Midwife Joanne Cull has received a National Institute for Health & Care Research and Wellbeing of Women Doctoral Fellowship to investigate what information and support can help pregnant women affected by previous trauma. Joanne tells Wellbeing of Women why she started working on this project and how the findings could improve outcomes for women and their babies.

I started thinking about researching trauma and its impact on women in pregnancy after a conversation I had with a friend who had grown up in a violent home. We were talking about a resource that already exists to support women who have been sexually abused in childhood and go on to become pregnant. She said: “I really wish there had been something like that when I was pregnant.”

During pregnancy, she became obsessed with the idea that she was going to hurt her baby. She started having really dark thoughts, she didn’t tell anyone, and she went through a terrible, spiralling mental health experience.

She wished there was a useful resource offering support, something that every woman got, so that she could have looked at it on her own without telling anyone. That conversation played on my mind, and I started to become aware of a massive gap between what we’re seeing as healthcare professionals and what women are experiencing and may need.

My study is called the EMPATHY study: EMpowering Pregnant women Affected by Trauma HistorY. I want to find out how and when midwives should ask about previous trauma such as abuse or violence (in childhood or adulthood), and what support should be given to women who have suffered trauma. It’s such a sensitive and complex subject, and it’s important to do it well. There’s very little research on this, and much of the research there is starts with the assumption that asking women about previous trauma is beneficial. It’s important that we have research that is giving women a voice, so we can make sure our maternity care services are giving women the support they need.

Pregnancy can be a difficult time for women who have suffered trauma. They are more likely to have problems with their mental health in the perinatal period and some women have unexpected and frightening flashbacks to their abuse. Women who have been the victim of sexual violence can also find some parts of maternity care, such as vaginal examinations, very distressing.

Asking women about previous trauma could help us plan the right care for them, including continuity of care, to help them develop trust and feel safe. It would also help with care planning. For example, in the literature review I’ve just carried out, one woman said she would have been absolutely devasted by a vaginal birth, while another had a home birth which was an amazing experience because she wanted to be in her home environment and be safe. It won’t be the same for every woman, so birth planning and care planning is vital.

I hope that through these discussions, more women who are suffering with their mental health will receive support. If we can help mothers to be well at this time it benefits the whole family, including their baby. It’s important to create an environment where women feel they can share their histories if they want to. That’s why I wanted to carry out research involving people who are often excluded in developing healthcare services. I am speaking to women who are seeking asylum, have been sexually abused in the past or have had contact with social services, to find out how it is for them and how we can ask questions in a way that doesn’t cause harm.

My findings are showing that there needs to be time to talk and there needs to be a relationship between maternity care professionals and women. The first appointment might not be the right time to have this discussion because the reality is that many women will not disclose without an established relationship with a healthcare professional. Even with a trusting relationship, some women will choose not to disclose their histories so it’s important all women are given information about how to seek support independently.

I’m developing a method of talking about trauma, a set of resources for women, and training for healthcare professionals. The next step will be to pilot it and hopefully roll it out across the NHS. I’d also love to develop training for student midwives. I lecture student midwives at Kingston University and they are so interested in this topic.

It's about giving women agency at every step. If they’ve chosen to share something with us that’s a privilege and we need to listen to them and listen to what they want.

Campaigns such as the Big Give and charities like Wellbeing of Women are vital in helping researchers make a difference for women and their babies. Thank you for your donations and for helping to improve outcomes for women.

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