Routine discussion of previous trauma in the perinatal period: Insights from interviews with women, voluntary sector representatives, and maternity care providers

Abstract

Background: Many pregnant women have a history of trauma, such as abuse or violence, which can significantly impact their mental and physical health. Discussing these experiences in maternity care presents an opportunity to support women, reduce stigma, and connect them with resources. However, concerns persist about stigmatisation, re-traumatisation and unwarranted safeguarding referrals. As part of a larger study that aimed to develop a methodology for conducting trauma discussions, interviews were carried out with a range of stakeholders.

Methods: Semi-structured interviews were conducted with women with trauma histories (experts by experience; n=4), representatives of voluntary sector organisations (n=7), and healthcare providers (n=12). Reflexive thematic analysis was used to analyse the data. The study employed a critical participatory action research approach, supported by a Patient and Public Involvement & Engagement group (named as the ‘Research Collective’ for this study) comprising experts by experience, maternity care professionals, and voluntary sector practitioners. The group contributed to both the design and analysis phases of the research.

Findings: Five key themes emerged from the interviews, exploring both the benefits and challenges of trauma discussion in maternity care. Participants reflected on who should lead these discussions, the appropriate settings and timings, and strategies for effective communication. The emotional and training needs of care providers conducting trauma discussions were also highlighted.

Conclusion: Trauma discussions in maternity care are a complex but necessary intervention that require careful consideration of timing, communication, and referral pathways. This paper offers concrete steps towards creating a more empathetic and supportive maternity care environment.

Problem: Traumatic experiences such as abuse or violence contribute to long term mental and physical health problems.

What is already known: Raising the issue of previous trauma within maternity care offers an opportunity to provide support, but if handled insensitively can be distressing to women.

What this paper adds: This paper shows that discussing trauma is complex and requires a system-wide approach which addresses when, where, and how to talk about trauma, referral pathways, and the need for training and support for maternity care providers. It also offers insights on conducting these discussions sensitively and effectively.