ABSTRACT
Study Objective
To understand the pregnancy and childbirth experiences and preferences of adolescent
mothers with a history of childhood trauma in order to develop trauma-informed care
practice recommendations for this unique group.
Design
Mixed methods convergent parallel design involving completion of the Adverse Childhood
Experiences (ACE) questionnaire, a survey of care experiences and preferences during
pregnancy and delivery, and a one-on-one interview.
Setting
hHospital-based medical home program for pregnant and parenting adolescents.
Participants
Adolescent and young adult mothers aged 12-22 years, receiving care between June 2018
and June 2019.
Results
A total of 29 adolescent mothers completed the questionnaire, out of a potential 38
in the program (76.3% participation). Five went on to complete an interview. The average
age was 17.9 years (standard deviation 1.8 years). The mean ACE score was 5.1 out
of 10, indicating childhood exposure to an average of 5 different types of potential
trauma. A total of 19 participants (65.5%) reported being triggered during pregnancy
or postpartum. Trauma memories were elicited during vaginal examinations in the clinic
(27.6%) and in the hospital (27.6%), abdominal examinations (13.8%), measurement of
vital signs (17.2%), and labor (17.2%). Ten participants (34.5%) felt that the providers
delivering their baby knew how to help them cope with trauma memories. Themes that
emerged included the following: acknowledgment of trauma by provider, avoiding re-telling
of story, building a relationship with provider, choice and control in care, and providing
coping strategies.
Conclusion
A majority of adolescent mothers in our sample experienced trauma memories during
pregnancy and postpartum medical interactions. Priorities for trauma-informed care
in this population are described.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric and Adolescent GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.2014
- The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death.Pediatrics. 2004; 113: 320
- Demographic characteristics and needs of the Canadian urban adolescent mother and her child.Paediatr Child Health. 2015; 20: 72
- Trauma-informed care in a patient-centered medical home for adolescent mothers and their children.Psychol Serv. 2019; 16: 67
- The reporting of maltreatment experiences during the Adult Attachment Interview in a sample of pregnant adolescents.Attach Hum Dev. 2012; 14: 119
- Childhood sexual abuse and adolescent pregnancy: a meta-analytic update.J Pediatr Psychol. 2009; 34: 366
- Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study see comment.Am J Prev Med. 1998; 14: 245
- A prospective study of perinatal depression and trauma history in pregnant minority adolescents.Am J Obstet Gynecol. 2013; 208: 211
- Experiences with childhood trauma among first-time adolescent and young adult mothers: risk factor for subsequent pregnancy within twelve months.Free Inq Creat Sociol. 2011; 39: 18
- Early childhood adversity and pregnancy outcomes.Matern Child Health J. 2016; 20: 790
- childhood abuse history, posttraumatic stress disorder, postpartum mental health, and bonding: a prospective cohort study.J Midwifery Womens Health. 2013; 58: 57
- Care of adolescent parents and their children.Am Acad Pediatr. 2012; 130: 429
- Adolescent pregnancy guidelines.J Obstet Gynaecol Can. 2015; 37: 740
- Women, co-occurring disorders, and violence study: a case for trauma-informed care.J Subst Abuse Treat. 2005; 28: 145
- Trauma-informed care: an ecological response.J Child Youth Care Work. 2015; (Available at:) (Accessed February 15, 2021)
- Integrating trauma-informed care into maternity care practice: conceptual and practical issues.J Midwifery Women's Heal. 2017; 62: 661-672
- Feeling safe: a metasynthesis of the maternity care needs of women who were sexually abused in childhood.Birth. 2013; 40: 88
- Pregnancy and childbirth after sexual trauma: patient perspectives and care preferences.Obstet Gynecol. 2018; 132: 1461
- A synthesis of the literature on trauma-informed care.Issues Ment Health Nurs. 2015; 36: 698
- Trauma-informed care: better care for everyone.Can Fam Physician. 2018; 64: 170
- The lived experience of childbearing from survivors of sexual abuse: “it was the best of times, it was the worst of times.J Midwifery Womens Health. 2016; 61: 474
- Abuse survivor perspectives on trauma inquiry in obstetrical practice.Arch Womens Ment Health. 2016; 19: 423
- The reliable, valid and economic assessment of early traumatization: first psychometric characteristics of the German version of the Adverse Childhood Experiences Questionnaire (ACE).Psychother Psychosom Medizinische Psychol. 2011; 61: 10
- Psychometric properties of the early trauma inventory-self report.J Nerv Ment Dis. 2007; 195: 211
- Focus on research methods: whatever happened to qulitative description?.Res Nurs Health. 2000; 23: 334
- Designing and Conducting Mixed Methods Research.2nd ed. Sage Publications, Thousand Oaks, CA2011
- Adolescent pregnancy outcomes in the province of ontario: a cohort study.J Obstet Gynaecol Canada. 2013; 35: 234
- Demographic characteristics and needs of the Canadian urban adolescent mother and her child.Paediatr Child Health. 2015; 20: 72
- Meeting the needs of adolescent parents and their children.Paediatr Child Health. 2016; 21: 2305
- Research participants telling the truth about their lives: the ethics of asking and not asking about abuse.Am Psychol. 2006; 61: 218
- A systematic literature review of the childbearing cycle as experienced by survivors of sexual abuse.Nurs Womens Health. 2016; 20: 582
- Promoting teen mothersʼ mental health.Am J Matern Nurs. 2016; 41: 84
- Engaging Women in Trauma-informed Peer Support: A Guidebook.2012 (Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). https://www.nasmhpd.org/content/engaging-women-trauma-informed-peer-support-guidebook (Mar 4, 2021))
Article info
Publication history
Published online: January 31, 2021
Accepted:
January 9,
2021
Received in revised form:
January 3,
2021
Received:
June 27,
2020
Footnotes
The authors have no conflicts of interest to disclose.
Financial support for this project was provided by a North American Society for Pediatric and Adolescent Gynecology (NASPAG) Fellow Research Award. NASPAG was not involved in the design or implementation of this project.
The findings presented in this manuscript have previously been presented at the North American Society for Pediatric and Adolescent Gynecology 33rd Annual Clinical and Research Meeting (New Orleans, Louisiana, April 11-13, 2019), the University of Toronto Department of Obstetrics and Gynaecology Research Day (Toronto, Ontario, Canada, May 3, 2019), and the Society of Obstetricians and Gynaecologists of Canada 75th Annual Clinical and Scientific Conference (Halifax, Nova Scotia, Canada, June 11-14, 2019).
Identification
Copyright
© 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Obstetric Trauma-Informed Care: Pregnant Adolescents’ VoicesJournal of Pediatric and Adolescent GynecologyVol. 34Issue 3
- PreviewAlthough rates of births to young women aged 15-19 years have declined significantly in the United States between 2007 and 2017, a total of 194,377 babies were born to young women in this age group in 2017.1 Numerous studies have established that social determinants of health such as race, low socioeconomic status, and inadequate education among pregnant adolescents are associated with adverse maternal and birth outcomes.2 Of special concern in recent years has been the effect of a history of trauma and adverse childhood experiences (ACEs) on pregnant and parenting adolescents.
- Full-Text
- Preview
