Best practices for limiting risk of posttraumatic stress relapse during childbirth

Women who have a past history of sexual assault, childhood abuse, or other traumatic experiences are at high risk of developing posttraumatic stress disorder (PTSD), which can have devastating effects on the individual women, their children, and their entire families. When women with a past history of trauma go through the stressful process of childbirth, they are likely to encounter several triggers that could lead to a sudden exacerbation of PTSD symptoms, which include uncontrolled anxiety, flashbacks of prior trauma, and re-traumatization.;Current obstetrical care practices do not routinely include screening patients for PTSD or employing an individualized approach to women in labor who have a history of prior trauma. Since it is known that a woman with a trauma history may experience labor and delivery as an acute, re-traumatizing event, clinicians must begin to identify women with such a history, screen for posttraumatic stress symptoms, and facilitate mental health referral for symptom management. Yet even beyond providing referrals, the obstetrician has a unique role to play in reducing the risk of posttraumatic stress exacerbation.;Resilience, the capacity for adaptive stress coping, is a protective and potentially modifiable characteristic that enables individuals to thrive despite trauma exposure. Therapeutic interventions that build resilience have been effective in strengthening trauma survivors to cope without relapse in the setting of future stressful events. This thesis will explore the concept of resilience-building, apply specific elements of this concept to obstetrical practice, and ultimately propose best practices for supporting women in labor who have been the victims of prior trauma. Ultimately, this thesis will outline a new three-part strategy for trauma-informed obstetrical care that calls for PTSD screening, avoiding posttraumatic stress triggers, and enhancing stress-coping resilience in order to promote the physical and mental well-being of trauma survivors during the birthing process.