Title: EMpowering Pregnant women Affected by Trauma HistorY (EMPATHY): a critical participatory action research study
Funder: Department of Health and Social Care

Abstract: Research question How can maternity services empower pregnant women affected by previous trauma to access support? Background Over a third of pregnant women (~250,000) each year in the UK have experienced trauma such as domestic abuse, childhood trauma or sexual assault. Women who have experienced trauma are more likely to have poorer mental health in the perinatal period, and to smoke, drink alcohol or use drugs in pregnancy. However, at present, maternity care professionals do not discuss trauma with pregnant women. Aim of the researchThe aim of the research is to co-develop a trauma-informed intervention to address the following research question: how can maternity services empower pregnant women affected by previous trauma to access support? Methods The project is a critical participatory action research study, with an Intervention Mapping approach used to inform study development. A research collective comprising women with lived experience of trauma, experts from the voluntary sector and midwives has been formed to support the design and conduct of the study. A research collective workshop was held on 24th July 2020 using video conferencing, and six further research collective workshops will be held across the study period. The study will be undertaken over 4 phases. Previous literature will be reviewed, and key stakeholders consulted using interviews and focus groups (Phase 1). With the input of the research collective, this evidence will be used to co-develop a trauma-informed intervention underpinned by a logic model of the problem and a theory of change (Phases 2 and 3). The acceptability and feasibility of the intervention will be explored with an opportunistic sample of women and midwives (Phase 4).The proposed intervention is expected to comprise three elements: a tool and methodology for screening women for trauma history within maternity care; resources that can be provided to all women, whether or not they disclose trauma history, so they can access support and information independently; and a training tool for maternity care professionals. Timelines for delivery Between May 2021 and August 2022, I will develop an in-depth understanding of the problem and design the theory of change. The intervention will be developed between September 2022 and February 2023 and evaluated between March and August 2023. Thesis submission will be in April 2024; paper writing and dissemination will occur throughout.Anticipated impact and dissemination It is anticipated that women with previous trauma histories will be more likely to identify themselves or be identified, and to receive suitable support because of this intervention. The intervention will help maternity services to be more sensitive to the needs of women who have experienced trauma. Implementing the findings of the study could result in improved health outcomes and financial benefits for the NHS. The findings will be shared using a range of methods including publishing in peer reviewed journals such as Women and Birth, and presenting at conferences such as the International Marce Society for Perinatal Mental Health. Lay summaries will be produced. All outputs will be made freely available via Open Access or Creative Commons.

Lay abstract: Background to the researchOver a third of pregnant women each year in the UK (250,000 women) have experienced trauma such as domestic abuse, childhood trauma or sexual assault. Women who have experienced trauma are more likely to have poorer mental health, and to smoke, drink alcohol or use drugs in pregnancy. Maternity care professionals do not routinely discuss trauma with pregnant women. There is no standard guidance on how and when women's trauma histories should be discussed within maternity care, and what information and support could help women who are negatively affected by trauma. Aim of the research The research aims to answer the question: how can maternity services empower pregnant women affected by trauma to seek support? Patient and public involvement I have created a 'research collective' to support my study. This group includes women who have experienced trauma (such as those seeking asylum, victims of rape, sexual abuse and/or female genital mutilation and sufferers of birth trauma), as well as experts from the voluntary sector, and midwives. We have met once already and they helped me to design the study; we will meet again six times during the study. All of the members of the research collective feel that this is an important topic which should be addressed.Design and methods used The project is a critical participatory action research (CPAR) study. CPAR studies are carried out with the community affected by an issue. I will start by understanding the problem. This will involve reading studies involving pregnant women who have experienced trauma. I will also read information produced by key organisations which support trauma survivors, such as the Survivors Trust and Family Rights Group. I will carry out interviews and focus groups with women who have experienced trauma, midwives and other healthcare professionals, and experts from the voluntary sector. This information will help me find out how trauma affects women, what prevents them from talking to their midwife about it, and how they would like to be supported. I will share this information with the research collective, and we will use the findings to co-develop a support package (called an intervention) that includes: How and when women's trauma histories should be discussed; Resources such as a website, leaflets or bookmark that can be provided to all women, whether or not they disclose trauma history, so they can access support and information on their own; A training tool for maternity care professionals, including how to sensitively discuss trauma with women, and how to respond to the needs of women who have experienced trauma. Pregnant women and midwives will be asked to give feedback on the intervention. After this study I would like to apply for funding to start using the intervention across the country, and test if it is helpful to women and used by staff.Dissemination I will ask the research collective for advice on how to share information about the study, for example by vlog, blog, or podcast. I will publish the findings in peer reviewed journals and present them at conferences. The data from this study will also be made freely available for others to use.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH;MENTAL HEALTH