Trauma-informed care education initiative for labor and delivery nurses: a quality improvement project

Abstract

Background: Up to 45% of birthing people report psychologically traumatic births, contributing to PTSD, postpartum depression, anxiety, impaired bonding, and long-term health consequences. Labor and delivery (L&D) nurses, who frequently witness obstetric emergencies, loss, and distress, also experience high rates of secondary traumatic stress (STS), which affects well-being, retention, and quality of care. Problem: Trauma-informed care (TIC) is endorsed by national organizations as a standard of perinatal practice, but implementation remains inconsistent, particularly in rural states such as Montana, where trauma exposure is high, and access to specialized mental health resources is limited. Intervention: This project evaluated the feasibility and impact of the Trauma-Informed Birth Nurse (TIBN) program, a multifaceted TIC education initiative designed to strengthen trauma-informed attitudes and reduce STS among L&D nurses. Methods: Using the Replicating Effective Programs (REP) framework, the project implemented the TIBN curriculum with 11 L&D nurses at a regional Montana hospital. Mixed- methods evaluation included validated quantitative measures (ARTIC-10, STSS, TICS-10) administered at baseline, post-intervention, and follow-up, along with qualitative feedback analyzed through inductive thematic analysis. Results: Results demonstrated significant improvements in trauma-informed attitudes, a sustained and clinically meaningful reduction in STS symptoms, and enhanced perceptions of trauma-informed organizational climate. Qualitative findings highlighted increased confidence, deeper understanding of trauma, and greater intentionality in communication, alongside identified needs for shorter modules and more practical strategies. Conclusion: The TIBN program proved feasible, impactful, and well-aligned with organizational priorities. Findings support broader implementation, policy alignment, and continued investment in trauma-informed education to improve perinatal care and workforce well-being.