute to postpartum mental health challenges. Despite these known risks, there are few interventions addressing the host of challenges presented. There are multiple promising research endeavors centered on providing tele-mental health for PPD; however, none are within the context of COVID-19 trauma or other acute stressful events, and none specifically address racial and ethnic disparities in the perinatal care experience. To fill this gap, an intervention was developed from research conducted during the COVID-19 pandemic on acute stressful events, environmental stressors, and postpartum mental health. The developed intervention has the potential to bridge the gap in maternal mental health disparities by providing a no-cost, trauma-informed tele-mental health intervention for PMADs.

Methods: This research used previously collected and analyzed data from a study investigating the experiences of mothers belonging to marginalized groups who became mothers during the COVID-19 pandemic. The original study centered on environmental conditions of perinatal care, perceived racism, trauma experienced, and the perinatal experience. The study used a qualitative story inquiry design that gathered stories from pregnant mothers (n=15), mothers who gave birth (n=35), nurses, doulas and midwives who worked with perinatal populations (n=5), and persons who were support people (n=5) to perinatal populations. The original study centered around the Theory of Supportive Care Environments and focused on what factors created a supportive care environment for mothers during the perinatal period. Using this analyzed data, the research team used intervention mapping, which is a six-step documented process for creating an intervention.

Results: These findings illuminated specific, contextual ways that therapeutic providers could create a safe, culturally relevant, trauma-informed space for mothers experiencing mental health challenges. The intervention matrix contains five research informed modules (Depression, Pervasive Uncertainty, Social Connection, Health Care Empowerment, and Maternal Role) in addition to 3 potential add-ons (Suicidality, Cultural Specificity, and IPV) based on clinician decisions. Each module includes goals, targets, and resources for clinicians.

Conclusions and Implications: This intervention was evidence-based and trauma-informed and has the potential to overcome multi-dimensional disparities in maternal mental health care. Participants will learn steps to intervention development that are culturally, trauma, and research informed. In addition, participants will understand specific environmental stressors that impact those giving birth and how that impacts their mental health.