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Pregnancy and Childbirth After Sexual Trauma

Patient Perspectives and Care Preferences

Sobel, Lauren, DO, MPH; O'Rourke-Suchoff, Danielle, MD, MPH; Holland, Erica, MD; Remis, Kimberly, BSW; Resnick, Kirsten, MS; Perkins, Rebecca, MD, MSc; Bell, Shannon, MD

doi: 10.1097/AOG.0000000000002956
Violence: Original Research: PDF Only

OBJECTIVE: To explore the pregnancy and childbirth experiences and preferences of women with a history of sexual trauma in order to identify trauma-informed care practices that health care providers may use to improve obstetric care.

METHODS: We conducted a qualitative study consisting of semistructured interviews with women who either self-identified as having a history of sexual trauma or did not. Participants were recruited from a tertiary care ambulatory clinic and had at least one birth experience within the past 3 years. Interviews were audio-recorded and transcribed verbatim. Grounded theory was used to derive themes using the participants' own words.

RESULTS: From 2015 to 2017, we interviewed 20 women with a history of sexual trauma and 10 without. Women with a history of sexual trauma desired clear communication about their history between prenatal care providers and the labor and delivery team. In the intrapartum period, they desired control over who was present in the labor room at the time of cervical examinations and for health care providers to avoid language that served as a stressing reminder of prior sexual trauma. They wanted control over the exposure of their bodies during labor and to be asked about their preference for a male health care provider. In the postpartum period, some women with a history of sexual trauma found breastfeeding healing and empowering.

CONCLUSION: Women with a history of sexual trauma have clear needs, preferences, and recommendations for obstetric care providers regarding disclosure, cervical examinations, health care provider language, body exposure, and male health care providers. They offer insight into unique breastfeeding challenges and benefits.

Patient-centered perspectives can facilitate trauma-informed care practices that may improve the prenatal and labor and delivery experiences of women with a history of sexual trauma.

Boston Medical Center and Brigham and Women's Hospital, Boston, Massachusetts.

Corresponding author: Lauren Sobel, DO, MPH, 85 E Concord Street, 6th Floor, Boston, MA; email: Lauren.sobel@bmc.org.

Supported by the 2017 Lynne Stevens Memorial Practice Improvement Grant and a 2015 Seed Grant though the Boston Medical Center, Department of Obstetrics & Gynecology.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the American College of Obstetricians and Gynecologists' Annual Clinical and Scientific Meeting, April 27–30, 2018, Austin, Texas.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer review history is available at http://links.lww.com/AOG/B177.

Received June 30, 2018

Received in revised form August 21, 2018

Accepted August 29, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.