Using Theories of Posttraumatic Stress to Inform Perinatal Care Clinician Responses to Trauma Reactions

Abstract

Understanding of the importance of addressing trauma in health care is increasing rapidly. Health care providers may be actively seeking ways to address trauma sequelae affecting their patients with a trauma‐informed continuum of care. Such a continuum includes a universal approach, targeted interventions (ie, practices and programs), and specialist treatment for posttraumatic stress disorder (PTSD), as well as responses to historic and intergenerational trauma. Client presentations and their needs are highly individualized. Therefore, an understanding of prominent theories of what causes PTSD may assist perinatal care professionals in adapting their practice to be trauma‐informed and trauma‐specific. The purpose of this article is to review 4 theories of PTSD relevant to perinatal practice and present an evidence‐based practice framework that encourages collaborative choices consistent with client values and preferences. A brief summary of current evidence‐based PTSD treatment guidelines is presented.

Post‐traumatic stress symptoms and parenting in military families: A systematic integrative review

“…Research with the non‐military population suggests that females, racial, and ethnic minorities (Alexander et al, 2017; Olff, 2017; Sibrava et al, 2019) are at a higher risk of developing PTSD, and parent–child outcomes vary for maternal and paternal PTSD symptoms (Yehuda et al, 2008). Studies with racial/ethnic minorities suggest a protective role of culture in influencing different parenting domains (Cooper et al, 2020) and some evidence for a greater risk of post‐traumatic stress symptoms (Granner & Seng, 2021; Roberts et al, 2011). As military families are becoming more diverse (NASEM, 2019), future researchers should strive for more diversity in both military and non‐deployed comparison samples to study the links between demographic characteristics, PTSD symptoms, and parenting domains.…”

A student-led educational activity on trauma informed care: Reflections and recommendations.

“…HCPs are typically not well-trained in incorporating TIC principles into obstetric care, which may lead to retraumatization. Indeed, survivors of traumatic experiences may present with a failure to inhibit a fear response during such experiences, even when they are within a safe context, leading to retraumatization (Granner & Seng, 2021). Through better incorporating TIC practices into perinatal care that recognize these theoretical principles, practitioners will be more able to identify and prevent these negative sequelae of retraumatization in the perinatal period (Sperlich et al, 2017).…”

A Trauma-informed Approach to Postpartum Care

“…Patients who openly express anger or irritability in their clinical encounters 33 or who engage in high-risk behaviors such as tobacco use, substance use, overeating, or unsafe sexual activity may be doing so in an attempt to "self-regulate" and cope with untreated posttraumatic stress symptoms. 34 For this reason, TIC requires attention to universal precautions regardless of the patient's outward level of expressiveness or disclosures. Proactively describing available choices gives patients the chance to consider what seems best for them and to express their preferences; this is particularly important for those who may not be able to verbalize what they want or who do not have the health literacy skills to know what choices are available.…”

“…Given that our health care system can sometimes inadvertently harm patients, patients should be advised of their treatment options and be provided with clear information about their rights, including access to interpretation services, nondiscriminatory treatment, and ideally empathetic and supportive care from all health care team members. Patients who openly express anger or irritability in their clinical encounters33 or who engage in high-risk behaviors such as tobacco use, substance use, overeating, or unsafe sexual activity may be doing so in an attempt to “self-regulate” and cope with untreated posttraumatic stress symptoms 34. For this reason, TIC requires attention to universal precautions regardless of the patient’s outward level of expressiveness or disclosures.…”