Implementing birth trauma screening at the post-partum appointment: a quality improvement project

Abstract

Birthing individuals perceive their birth experience as a traumatic experience in 30-45% of births. This can lead to negative consequences such as increased maternal stress, fears of subsequent pregnancies, and impaired infant bonding. Post-Partum Post Traumatic Stress Disorder (PP-PTSD) after childbirth is a significant clinical problem, as 4-9% of birthing individuals develop it. In order to prevent and reduce the negative impacts of traumatic births, perinatal providers can implement birth trauma screening into their assessments of perinatal mood disorders, increasing the identification and implementation of treatment. An Ob/Gyn clinic in Southwestern Montana sought to improve the identification of birth trauma in their population, as they relied on the patient to self-report concerns and post-traumatic symptoms. The Iowa Model of Evidence-Based Practice informed the implementation of birth trauma screening at the 2-week post-partum appointments over a 3-week period. At the 2-week post-partum appointment, birth trauma screening was implemented by the RN using the first two questions of the City Birth Trauma Scale (CBTS). If the patient screened positive, they were given a counseling referral and supportive education from the RN. The electronic health record (EHR) was modified for documentation. 37 patients attended a 2-week post-partum appointment. 37.84% received birth trauma screening. Of the patients screened, 100% received correct documentation of screening in the EHR. 14.29% screened positive for birth trauma. 100% of positive screens received an offer for a counseling referral and 50% attended that appointment. This project was effective at increasing the screening rate of birth trauma in birthing individuals and provided increased access to counseling and education on this topic to every patient screened, regardless of the result. By including involvement of Ob/Gyn providers, nursing staff and mental health clinicians in the development of this project, allowed for an increased knowledge base of this clinical issue, leading to increased commitment for the early identification of birth trauma for this organization.