Women’s Perspectives on the Impact of Trauma on Pregnancy, Substance Use and Parenting

© 2021 Kerri Lee FelemonowThere are few in-depth enquiries with pregnant women affected by substance use issues that have asked them about their past trauma experiences and the therapeutic interventions they think are required in an obstetric setting to address the implications of adverse events. Large-scale studies that have examined trauma histories in alcohol and other drug (AOD) services and in the wider population suggest a significant proportion of women affected by substance use have experienced trauma. However, prevalence studies tend to refer to post traumatic stress disorder (PTSD) to understand trauma and this may not be the most appropriate reference for research or clinical interventions for a pregnant substance using population. This is a qualitative research project that explored how 12 women from the Royal Women’s Hospital, Women’s Alcohol and Drug Service (WADS) understand the impact of past trauma on recovery from alcohol and other drug use (AOD), pregnancy, healthcare, and parenting. This research also examined what interventions pregnant women affected by AOD think could assist in their recovery from substance use and trauma and improve parenting capacity in the perinatal period. Constructivist theory is the overarching methodological approach chosen for this research, that is influenced by feminist theory. Data were collected through in-depth interviewing using a semi-structured interview and included obtaining basic demographic information. Thematic analysis was used to examine the data. This research suggests that pregnant women who have issues with substance abuse are likely to be affected by interpersonal trauma that commenced in childhood. Findings suggest that structural, systems and gender related violence can compound early childhood trauma and complicate recovery processes as these women mature. The multiple and enduring forms of trauma experienced by this population resulted in detrimental implications in a variety of psychosocial domains across the lifespan and in the perinatal period. Findings suggest that PTSD diagnostic criteria will not adequately capture the impact that adverse events have had on a pregnant substance using population. This research indicates that specialist obstetric services and clinical guidelines for pregnant women affected by AOD need to incorporate theory and practice approaches related to complex trauma, neurobiology, attachment, and betrayal trauma. Findings suggest that organisations which auspice clinical care to this population need to broaden their understanding of trauma, integrate this into policy and programming, and advocate for service systems change