The Effects of Trauma-informed Care Organization on Birth Professionals and Women's Experiences of Trauma.

Childbirth is generally considered a positive and meaningful life event; however, it may also be experienced as psychologically distressing or traumatic. Traumatic birth experiences may be associated with post-traumatic stress symptoms, including intrusive memories, avoidance, emotional distress, and heightened physiological arousal. Such experiences may affect maternal mental health, maternal-infant bonding, breastfeeding, and future reproductive decisions. Healthcare professionals who are repeatedly exposed to traumatic birth events may also experience secondary traumatic stress, burnout, and reduced job satisfaction.

Trauma-informed care (TIC) is an approach that recognizes the widespread and potentially long-lasting effects of trauma and seeks to minimize the risk of re-traumatization during healthcare interactions. Core principles include psychological and emotional safety, respectful and trauma-sensitive communication, informed consent, empowerment, collaboration, and support for individual autonomy and dignity. Within maternity care, a trauma-informed approach requires healthcare professionals to recognize that women may have previous or birth-related traumatic experiences, including experiences that have not been disclosed.

Effective implementation of TIC requires an organizational approach rather than isolated educational interventions. Women interact with multiple healthcare professionals and support personnel throughout maternity care, from admission to discharge. Therefore, communication practices, attitudes, institutional procedures, and the overall care environment may influence women's childbirth experiences. The present study will implement an organization-wide trauma-informed care model at Tarsus State Hospital involving organizational leaders, healthcare professionals, and support personnel.

The intervention will include educational programs specifically developed for different professional groups. Organizational leaders will receive training on institutional strategies for implementing trauma-informed care, recognizing secondary traumatic stress among staff, and developing sustainable action plans for integrating TIC principles into maternity services.

Healthcare professionals involved in maternity and perinatal care, including midwives, nurses, obstetricians, psychologists, psychiatrists, and social workers, will participate in a multi-module training program. Training will address recognition of psychological and birth-related trauma, trauma-sensitive communication, prevention of re-traumatization, informed consent, women's autonomy and dignity, and integration of trauma-informed principles into routine maternity care.

Support personnel who interact with women and families during hospital services will receive targeted training focusing on respectful communication, awareness of trauma-related sensitivities, and appropriate interactions with women receiving maternity care.

Educational activities will use interactive learning methods, including case discussions, group exercises, role-playing scenarios, and problem-solving activities. In addition to individual-level knowledge and awareness, the intervention is intended to support organizational changes that facilitate the sustainable integration of trauma-informed principles into maternity services.

The study will evaluate the effects of this organization-wide intervention on both healthcare professionals and women receiving maternity care. Outcomes will focus on changes related to trauma-informed care among professionals and trauma-related and childbirth experiences among women. The findings are expected to provide evidence regarding the feasibility and potential effects of implementing trauma-informed care as an organizational model within maternity services.

Inclusion criteria

Women:

• Aged 18 years or older.
• Giving birth at Tarsus State Hospital during the study period.
• Providing voluntary informed consent.

Healthcare professionals, organizational leaders, and support staff:

• Aged 18 years or older.
• Working in maternity or related services at Tarsus State Hospital.
• Participating in the trauma-informed care intervention according to their professional role.
• Providing voluntary informed consent.

Exclusion criteria

Women:

• Severe postpartum complications preventing participation or completion of study assessments.
• Incomplete study assessments.

Healthcare professionals, organizational leaders, and support staff:

-Failure to complete the required training or study assessments. Incomplete study assessments.