Past or ongoing trauma such as abuse, violence or a previous difficult birth can resurface in pregnancy as anxiety, flashbacks or fear of exams and labor. Trauma-informed care means asking safely, giving the patient control and linking them to support.
Key symptoms
- Intrusive memories, nightmares or flashbacks
- Avoiding exams, appointments or talk about birth
- Anxiety, panic, low mood or poor sleep
- Intense fear of childbirth
- Substance use or self-harm as a way to cope
What you find on exam
- Explain each step, ask permission and let the patient stop at any time
- Offer a chaperone and limit exams to what is needed
- Mental status exam with questions about suicide
- Look for injuries that suggest ongoing violence
Tests
- Private screening for intimate partner violence
- PTSD screen such as the PC-PTSD-5
- Depression and anxiety screens: EPDS, PHQ-9, GAD-7
- Substance use screening
Treatment basics
- Trauma-informed care at every visit
- Trauma-focused psychotherapy such as cognitive processing therapy
- SSRI such as sertraline if needed, weighing risks and benefits
- Birth plan that respects the patient's needs, plus safety planning and social work
Red flags
- Suicidal thoughts or self-harm
- Current violence or an unsafe home
- Dissociation or severe panic that blocks needed care
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.