How to assess and treat a client who reports that pregnancy is a trauma trigger?

Assessment and Treatment for Clients with Pregnancy as a Trauma Trigger

For clients who report pregnancy as a trauma trigger, comprehensive trauma-informed care should focus on early identification of coping abilities and implementation of active coping strategies to prevent post-traumatic stress symptoms and improve maternal-fetal outcomes.

Initial Assessment

• Screen for previous trauma history and specific pregnancy-related triggers to understand the nature and severity of the trauma response 1
• Assess coping skills and perceived ability to effectively deal with stress, as low levels of perceived coping ability during early pregnancy are associated with increased risk of PTSD symptoms postpartum 2
• Evaluate for avoidant coping behaviors, which are consistently associated with greater psychological distress during pregnancy and postpartum 2
• Check for signs of current psychological distress, including anxiety, depression, and post-traumatic stress symptoms 2
• Determine if the client is experiencing physical symptoms related to trauma responses (e.g., hyperarousal, dissociation) 1

Treatment Approaches

Psychological Interventions

• Implement approach-oriented coping strategies, which have been shown to predict reduced depressive symptoms postpartum 2
• Provide cognitive-behavioral therapy to address trauma responses and develop healthy coping mechanisms 2
• Focus on acceptance-based strategies, which correlate with less distress over time and better prenatal care in American women 2
• Avoid encouraging avoidant coping mechanisms, as greater avoidant coping is associated with increased psychological distress and potentially higher risk of preterm birth 2
• Consider cultural context when recommending coping strategies, as effectiveness may vary across different cultural backgrounds 2

Medication Management

• If pharmacological intervention is necessary, carefully weigh risks and benefits of medications such as SSRIs 3
• For pregnant patients requiring SSRIs, be aware that exposure in late pregnancy may lead to increased risk for neonatal complications requiring prolonged hospitalization and respiratory support 3
• Discuss the National Pregnancy Registry for Antidepressants as a resource for patients taking antidepressants during pregnancy 3
• Monitor for potential increased risk of postpartum hemorrhage with SSRI use in the month before delivery 3

Trauma-Informed Obstetric Care

• Maintain continuity of care with the same providers when possible to build trust 1
• Provide detailed information about all procedures and obtain ongoing consent throughout pregnancy care 1
• For Rh-negative women with trauma history, ensure appropriate anti-D immunoglobulin management to prevent additional medical complications 4
• After any physical trauma during pregnancy (even minor), arrange for systematic obstetrical examination to assess for potential fetal morbidity 2

Special Considerations

For Patients with Substance Use Disorders

• Encourage women with opioid use disorder to remain on prescribed medications throughout pregnancy, as MAT increases adherence to prenatal care 2
• Recognize that childbirth can be a stressful time for women with trauma histories, potentially diminishing coping mechanisms and triggering retraumatization 2
• Address fears about potential involvement of child welfare agencies and custody issues, which may exacerbate trauma responses 2

For Patients with Previous Traumatic Birth Experiences

• Develop a detailed birth plan that addresses specific trauma triggers and coping strategies 2
• Consider prenatal consultation with anesthesia and psychology services for women with significant trauma histories 2
• Provide education and anticipatory guidance about pain control options during labor and delivery 2

Monitoring and Follow-up

• Implement regular screening for PTSD symptoms throughout pregnancy and postpartum period 2, 1
• Monitor for signs of psychological decompensation that might indicate need for more intensive intervention 2
• Assess for changes in coping strategies and provide additional support as needed 2
• Be vigilant for signs of domestic violence, which is a common cause of trauma during pregnancy 5, 6

Prevention Strategies

• Incorporate trauma prevention education into routine prenatal care 6
• Teach specific coping skills to enhance psychological adjustment during pregnancy and postpartum 2
• Provide resources for social support and community connections 1
• Develop safety plans for women at risk of domestic violence or other forms of trauma 5