Abuse-related posttraumatic stress and desired maternity care practices: women's perspectives

Qualitative research participants who self-identified as having a history of childhood sexual abuse and abuse-related posttraumatic stress during the childbearing year were interviewed for the purpose of determining what these women perceive as optimal maternity care. Using a process of narrative analysis, desired care practices were identified. With the exception of one woman, all of the study participants wanted their maternity care provider to be competent to address trauma-related needs. Three groups emerged from the data, providing a useful structure for informing providers on how best to respond to diverse abuse-survivor clients: 1) women far along in recovery, 2) women who were not safe, and 3) women who were not ready to "know." The first group had the best trauma-related and maternity outcomes and the best childbearing experiences. For these women, having a provider who was a "collaborative ally" seemed beneficial. The second group had safety needs that required a "compassionate authority figure" who offered referral and follow-up care. Women in the third group were not ready to address trauma-related symptoms or issues overtly and appeared to need a provider who was a "therapeutic mentor." Four assessment factors help providers determine how to respond.