Implementing Routine Screening for Postpartum Posttraumatic Stress Disorder

Background: Postpartum posttraumatic stress disorder (PTSD) can develop following traumatic childbirth and can cause lower overall quality of life, impaired maternal-infant bonding, maternal isolation, negative impact on future pregnancies, and increased risk of suicide. Despite these impacts, postpartum PTSD it is not routinely screened for or treated. The purpose of this DNP project was for healthcare providers to screen for postpartum PTSD in a women's health clinic to identify women at risk for postpartum PTSD and help these patients access needed treatment. Methods: This quality improvement project examined the feasibility of implementing routine screening for postpartum PTSD using the City Birth Trauma Scale. Certified Nurse Midwives (CNMs) in a women's health practice participated in education sessions about postpartum PTSD and how to use the screening tool. The screening tool was then implemented and was given at the two- and six-week postpartum visits. Providers were surveyed before and after to compare confidence in diagnosing PTSD and discussing symptoms with patients, confidence patients could receive needed treatment, and willingness and ability to implement the screening program. Results: 11 midwives completed the pre-survey. 10 attended the training prior to initiating the screening intervention and 10 completed the post-survey. Significant increases were observed in confidence in diagnosing postpartum PTSD, confidence in discussing symptoms with patients, knowing when and how to refer patients with a positive screening, confidence in collaborating with a psychiatric provider, and confidence that patients could receive needed treatment. During the screening period (November 11, 2019- January 17, 2020), there were 145 patient appointments eligible for the screening. 77 (53.10%) received the screening. 18 patients (23.38%) screened positive for possible postpartum PTSD. Nine accepted the referral and were scheduled for a psychiatric evaluation and nine patients declined the referral. Conclusion: CNMs in this women's health practice strongly believe in the importance of screening for postpartum PTSD and a screening program can be implemented as long as key barriers are addressed. Educating CNMs about the symptoms, diagnostic criteria, and effects of postpartum PTSD likely contributed to significant increases in provider confidence when addressing these areas with patients.