Date of Award

Spring 5-28-2022

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

My Hahn (Theresa) Nguyen, PhD, RN, PMHNP-BC

Abstract

Purpose: The purpose of this project is to identify birthing people with childbirth-related posttraumatic stress disorder (CB-PTSD) symptoms using the City Birth Trauma Scale (CBTS). Once identified, at risk birthing people will receive verbal education about CB-PTSD and a social work consultation, if necessary.

Background: A birth is deemed traumatic, and thus fulfills one of eight criteria of posttraumatic stress disorder (PTSD), when during labor, delivery, and/or immediately postpartum, the birthing person perceives themselves and/or their baby’s life to be in danger and/or are at risk of being critically injured. These events include but are not limited to emergency cesarean sections, neonatal intensive care unit admissions, maternal hemorrhages, and operant vaginal deliveries. Up to 50% of birthing people describe a traumatic birth experience, with 9%–44% going on to develop CB-PTSD. One-third of birthing people with postpartum depression also develop CB-PTSD symptoms, lending to a significant gap in standard postpartum maternal mental health screening. Early detection is crucial because traumatic memories respond most robustly to trauma-specific mental health treatments two to three months after the trauma occurs. Screening for CB-PTSD increases the chance of birthing people receiving timely, trauma-specific mental health treatment.

Methods: CBTS is the only screening tool created specifically for CB-PTSD that incorporates the DSM-5 criteria for PTSD. This tool has excellent reliability and is easy to understand. The Doctor of Nursing Practice student screened 30 birthing people for CB-PTSD with the City Birth Trauma Scale on a postpartum unit. The postpartum nurse pre-screened their patients to determine if they were eligible to agree to participate in the evidence-based project. The DNP student provided participating patients with the CBTS to complete and education about CB-PTSD. If the patient was CBTS positive (CBTS(+)), the DNP student notified the patient’s nurse who then determined if a social work consultation is warranted.

Results: Postpartum nursing staff were able to manage the increased workload involved with pre-screening 30 birthing people for this pilot project. Of the 30 birthing people who were approached to participate in the project, 21 agreed to participate. The nine birthing people who were approached but declined to participate cited reasons of being too tired, in pain, or did not think they needed the intervention. Of the 21 birthing people screened, six were screened to be CBTS(+). Of those who were CBTS(+), two did not have social work consultations placed for routine reasons, heightening that trauma sequelae are not necessarily detected with routine postpartum depression and anxiety screening alone due to its unique symptomology and confounding factors.

Implications for Clinical Practice: The success of this project opens the door for future projects to explore feasibility of universally screening for CB-PTSD on a postpartum unit. CB-PTSD screening may also be appropriate for other areas of reproductive medicine and pediatric well-baby visits. Other areas of trauma informed care that can be explored are education about trauma-informed language in women’s health nursing, education about therapeutically talking to patients about emergent medical procedures, and screening for adverse childhood events and interpersonal violence.

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