Posttraumatic stress and depression may undermine abuse survivors’ self-efficacy in the obstetric care setting

Abstract

Introduction: Posttraumatic stress symptoms (PTS) are associated with increased risk of obstetric complications among pregnant survivors of trauma, abuse and interpersonal violence, but little is known about how PTS affects women’s actual experiences of obstetric care. This study investigated the rate at which abuse history was detected by obstetricians, whether abuse survivors experienced more invasive exams than is typically indicated for routine obstetric care, and whether psychological distress was associated with abuse survivors’ sense of self-efficacy when communicating their obstetric care needs.

Methods: Forty-one pregnant abuse survivors completed questionnaires about abuse history, current psychological distress and self-efficacy for communicating obstetric care needs and preferences. Electronic medical records (EMRs) were reviewed to examine frequency of invasive prenatal obstetric procedures (e.g. removal of clothing for external genital examination, pelvic exams and procedures) and to examine the detection rate of abuse histories during the initial obstetric visit.

Results: The majority of participants (83%) reported at least one past incident of violent physical or sexual assault. Obstetricians detected abuse histories in less than one quarter of cases. Nearly half of participants (46%) received invasive exams for non-routine reasons. PTS and depression symptoms were associated with lower self-efficacy in communicating obstetric care preferences.

Discussion: Women most at risk for experiencing distress during their obstetric visits and/or undergoing potentially distressing procedures may also be the least likely to communicate their distress to obstetricians. Results are discussed with implications for improving screening for abuse screening and distress symptoms as well as need for trauma-sensitive obstetric practices.

Keywords:

• Abuse screening during pregnancy
• obstetric care
• posttraumatic stress
• self-efficacy

Disclosure statement

The authors report no conflicts of interest.

Current knowledge on the subject

• Pregnant women with histories of abuse, trauma and interpersonal violence area at risk for posttraumatic stress (PTS), depression and anxiety.

• Pregnant abuse survivors are at increased risk of medical complications of pregnancy.

• Trauma sensitivity is virtually absent from standard obstetric care, despite ACOG recommendations to enhance trauma sensitivity for abuse survivors.

What this study adds

• Pregnant abuse survivors receive more frequent invasive obstetric exams and procedures than is typically indicated for routine prenatal obstetric care.

• Posttraumatic stress (PTS) and depression symptoms may impair abuse survivors? sense of self-efficacy when communicating preferences for care to their obstetricians.

• These data have important clinical implications for developing standards for trauma-sensitive obstetric care, including improving detection of trauma histories at obstetric intake and using strategies to promote women?s sense of empowerment and self-efficacy during invasive obstetric procedures.