Trauma-Informed Obstetric Care: Development and Implementation of a Stakeholder-Informed Toolkit for Obstetric Providers and Patients

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PROJECT SUMMARY/ABSTRACT Many pregnant women have experienced trauma, which can make perinatal care stressful and increase the risk of pregnancy-related health conditions. However, obstetric providers can modify procedures to reduce distress and enhance patients’ sense of control and safety. Although obstetric providers frequently care for trauma survivors, most are not trained in trauma-informed care (TIC). Additionally, there are no data on feasibility, appropriateness, or acceptability of TIC tools and interventions in the context of obstetrics. The goal of the proposed K23 project is to develop the first, stakeholder-informed obstetric TIC toolkit composed of treatment protocols, clinician training, trauma and violence screening tools, and other resources to help obstetric providers apply TIC practices to all clinical interactions in addition to identifying and providing support for trauma survivors. The obstetric TIC intervention toolkit (OB-TIC) will be developed in collaboration with key stakeholders (pregnant and postpartum patients, nurses, physicians, and administrators) to ensure that it is feasible, acceptable, appropriate, cost-effective, and clinically useful. Current practices and preferences will be characterized in qualitative interviews with stakeholders which will inform the development of OB-TIC in collaboration with a community working group of stakeholders. A pilot implementation trial of OB-TIC will be conducted in two outpatient obstetrics clinics to gather real-world data that will inform the final intervention toolkit, which will be tested on a larger scale in future (R01) studies. The K23 award will facilitate the candidate’s transition towards an independent research career focused on improving the well-being of women through trauma-informed perinatal healthcare and implementation science, which is directly in line with the NICHD pregnancy and perinatology priority of “improving the health of women before, during, and after pregnancy.” To date, the candidate’s training has focused on developing clinical expertise in perinatal behavioral medicine, and research experience in obstetrics, perinatal stress, and behavioral interventions for stress and discrimination. The K23 award will provide protected time for training in 1) implementation science methodology focused on the development of stakeholder informed interventions and scale-up and spread of evidence-based interventions; 2) qualitative research methodology, a foundational component of implementation science and stakeholder-based intervention development; 3) and trauma-informed care in obstetrics, which will provide a knowledge base for OB-TIC. Experts in each of the key training domains will provide individual mentorship in addition to specialized workshops and didactics. During the proposed K23 award, the candidate will be a Research Scientist at The Miriam Hospital and an Assistant Professor at Brown University. This environment is rich with innovation and collaboration and will enhance the candidate’s training and facilitate their research goals. The mentorship and skills gained as part of this K23 award, will prepare the candidate to pursue funding for an R01 focused on a randomized controlled trial of OB-TIC.