A feasibility study of trauma-sensitive obstetric care for low-income, ethno-racial minority pregnant abuse survivors

Abstract

Purpose: This study evaluated the feasibility and acceptability of an integrated (psychological and obstetric) intervention for pregnant abuse survivors with posttraumatic stress symptoms (PTS) from low-income, ethno-racial minority backgrounds.

Methods: Trauma-sensitive obstetrics to promote control, anxiety-reduction and empowerment (TO-CARE) offers cognitive-behavioral therapy (CBT) coping skills delivered over six sessions by therapists, coupled with trauma-sensitive obstetric care from specially-trained obstetric physicians.

Results: Participants were 21 women who completed at least three sessions of CBT, totaling 51.2% of eligible participants. Participants received approximately one-third (M = 2.29; SD = 2.15) of their prenatal visits with obstetric residents trained in trauma-sensitive care. Nearly all participants (95%) reported that they benefited from the intervention. Although most participants demonstrated improvement in PTS, only four demonstrated reliable improvement, and two demonstrated reliable improvement in depression symptoms. These improvements appeared to be maintained at postpartum follow-up for two of the participants.

Conclusions: Our findings suggest that TO-CARE was acceptable to pregnant abuse survivors and may be a promising intervention to reduce symptoms of distress. Implications of the low retention rate for the CBT (51.2%) are discussed in the context of interventions for low-income minority pregnant women. Limitations regarding feasibility of the integrated intervention are discussed.

Keywords:

• Pregnancy
• abuse
• posttraumatic stress
• obstetric care
• trauma-sensitive care

Disclosure statement

The authors report no conflicts of interest.

Current knowledge on the subject

• Abuse histories often go undetected in obstetric patients despite the fact that prior abuse has been associated with an increased risk of psychological distress (i.e., PTSD and depression) as well as medical compilations of pregnancy.

• Pregnant abuse survivors, and particularly those who are also low-income and ethnic minorities, are vulnerable to increased anxiety and pain during obstetric care.

• Currently, no standardized interventions exist to address the unique needs of pregnant abuse survivors in the context of their obstetric care.

What this study adds

• Trauma-sensitive Obstetrics to promote Control, Anxiety-Reduction and Empowerment (TO-CARE) is the first integrated (psychological and obstetric trauma-focused integration) intervention designed to help pregnant abuse survivors reduce distress, feel empowered and minimize the trauma-evoking aspects of their obstetric care.

• TO-CARE demonstrated adequate treatment acceptability and was evaluated favorably by our sample of underserved pregnant abuse survivors with symptoms of PTSD. TO-CARE shows promise as an intervention that may help women overcome psychological distress during pregnancy.

• Additional research is needed to address uptake and retention issues endemic to low-income minority populations that face substantial care barriers.

Additional information

Funding

The study described in this report was funded in part by the NIH-NHLBI 1P50HL105189, Rush Center for Urban Health Equity and National Heart, Lung and Blood Institute.