Clinicians' Experiences and Recommendations for Implementing Trauma-Informed Care in Perinatal Settings.

Abstract

Although trauma-informed care (TIC) is increasingly recognized as essential, its inclusion in perinatal care remains limited. Over 50% of reproductive-age individuals in the United States report experiencing childhood adversity, highlighting a critical need for TIC. The contextual factors shaping TIC implementation in perinatal settings remain underexplored. This study seeks to understand perinatal clinicians' experiences of the implementation determinants that influence TIC integration at system- and practice-levels. Between June 2024 and October 2024, we conducted in-depth, semi-structured interviews with perinatal clinicians practicing in an urban academic health system about their perspectives on incorporating TIC into perinatal services. Interviews were audio- and video-recorded and transcribed verbatim. The Consolidated Framework for Implementation Research (CFIR) was used as the theoretical framework for the analysis. Transcripts were analyzed inductively to identify emergent themes, and then deductively mapped to CFIR's 5 inner setting factors. Among 23 clinicians interviewed, there were certified nurse-midwives, obstetrician-gynecologists, advanced practice registered nurses, and a family physician. Most participants (95.7%) identified as women with an average of 11.8 years in practice (SD = 9.4). Participants shared that challenges to implementing TIC are largely systemic and rooted in system inflexibility, which is reflected by a lack of supportive structures, standardized processes, and dedicated resources. Perinatal clinicians' responses illuminated best practices in addition to insights and opportunities to improve clinical practice and organizational culture in providing TIC for pregnant individuals. Despite persistent challenges, leveraging identified facilitators, such as enhanced institutional support, and promoting interprofessional collaboration can inform strategies to more effectively embed TIC in perinatal care and improve outcomes for pregnant and postpartum individuals.