How does a history of sexual trauma impact obstetric (OB) care?

From the Guidelines

When providing obstetric care to patients with a history of sexual trauma, it is essential to create a trauma-informed environment that prioritizes patient control, clear communication, and sensitivity to avoid triggering past traumas, as supported by the USPSTF recommendation statement 1. To achieve this, several key modifications should be made to standard care.

• Begin by asking permission before touching the patient, explaining procedures thoroughly before beginning, and offering options when possible, such as self-collection of samples or alternative positions for examinations.
• Use clear, direct communication and avoid medical jargon that might trigger feelings of powerlessness.
• Consider scheduling longer appointment times to allow for breaks if needed and minimize the number of different providers involved in care.
• During physical examinations, maintain continuous verbal communication, use the smallest appropriate speculum, and consider offering anxiolytic medication for particularly distressing procedures if indicated, as suggested by studies on intimate partner violence and abuse 1.
• Document trauma history in the chart (with patient permission) but flag it sensitively to avoid repeated disclosures. For labor and delivery, develop a detailed birth plan addressing triggers and coping strategies, and consider alternative pain management approaches, taking into account the potential benefits of interventions like prenatal and postpartum behavioral counseling 1. These modifications are crucial because trauma survivors may experience heightened anxiety, flashbacks, or dissociation during examinations or procedures that remind them of past trauma, potentially leading to avoidance of necessary care and poorer health outcomes, highlighting the importance of a trauma-informed approach in obstetric care 1.

From the Research

Trauma-Informed Care in Obstetric Settings

• Trauma is highly prevalent among women, and those with a history of trauma are at increased risk for posttraumatic stress disorder (PTSD) and other psychiatric comorbidities 2, 3.
• A trauma-informed care approach can help mitigate the negative effects of trauma on treatment engagement and the experience of pregnancy, postpartum, and parenting 2, 4.
• Obstetric care providers should become familiar with the trauma-informed model of care and strive to universally implement a trauma-informed approach across all levels of their practice 4.

Screening and Assessment

• Screening for trauma in obstetric care can provide an opportunity to address risk and offer targeted intervention 3.
• Brief evidence-based screening tools are available to detect trauma-related symptoms in obstetric patients 3.
• Individuals who screen positive require assessment of immediate safety and targeted referrals 3.

Patient Preferences and Care Practices

• Women with a history of sexual trauma desire clear communication about their history between prenatal care providers and the labor and delivery team 5.
• They also desire control over who is present in the labor room, avoidance of language that serves as a stressing reminder of prior sexual trauma, and control over the exposure of their bodies during labor 5.
• Some women with a history of sexual trauma find breastfeeding healing and empowering, while others may experience unique challenges 5.

Providing Competent Care

• Obstetric care providers should balance providing appropriate care with respect and autonomy of the patient, particularly among individuals with a history of sexual trauma 6.
• Recognizing the signs of trauma and initiating or referring to appropriate treatments can help obstetric care providers better understand their patients and improve their care 3.