Exploring women's perspectives on prenatal screening for adverse childhood experiences

Abstract

Objective: To learn more about women's views on screening for adverse childhood experiences (ACEs) during healthcare visits in pregnancy.Design: Mixed methods with an online survey. Sample:A convenience sample of 154 women with a history of one or more pregnancies was recruited through public health department social media pages in one predominantly rural region of a Midwest state.Measurements: Quantitative measures included demographic variables, ACE scores, and preferences regarding screening format, strategies, and resources. Additional perspectives were captured through open-ended questions.Results: Women's mean ACE score was 2.56 (SD = 2.37) with 68% reporting 0-3 ACEs and 32% reporting four or more. Routine screening for ACEs during prenatal care was supported by 67.5% of women with 9.1% indicating sometimes, 20.8% unsure, and 2.6% against. Strong preference was indicated for screening by one's physician or midwife (80.3%), in an exam room (83.1%), using an independently completed questionnaire (64.2%). Preferred approaches for screening and post-screening interventions also were identified with qualitative themes providing additional insights.Conclusions: Findings inform strategies for efficiently and sensitively screening for ACEs during pregnancy, highlight the importance of using a trauma-informed approach, and provide direction for educational and interventional resource development.

Views from women and maternity care professionals on routine discussion of previous trauma in the perinatal period: A qualitative evidence synthesis

“…The overall finding that women accepted routine trauma discussion masks several complexities and contradictions. In eight studies, women reported feeling unprepared for the discussion and found it intrusive [32,33,[35][36][37][38][39]42]. This was reflected by a woman who was interviewed in the study by Millar et al (2021) [35]:…”

“…Participants in 14 studies expressed that they felt routine trauma discussion is acceptable and worthwhile [31][32][33][34][35][36][37][38][39][40][41][42][43][44]. One of the participants in the study undertaken by Montgomery, Seng and Chang (2021) [36] proposed: "It might have just put a thought in my head, even if it wasn't something that I shared with anybody, it might have just put a thought in my head which might have been useful at some point" [36].…”

“…Participants in the study by Kohlkoff et al felt there were three key benefits of routine trauma discussion: identify women at higher risk of mental health problems or family violence, increase referrals to appropriate support services, and provide support and education [47]. However, in seven studies, women felt that trauma discussions should only take place if clinicians had enough time to respond to disclosures and could provide or refer into appropriate support [32,38,39,[41][42][43][44]. Having disclosed prior trauma, some women expected that they would be treated more sensitively and that other care providers would be aware of their history, and were aggravated when this wasn't the case [39,41]: [39].…”

“…The researchers found there were a range of reasons, including lack of trust of the person asking, fear of judgement, use of closedended questions and lack of time, but also simply privacy: they did not want to share this information [37]. Similarly, a participant in Olsen, Galloway and Guthman (2021) proposed that "some people may not be ready" [38] while a woman taking part in the study by Gokhale et al (2020) suggested that "it's not easy speaking up about situations like that and a lot of people don't because they don't feel comfortable or they don't feel like they could trust people enough to do that" [33]. This implies that even within a trusting relationship, some women who would benefit from support will choose not to share their histories.…”

Physician Perspectives on the Implementation of a Trauma Informed Care Initiative in the Maternity Care Setting

“…A TIC initiative can include asking about past and current traumatic experiences, which has been subject to debate in the literature (Finkelhor, 2018;McLennan et al, 2020;McLennan et al, 2019). Although most patients would feel comfortable discussing their ACEs with their healthcare provider (Flanagan et al, 2018;Olsen et al, 2021;Purkey et al, 2018), many healthcare providers do not incorporate asking about ACEs in their routine medical practice or feel comfortable discussing ACEs with their patients (Tink et al, 2017;Weinreb et al, 2010). A quantitative study conducted with 145 obstetrics and gynecology fellows found that less than 30% of physicians spoke to their patients about childhood trauma (Farrow et al, 2018).…”