SEXUAL VICTIMIZATION AND THE PERINATAL PERIOD: RECOGNIZING AND REDUCING RETRAUMATIZATION

The perinatal period, typically defined as the time from conception to one year postpartum, is commonly considered a positive period in a woman’s life. However, for women who have experienced past sexual victimization (SV), the perinatal period can be fraught with trauma-related triggers and reactions. Though a staggering number of women who receive obstetric care have experienced SV, many women are unprepared for and unaware of how their SV history will affect them during the perinatal period. Further, many obstetric providers are insufficiently trained to address experiences of trauma and prevent retraumatization. This three-paper dissertation will contribute to the literature in three ways: 1) by examining the current state and quality of the literature related to a lifetime history of SV and perinatal mental health disorders; 2) by using longitudinal data to understand the effect of a lifetime history of SV on perinatal post-traumatic stress disorder (PTSD), perinatal depression, and perinatal anxiety; and 3) examining why and how a hospital system is implementing a specific intervention for survivors of victimization, particularly SV, as well as survivors of birth trauma in the perinatal period.The first paper synthesizes and quantitatively evaluates the literature to date on a lifetime history of SV and PTSD in the perinatal period by conducting a systematic review and meta-analysis. Results indicate that the odds of having PTSD in the perinatal period are 3.8 times higher for women with a lifetime history of SV compared to women who did not disclose a history of SV. Implications for practice, policy, and future research are discussed.The second paper uses the National Longitudinal Study of Adolescent to Adult Health (Add Health) to explore the effect of a lifetime history of SV on perinatal PTSD, perinatal depression, and perinatal anxiety using logistic regression. Additionally, this paper uses logistic regression to examine differences in perinatal PTSD, perinatal depression, and perinatal anxiety among survivors of SV compared to survivors of physical intimate partner violence. All models control for demographic characteristics and psychosocial history (e.g., sexual orientation, immigration status). Results indicate that SV is a greater risk factor for perinatal PTSD and that IPV is a greater risk factor for perinatal anxiety. Findings support the previous finding that SV elicits trauma-related responses during the perinatal period. The third paper uses a qualitative case study approach to detail the development and implementation of a novel program within the labor and delivery unit of a hospital system. This program, Supportive Services, provides specialized perinatal support to pregnant women who have experienced previous birth trauma and/or a previous history of victimization (e.g., SV, intimate partner violence, child abuse). Findings suggest that Supportive Services may fill a considerable gap in obstetric care and that implementing similar programs will require significant system-level changes.Doctor of Philosoph