Reframing obstetric care through a trauma-informed lens: A narrative review of trauma-informed principles and clinical applications.

Importance: Trauma is exceedingly common in the United States adult population; therefore, obstetric patients have more than likely experienced trauma within their lifetime and are at risk of re-traumatization in the perinatal period. Trauma-informed care is a model that seeks to address patient trauma histories and how that affects their ability to seek healthcare, as well as try to mitigate re-traumatization through medical care. However, there is little dedicated curricula around this topic, and many providers feel unequipped to implement trauma-informed care. Therefore, the goal of this narrative review is to provide an overview of trauma-informed care in obstetrics and highlight actionable steps that providers can take to integrate trauma-informed care in their practice. Methods: We conducted a literature search (2005-2025) on PubMed and OVID using the terms ("trauma-informed care" OR "trauma-based care" OR "trauma-sensitive care") AND ("pregnancy" OR "pregnant women" OR "prenatal care" OR "perinatal care" OR "labor and delivery" OR "childbirth" OR "birth" OR "obstetrics"). A total of 482 PubMed and 167 OVID articles were screened for relevance. Additionally, key society guidelines and existing trauma-informed care curricula were reviewed to provide context and recommendations. Results: Our findings indicate that traumatic life events (TLEs) are highly prevalent among pregnant individuals, particularly among adolescents, racial and sexual minorities, and those of lower socioeconomic status. Pregnancy increases risk for intimate partner violence and mood disorders, and one-third of women report birth itself as traumatic, with higher rates of distress after emergency cesarean delivery (up to 80.6%). A history of trauma is associated with adverse perinatal outcomes including heightened risk of preterm birth, pregnancy loss, postpartum depression, and post-traumatic stress disorder. Trauma also affects maternal-child bonding, breastfeeding success, and long-term child development. Evidence supports that trauma-informed care can mitigate these outcomes. Strategies including patient-centered communication, doula support, group prenatal care, and multidisciplinary perinatal mental health programs have shown improved engagement in care, reduced cesarean risk, and better psychological outcomes for pregnant patients. Conclusions: Trauma and traumatic stress are highly prevalent in the obstetric population, with unmanaged stress contributing to worsened maternal and fetal outcomes. Implementing both individual and institutional interventions can enhance patient-centered care and support resilience among trauma survivors. By mitigating adverse health effects, trauma-informed care serves as a vital strategy for advancing health equity and reducing disparities in maternal morbidity and mortality.