Qualitative study finds gaps in trauma-informed perinatal care

A descriptive qualitative study comparing 30 Black, Medicaid-insured perinatal patients with 23 clinicians found strong agreement that discrimination, trauma, social support, communication and structural resource gaps affect safety and trust in care, while also revealing gaps between clinicians’ intentions and patients’ routine experiences. Patients described the lived burden of intersecting social and structural vulnerabilities, whereas clinicians focused on the clinical and systemic mechanisms underlying those experiences. The findings do not measure whether a particular care model improves maternal or infant outcomes; instead, they identify how an expanded Race and Equity-Centered Trauma-Informed Care framework could clarify barriers to implementing trauma-informed principles across the perinatal continuum.

Researchers recruited participants through purposive sampling from a predominantly medically underserved urban healthcare system between June and October 2024. They conducted semi-structured interviews with perinatal patients and clinicians, then analyzed the interviews using Braun and Clark’s six-step approach to reflexive thematic analysis. A crosswalk analytic structure was used to compare patient and clinician themes, with representative excerpts assessed for the degree of convergence between perspectives. All patient participants identified as Black or African American and were Medicaid recipients. The clinicians included 12 certified nurse-midwives, eight obstetrician-gynecologists, two advanced practice registered nurses and one family physician.

Strong convergence emerged around the effects of discrimination, trauma sequelae, social support, communication and structural resource gaps. Both groups described safety as foundational to trauma-informed care, emphasized avoiding retraumatization and supported implementation across the perinatal continuum. The comparison also showed a partial convergence around implementation: trauma-informed care was often described as aspirational rather than consistently embedded in routine practice, leaving a visible gap between clinician intent and patient experience. These findings do not establish that interpersonal behavior alone is insufficient to deliver trauma-informed care, nor do they test the effectiveness of any intervention. They instead show that the accounts gathered in this study identified a divide between articulated principles and what patients experienced in practice.

The authors characterize trauma-informed care as structurally contingent, meaning that experiences of safety, trust, accessibility and empowerment are shaped by intersecting social and structural determinants of health. The expanded Race and Equity-Centered Trauma-Informed Care, or RECTIC, framework extends analysis beyond individual clinical encounters to emphasize organizational, community and policy-level investment in structural equity, trust and the conditions needed for equitable maternal and infant health care. The study offers a qualitative account of barriers reported by a defined group in one healthcare system, rather than a population estimate or outcome trial. Its purposive sample and setting limit broad generalization, and the crosswalk analysis identifies aligned themes and implementation gaps without determining which differences are most common across perinatal populations. The central reported concern is therefore not merely whether clinicians and patients share the same ideals, but whether the surrounding system consistently turns those ideals into accessible, trustworthy and empowering care.

Subject of Research: Qualitative comparison of patient and clinician experiences with structural and social barriers in perinatal care

Article Title: An expanded Race and Equity-Centered Trauma-Informed Care (RECTIC) framework: crosswalk analysis of patient and clinician perspectives on structural and social barriers in perinatal care

Article References: Goldstein, E., & Itani, M. S. (2026). An expanded Race and Equity-Centered Trauma-Informed Care (RECTIC) framework: crosswalk analysis of patient and clinician perspectives on structural and social barriers in perinatal care. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03060-1

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03060-1

Keywords: perinatal care, trauma-informed care, racial equity, maternal health, patient experience, clinician perspectives, social determinants of health, Medicaid, qualitative research, health disparities, expanded, Race