Best practice guidelines and service provision for supporting women with birth-related trauma: A scoping review of international literature

Abstract

• Problem or Issue • Birth trauma is a significant public health concern. One third of women still experience birth as traumatic, resulting in significant impacts on maternal mental health, infant well-being, and societal costs intervention. • What is Already Known • The absence of dedicated guidelines worldwide contributes to variable care and adverse outcomes for women. The mixed findings and varied research goals in the literature underline the need for a comprehensive scoping review, especially as awareness of Birth Trauma increases. • What this Paper Adds • This review identifies gaps between guideline recommendations and service experiences, barriers and facilitators at the patient, provider, and system levels as well as between research, policy and clinical practice. • The outcomes of this review emphasise the urgent need for standardised, evidence-based guidelines that are user-friendly and provide practical advice for implementing trauma-informed care. Birth trauma (BT) is a significant public health concern affecting approximately one-third of the 140 million annual births worldwide, yet it lacks a unified approach for effective intervention. This study investigates the global landscape of BT management, focusing on the current best practice guidelines and service provisions for supporting women with birth-related trauma and the practicable actionable gaps that needs to be addressed. This scoping review followed the PRISMA Extension for Scoping Reviews guidelines, and systematically searched 13 electronic databases and websites for clinical guidelines, policy documents, care standards, practice recommendations and service provisions related to BT. The search yielded eight guidelines, of which were assessed using the AGREE II appraisal tool. Additionally, eight peer-reviewed articles focusing on current practices and service recommendations were analysed alongside the guidelines using a narrative synthesis approach. There are gaps between guideline recommendations and service experiences, barriers and facilitators at the patient, provider, and system levels as well as between research, policy and clinical practice. Of the guidelines included, only three rated high quality (>70%). There was consistency in recommending trauma-informed care, collaborative care between health professionals, patient and practitioner education and debriefing as an intervention. However, there were inconsistencies in the definition of BT and most lacked details on the steps, structure or practical tools that should be used. Seven key themes were identified regarding gaps between proposed guidelines and actual experiences of women after traumatic birth. There is an urgent need for standardised, evidence-based guidelines that are user-friendly and provide practical advice for implementing trauma-informed care.

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