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Women\u2019s Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>At least one in four women in the UK has experienced trauma, such as sexual abuse or violence, with profound implications for mental and physical health, particularly during the perinatal period. Despite the potential benefits of addressing trauma in maternity care, many women are reluctant to disclose their experiences due to stigma, fear of judgment, or lack of trust in healthcare systems. This paper presents the development and evaluation of the EMPATHY framework, a novel, evidence-based approach to routine trauma discussions in maternity care, designed to address these challenges and promote emotionally-centred care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The EMPATHY framework was developed through a critical participatory action research approach, integrating findings from a systematic review, qualitative interviews, and stakeholder input, including experts by experience, healthcare professionals, and voluntary sector practitioners. The framework was refined through iterative workshops and a public consultation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200952), ensuring its relevance and applicability. The development and evaluation of the EMPATHY framework were guided by the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool, ensuring methodological rigor, transparency, and adherence to established standards in guideline development.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The framework is structured around six core principles: system-wide change, promote trauma awareness, trust and relationships, training and support, local tailoring, and continuous improvement. A key innovation is the recommendation that all women, regardless of disclosure, should have access to information and support. Feedback from the public consultation highlighted the framework's value and its potential to transform perinatal experiences. Challenges such as resource constraints and implementation barriers were acknowledged, but respondents emphasised the importance of the framework in improving care for women who have experienced trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion\/conclusion<\/jats:title>\n                    <jats:p>The EMPATHY framework addresses a critical gap in existing guidance by offering a structured yet flexible approach to routine trauma discussions. Its implementation has the potential to empower women, strengthen therapeutic relationships, and reduce re-traumatisation. The framework represents a significant step forward in trauma-informed perinatal care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fgwh.2025.1608174","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T06:33:23Z","timestamp":1764830003000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Empowering women through trauma-informed maternity care: the EMPATHY framework"],"prefix":"10.3389","volume":"6","author":[{"given":"Joanne","family":"Cull","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gill","family":"Thomson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo","family":"Downe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Topalidou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Fine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"B1","volume-title":"Sexual Offences in England and Wales Overview: Year Ending March 2022","year":"2023"},{"key":"B2","doi-asserted-by":"publisher","first-page":"E036374","DOI":"10.1136\/bmjopen-2019-036374","article-title":"Health and financial burden of adverse childhood experiences in England and Wales: a combined primary data study of five surveys","volume":"10","author":"Hughes","year":"2020","journal-title":"BMJ Open"},{"key":"B3","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s00737-023-01312-5","article-title":"Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study","volume":"26","author":"Abrahams","year":"2023","journal-title":"Arch Womens Ment Health"},{"key":"B4","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1186\/s12884-015-0626-9","article-title":"The re-enactment of childhood sexual abuse in maternity care: a qualitative study","volume":"15","author":"Montgomery","year":"2015","journal-title":"BMC Pregnancy Childbirth"},{"key":"B5","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12884-020-03515-5","article-title":"Co-production of an e-resource to help women who have experienced childhood sexual abuse prepare for pregnancy, birth, and parenthood","volume":"21","author":"Montgomery","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B6","author":"Knight","year":"2022"},{"key":"B7","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1089\/jwh.2018.7108","article-title":"Adverse childhood experiences and mental and behavioral health conditions during pregnancy: the role of resilience","volume":"28","author":"Young-Wolff","year":"2019","journal-title":"J Women\u2019s Health"},{"key":"B8","volume-title":"College Report CR232: \u2018Perinatal Mental Health Services: Recommendations for the Provision of Services for Childbearing Women\u2019","year":"2021"},{"key":"B9","doi-asserted-by":"publisher","first-page":"E0225441","DOI":"10.1371\/journal.pone.0225441","article-title":"Healing the past by nurturing the future: a qualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views 211 of parents with a history of childhood maltreatment","volume":"14","author":"Chamberlain","year":"2019","journal-title":"PLoS One"},{"key":"B10","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1089\/jwh.2017.6649","article-title":"Feasibility and acceptability of screening for adverse childhood experiences in prenatal care","volume":"27","author":"Flanagan","year":"2018","journal-title":"J Women\u2019s Health"},{"key":"B11","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1186\/1472-6874-13-18","article-title":"Digging over that old ground: an Australian perspective of women\u2019s experience of psychosocial 229 assessment and depression screening in pregnancy and following birth","volume":"13","author":"Rollans","year":"2013","journal-title":"BMC Women\u2019s Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1111\/phn.12956","article-title":"Exploring women\u2019s perspectives on prenatal screening for adverse childhood experiences","volume":"38","author":"Olsen","year":"2021","journal-title":"Public Health Nurs"},{"key":"B13","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1093\/pubmed\/fdab238","article-title":"Does screening or routine enquiry for adverse childhood experiences (ACEs) meet criteria for a screening programme? 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