Advancing equity in perinatal PTSD: a systemic trauma framework for written exposure therapy

This article applies a systemic trauma framework to perinatal PTSD and advances Written Exposure Therapy as a scalable, equity-aligned intervention that can be integrated into routine perinatal care pathways, addressing critical gaps in current obstetric and mental health systems. Perinatal posttraumatic stress disorder (PTSD) affects ~9% of pregnant and postpartum individuals in the United States, with another 18% at elevated risk, yet it remains inconsistently identified in clinic care. From a systemic trauma perspective, perinatal PTSD arises from interactions between individual experiences and structural inequities in healthcare, including discrimination, fragmented services, and access barriers. These factors intersect with pregnancy-, birth-, and NICU-related stressors to increase maternal morbidity, disrupt maternal-infant bonding, and affect early developmental outcomes. Despite this burden, few trauma-focused treatments are feasible during the perinatal period, as standard protocols often conflict with caregiving and medical demands. Written Exposure Therapy (WET), a five-session intervention, promotes trauma recovery through repeated written engagement with trauma narratives, facilitating emotional processing and extinction of trauma-related distress. WET offers a scalable alternative, with preliminary evidence for obstetric groups comparable to longer treatments in non-perinatal populations. This conceptual synthesis advances a systemic trauma-informed framework for embedding WET within perinatal care pathways, emphasizing how brief, low-burden interventions can be integrated into routine obstetric, postpartum, and NICU-linked settings to improve access to trauma-focused care. By linking mechanisms of trauma recovery with health system delivery structures, this framework clarifies how scalable interventions like WET may reduce inequities in treatment access and improve maternal and infant outcomes. While the proposed framework is grounded primarily in evidence from U.S. healthcare systems, it provides a foundation for future adaptation and evaluation in diverse international perinatal care settings. Future priorities include testing feasibility, mechanisms, and equity-focused implementation across diverse perinatal populations.