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Stroud LR, Jao NC, Ward LG, Lee SY, Marsit CJ. Differential impact of prenatal PTSD symptoms and preconception trauma exposure on placental NR3C1 and FKBP5 methylation. Stress 2024; 27:2321595. [PMID: 38676353 PMCID: PMC11238900 DOI: 10.1080/10253890.2024.2321595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/16/2024] [Indexed: 04/28/2024] Open
Abstract
Perinatal stress is associated with altered placental methylation, which plays a critical role in fetal development and infant outcomes. This proof-of-concept pilot study investigated the impact of lifetime trauma exposure and perinatal PTSD symptoms on epigenetic regulation of placenta glucocorticoid signaling genes (NR3C1 and FKBP5). Lifetime trauma exposure and PTSD symptoms during pregnancy were assessed in a racially/ethnically diverse sample of pregnant women (N = 198). Participants were categorized into three groups: (1) No Trauma (-T); (2) Trauma, No Symptoms (T - S); and (3) Trauma and Symptoms (T + S). Placental tissue was analyzed via bisulfite pyrosequencing for degree of methylation at the NR3C1 promoter and FKBP5 regulatory regions. Analyses of covariance were used to test group differences in percentages of NR3C1 and FKBP5 methylation overall and at each CpG site. We found a significant impact of PTSD symptoms on placental NR3C1 methylation. Compared to the -T group, the T + S group had greater NR3C1 methylation overall and at CpG6, CpG8, CpG9, and CpG13, but lower methylation at CpG5. The T + S group had significantly higher NR3C1 methylation overall and at CpG8 compared to the T - S group. There were no differences between the T - S group and - T group. Additionally, no group differences emerged for FKBP5 methylation. Pregnant trauma survivors with PTSD symptoms exhibited differential patterns of placental NR3C1 methylation compared to trauma survivors without PTSD symptoms and pregnant women unexposed to trauma. Results highlight the critical importance of interventions to address the mental health of pregnant trauma survivors.
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Affiliation(s)
- Laura R. Stroud
- COBRE Center for Stress, Trauma, and Resilience*, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Nancy C. Jao
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - L. G. Ward
- COBRE Center for Stress, Trauma, and Resilience*, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Sharon Y. Lee
- COBRE Center for Stress, Trauma, and Resilience*, Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Carmen J. Marsit
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
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Isobel S. Trauma and the perinatal period: A review of the theory and practice of trauma-sensitive interactions for nurses and midwives. Nurs Open 2023; 10:7585-7595. [PMID: 37775971 PMCID: PMC10643851 DOI: 10.1002/nop2.2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023] Open
Abstract
AIM With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma-sensitive interactions. DESIGN AND METHODS This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma-sensitive practice in the perinatal period. RESULTS Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re-enacting dynamics of trauma. To be trauma-sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE This paper fills a gap in the translation of theory to practice for trauma-sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sophie Isobel
- University of SydneySydneyNew South WalesAustralia
- Perinatal Mental Health, Sydney Local Health DistrictSydneyNew South WalesAustralia
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3
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Johnson S, Kasparian NA, Cullum AS, Flanagan T, Ponting C, Kowalewski L, Main EK. Addressing Adverse Childhood and Adult Experiences During Prenatal Care. Obstet Gynecol 2023:00006250-990000000-00759. [PMID: 37141600 PMCID: PMC10184824 DOI: 10.1097/aog.0000000000005199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/08/2022] [Indexed: 05/06/2023]
Abstract
Adverse childhood and adult experiences can affect health outcomes throughout life and across generations. The perinatal period offers a critical opportunity for obstetric clinicians to partner with patients to provide support and improve outcomes. This article draws on stakeholder input, expert opinion, and available evidence to provide recommendations for obstetric clinicians' inquiry about and response to pregnant patients' past and present adversity and trauma during prenatal care encounters. Trauma-informed care is a universal intervention that can proactively address adversity and trauma and support healing, even if a patient does not explicitly disclose past or present adversity. Inquiry about past and present adversity and trauma provides an avenue to offer support and to create individualized care plans. Preparatory steps to adopting a trauma-informed approach to prenatal care include initiating education and training for practice staff, prioritizing addressing racism and health disparities, and establishing patient safety and trust. Inquiry about adversity and trauma, as well as resilience factors, can be implemented gradually over time through open-ended questions, structured survey measures, or a combination of both techniques. A range of evidence-based educational resources, prevention and intervention programs, and community-based initiatives can be included within individualized care plans to improve perinatal health outcomes. These practices will be further developed and improved by increased clinical training and research, as well as through broad adoption of a trauma-informed approach and collaboration across specialty areas.
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Affiliation(s)
- Sara Johnson
- La Clinica de La Raza, Oakland, the California Maternal Quality Care Collaborative and the Departments of Pediatrics and Obstetrics and Gynecology, School of Medicine, Stanford University, Palo Alto, and the Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California; and the Department of Pediatrics, University of Cincinnati College of Medicine, Center for Heart Disease and Mental Health, Heart Institute, and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Perera E, Chou S, Cousins N, Mota N, Reynolds K. Women's experiences of trauma, the psychosocial impact and health service needs during the perinatal period. BMC Pregnancy Childbirth 2023; 23:197. [PMID: 36944924 PMCID: PMC10028773 DOI: 10.1186/s12884-023-05509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/09/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Traumatic events are associated with psychological and physical health problems for women in the perinatal period (i.e., pregnancy-12-months after childbirth). Despite the negative impact of trauma on perinatal women, the long-term impact of such diverse trauma and women's experience during the perinatal period remains understudied. METHODS This study explored two research questions: 1) What are the psychological experiences of perinatal women who have experienced interpersonal traumatic events? And 2) What are the service needs and gaps expressed by women relating to perinatal medical protocols and psychological services? These questions were addressed via in-depth semi-structured qualitative interviews with nine perinatal women (one pregnant and eight postpartum) residing in central Canada who reported experiencing interpersonal traumatic events occurring from adolescence to the perinatal period. Recruitment and data collection occurred from October 2020 to June 2021. Interviews were audio-recorded, transcribed, and analyzed according to constructivist grounded theory. RESULTS The emergent grounded theory model revealed the central theme of the role of prior trauma in shaping women's perinatal experiences, with four related main themes including perinatal experiences during the COVID-19 pandemic, the role of social support in women's perinatal experiences, the barriers that women experienced while seeking psychological and medical services prior to the perinatal period and during the perinatal period, and the specific needs of perinatal women with a history of interpersonal trauma. CONCLUSIONS Findings of this research highlight the negative and long-lasting impact of traumatic events experienced on women's psychological health and psychosocial functioning during the perinatal period, as well as perinatal women's unmet psychological and medical service needs. A call to action for perinatal researchers and clinicians is imperative in furthering this important area of research and practicing person-centered and trauma-informed care with this population.
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Affiliation(s)
- Essence Perera
- Department of Psychology, University of Manitoba, P313 Duff Roblin Building, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Sharon Chou
- Department of Psychology, University of Manitoba, P313 Duff Roblin Building, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada
| | - Nicole Cousins
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Natalie Mota
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, P313 Duff Roblin Building, 190 Dysart Rd, Winnipeg, MB, R3T 2N2, Canada.
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.
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5
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Cull J, Thomson G, Downe S, Fine M, Topalidou A. Views from women and maternity care professionals on routine discussion of previous trauma in the perinatal period: A qualitative evidence synthesis. PLoS One 2023; 18:e0284119. [PMID: 37195971 DOI: 10.1371/journal.pone.0284119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/23/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Over a third of pregnant women (around 250,000) each year in the United Kingdom have experienced trauma such as domestic abuse, childhood trauma or sexual assault. These experiences can have a long-term impact on women's mental and physical health. This global qualitative evidence synthesis explores the views of women and maternity care professionals on routine discussion of previous trauma in the perinatal period. METHODS Systematic database searches (MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and Global Index Medicus) were conducted in July 2021 and updated in April 2022. The quality of each study was assessed using the Critical Appraisal Skills Programme. We thematically synthesised the data and assessed confidence in findings using GRADE-CERQual. RESULTS We included 25 papers, from five countries, published between 2001 and 2022. All the studies were conducted in high-income countries; therefore findings cannot be applied to low- or middle-income countries. Confidence in most of the review findings was moderate or high. The findings are presented in six themes. These themes described how women and clinicians felt trauma discussions were valuable and worthwhile, provided there was adequate time and appropriate referral pathways. However, women often found being asked about previous trauma to be unexpected and intrusive, and women with limited English faced additional challenges. Many pregnant women were unaware of the extent of the trauma they have suffered, or its impact on their lives. Before disclosing trauma, women needed to have a trusting relationship with a clinician; even so, some women chose not to share their histories. Hearing trauma disclosures could be distressing for clinicians. CONCLUSION Discussions of previous trauma should be undertaken when women want to have the discussion, when there is time to understand and respond to the needs and concerns of each individual, and when there are effective resources available for follow up if needed. Continuity of carer should be considered a key feature of routine trauma discussion, as many women will not disclose their histories to a stranger. All women should be provided with information about the impact of trauma and how to independently access support in the event of non-disclosures. Care providers need support to carry out these discussions.
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Affiliation(s)
- Joanne Cull
- School of Community Health and Midwifery, University of Central Lancashire, Preston, England
| | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, England
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, England
| | - Michelle Fine
- Public Science Project, The Graduate Center, City University of New York, New York, United States of America
| | - Anastasia Topalidou
- School of Community Health and Midwifery, University of Central Lancashire, Preston, England
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Yee LM, Shah SK, Grobman WA, Labellarte PZ, Barrera L, Jhaveri R. Identifying barriers and facilitators of the inclusion of pregnant individuals in hepatitis C treatment programs in the United States. PLoS One 2022; 17:e0277987. [PMID: 36399489 PMCID: PMC9674123 DOI: 10.1371/journal.pone.0277987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The rising prevalence of hepatitis C virus (HCV) infection and the availability of direct acting antivirals for HCV treatment has prompted a public health goal of HCV eradication. Despite the availability of treatment for HCV, treatment programs have generally excluded pregnant individuals. Our objective was to query patients and clinicians to identify barriers to including pregnant individuals in HCV treatment programs. METHODS AND FINDINGS This qualitative investigation included obstetricians and previously/currently pregnant individuals with HCV. Participants completed interviews regarding knowledge of and attitudes towards HCV treatment and perceived barriers to treatment during pregnancy. Data were analyzed using the constant comparative method. Obstetricians (N = 18) and patients (N = 21) described concerns about equity, access, and cost. Both expressed uncertainty about safety and confirmed a need for clinician education. Obstetricians emphasized the lack of professional guidelines. Although some clinicians expressed concern about patient adherence and engagement, patients were largely desirous of treatment; both groups identified potential benefits of antenatal treatment. CONCLUSIONS Both patients and obstetricians were generally receptive to HCV treatment in pregnancy and recognized pregnancy as an important window of opportunity for treatment. Our findings suggest the need for further research on maternal-fetal safety of HCV treatment as well as on interventions to ensure fair and appropriate access to HCV treatment for pregnant individuals.
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Affiliation(s)
- Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | - Seema K. Shah
- Division of Advanced General Pediatrics, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Smith Child Health Outcomes Research and Evaluation Center, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, United States of America
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University School of Medicine, Columbus, Ohio, United States of America
| | - Patricia Z. Labellarte
- Smith Child Health Outcomes Research and Evaluation Center, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, United States of America
| | - Leonardo Barrera
- Smith Child Health Outcomes Research and Evaluation Center, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois, United States of America
| | - Ravi Jhaveri
- Division of Infectious Diseases, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Keedle H, Schmied V, Burns E, Dahlen HG. From coercion to respectful care: women's interactions with health care providers when planning a VBAC. BMC Pregnancy Childbirth 2022; 22:70. [PMID: 35086509 PMCID: PMC8793226 DOI: 10.1186/s12884-022-04407-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/14/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women's perspective. METHODS A national Australian VBAC survey was undertaken in 2019. In total 559 women participated and provided 721 open-ended responses to six questions. Content analysis was used to categorise respondents' answers to the open-ended questions. RESULTS Two main categories were found capturing the positive and negative interactions women had with health care providers. The first main category, 'Someone in my corner', included the sub-categories 'belief in women birthing', 'supported my decisions' and 'respectful maternity care'. The negative main category 'Fighting for my birthing rights' included the sub-categories 'the odds were against me', 'lack of belief in women giving birth' and 'coercion'. Negative interactions included the use of coercive comments such as threats and demeaning language. Positive interactions included showing support for VBAC and demonstrating respectful maternity care. CONCLUSIONS In this study women who planned a VBAC experienced a variety of positive and negative interactions. Individualised care and continuity of care are strategies that support the provision of positive respectful maternity care.
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Affiliation(s)
- Hazel Keedle
- Lecturer of Nursing & Midwifery School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, 2751, Penrith, NSW, Australia.
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia.
| | - Elaine Burns
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia.
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia.
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Maternal-Child Health Outcomes from Pre- to Post-Implementation of a Trauma-Informed Care Initiative in the Prenatal Care Setting: A Retrospective Study. CHILDREN 2021; 8:children8111061. [PMID: 34828774 PMCID: PMC8622334 DOI: 10.3390/children8111061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
Background: There has been an increase in use of trauma-informed care (TIC) approaches, which can include screening for maternal Adverse Childhood Experiences (ACEs) during prenatal care. However, there is a paucity of research showing that TIC approaches are associated with improvements in maternal or offspring health outcomes. Using retrospective file review, the current study evaluated whether differences in pregnancy health and infant birth outcomes were observed from before to after the implementation of a TIC approach in a low-risk maternity clinic, serving women of low medical risk. Methods: Demographic and health data were extracted from the medical records of 601 women (n = 338 TIC care, n = 263 pre-TIC initiative) who received prenatal care at a low-risk maternity clinic. Cumulative risk scores for maternal pregnancy health and infant birth outcomes were completed by health professionals. Results: Using independent chi-squared tests, the proportion of women without pregnancy health risks did not differ for women from before to after the implementation of TIC, χ2 (2, 601) = 3.75, p = 0.15. Infants of mothers who received TIC were less likely to have a health risk at birth, χ2 (2, 519) = 6.17, p = 0.046. Conclusion: A TIC approach conveyed modest benefits for infant outcomes, but not maternal health in pregnancy. Future research examining other potential benefits of TIC approaches are needed including among women of high socio-demographic and medical risk.
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Abstract
The integration of trauma-informed care practices into the care of obstetric patients requires an understanding of psychological trauma, its impact on this population, and how trauma-informed care can be adapted to improve outcomes for those patients with a previous history of trauma or for those that experience peripartum trauma. System-based changes to policies, protocols, and practices are needed to achieve sustainable change. Maternal morbidity and mortality that result from trauma-related and other mental health conditions in the peripartum period are significant. Innovative approaches to the prevention of negative birth experiences and retraumatization during labor and delivery are needed.
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Affiliation(s)
- Tracey M Vogel
- Department of Anesthesiology, West Penn Hospital/Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA.
| | - Erica Coffin
- Obstetric Anesthesia, Department of Anesthesiology, West Penn Hospital/Allegheny Health Network, 4800 Friendship Avenue, Pittsburgh, PA 15224, USA. https://twitter.com/coffin_erica
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10
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Olsen JM, Galloway EG, Guthman PL. Exploring women's perspectives on prenatal screening for adverse childhood experiences. Public Health Nurs 2021; 38:997-1008. [PMID: 34402097 DOI: 10.1111/phn.12956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To learn more about women's views on screening for adverse childhood experiences (ACEs) during healthcare visits in pregnancy. DESIGN Mixed methods with an online survey. SAMPLE A convenience sample of 154 women with a history of one or more pregnancies was recruited through public health department social media pages in one predominantly rural region of a Midwest state. MEASUREMENTS Quantitative measures included demographic variables, ACE scores, and preferences regarding screening format, strategies, and resources. Additional perspectives were captured through open-ended questions. RESULTS Women's mean ACE score was 2.56 (SD = 2.37) with 68% reporting 0-3 ACEs and 32% reporting four or more. Routine screening for ACEs during prenatal care was supported by 67.5% of women with 9.1% indicating sometimes, 20.8% unsure, and 2.6% against. Strong preference was indicated for screening by one's physician or midwife (80.3%), in an exam room (83.1%), using an independently completed questionnaire (64.2%). Preferred approaches for screening and post-screening interventions also were identified with qualitative themes providing additional insights. CONCLUSIONS Findings inform strategies for efficiently and sensitively screening for ACEs during pregnancy, highlight the importance of using a trauma-informed approach, and provide direction for educational and interventional resource development.
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Affiliation(s)
- Jeanette M Olsen
- College of Nursing and Health Sciences, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Elizabeth G Galloway
- College of Nursing and Health Sciences, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
| | - Pamela L Guthman
- College of Nursing and Health Sciences, University of Wisconsin-Eau Claire, Eau Claire, Wisconsin, USA
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11
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Long T, Aggar C, Grace S, Thomas T. Trauma informed care education for midwives: An integrative review. Midwifery 2021; 104:103197. [PMID: 34788724 DOI: 10.1016/j.midw.2021.103197] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nearly half of new mothers describe their childbirth as traumatic. Perinatal trauma impacts both short and long-term biopsychosocial outcomes for mother and child. Midwife trauma-informed care education and practice is essential to mitigate this risk. OBJECTIVE This review aimed to identify and describe the nature and extent of trauma informed care education provided for midwives and midwifery students. DESIGN An integrative review. METHODS Five databases (Medline, Embase, CINAHL, Psycinfo, and Emcare) were searched to identify primary research regarding trauma informed care education for midwives and midwifery students. Quality appraisal was conducted using the Mixed Methods Appraisal Tool. RESULTS Three papers were identified. None of the papers were midwifery focused, with midwives representing a small proportion of the participants. Most midwives reported receiving no previous trauma informed care education and lacked confidence to provide quality care to women with lived trauma. Midwives reported trauma informed care education as essential and relevant for providing quality practice. Improvements in knowledge, skills and attitudes was demonstrated following trauma informed care education. More in-depth content and content delivered in multiple ways were recommended. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Midwives are well placed to deliver trauma informed care. Trauma informed care education for midwives is limited. Given the impact of perinatal trauma, further trauma informed care education and research is paramount.
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Affiliation(s)
- Trish Long
- Northern New South Wales Local Health District, 89 Tamar St, Ballina NSW 2478 Australia.
| | - Christina Aggar
- Northern New South Wales Local Health District, 89 Tamar St, Ballina NSW 2478 Australia; Southern Cross University, School of Health & Human Sciences, School of Health & Human Sciences, Southern Cross Drive, Bilinga QLD 4225 Australia
| | - Sandra Grace
- Southern Cross University, School of Health & Human Sciences, School of Health & Human Sciences, Southern Cross Drive, Bilinga QLD 4225 Australia
| | - Tamsin Thomas
- Southern Cross University, School of Health & Human Sciences, School of Health & Human Sciences, Southern Cross Drive, Bilinga QLD 4225 Australia
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12
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Pettigrew JA, Novick AM. Hypoactive Sexual Desire Disorder in Women: Physiology, Assessment, Diagnosis, and Treatment. J Midwifery Womens Health 2021; 66:740-748. [PMID: 34510696 DOI: 10.1111/jmwh.13283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/02/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
Nearly half of women in the United States report problems with sexual function. Many health care providers do not ask about sexual concerns during routine clinical encounters because of personal discomfort, lack of familiarity with treatment, or the belief that they lack adequate time to address this complex issue. This may be especially true for hypoactive sexual desire disorder (HSDD), the most commonly identified sexual problem among women. HSDD is characterized by a deficiency of sexual thoughts, feelings, or receptiveness to sexual stimulation that has been present for at least 6 months, causes personal distress, and is not due to another medical condition. This is an up-to-date overview of HSDD for clinicians, discussing its physiology, assessment, diagnosis, and treatment strategies. Although a definitive physiology of HSDD is still unknown, multiple hormones and neurotransmitters likely participate in a dual-control model to balance excitation and inhibition of sexual desire. For assessment and diagnosis, validated screening tools are discussed, and the importance of a biopsychosocial assessment is emphasized, with guidance on how this can be implemented in clinical encounters. The 2 recently approved medications for HSDD, flibanserin and bremelanotide, are reviewed as well as off-label treatments. Overall, HSDD represents a common yet likely underrecognized disorder that midwives and other health care providers who care for women across the life span are in a unique position to address.
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Affiliation(s)
- Jessica A Pettigrew
- Department of Obstetrics & Gynecology, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, Colorado
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, Colorado
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13
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McCormick R, Painter L. Seeing Past the Sentence: Caring for Pregnant Women Who Are Incarcerated. J Christ Nurs 2021; 38:166-173. [PMID: 34085654 DOI: 10.1097/cnj.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The number of women who are incarcerated in the United States has grown significantly since 1980. Caring for pregnant women who are in the correctional system requires special knowledge and the skills of advocacy and compassion. The purpose of this article is to discuss strategies to provide compassionate, sensitive, and trauma-informed care that demonstrates the love of Christ to incarcerated pregnant women.
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Frank GD, Fox D, Njue C, Dawson A. The maternity experiences of women seeking asylum in high-income countries: a meta-ethnography. Women Birth 2021; 34:531-539. [PMID: 33414082 DOI: 10.1016/j.wombi.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
PROBLEM The maternity care experiences and perinatal outcomes of women seeking asylum in high-income countries (HICs) are poorer than the general population of pregnant women in that HIC. There is a paucity of literature on the maternity experiences of women seeking asylum in HICs. BACKGROUND There is an increasing number of women seeking asylum in HICs due to escalating violence and human rights abuses. Asylum-seeking women are a distinct group whom are likely to have different needs to refugees or migrants as a result of their undocumented status. AIM This literature review aimed to explore the emotional, physical and health information needs of women seeking asylum in the perinatal period in HICs, to provide insights to better address their maternity needs. METHOD A meta-ethnography described by Noblit and Hare, was applied to analyse the studies, to reflect the voices of women seeking asylum, hosted in HICs in their perinatal period. FINDINGS Eight studies were included in the review. The overarching theme was 'just having to survive.' Four sub-themes were revealed which highlighted the vulnerability of asylum-seeking women. They included: 'I was never sure if I had understood', 'feeling ignored and alone', 'ongoing dislocation and recurrent relocation' and 'knowing there's someone who cares for you'. DISCUSSION Improved maternity care for women seeking asylum requires culturally appropriate respectful maternity care and supportive strategies such as consistent access to language services. CONCLUSION It is recommended that future research is targeted to explore the maternity experience of women seeking asylum in HICs, such as Australia.
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Affiliation(s)
- Glenys D Frank
- University of Technology (UTS), Sydney, PO Box 123, Broadway, NSW, 2007, Australia.
| | - Deborah Fox
- University of Technology (UTS), Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| | - Carolyne Njue
- University of Technology (UTS), Sydney, PO Box 123, Broadway, NSW, 2007, Australia
| | - Angela Dawson
- University of Technology (UTS), Sydney, PO Box 123, Broadway, NSW, 2007, Australia
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Abstract
The increase in prescription and illicit opioid use since 2000 has become an urgent public health crisis. While the opioid epidemic spans racial, regional, and socioeconomic divides, women have surfaced as one demographic affected by opioid use and related sequelae. Certain federal and state regulations, secondary to the Child Abuse Prevention and Treatment Act, strip pregnant women with opioid use disorders of the ability to engage autonomously with their health care clinician while simultaneously impeding their ability to achieve and sustain recovery. The purpose of this article is to explore current health policy that impacts pregnant women who use opioids. Recommendations to improve care, broadly, will be highlighted to include access to contraceptive services, universal screening for perinatal substance use, and access to appropriate treatment strategies. Policy modifications to facilitate these recommendations are discussed. The Centers for Disease Control and Prevention Policy Analytical Framework was utilized to derive recommendations. The recommendations are relevant to advanced practice registered nurses and midwives who have the potential to treat substance use in women, to women's health and pediatric registered nurses, and to nursing administrators who are involved in decision-making in obstetric and pediatric settings.
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Affiliation(s)
- Brayden N Kameg
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, United States
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