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. 2023 May 17;18(5):e0284119.
doi: 10.1371/journal.pone.0284119. eCollection 2023.

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

Joanne Cull  1 , Gill Thomson  1 , Soo Downe  1 , Michelle Fine  2 , Anastasia Topalidou  1
Affiliations

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

Joanne Cull et al. PLoS One. .

Abstract

Background: Over a third of pregnant women (around 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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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow chart.
See this image and copyright information in PMC

References

    1. Crown Prosecution Service. Violence Against Women and Girls Report. England: 2019.
    1. Bellis M, Hughes K, Hardcastle K, Ashton K, Ford K, Quigg Z, et al.. The impact of adverse childhood experiences on health service use across the life course using a retrospective cohort study. J Health Serv Res Policy. 2017;22(3):168–77.
    1. Bellis MA, Hughes K, Ford K, Ramos Rodriguez G, Sethi D, Passmore J. Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. The Lancet Public Health. 2019;4(10):e517–28. doi: 10.1016/S2468-2667(19)30145-8 - DOI - PMC - PubMed
    1. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al.. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health. 2017;2(8):e356–66. doi: 10.1016/S2468-2667(17)30118-4 - DOI - PubMed
    1. Sara G, Lappin J. Childhood trauma: psychiatry’s greatest public health challenge? The Lancet Public Health. 2017;2(7):e300–1. doi: 10.1016/S2468-2667(17)30104-4 - DOI - PubMed

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