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Trauma-Informed Care for Obstetric and Gynecologic Settings

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Abstract

Purpose

Trauma is common among those seeking Ob-Gyn care and may have pervasive impact on obstetrical and gynecological health, social functioning, and healthcare engagement. While guidelines exist on the detection and treatment of perinatal mood and anxiety disorders within Ob-Gyn care, the role of Ob-gyn clinicians in identifying and addressing patients’ traumatic experiences and related symptoms is less clearly delineated. This manuscript provides an overview of trauma-related symptoms in the context of Ob-Gyn care and practical guidance of clinicians aiming to improve their detection and response to trauma in their clinical practice.

Description

Posttraumatic stress disorder (PTSD) describes a psychiatric illness which develops as a response to a traumatic event. Women who have experienced trauma are also at increased risk for borderline personality disorder and other psychiatric comorbidities. Postpartum PTSD has particular relevance to obstetrical care.

Assessment

Screening for trauma in Ob-Gyn care can provide an opportunity to address risk and offer targeted intervention. Several brief evidence-based screening tools are available. Individuals who screen positive require assessment of immediate safety and targeted referrals. Trauma informed care describes an approach to healthcare aimed to enhance physical and emotional safety for patients and clinicians.

Conclusion

Given the prevalence and the potentially devastating and enduring impact of trauma and trauma-related symptoms, there is a critical need to address trauma within Ob-Gyn care. By recognizing the signs of trauma and initiating or referring to appropriate treatments, Ob-Gyn clinicians have a unique opportunity to better understand their patients and to improve their care.

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Acknowledgements

The authors acknowledge Alissa Huth-Bocks PhD of University Hospitals Cleveland Medical Center for her suggestions on the overall approach of trauma informed care in obstetric and gynecologic settings and for her review of recommended screening tools.

Funding

Dr. Nancy Byatt has received salary and/or funding support from Massachusetts Department of Mental Health via the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms). Dr. Moore Simas is a consultant as the Obstetric Engagement Liaison for the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms and as such has received a stipend from the Massachusetts Department of Mental Health via Beacon Health Options.

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Authors and Affiliations

  1. Department of Psychiatry, University of Colorado School of Medicine, 13001 E 17th Place; MS F546, 80045, Aurora, CO, USA

    Sarah Nagle-Yang

  2. Departments of Psychiatry and Behavioral Neuroscience and Obstetrics and Gynecology, University of Cincinnati School of Medicine, Cincinnati, OH, USA

    Jyoti Sachdeva

  3. Department of Obstetrics & Gynecology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Lulu X. Zhao

  4. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Neeta Shenai, Priya Gopalan & Meredith Spada

  5. Lakeland Regional Health, Lakeland, Florida, USA

    Nicole Shirvani

  6. Departments of Psychiatry and Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Linda L.M. Worley

  7. The Motherhood Center of New York, New York, NY, USA

    Elizabeth S Albertini

  8. Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA

    Leena Mittal

  9. Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry, and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, UMass Memorial Health, Worcester, MA, USA

    Tiffany A. Moore Simas

  10. Departments of Psychiatry, Obstetrics & Gynecology and Population & Quantitative Health Sciences, University of Massachusetts Chan Medical School, UMass Memorial Health, Worcester, MA, USA

    Nancy Byatt

Authors
  1. Sarah Nagle-Yang
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  2. Jyoti Sachdeva
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  3. Lulu X. Zhao
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  4. Neeta Shenai
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  5. Nicole Shirvani
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  6. Linda L.M. Worley
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  7. Priya Gopalan
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  8. Elizabeth S Albertini
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  9. Meredith Spada
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  10. Leena Mittal
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  11. Tiffany A. Moore Simas
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  12. Nancy Byatt
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Contributions

The authors confirm contribution to the paper as follows: Manuscript conception and design: SNY JS, NShe, NShi, LW, PG, EA, MS, NB. Draft manuscript preparation: SNY, JS, LZ, NShe, Nshi, LW, PG, EA, MS, LM. Manuscript revision and editing: SNY, TMS and NB. All authors reviewed the results and approved final version of manuscript.

Corresponding author

Correspondence to Sarah Nagle-Yang.

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Conflict of Interest

The authors Drs. Sarah Nagle-Yang, Jyoti Sachdeva, Lulu Zhao, Neeta Shenai, Nicole Shirvani, Linda Worley, Priya Gopalan, Elizabeth Albertini and Meredith Spada have no conflicts of interest. Dr. Leena Mittal served as a consultant for Sage Therapeutics in February 2019. Dr. Moore Simas is the Medical Director of Lifeline for Moms. She is the co-chair of the ACOG Maternal Mental Health Expert Work Group. Dr. Nancy Byatt is also the statewide Medical Director of MCPAP for Moms and the Executive Director of Lifeline for Families. She has served on the Medscape Steering Committee on Clinical Advances in Postpartum Depression. She has received honoraria from Global Learning Collaborative, Medscape, Miller Medical Communications and Mathematica. She has served on Advisory Boards for Sage Therapeutics. She has also served as a consultant for The Kinetix Group.

Ethical Statement

This manuscript includes a short analysis of a topic relevant to Ob-Gyn care. As it does not entail human subject research, include original data or protected health information, Institutional Review Board approval was not obtained.

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Nagle-Yang, S., Sachdeva, J., Zhao, L.X. et al. Trauma-Informed Care for Obstetric and Gynecologic Settings. Matern Child Health J 26, 2362–2369 (2022). https://doi.org/10.1007/s10995-022-03518-y

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