Empowering women through trauma-informed maternity care: the EMPATHY framework

Background: 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. Methods: 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 = 52), 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. Results: 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. Discussion/conclusion: 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.