1. Weaving a safety net : Towards an
integrated approach to maternal
trauma
COE-W&CH ,Workshop
February 20 , 2015
2. OBJECTIVES
- Recognize signs and symptoms of maternal
trauma
-Recognize mental health correlates of trauma
exposure during pregnancy
-Discuss roadblocks in recognition of maternal
trauma by obstetricians and pediatricians
- Apply methods for recognition, assessment and
basic support for patients exposed to maternal
trauma
4. The use of physical, sexual, economic, and/or
emotional abuse by one person in an intimate
relationship in order to establish and maintain
power and control over the other person.
DOMESTIC VIOLENCE
5. How common is the problem?
• 10-69% of women abused by their
intimate partner - WHO(2002)
• 34% of women physically abused,15%
during pregnancy – Fikree and Bhatti
(1999)
6. Domestic violence Mental health.
• Profound physical and psychological sequelae
following intimate partner violence.
• Presentation is cultural specific.
• Expansion of human rights analysis describes
particular - dowry deaths, honor murder, sati,
and disproportional exposure to HIV/AIDS as
well as globally generic perils including abuse,
battering, marital rape, and murder.
Fischbach, R. L.(1997).Social science & medicine
7. Health Problems
• Pregnancy influences the pattern of injury.
Maternal death, high Injury Severity Score,
serious abdominal injury, and hemorrhagic
shock are risk factors for fetal loss.
Shah, Kayur H., et al. Journal of Trauma and
Acute Care Surgery 1998
9. • 1,376 Pregnant women for prevalence of Depression and associated factors in
Hyderabad, Pakistan.
• 42% of women who experienced physical and/or sexual abuse and 23%
experiencing only verbal abuse had depression/anxiety compared to 8% who
reported no abuse.
• The mean AKUADS-SF scores increased with increasing severity of abuse. Women
reporting no abuse had a mean score of 5.7, while those reporting verbal abuse
only had a mean score of 9.0, and those reporting physical and/or sexual abuse
had a mean score of 11.8 (p < 0.05).
RESULTS
10.
11.
12. Results
• Women at the greatest risk for having suicidal
thoughts or a suicide attempt were those who
were depressed/ anxious and had experienced
some form of domestic abuse. With the high
prevalence of these conditions, attention
should be given to the establishment of
effective mental health treatment programs
for pregnant women
15. Clues to identify a DV victim
• Unexplained or multiple injuries: bruises, burns, lacerations, bites.
• Injuries at different stages of healing
• Injuries hidden by clothing or on central body areas
• Delay between injury and care-seeking behavior
• Describes self as "accident prone"
• Partner present at office visits and/or speaks for the patient
• Appearance of low self esteem
• History of alcohol or drug abuse
• History of anxiety, depression, or suicide attempt
• Frequent office visits for somatic complaints (e.g, pelvic pain,
headaches, gastric upset)
Furniss (1993)
Buel (1995)
16. Why HCPs miss out behaviors and
signs associated with Violence?
• Lack of knowledge and training in domestic
violence.
• Deficiencies in the education of HCPs include
the inability to identify, assess, document, and
manage the care of clients experiencing
domestic violence.
AMA, 1992
Holtz and Safran ,1989
17. • limitations in the education of
obstetric/gynecology residents related to
domestic violence include: lack of faculty
interest, underestimated prevalence and failure
to recognize common presentations.
Chambliss, Curtis-Bay, and Jones (1995)
