EMpowering Pregnant women Affected by Trauma HistoRY: The EMPATHY study

Abstract

Over a quarter of pregnant women (~150,000) each year in the UK have suffered trauma such as domestic abuse, adverse childhood experiences, or sexual assault. These experiences can have a lasting effect on mental and physical health, and impact pregnancy and parenting. Despite this prevalence and the potential consequences, discussing prior trauma is not standard practice in maternity care in the United Kingdom. This critical participatory action research study aimed to address the research question: How can maternity services empower pregnant women affected by previous trauma to access support?

The study was underpinned by critical social theory and guided by a Research Collective comprising experts by experience, voluntary sector practitioners, and maternity care professionals. A systematic literature review and qualitative evidence synthesis was conducted which included 25 papers from 5 countries, representing the views of 1602 women and 286 healthcare professionals and experts from the voluntary sector. Interviews were then undertaken with women with lived experience of trauma (n=4), healthcare professionals (12), and voluntary sector experts (n=7).

Findings from the qualitative synthesis and interviews were reported separately and then integrated with insights from the Research Collective to develop an evidence-based framework of guiding principles for routine discussion of previous trauma in the perinatal period. The development process included a rigorous public consultation with 52 responses.

The framework contains 23 recommendations based on six core principles. Routine trauma discussion should be introduced as part of a system-wide change; maternity care providers should let women know previous trauma can affect their well-being and help them access support; trauma conversations need to be carried out sensitively, to build trust and relationships; staff must be provided with adequate training and support; trauma discussions should be tailored to local needs and services; and services should systematically assess the implementation and impact of routine trauma discussions and seek to continuously improve trauma pathways based on these insights.

The research marks a unique contribution to knowledge by offering a new model for trauma discussions, informed by meaningful engagement with trauma survivors and stakeholders. Further research is needed to determine whether implementation of the framework improves maternal and neonatal outcomes.