Obstetrical Trauma: A Review of Pregnancy and Violence

Teh provided text discusses Marlène Schiappa’s work and views on various women’s issues, notably focusing on late pregnancies, obstetric violence, and the challenges women face in balancing career and motherhood.

Here’s a breakdown of the key points:

1. Deceptive Depiction of Late Pregnancies in Media:

Schiappa criticizes the media’s portrayal of late pregnancies (in women aged 40s and 50s) without acknowledging the meaningful medical interventions often involved.
She believes this can create unrealistic expectations and led to “complex” perceptions because the public is often unaware of theassisted reproductive technologies (PMA), egg donation, and other medical procedures that make these pregnancies possible.
She emphasizes the importance of clarity in this regard.

2. Fight Against Obstetric Violence and Change of Medical Practices:

Schiappa spearheaded efforts to recognize and address gynecological and obstetric violence.
Her initiative in 2017, which led to a report on the topic, was initially met with controversy and resistance from some gynecologists who felt it implied they were inherently violent.
Though, her advocacy has led to a significant evolution in medical practices.
She highlights that healthcare providers are now more likely to seek consent before performing procedures, asking questions like “Can I allow myself to introduce the probe?” or “Are you okay?”.
This demonstrates a shift towards prioritizing patient consent and well-being.

3. Late maternity and Career Imbalance:

As the founder of the “Mom Association works” in 2006, Schiappa has long advocated for better work-life balance for mothers.
While recognizing progress like extended paternity leave, she points out persistent obstacles for women.
In her book “Our six small ambitions,” she analyzes how maternity often hinders women’s professional advancement. She laments the “invisibilization” of pregnant women in the workplace, where after the initial congratulations, they tend to “disappear” professionally.
She considers the childcare system to be a crucial area needing improvement, judging its current state as “still extremely complicated and two speeds.”

4. Legion of Honor and Recognition of Commitment:

Schiappa views her recent awarding of the Legion of Honor not as a political favor but as a recognition of her long-standing commitment to women’s rights.
She attributes the honor to her decade-long leadership of an association, her volunteer work for women’s rights, and her role in bringing about twelve laws. The text concludes by emphasizing her ability to transform personal experiences into political and societal discussions, a defining characteristic of her career and an inspiration to many women.

What are teh key indicators healthcare providers should be aware of to identify potential pregnancy-related violence during routine prenatal care?

Understanding the Scope of the Problem

Obstetrical trauma, encompassing physical and psychological harm experienced during pregnancy, labour, and the postpartum period, is a notable yet often underreported public health concern. While often associated with medical complications, a crucial – and frequently overlooked – component is violence against pregnant women. This violence can take many forms, significantly impacting maternal and fetal health. Recognizing the intersection of pregnancy and violence is paramount for effective intervention and support. Key terms related to this include maternal trauma, pregnancy-related violence, and postpartum trauma.

Forms of Violence During Pregnancy

Violence experienced during pregnancy isn’t limited to physical abuse. It’s a spectrum, and understanding the different forms is vital for accurate identification and appropriate response.

Physical Abuse: This includes hitting, kicking, shoving, or any other form of physical harm. It’s frequently enough the most readily identifiable, but can be minimized or hidden.

Sexual Abuse: Non-consensual sexual acts, including marital rape, are tragically common during pregnancy.

Emotional/Psychological Abuse: This can manifest as constant criticism, threats, intimidation, controlling behavior, and isolation. The impact on maternal mental health is substantial. This is often linked to postpartum depression and anxiety.

Economic Abuse: controlling access to finances, preventing a woman from working, or sabotaging her employment are forms of abuse that can severely limit her options and safety.

Stalking: Repeated harassment and unwanted attention can create a climate of fear and endangerment.

The Impact on Maternal Health

The consequences of violence during pregnancy are far-reaching and can affect both the mother and the developing fetus.

Increased Risk of Miscarriage & Preterm Labor: Stress and physical trauma can trigger premature labor and increase the risk of miscarriage.

Low Birth Weight: Exposure to violence is linked to lower birth weights, increasing the risk of infant health problems.

Preeclampsia & Gestational Hypertension: Violence can exacerbate existing health conditions or contribute to the development of pregnancy-related hypertension.

Postpartum Hemorrhage: Physical trauma can increase the risk of complications during and after delivery, including postpartum hemorrhage.

Mental Health Disorders: Post-traumatic stress disorder (PTSD), depression, and anxiety are significantly more prevalent in women who experience violence during pregnancy.

Chronic Pain Conditions: Physical abuse can lead to chronic pain syndromes,impacting long-term health and well-being.

Fetal and Neonatal Consequences

The effects of intimate partner violence (IPV) during pregnancy extend to the developing fetus and newborn.

neurological Development: Chronic stress exposure can impact fetal brain development, potentially leading to cognitive and behavioral problems later in life.

Increased Infant mortality: Babies born to mothers experiencing violence have a higher risk of mortality.

Failure to Thrive: Infants may experience difficulties with feeding and weight gain.

Behavioral Problems: Children exposed to violence in utero may exhibit behavioral issues as they grow.

Identifying Women at Risk: Screening & Assessment

Routine screening for domestic violence during prenatal care is crucial. However, it must be conducted sensitively and with a clear understanding of the potential risks to the patient.

Universal Screening: Many healthcare organizations recommend universal screening, asking all pregnant women about their safety.

Trauma-Informed Approach: Healthcare providers should be trained in a trauma-informed approach, recognizing the potential for past trauma to influence a patient’s responses.

Confidentiality: Assure patients that their responses will be kept confidential, within the limits of mandatory reporting laws.

Validated Screening Tools: Utilize validated tools like the Abuse Assessment Screen (AAS) or the Partner Violence Screen (PVS).

Direct Questioning: Directly asking about experiences of violence is often more effective than indirect questioning. For example, “Have you been hurt by your partner?”

Resources and Support Systems

Connecting pregnant women experiencing violence with appropriate resources is essential.

National domestic Violence Hotline: [phone]-SAFE (7233) – Provides 24/7 confidential support.

National Coalition Against Domestic Violence (NCADV): https://ncadv.org/ – Offers information, resources, and advocacy.

Local Domestic Violence Shelters: Provide safe housing and support services.

Mental Health Professionals: therapists specializing in trauma can provide counseling and support.

Legal Aid Organizations: Offer assistance with protective orders and other legal matters.

prenatal Support programs: Some programs specifically address the needs of pregnant women experiencing violence.

Legal Considerations & Mandatory Reporting

Healthcare providers must be aware of their legal obligations regarding reporting suspected abuse. Mandatory reporting laws vary by state, but generally require reporting of suspected child abuse or neglect. Reporting requirements for adult abuse are less consistent. Understanding these laws is critical to ensure both patient safety and legal compliance. Protective orders and restraining orders are vital legal tools for safeguarding pregnant women.

Case Study: the Impact of a Trauma-Informed Approach

A 32-year-old pregnant woman presented for routine prenatal care. During universal screening, she