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

Abstract

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.

A Physical Therapist's Role in Providing a Trauma-Informed, Whole-Body, Holistic Approach to Address the Spiritual and Mental Health of Patients

“…The experience of each person must be understood as an individual and unique response, with triggers and subsequent responses being drastically different from person to person 14,15. For example, some people are aware immediately they have been through a traumatic experience, while others, especially those who have experienced childhood trauma, may not realize for years the full extent of the trauma they have endured or continue to experience 14,15. The physical therapist may meet them at any point on their journey to this realization 14,15…”

“…For example, some people are aware immediately they have been through a traumatic experience, while others, especially those who have experienced childhood trauma, may not realize for years the full extent of the trauma they have endured or continue to experience 14,15. The physical therapist may meet them at any point on their journey to this realization 14,15…”

“…Past trauma and religious customs may dictate the need for a specific gender of the provider, and gender of the provider is the number one reason why a patient will choose one provider over another 15,27,40. A simple way to address both mental health and spirituality is to comply with a patient's request of a gender-specific provider.…”

“…It takes a high level of autonomy, resilience, and personal awareness to be effective in this model of care. Listening to a patient's history of trauma or oppression can be triggering to the provider, especially if the provider has a history of domestic violence or shares a similar trauma 15. Providers should seek out the above-described services for their own well-being if they are having difficulty holding space for their patient 22…”

“…Unfortunately, trauma survivors are often misjudged by clinicians and the general public. Agitation, irritability, anxiety, depression, inappropriate outbursts, startling easily, sudden sweating, dissociation, inability to concentrate, difficulty trusting, self-blame, guilt, shame, and feeling numb are all mental health manifestations of unresolved trauma 3,14,15…”