https://www.infirmiere-canadienne.com/blogs/ic-contenu/2025/11/10/depression-post-partum-parti-2-de-2
Part 2 of 2: we summarize our application of a trauma-informed care approach when developing a new integrated care pathway
istockphoto.com/Drazen Zigic
Parents are inundated with the message that welcoming a baby is a time of joy. However, feelings in response to this life-altering event are individualized and complicated.
Editor’s note: This is the second in a two-part series. Part 1 was published on November 3, 2025.
There is an urgent need to provide access to postpartum mental health services (World Health Organization, 2022). To address this need, birthing parents with a primary care provider who screen positive for postpartum depression are given access to services through Ottawa Public Health and Hôpital Montfort programming.
When birthing parents without a primary care provider needed an alternative method to access care, an integrated care pathway was implemented by Archipel Ontario Health Team members, Hôpital Montfort, and Ottawa Public Health (see last week’s article, “When Advocacy Demands Collaboration”). During planning and implementation, parent and provider experiences were evaluated, highlighting a key finding: the need to provide trauma-informed care, which is a healing-oriented approach to patient care that recognizes trauma, uses knowledge integration to support those with trauma at the individual and organizational levels, and aims to prevent re-traumatization (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014).
Trauma-informed care follows six key principles: 1) safety; 2) trustworthiness and transparency; 3) peer support; 4) collaboration and mutuality; 5) empowerment; and 6) recognizing and addressing cultural, historical and gender issues (SAMHSA, 2014). Trauma-informed care supports a universal precautionary presupposition that all patients have experienced some form of trauma (Racine et al., 2020). Trauma relevant to postpartum depression is all-encompassing, including gendered violence and birth trauma (e.g., obstetric emergencies) (Polmanteer et al., 2018).
In this article, we summarize our application of a trauma-informed care approach when developing a new integrated care pathway, with a focus on how such an approach can help identify opportunities for improvement during implementation.
Stigmatization of postpartum depression
Parents are inundated with the message that welcoming a baby is a time of joy. However, feelings in response to this life-altering event are individualized and complicated. It can be very difficult when the postpartum experience does not follow the normalized path (Law et al., 2021). In addition to dramatic physical changes, significant mental health challenges can occur in both birthing and non-birthing postpartum parents (Johansson et al., 2020). The baby blues (i.e., anxiety and depression symptoms in new parents) are considered a normal, mild, temporary problem, but when depressive symptoms persist, worsen and/or impact functional ability, parents may be diagnosed with postpartum depression (Stewart & Vigod, 2019).
For parents with postpartum depression, there is a compounded shaming effect when the mental health stigma intersects with violations of social expectations for new parenthood (Law et al., 2021). Fears can emerge about being labelled a “bad parent,” being a failure or being judged for not having the traditional happy experience, with stigma significantly affecting help-seeking behaviours (Grissette et al., 2018).
Recommendations to reduce mental health stigma include raising awareness and advocacy by influential groups (Shahwan et al., 2022). Health-care providers must normalize the full range of postpartum experiences without creating additional trauma (Polmanteer et al., 2018). In our co-designed integrated care pathway, offering patients reassurance to normalize postpartum depression was important during referrals. Throughout the pathway, public health nurses, primary care providers and psychiatrists aimed to create therapeutic relationships that supported an open dialogue about postpartum depression. In trauma-informed care, these practices of creating a collaborative, therapeutic environment are important (Horan et al., 2022).
Additionally, a responsibility to discuss stigma emerged from our evaluative reflections. Trauma and stigma were always included when creating quality improvement reports and presenting findings to the community. The project became a platform to speak about postpartum depression with other health-care providers and organizations. For example, as part of our networking and dissemination, presentations were made at Hôpital Montfort and Ottawa Public Health to discuss postpartum depression and introduce the pathway.
Establishing a trusting relationship
During early implementation, team members missed a significant opportunity to provide trauma-informed care by failing to adopt universal trauma precautions during a patient visit. We reassessed to ensure the principles of trauma-informed care foregrounded every care interaction. It was important to ensure we created a safe space throughout the pathway by designing it to support the development of a trusting relationship. Instead of self-presenting (i.e., at the emergency department, walk-in clinic), birthing parents had an appointment to meet the primary care providers at the Postpartum Wellness Clinic.
With an allotted appointment duration of one hour, birthing parents could be seen up to three times. This contrasts with self-presenting options, where turnover and patient flow take precedence over elongated, holistic encounters. Parents would sometimes only begin discussing mental health during the third appointment.
Additionally, care was not limited to postpartum depression, but centred on what the parent prioritized, including physical health concerns or availability of social supports. Diversity in birthing parents positioned them differently in terms of need, making shared decision-making necessary to validate and address their experiences. In addition to the mental and physical health services provided by the primary care provider, the social determinants of health were assessed by the public health nurse who followed the parent throughout the pathway. This is important because the social determinants of health have been shown to negatively impact postpartum mental health (Scroggins et al., 2024). These nurses identified additional community services and resources for parents. By including the public health nurses in the pathway, holistic care delivery extended beyond the clinic office and into the home.
Additionally, one of the greatest strengths of this pathway is the warm transfer. After obtaining consent, the public health nurse facilitates an introduction to the Postpartum Wellness Clinic provider by introducing the birthing parent and sharing any concerns, along with the positive screening result for postpartum depression. Strategies such as warm transfers are key to trauma-informed care to reduce stress for patients, increase the likelihood of engagement and follow-through and minimize the risk of being triggered unknowingly by the provider (Jack & Wathen, 2021).
How to improve?
Our integrated team meetings were an important space to discuss trauma-informed care through the lenses of different professions, organizations and sectors in order to make appropriate changes to the program. Future improvements include moving the Postpartum Wellness Clinic to a community setting, promoting peer support and considering social prescribing.
The clinic was initially located at the hospital, a potentially problematic and traumatizing environment for individuals seeking mental health services. For birthing parents, this is also the location of potential birth trauma. Parents attending to their postpartum depression (likely with a newborn in tow) could be better served by a smaller, quieter physical environment such as an outpatient community health setting. Women with postpartum depression have been shown to prefer private mental health practices and community-based treatment centres or home visits over hospital settings (Simhi et al., 2019).
Although peer support is important to trauma-informed care (Polmanteer et al., 2018), it was not used in this pathway. Peer support could potentially serve to reduce stigma further and normalize postpartum depression.
After consultations with birthing parents at the clinic, social prescribing was emphasized by a primary care provider as an emerging practice that would benefit parents. Social prescribing aims to co-create holistic care solutions by having health-care providers refer patients to non-clinical social or community services that address the social determinants of health (Ontario Hospital Association, 2022). For example, parents might be given a social prescription to join a new mom support group. A pilot study of social prescribing at 11 community health centres in Ontario demonstrated improved mental health outcomes for participants, reduced loneliness, and enhanced community capacity (Ontario Hospital Association, 2022).
Resiliency of the birthing parents
Birthing parents accessing this pathway demonstrated incredible strength, resilience and agency. The goal of the Postpartum Wellness Clinic was to ease access to required mental health services, but parents still had to overcome obstacles along the way. Throughout the pathway, birthing parents persisted in attending appointments despite the known stigma towards postpartum depression. They demonstrated an openness to educate themselves on depression and took concrete actions to improve their mental health. They courageously shared their stories with providers and used their own resources to ensure they received the care they needed. For example, when referrals were missed at different points in the pathway, they had to speak up to ensure appropriate communication occurred. They also navigated ways to care for their child during appointments, whether that be by bringing them along or finding alternative arrangements. We are indebted to these birthing parents who allowed us to pilot this project, evaluate our pathway, and improve it for future use.
Importance of supporting birthing parents
Based on our experience implementing trauma-informed care through an integrated care pathway, this approach is well-suited to caring for parents with postpartum depression. We believe supporting birthing parents through the vulnerable and complex experience of depression will support the wellness of the overall population. Appropriate care during the postpartum period has a generational impact when the parent becomes better able to support their child. This is supported by researchers who have demonstrated negative lifelong health impacts on children of parents diagnosed with postpartum mental health problems (Aktar et al., 2019; Pierce et al., 2019).
The health of parents is reciprocally entangled with the health of children. When considered in this way, taking a trauma-informed care approach when implementing new integrated care pathways can have a sustainable, lasting impact on overall population health. Holistic care that engages shared decision-making and prioritizes establishing a trusting relationship can help to overcome trauma as a barrier to accessing resources. Health care does not have to be a source of re-traumatization, as is so often the case for many patients; but, for this to be true, we must subject ourselves to a critical reflective practice that acknowledges where we have failed and when we can do better.
Acknowledgements
RNAO’s Advanced Clinical Practice Fellowship supported this project. The creation and implementation of the Archipel Ontario Health Team integrated care pathway would not have been possible without the following team members: Sharlene Clarke (Archipel Ontario Health Team), Louise Gilbert (Ottawa Public Health), Geneviève Mosher (Ottawa Public Health), Manar El Malmi (Ottawa Public Health), Josée Gauthier (Ottawa Public Health), Judith Makana (Hôpital Montfort), Camille Brunet (Hôpital Montfort), Dania Versailles (Canadian Mental Health Association – Ottawa branch), and Stephanie Bonenfant (Montfort Renaissance).
References
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Horan, H., Ryu, J., Stone, J., & Thurston, L. (2022). Healing trauma with interprofessional collaboration and trauma-informed perinatal care: A qualitative case study. Birth Issues in Perinatal Care, 50(3), 525-534. https://doi.org/10.1111/birt.12672
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Andrea Bentz, RN, BScN, is a PhD candidate in the School of Nursing at the University of Ottawa.
Natalie Rozon, BScN, RN, is a supervisor in healthy growth and development at Ottawa Public Health.
Judith Makana, RN, BScN, MScN, CSIC(C), is a nursing professional practice advisor at Hôpital Montfort in Ottawa.
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