“No, You Need to Explain What You Are Doing”: Obstetric Care Experiences and Preferences of Adolescent Mothers With a History of Childhood Trauma

Millar, Heather; Lorber, Sharon; Vandermorris, Ashley; Thompson, Gillian; Thompson, Marysa; Allen, Lisa; Aggarwal, Anjali; Spitzer, Rachel F.

doi:10.1016/j.jpag.2021.01.006

Cited by 15 publications

(25 citation statements)

References 25 publications

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“…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].…”

Section: 'I Did Not Know How To Say It and No-one Asked Me': Should M...mentioning

confidence: 99%

“…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]:…”

Section: 'I Did Not Know How To Say It and No-one Asked Me': Should M...mentioning

confidence: 99%

“…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]:…”

Section: 'I Did Not Know How To Say It and No-one Asked Me': Should M...mentioning

confidence: 99%

“…Participants in 13 studies highlighted the importance of a trusting relationship, built through multiple encounters, as a prerequisite for trauma disclosure [30-32, 34-39, 41, 43, 44, 51]. A mother from the study by Millar et al undertaken in 2021 [35] suggested: "I think if I had a relationship, then yes I [would disclose trauma history]. But with the amount of time I was seeing them, no.…”

Section: 'A Real Whitefella Way To Start': Standardisation and Tick-b...mentioning

confidence: 99%

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

Cull¹,

Thomson²,

Downe³

et al. 2022

Preprint

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Background Over a third of pregnant women (~250,000) each year in the United Kingdom have experienced trauma such as domestic abuse, childhood trauma or sexual assault. These experiences can have a long-term impact on women's mental and physical health. This global qualitative evidence synthesis explores the views of women and maternity care professionals on routine discussion of previous trauma in the perinatal period. Methods Systematic database searches (MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and Global Index Medicus) were conducted in July 2021 and updated in April 2022. The quality of each study was assessed using the Critical Appraisal Skills Programme. We thematically synthesised the data and assessed confidence in findings using GRADE-CERQual. Results We included 25 papers, from five countries, published between 2001 and 2022. All the studies were conducted in high-income countries; therefore findings cannot be applied to low- or middle-income countries. Confidence in most of the review findings was moderate or high. The findings are presented in six themes. These themes described how women and clinicians felt trauma discussions were valuable and worthwhile, provided there was adequate time and appropriate referral pathways. However, women often found being asked about previous trauma to be unexpected and intrusive, and women with limited English faced additional challenges. Many pregnant women were unaware of the extent of the trauma they have suffered, or its impact on their lives. Before disclosing trauma, women needed to have a trusting relationship with a clinician; even so, some women chose not to share their histories. Hearing trauma disclosures could be distressing for clinicians. Conclusion Discussions of previous trauma should be undertaken when women want to have the discussion, when there is time to understand and respond to the needs and concerns of each individual, and when there are effective resources available for follow up if needed. Continuity of carer should be considered a key feature of routine trauma discussion, as many women will not disclose their histories to a stranger. All women should be provided with information about the impact of trauma and how to independently access support in the event of non-disclosures. Care providers need support to carry out these discussions.

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Section: 'I Did Not Know How To Say It and No-one Asked Me': Should M...mentioning

confidence: 99%

Section: 'I Did Not Know How To Say It and No-one Asked Me': Should M...mentioning

confidence: 99%

Section: 'I Did Not Know How To Say It and No-one Asked Me': Should M...mentioning

confidence: 99%

Section: 'A Real Whitefella Way To Start': Standardisation and Tick-b...mentioning

confidence: 99%

See 2 more Smart Citations

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

Cull¹,

Thomson²,

Downe³

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Our findings suggest that people who suffered trauma in childhood also have more difficulty adhering to medical recommendations. Several studies have shown that people with childhood trauma are more likely to develop insecure attachment styles, which are associated with difficulties in seeking help and maintaining stable relationships ( Pearlman and Courtois, 2005 ; Clark et al, 2011 ; Millar et al, 2021 ) and other factors related to somatic medicine ( Graetz et al, 2013 ; Graf et al, 2020 ; Graetz et al, 2021 ). Therapeutic alliance, a marker of a stable relationship, indeed appears to play an important role in adherence ( Pringle and Fawcett, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study

et al. 2022

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ObjectiveAlthough treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence.Methods194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale.ResultsNon-adherence correlated significant with personality functioning (r = 0.325), childhood trauma (r = 0.204) and depressiveness (r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R2 = 0.149, F(3,190) = 12.225, p < 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model.ConclusionIn cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.

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Trauma and the perinatal period: A review of the theory and practice of trauma‐sensitive interactions for nurses and midwives

Isobel

2023

Nursing Open

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AimWith high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma‐sensitive interactions.Design and MethodsThis discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma‐sensitive practice in the perinatal period.ResultsNurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery.Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re‐enacting dynamics of trauma. To be trauma‐sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment.Implications for the Profession and/or Patient CareThis paper fills a gap in the translation of theory to practice for trauma‐sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress.Patient or Public ContributionNo patient or public contribution.

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“No, You Need to Explain What You Are Doing”: Obstetric Care Experiences and Preferences of Adolescent Mothers With a History of Childhood Trauma

Cited by 15 publications

References 25 publications

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

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

Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study

Trauma and the perinatal period: A review of the theory and practice of trauma‐sensitive interactions for nurses and midwives

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