How did we get here? A qualitative study of contributors to traumatic birth experiences in NICU parents

Birth trauma is a complex concept that encompasses experiences spanning the perinatal period, from prenatal care to delivery and postpartum care. Despite NICU parents being a high-risk population, there are limited studies examining interpersonal trauma in the NICU. Our study sought to explore the perspectives of NICU families on contributors to birth trauma and assess concordance with NICU staff knowledge on traumatic births.

A multi-methods study was performed exploring the qualitative experience of postpartum parents with infants admitted to a level IV NICU. Each participant shared their prenatal, delivery, and postnatal experiences through a semi-structured, audio-recorded interview. Interviews were transcribed using HIPAA compliant software and verified by principal investigators for accuracy. Each principal investigator performed thematic analysis using the constant comparative method until saturation and consensus was reached. Additionally, NICU Staff completed an anonymous survey soliciting baseline knowledge and attitudes regarding birth trauma. Perspectives from birthing parents and medical staff were compared.

Three themes contributing to birth trauma emerged among birthing parents (1) inadequate communication with the medical team (2) lack of support from trusted sources (3) fear of the unknown regarding their infants medical condition. While 96% of medical staff acknowledged that implicit bias and interpersonal trauma contribute negatively to healthcare disparities, when probed about real life examples, 50% of staff were unsure if they had personally witnessed such events. Majority of staff believed "deviation from birth plans", "prolonged hospitalization", and "treatment decisions" would be the primary contributors to patients' negative feelings about their birth. This was discordant with patient perspectives who frequently cited provider-patient interactions as the biggest contributor.

Interpersonal interactions play a huge role in patients' perception of the birth experience. Despite this, good communication, access to support, and anticipatory guidance can be protective factors, but providers need more education to better understand birth trauma and how it can present. Trauma-informed care education among medical staff is needed to improve recognition of signs and symptoms of trauma responses and reduce re-traumatization of patients during the perinatal experience.