Reducing Birth Trauma Among High-Risk Pregnant Women: A Case Study of a Community Hospital Intervention Site

Background: Pregnant women with histories of past trauma (e.g., sexual victimization, domestic violence, and childhood abuse or neglect) and prior traumatic pregnancies and/or childbirth experiences represent a subset of the population who are at increased risk of a subsequent traumatic birth. A traumatic birth may include an emotionally and/or physically traumatic experience. Women with past histories of trauma have reported feeling emotionally traumatized through feelings powerlessness and being paralyzed by fear during labor and delivery, while other women have reported feeling physically traumatized as the sensations of labor and delivery feel similar to experiences of past trauma. Interventions during the perinatal period for high-risk populations are severely lacking, even though many trauma survivors will go on to have a child and there is evidence that they are more likely to experience re-traumatization during the birth process and perinatal mental health complications subsequent to giving birth. An intervention for women in the perinatal period who have prior histories of trauma could improve overall perinatal experiences, increase care utilization, and better screen for and treat perinatal mental health disorders. Moreover, such an intervention could prove to be especially important given the decreased care utilization since the COVID-19 pandemic began.

Methods: This study uses a qualitative case study approach to detail the development and implementation of a novel program within the labor and delivery unit of a hospital system. This program, Supportive Services, provides specialized perinatal support to pregnant women who have experienced previous birth trauma and/or a previous history of victimization. Participants recruited include perinatal healthcare professionals (e.g., OBGYN’s, labor and delivery nurses, hospital administration). Focus groups and individual interviews were conducted to learn more about the development and implementation of Supportive Services and open coding and thematic analysis was conducted on all data.

Findings: Three distinct themes emerged from participants responses that describe the ongoing process of change that comes with development and implementation of Supportive Services: (a) a program that will mitigate future trauma; (b) helping patients will challenge the system status quo; and (c) there is not a template for this program. Obstetric providers see a common need for Supportive Services, share common experiences related to how the COVID-19 pandemic may have been especially difficult for patients with previous histories of trauma, share similar expectations that the program will create positive changes for both patients and providers, and share similar concerns about potential challenges that may arise.

Conclusions/Implications: The results of this study suggests that Supportive Services potentially fill an important gap in obstetric-related interventions for survivors of previous trauma, especially during the height of the COVID-19 pandemic. However, the broader implementation of Supportive Services will require significant system-level changes such as trauma-related training for all obstetric providers, dedicated providers to provide patient consultations, and funding to ensure the program’s long-term financial sustainability.