Healing The Past By Nurturing The Future: A qualitative systematic review and meta-synthesis of pregnancy, birth and early postpartum experiences and views of parents with a history of childhood maltreatment

Abstract

BackgroundChild maltreatment can have serious effects on development and physical, social and emotional wellbeing. Any long-lasting relational effects can impede the capacity to nurture children, potentially leading to ‘intergenerational trauma’. Conversely, the transition to parenthood during pregnancy, birth and the early postpartum period offers a unique life-course opportunity for healing. This systematic review aims to understand the pregnancy, birth and early postpartum experiences of parents who reported maltreatment in their own childhood.MethodsA protocol, based on the ENTREQ statement, was registered with PROSPERO. We searched Medline, PsycINFO, CINAHL, EMBASE, NHS Evidence and key Web of Science databases from date of inception to June 2018 to identify qualitative studies exploring perinatal experiences of parents who were maltreated in their own childhood. Two reviewers independently screened articles for inclusion and extracted data. Data were synthesised using grounded theory and thematic analysis approaches.FindingsThe search yielded 18329 articles, 568 full text articles were reviewed, and 50 studies (60 articles) met inclusion criteria for this review. Due to the large number of studies across the whole perinatal period (pregnancy to two years postpartum), this paper reports findings for experiences during pregnancy, birth and early postpartum (27 studies). Parents described positive experiences and strategies to help them achieve their hopes and dreams of providing safe, loving and nurturing care for their children. However, many parents experienced serious challenges. Seven core analytic themes encapsulated these diverse and dynamic experiences: New beginnings; Changing roles and identities; Feeling connected; Compassionate care; Empowerment; Creating safety; and Reweaving a future.ConclusionsPregnancy birth and the early postpartum period is a unique life-course healing opportunity for parents with a history of maltreatment. Understanding parent’s experiences and views of perinatal care and early parenting is critical for informing the development of acceptable and effective support strategies.

Reported maternal childhood maltreatment experiences, amygdala activation and functional connectivity to infant cry

“…While mothers’ reported that CMEs do not represent a current active threat, they nonetheless may inform empathic responses to infants in a way that seeks to repair their own prior childhood experiences as has been suggested in qualitative analyses (i.e. ‘I want my infant’s life to be different than mine’) ( Chamberlain et al. , 2019 ).…”

Adverse Childhood Experiences are associated with choice of partner, both partners' relationship and psychosocial health as reported one year after birth of a common child. A cross-sectional study

“…Therefore, it seems to be quite feasible to ask about ACEs and mental health and expect co-operation from the majority. The time interval around childbirth might thus constitute a window of opportunity [ 32 ]. Questions that would normally be regarded as an intrusion of privacy and cause unease in health care staff might thus be accepted willingly and this might help to understand better what kind of assistance might be needed in order to improve the future of the couple and the child [ 33 , 34 ].…”

“…This was most true for couples where both members were exposed to multiple ACEs, as shown in the present study. Global action to prevent and diminish these consequences must be the obligation for every society and is in accordance with the sustainable goals of the UN [ 32 , 35 ]. These preventive and therapeutic efforts demand development of a new concept of primary care/general practice/health care as a whole, social welfare services as well as staff in schools with broadened competences in meeting, understanding and helping people afflicted by ACEs and other demanding life conditions [ 36 ].…”

(Re)activation of survival strategies during pregnancy and childbirth following experiences of childhood sexual abuse

“…For some, pregnancy and birth empowers women to take control of their own bodies and challenges the memory of the abuse by focusing on the body as a site of growth, rather than of abuse. Further, it may supplant negative memories with ones of pride in their creation (Chamberlain et al, 2019;LoGiudice & Beck, 2016). Research suggests pre-emptive work can be undertaken to improve labour (Gerber, 2019;Sperlich et al, 2017), such as: creating birth plans (Rhodes & Hutchinson, 1994), prioritising trusting relationships with HCPs (Florian, 2018;Montgomery, 2013), and respecting privacy (Parratt, 1994).…”