How Did We Get Here? A Qualitative Study of Contributors to Traumatic Birth Experiences in NICU parents

Background: Birth trauma is a complex concept that encompasses various experiences related to events in the perinatal period, including prenatal care, delivery, and postpartum care. Despite NICU parents being a high-risk population, there are limited studies in this group and many studies reference the stress of the medical complexities, while the dynamics of interpersonal trauma remain poorly understood by the medical community. The purpose of our study was to explore perspectives of NICU families and staff on contributors to traumatic birth experiences. Methods: A mixed methods study was performed exploring the qualitative experience of postpartum mothers with infants currently admitted to a level IV NICU. A single semi-structured interview was conducted with each participant which included questions about their prenatal, delivery, and postnatal experiences. Interviews were audio-recorded and transcribed using HIPAA compliant transcription software then manually verified by principal investigators for accuracy. Thematic analysis using the constant comparative method was performed by each principal investigator until saturation and consensus was reached. Additionally, NICU Staff completed an anonymous Qualtrics survey soliciting baseline knowledge and attitudes regarding traumatic birth experiences. Perspectives from birthing parents and medical staff were compared to assess for concordance. Results: There were 3 salient themes among birthing parents that negatively contributed to the perception of a traumatic birth: 1) inadequate communication with the medical team 2) lack of support from trusted sources and 3) fear of the unknown of what would happen to them or their infants. While 96% of medical staff acknowledged they were aware that implicit bias and interpersonal trauma contributes negatively to healthcare disparities, when probed about real life examples, 50% of staff were unsure if they had personally witnessed such events. Conclusions and Relevancy: There seems to be a collective lack of provider awareness of the ways interpersonal trauma plays a role in potential short- and long-term consequences in birthing parents and their infants. It is imperative that we enhance education among medical staff to improve recognition of signs and symptoms of trauma responses and trauma-informed care to reduce re-traumatization of our patients throughout the entire perinatal experience.