has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version.If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting).
(Obstet Gynecol. 2018;132:1461–1468)
Although recommendations do exist, there is a lack of evidence-based guidelines for the care of women with a history of sexual trauma. Current literature, which consists predominantly of qualitative studies, supports the use of trauma-informed care, defined as the recognition of the prevalence of trauma, acknowledgment of the role trauma may have played, and integration of that knowledge into treatment. In order to identify effective trauma-informed care practices, the authors of the present study interviewed women with a history of sexual trauma and discussed their preferences regarding pregnancy and the childbirth experience.
INTRODUCTION:
Opioid use in pregnancy has increased dramatically, paralleling the epidemic observed in the general population. Many of these women have a history of sexual trauma. Our objective was to identify factors that adversely affect the labor and delivery experience for women with opioid use disorder and concomitant sexual trauma history.
METHODS:
This is a subgroup analysis of 13 women with a history of sexual trauma who participated in an opioid replacement therapy program during pregnancy. Participants underwent semi-structured qualitative interviews for a study about women with a history of sexual trauma. Interviews focused on the antenatal, intrapartum, and immediate post-partum experiences.
RESULTS:
Participants felt stigmatized by unfamiliar providers for their opioid use disorder and voiced desire for a childbirth experience unaffected by addiction, except when medically necessary. Most participants were concerned their opioid tolerance would lead to inadequate intrapartum pain management. Many felt they received less breastfeeding encouragement than women without opioid use disorder. Separation from infants for routine care or management of neonatal abstinence syndrome without adequate explanation concerned participants. In this situation, many feared they had lost custody, felt there was little institutional concern for maternal-infant bonding and reported guilt about the impact of addiction on the infant.
CONCLUSION:
Women with opioid use disorder and concomitant sexual trauma history report distrust of the medical system. Emphasizing established therapeutic relationships, ensuring clear communication regarding intrapartum pain control, promoting infant care in the post-partum room, and reinforcing legal determination of custody may improve labor and delivery experiences for this group of women.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.