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Trauma-Informed Maternity Care

  • Megan R. GerberEmail author
Chapter

Abstract

Pregnancy and childbirth are often difficult experiences for women who have experienced trauma. Exposure to interpersonal trauma is common in the US population, women experience high lifetime rates of child abuse, sexual assault, and intimate partner violence and these, in turn, may impact reproductive health. The data on sexual abuse in childhood, alone, indicate that at least one in four expectant women will have a history of sexual abuse. The Centers for Disease Control and Prevention (CDC) recently estimated that one in five adult women experience completed or attempted rape. Many women experience multiple forms of trauma, and some subsequently develop posttraumatic stress disorder (PTSD). When present prior to pregnancy and childbirth, PTSD can impact pregnancy outcomes and subsequent parenting, contributing to enduring intergenerational effects of trauma. Routine screening and inquiry for interpersonal trauma is critical because providers of maternity care may not always be aware of a woman’s history. Even if a patient does not wish to disclose, the care team has communicated to her that this is an important issue that can impact birth experience and outcomes. The birth experience itself can be traumatic, even for women with no antecedent trauma history. This chapter provides practical recommendations for implementing trauma-informed care (TIC) in maternity settings and discusses examples of programs that employ principles of TIC.

Keywords

Trauma-informed maternity care Birth trauma Sexual abuse Posttraumatic stress disorder Survivor childbirth Birth plan 

References

  1. 1.
    Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14(4):245–58.Google Scholar
  2. 2.
    Smith SG, Zhang X, Basile KC, Merrick MT, Wang J, Kresnow M, Chen J. The National intimate partner and sexual violence survey (NISVS): 2015 data brief. Atlanta: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention; 2018.Google Scholar
  3. 3.
    Polaris Project. 2017 human trafficking hotline, Washington, DC; 2018. Accessed 14 Dec 2018. Available from: https://polarisproject.org/2017statistics.
  4. 4.
    Miller E, Decker MR, McCauley HL, Tancredi DJ, Levenson RR, Waldman J, et al. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception. 2010;81(4):316–22.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Campbell R, Greeson MR, Bybee D, Raja S. The co-occurrence of childhood sexual abuse, adult sexual assault, intimate partner violence, and sexual harassment: a mediational model of posttraumatic stress disorder and physical health outcomes. J Consult Clin Psychol. 2008;76(2):194–207.PubMedGoogle Scholar
  6. 6.
    Sperlich M, Seng JS, Li Y, Taylor J, Bradbury-Jones C. Integrating trauma-informed care into maternity care practice: conceptual and practical issues. J Midwifery Womens Health. 2017;62(6):661–72.PubMedGoogle Scholar
  7. 7.
    Ferszt GG, Palmer M, McGrane C. Where does your state stand on shackling of pregnant incarcerated women? Nurs Womens Health. 2018;22(1):17–23.PubMedGoogle Scholar
  8. 8.
    Bonomi AE, Thompson RS, Anderson M, Reid RJ, Carrell D, Dimer JA, et al. Intimate partner violence and women’s physical, mental, and social functioning. Am J Prev Med. 2006;30(6):458–66.PubMedGoogle Scholar
  9. 9.
    Ottisova L, Hemmings S, Howard LM, Zimmerman C, Oram S. Prevalence and risk of violence and the mental, physical and sexual health problems associated with human trafficking: an updated systematic review. Epidemiol Psychiatr Sci. 2016;25(4):317–41.Google Scholar
  10. 10.
    Silverman JG, Decker MR, Reed E, Raj A. Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: associations with maternal and neonatal health. Am J Obstet Gynecol. 2006;195(1):140–8.PubMedGoogle Scholar
  11. 11.
    Williams CM, Larsen U, McCloskey LA. Intimate partner violence and women’s contraceptive use. Violence Against Women. 2008;14(12):1382–96.PubMedGoogle Scholar
  12. 12.
    Poli-Neto OB, Tawasha KAS, Romao A, Hisano MK, Moriyama A, Candido-Dos-Reis FJ, et al. History of childhood maltreatment and symptoms of anxiety and depression in women with chronic pelvic pain. J Psychosom Obstet Gynaecol. 2018;39(2):83–9.PubMedGoogle Scholar
  13. 13.
    Schliep KC, Mumford SL, Johnstone EB, Peterson CM, Sharp HT, Stanford JB, et al. Sexual and physical abuse and gynecologic disorders. Hum Reprod (Oxford, England). 2016;31(8):1904–12.Google Scholar
  14. 14.
    Bauer HM, Gibson P, Hernandez M, Kent C, Klausner J, Bolan G. Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases. Sex Transm Dis. 2002;29(7):411–6.PubMedGoogle Scholar
  15. 15.
    Stellar C, Garcia-Moreno C, Temmerman M, van der Poel S. A systematic review and narrative report of the relationship between infertility, subfertility, and intimate partner violence. Int J Gynaecol Obstet: Off Organ Int Fed Gynaecol Obstet. 2016;133(1):3–8.Google Scholar
  16. 16.
    Yost NP, Bloom SL, McIntire DD, Leveno KJ. A prospective observational study of domestic violence during pregnancy. Obstet Gynecol. 2005;106(1):61–5.PubMedGoogle Scholar
  17. 17.
    Alvarez-Segura M, Garcia-Esteve L, Torres A, Plaza A, Imaz ML, Hermida-Barros L, et al. Are women with a history of abuse more vulnerable to perinatal depressive symptoms? A systematic review. Arch Womens Ment Health. 2014;17(5):343–57.PubMedGoogle Scholar
  18. 18.
    Jasinski JL. Pregnancy and domestic violence: a review of the literature. Trauma Violence Abuse. 2004;5(1):47–64.PubMedGoogle Scholar
  19. 19.
    Bastos MH, Furuta M, Small R, McKenzie-McHarg K, Bick D. Debriefing interventions for the prevention of psychological trauma in women following childbirth. Cochrane Database Syst Rev. 2015;(4):Cd007194.Google Scholar
  20. 20.
    Finkelhor D, Hotaling G, Lewis IA, Smith C. Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child Abuse Negl. 1990;14(1):19–28.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Smith SG, Zhang X, Basile KC, Merrick MT, Wang J, Kresnow M, et al. The National Intimate partner and Sexual Violence Survey (NISVS): 2015 data brief – Updated Release. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; 2018. Accessed 14 Dec 2018. Available from: https://www.cdc.gov/violenceprevention/nisvs/2015NISVSdatabrief.html.
  22. 22.
    Seng JS, Taylor J. Trauma informed care in the perinatal period. Edinburgh, Scotland: Dunedin Academic Press; 2015.Google Scholar
  23. 23.
    Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008-2011. N Engl J Med. 2016;374(9):843–52.PubMedPubMedCentralGoogle Scholar
  24. 24.
    National Institute for Health and Care Excellence (NICE). Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors, Clinical guideline [CG110] London, UK; 2010, September. Accessed 14 Dec 2018. Available from: https://www.nice.org.uk/guidance/cg110.
  25. 25.
    Robinson K. Childhood sexual abuse. Implications for care during pregnancy and birth. Soc Obstet Gynaecol Can. 2000;22(4):303–6.Google Scholar
  26. 26.
    Simkin P, Klaus P. When survivors give birth: understanding and healing the effects of early sexual abuse on childbearing women. 1st ed. Seattle: Classic Day Publishing; 2004.Google Scholar
  27. 27.
    Seng JS, Low LK, Sperlich M, Ronis DL, Liberzon I. Prevalence, trauma history, and risk for posttraumatic stress disorder among nulliparous women in maternity care. Obstet Gynecol. 2009;114(4):839–47.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Seng JS, Sperlich M, Low LK. Mental health, demographic, and risk behavior profiles of pregnant survivors of childhood and adult abuse. J Midwifery Womens Health. 2008;53(6):511–21.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Seng JS, Low LK, Sperlich M, Ronis DL, Liberzon I. Post-traumatic stress disorder, child abuse history, birthweight and gestational age: a prospective cohort study. BJOG. 2011;118(11):1329–39.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Rosen D, Seng JS, Tolman RM, Mallinger G. Intimate partner violence, depression, and posttraumatic stress disorder as additional predictors of low birth weight infants among low-income mothers. J Interpers Violence. 2007;22(10):1305–14.PubMedGoogle Scholar
  31. 31.
    Bryant RA, Friedman MJ, Spiegel D, Ursano R, Strain J. A review of acute stress disorder in DSM-5. Depress Anxiety. 2011;28(9):802–17.PubMedGoogle Scholar
  32. 32.
    Reed R, Sharman R, Inglis C. Women’s descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy Childbirth. 2017;17(1):21.PubMedPubMedCentralGoogle Scholar
  33. 33.
    Harris R, Ayers S. What makes labour and birth traumatic? A survey of intrapartum ‘hotspots’. Psychol Health. 2012;27(10):1166–77.PubMedGoogle Scholar
  34. 34.
    Seng JS, Sperlich M, Low LK, Ronis DL, Muzik M, Liberzon I. Childhood abuse history, posttraumatic stress disorder, postpartum mental health, and bonding: a prospective cohort study. J Midwifery Womens Health. 2013;58(1):57–68.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Muzik M, McGinnis EW, Bocknek E, Morelen D, Rosenblum KL, Liberzon I, et al. PTSD symptoms across pregnancy and early postpartum among women with lifetime PTSD diagnosis. Depress Anxiety. 2016;33(7):584–91.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Muzik M, Bocknek EL, Broderick A, Richardson P, Rosenblum KL, Thelen K, et al. Mother-infant bonding impairment across the first 6 months postpartum: the primacy of psychopathology in women with childhood abuse and neglect histories. Arch Womens Ment Health. 2013;16(1):29–38.PubMedGoogle Scholar
  37. 37.
    Substance Abuse and Ment Health Services Administration (SAMHSA). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. 2014. Accessed 14 Dec 2018. Available from: https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884.html.
  38. 38.
    National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC). Substance abuse and mental health services administration. 2017, September 15 (Updated). Accessed 30 June 2018. Available from: https://www.samhsa.gov/nctic.
  39. 39.
    Seng JS, Petersen BA. Incorporating routine screening for history of childhood sexual abuse into well-woman and maternity care. J Nurse Midwifery. 1995;40(1):26–30.PubMedGoogle Scholar
  40. 40.
    American College of Obstetricians and Gynecologists (ACOG). Sexual assault. Committee opinion no. 592. Obstet Gynecol. 2014;123:905–9.Google Scholar
  41. 41.
    American College of Obstetricians and Gynecologists (ACOG). Intimate partner violence: committee opinion no. 518. Washington, DC; 2012, February. Contract No.: 518.Google Scholar
  42. 42.
    Flanagan T, Alabaster A, McCaw B, Stoller N, Watson C, Young-Wolff KC. Feasibility and acceptability of screening for adverse childhood experiences in prenatal care. J Womens Health (Larchmt). 2018;27(7):903–11.Google Scholar
  43. 43.
    Nieuwenhuijze MJ, Korstjens I, de Jonge A, de Vries R, Lagro-Janssen A. On speaking terms: a Delphi study on shared decision-making in maternity care. BMC Pregnancy Childbirth. 2014;14:223.PubMedPubMedCentralGoogle Scholar
  44. 44.
    National Resource Center on Domestic Violence (NRCDV). Trauma informed birth support: Survivor + Doula + Advocate. Harrisburg: National Resource Center on Domestic Violence (NRCDV); 2015.Google Scholar
  45. 45.
    Beaulieu S. Commentary: when sexual violence survivors give birth, here’s what you should know. Boston: WBUR, National Public Radio; 2016. Accessed 25 June 2018. Available from: http://www.wbur.org/commonhealth/2016/01/21/sexual-violence-survivor-childbirth.
  46. 46.
    Rising SS. Centering pregnancy. An interdisciplinary model of empowerment. J Nurse Midwifery. 1998;43(1):46–54.PubMedGoogle Scholar
  47. 47.
    Chen L, Crockett AH, Covington-Kolb S, Heberlein E, Zhang L, Sun X. Centering and racial disparities (CRADLE study): rationale and design of a randomized controlled trial of centering pregnancy and birth outcomes. BMC Pregnancy Childbirth. 2017;17(1):118.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Mazzoni SE, Carter EB. Group prenatal care. Am J Obstet Gynecol. 2017;216(6):552–6.PubMedGoogle Scholar
  49. 49.
    DeCesare JZ, Jackson JR. Centering pregnancy: practical tips for your practice. Arch Gynecol Obstet. 2015;291(3):499–507.PubMedGoogle Scholar
  50. 50.
    Humphrey T, Tucker JS, de Labrusse C. Does women’s contribution to co-constructed handheld maternity records support patient-centered care? Int J Childbirth. 2013;3(2):117–27.Google Scholar
  51. 51.
    Hawley G, Hepworth J, Wilkinson SA, Jackson C. From maternity paper hand-held records to electronic health records: what do women tell us about their use? Aust J Prim Health. 2016;22(4):339–48.PubMedGoogle Scholar
  52. 52.
    Say R, Robson S, Thomson R. Helping pregnant women make better decisions: a systematic review of the benefits of patient decision aids in obstetrics. BMJ Open. 2011;1(2):e000261.PubMedPubMedCentralGoogle Scholar
  53. 53.
    Vlemmix F, Warendorf JK, Rosman AN, Kok M, Mol BW, Morris JM, et al. Decision aids to improve informed decision-making in pregnancy care: a systematic review. BJOG. 2013;120(3):257–66.PubMedGoogle Scholar
  54. 54.
    Ledford CJW, Womack JJ, Rider HA, Seehusen AB, Conner SJ, Lauters RA, et al. Unexpected effects of a system-distributed Mobile application in maternity care: a randomized controlled trial. Health Educ Behav. 2018;45(3):323–30.PubMedGoogle Scholar
  55. 55.
    Gruber KJ, Cupito SH, Dobson CF. Impact of doulas on healthy birth outcomes. J Perinat Educ. 2013;22(1):49–58.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Seng JS, Sperlich M, Rowe H, Cameron H, Harris A, Rauch SAM, et al. The survivor moms’ companion: open pilot of a posttraumatic stress specific psychoeducation program for pregnant survivors of childhood maltreatment and sexual trauma. Int J Childbirth. 2011;1(2):112–20.Google Scholar
  57. 57.
    Sperlich M, Seng JS, Rowe H, Cameron H, Harris A, McCracken A, et al. The survivor mom’s companion: feasibility, safety, and acceptability of a posttraumatic stress specific psychoeducation program for pregnant survivors of childhood maltreatment and sexual trauma. Int J Childbirth. 2011;1(2):122–33.Google Scholar
  58. 58.
    Tuck SG, Summers AC, Bowie J, Fife-Stallworth D, Alston C, Hayes S, et al. B’More fit for healthy babies: using trauma-informed care policies to improve maternal health in Baltimore City. Womens Health Issues. 2017;27(Suppl 1):S38–45.PubMedGoogle Scholar
  59. 59.
    Kiser LJ, Medoff DR, Black MM. The role of family processes in childhood traumatic stress reactions for youths living in urban poverty. Traumatology. 2010;26(2):33–42.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Shields SG, Candib LME. Women-centered care in pregnancy and childbirth. Oxford: Radcliffe Publishing Ltd; 2010.Google Scholar
  61. 61.
    Bailey JM, Crane P, Nugent CE. Childbirth education and birth plans. Obstet Gynecol Clin N Am. 2008;35(3):497–509. ixGoogle Scholar
  62. 62.
    Maher S, Crawford-Carr A, Neidigh K. The role of the interpreter/doula in the maternity setting. Nurs Womens Health. 2012;16(6):472–81.PubMedGoogle Scholar
  63. 63.
    Sobel L, O’Rourke-Suchoff D, Holland E, Remis K, Resnick K, Perkins R, et al. Pregnancy and childbirth after sexual trauma: patient perspectives and care preferences. Obstet Gynecol. 2018;132(6):1461–8.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Section of General Internal MedicineBoston University School of Medicine, Veterans Affairs (VA) Boston Healthcare SystemBostonUSA

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