Many trauma-informed care frameworks focus on the patient outcomes alone. Nurses are trained to understand their patients’ trauma and notice trauma responses, adjust language, and protect dignity. Those are all important factors in trauma-informed care, but there aren’t any models that address the nervous system of the caregiver providing this care. This gap shows up as moral distress, nurse burnout, and workforce loss.
As a labor and delivery nurse, I was expected to individualize care for every patient but also review the standing order set to initiate IV Pitocin as soon as a foley bulb fell out. I was expected to treat the family as an extension of the patient, but I didn’t have approval or access to get a food tray for them during a 40-hour marathon labor. My intake admission needed to be thorough and include the social determinants of health, but I was rarely given the time needed to complete such assessments and resourcing before being called to the next room,
the next admission,
the next task.
This dissonance is disorienting, exhausting and requires a shift from unclear wellness standards between patients and clinicians. Labor nurses need a new trauma-informed care framework for sustainable birth care.
The Embodied Trauma-Informed Care Framework grew from this bedside nursing reality. The framework holds patient care and nurse wellbeing together as two groups within the same system. The design reflects the simple truth that trauma-informed care fails when nurses self-abandon to provide physically and psychologically safe care.
The approach supports ethical nursing practice under the everyday pressures of the healthcare environment. The framework now guides education, training, and consultation work at The Birth Nurse.
What This Trauma-Informed Care Framework Is Built On
Trauma-informed care requires presence, attunement, and ethical clarity. These skills depend on a regulated nervous system. Without support for the caregiver, individualized care that is psychologically safe for the patient can be dysregulating and highly stressful for the clinician. The purpose of this framework is to offer a sustainable approach to nervous system regulation and transitioning to a trauma-informed standard of care.
A core principle of trauma-informed care is that the approach must include the caregiver (SAMHSA, 2014).
The Five Elements of the Trauma-Informed Care Framework
The trauma-informed care framework centers the nurse — not as a bystander to care, but as an active part of it. Nurses provide compassionate care from a personal place. They bring their body, their past experiences, nervous system, and values into every care interaction.
When healthcare asks clinicians to override their own signals of safety to meet system expectations, that’s an act of self abandonment. This happens when there’s dissonance between nursing ethics and professional expectations in the workplace.
A collaborative approach between The Birth Nurse and Your Birth Partners led to the development of this framework to guide patient-centered care with a trauma-responsive approach to nurse wellness.
Appreciate
Appreciation begins with noticing how often trauma shows up in birth spaces everyday without judgement. Trauma responses can be seen in patient behavior, family dynamics, and staff communication. Every individual is carrying their own stress responses shaped by past shifts, past birth experiences, cumulative exposure to stress and trauma, and systemic and social pressures. Awareness of this stress and trauma shifts nurses from reaction to an elevated place of clarity and provides some context to complex moments.
Foster
Care relationships shape the nervous system state through co-regulation. Tone, pacing, and presence regulate or escalate stress on a two-way street. For example, a patient is resting comfortably in their labor bed, the family is scrolling on the couch nearby. You’ve noticed a few variable decals on the external fetal monitor (EFM), however, so you go into the room. Everyone in the room can sense your concern, and you know this because everyone on the couch puts down their phones and the patient turns to you and asks, “What’s wrong?”
Even when you try to soothe their worry with, “Nothing is wrong. I just see some heart rate dips, so I’d like to ask if I can help you change positions in bed and then get more information from the EFM monitor.” They don’t buy it. They stay on alert, eyes darting to blinking heart on the monitor, then back at you desperately working to read your facial expressions.
This is an example of co-regulation – where one person’s vibe can change the whole temperature of the room.
Nurses are responsible for understanding co-regulation and learning to self-regulate as a practical skill. This framework emphasizes embodied practice over theory alone. Small, repeatable actions during routine care creates patterns and supports psychological safety. These skills strengthen trust with patients and within teams, which has the power to change the birth care culture.
Advocate
Advocacy for patients and self depends on regulation. Patient voice and choice require timing, clarity, and awareness of power dynamics. Consent is a powerful way that patients advocate for themselves. Consent only exists if clinicians respect this form of advocacy ongoing throughout care. When nurses stay regulated, advocacy becomes an ethical, responsive part of care. Regulation reduces the risk for coercion during decision-making, and moral injury can be avoided when actions align with values. Skilled advocacy supports healing for everyone involved in birth care.
I went deeper on this in a conversation with Dr. Rebecca Dekker of Evidence Based Birth.
Support
Trauma-responsive care requires team structures, which provide organizational backing to a care transformation. Nurses require structures that purport collaboration, shared responsibility, and the opportunity for repair. Teams function best when nurses trust one another to speak up, call out unsafe actions, ask for help, and name concerns early and directly. This reduces isolation and error during high-stakes healthcare.
Leadership shapes nervous system safety on a unit and signals what’s important to a team. Charge nurses, managers, and directors set the tone through their responses and modeled behavior. Supportive leadership looks like leadership consistently advocates for nurse judgement, addresses harmful behavior, and prioritizes psychological safety alongside clinical outcomes. Nurses perform best, collaborate more effectively, and remain engaged in the work when leadership supports ethical care decisions. This element connects bedside care to systems change.
Debrief
Care does not end when the shift ends. Processing protects learning and retention. Debriefing allows reflection without blame. Nurses integrate experience, release stress, and strengthen clinical judgment. This step prevents accumulation of unresolved stress injury. Reflection supports growth, not weakness. Sustainable practice depends on space to process care honestly.
Debriefing with patients is already part of nursing practice, yet it often stays informal, rushed, or limited to crisis events. Nurses debrief with each other at the desk, in hallways, or over nachos after their shift, often without structure or actionable next steps. Structured reflection supports learning, ethical clarity, releases unwarranted responsibilities, and nervous system recovery. This framework names debriefing as a necessary clinical skill that all patients and nurses deserve.
Bedside debriefing with patients matters as it’s simple, grounded conversations that help patients integrate their experience, their care, ask questions, and restore a sense of agency. When nurses have language and permission to debrief both with each other and with patients, this staves off the quiet accumulation of stress. It’s a way to actively and regularly process the expected stress and chaos within birth care. Debriefing strengthens trusting relationships, protects wellbeing, and supports safer, more regulated care moving forward.
How The Birth Nurse Uses the Framework
The Embodied Trauma-Informed Care Framework guides all work at The Birth Nurse. Education, workshops, and consultations align with this structure. Peanut Ball Learning Days, trauma-informed care training, and leadership programs use the same shared language. Nurses apply the framework during patient care, leadership development, team discussions, self-centered care, and reflection. Confidence, psychological safety, and ethical clarity increase when the framework anchors practice.
Changes That Nurses Notice
Nurses and hospital systems report clear practice shifts after using this framework. Nurses describe stronger confidence during high-pressure care. Communication becomes clearer and more grounded, even during conflict or urgency. Boundaries strengthen without loss of compassion and without added guilt or shame. Teams develop trust through shared language and intentional reflection. These shifts show up at the bedside and across unit culture.
Why This Matters Now
Perinatal nurses report rising exposure to overt traumatic events at work. High-acuity births, violence, moral conflict, and repeated crises strain nervous systems over time. Many nurses name moments from their shifts as traumatic experiences, and they’re affecting nursing decision-making, communication, and retention.
Nurses are asking for support from health systems. They want more than resilience messaging or the tired, victim-blaming self-care reminders. They want structures that protect ethical practice, psychological safety, and professional dignity. It’s clear that trauma-informed care, a whole-system issue, must include the workforce delivering it.
Moving Forward
The Embodied Trauma-Informed Framework invites self-reflection on how you show up in perinatal care. It affirms the value of nurse presence, skill, and leadership while prioritizing nurse and birthing person well being and psychological safety simultaneously. This framework guides the transition to trauma-informed care as the standard in perinatal healthcare. This transition can happen through a shared commitment, ongoing reflection and reorientation, and supportive and embodied leadership. Nurses shape safer birth care when they receive the support they deserve.
References
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- Runyon, M. C., Irby, M. N., & Rojas Landivar, P. (2024). Trauma-Informed Care Education Initiative Explores Impact on Perinatal Nurse Secondary Traumatic Stress and Workforce Challenges. The Journal of perinatal & neonatal nursing, 38(2), 167–177. https://doi.org/10.1097/JPN.0000000000000822
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- Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.
