Associate Professor of Psychiatry and Obstetrics and Gynecology, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH.
Associate Professor of Psychiatry, University of Colorado School of Medicine, Aurora, CO.
J Acad Consult Liaison Psychiatry. 2022 Sep-Oct;63(5):485-496. doi: 10.1016/j.jaclp.2022.04.005. Epub 2022 May 3.
Trauma is highly prevalent, and women are twice as likely as men to develop posttraumatic stress disorder following a traumatic exposure. Consequently, many women entering the perinatal period have trauma histories. In the perinatal period, a trauma history can negatively impact treatment engagement and adversely affect the experience of pregnancy, postpartum, and parenting. A trauma-informed care approach can mitigate these effects.
This review aims to summarize literature that can aid psychiatrists in (1) identifying signs and symptoms of trauma in perinatal women, (2) integrating elements of trauma-informed care into perinatal mental health care, and (3) offering interventions that can minimize adverse outcomes for perinatal women and their children.
A PubMed search was conducted with keywords including trauma, pregnancy, perinatal, posttraumatic stress disorder, postpartum posttraumatic stress disorder, and trauma informed care.
Perinatal care, given its somewhat invasive nature, has the potential to traumatize or cause retraumatization. Trauma-related disorders are common and can present or worsen in the perinatal period. Trauma can manifest in multiple forms in this population, including exacerbation of preexisting posttraumatic stress disorder, new onset acute stress disorder in the perinatal period, or postpartum posttraumatic stress disorder secondary to traumatic childbirth. Unaddressed trauma can adversely affect the experience of pregnancy, postpartum, and parenting. Psychiatrists caring for women in the perinatal period are in an ideal position to screen for trauma and offer appropriate intervention. A trauma-informed approach to obstetric care can help clinical teams respond to the unique trauma-related challenges that can arise during obstetric care. Trauma-informed care, with its emphasis on establishing a culture of safety, transparency, trustworthiness, collaboration, and mutuality, can empower health care providers and systems with powerful tools to respond to trauma and its myriad effects in a strengths-based manner. By applying a trauma-informed lens, psychiatrists can help their obstetric colleagues provide patient-centered compassionate care and treatment.
Applying a trauma-informed approach to evaluation and treatment of perinatal populations could decrease the toll trauma has on affected women and their children.
创伤很普遍，女性在经历创伤后发生创伤后应激障碍的可能性是男性的两倍。因此，许多进入围产期的女性都有创伤史。在围产期，创伤史会对治疗参与产生负面影响，并对怀孕、产后和育儿体验产生不利影响。以创伤知情护理方法可以减轻这些影响。
本综述旨在总结文献，帮助精神科医生：(1)识别围产期女性的创伤迹象和症状，(2)将创伤知情护理的要素纳入围产期精神保健，以及(3)提供干预措施，尽量减少围产期妇女及其子女的不良后果。
使用包括创伤、怀孕、围产期、创伤后应激障碍、产后创伤后应激障碍和创伤知情护理在内的关键词，在 PubMed 上进行了搜索。
围产期护理因其具有一定的侵入性，有可能造成或加重创伤。与创伤相关的障碍很常见，并可能在围产期出现或恶化。在这一人群中，创伤可以多种形式表现出来，包括先前存在的创伤后应激障碍恶化、围产期新发急性应激障碍，或创伤性分娩导致的产后创伤后应激障碍。未得到解决的创伤会对怀孕、产后和育儿体验产生不利影响。照顾围产期女性的精神科医生处于理想的位置，可以进行创伤筛查并提供适当的干预。以创伤知情的方式进行产科护理可以帮助临床团队应对产科护理期间可能出现的独特与创伤相关的挑战。以创伤知情护理为重点，建立安全、透明、值得信赖、协作和相互尊重的文化，可以为医疗保健提供者和系统提供强大的工具，以基于优势的方式应对创伤及其众多影响。通过应用创伤知情视角，精神科医生可以帮助他们的产科同事提供以患者为中心的关爱和治疗。
将创伤知情方法应用于围产期人群的评估和治疗，可以减少创伤对受影响的女性及其子女的影响。
