ACEs and the Law

This was done only during direct interviews and not very often initially. Why? It is very uncomfortable to recognize being pregnant only on the 2^nd trimester or 3^rd trimester of the pregnancy as the results of pregnancy denial. They cannot speak about the baby. It is only possible to ask first about their pregnancy: How they feel to recognize it lately? To whom they share their situation? Can they say a few words about their partner, their family circle?  Do they need any protection, shelter support for the end of the pregnancy? My first action is to introduce them to a midwife in order to be sure that they have a place to deliver with a compassionate welcome and protection if needed rather to deliver alone.

They are often very fearful. Some may refuse to speak about their partner. Some may be afraid of negative reactions of the family circle, if they know they have become pregnant. Some may have been threatened if they disclose sexual abuses. A lot of them conceal the pregnancy after denied it.

If you press them with details questions in a first interview without protecting them first, they may not go to the hospitals, or/and come back for a second interviews and may deliver alone. In my experience the protection of their delivery in good health setting is first needed. Each case is different and I cannot say when it is the best time to ask but it is necessary to find a time before they leave the maternity wards.   

Nancy, I shall be happy to know if you receive in your hospital teenagers or women with similar clinical findings? How are you screening IPV?

Absolutely.  I'd want to know if this is done initially by questionnaire or initially by direct interview.  

One of the newer members, Nancy Hardt, who is an ob-gyn and pathologist in Micanopy, FL, said that she screens for trauma in her obstetric and pediatric clinics. It would be interesting to find out more about how that works. 

I agree that it would certainly be an advance if childhood and sexual traumas were routinely inquired after in obstetrical settings.  Speaking as an internist, I hope I live to see the day when it is routinely done in all medical settings, for all new patients.  Many of us defensively assume patients would be  resentful of such questions.  Having run a large medical department where these questions were asked routinely, by paper-based questionnaire filled out at home, of over a half million adult patients in the course of a decade, the thing that surprised me was how grateful many were.  I well remember a poignant note from an elderly woman: "Thank you for asking.  I feared I would die and no one would ever know what had happened."  On the other hand, when I first went into practice, such a reality would have been inconceivable.  It's too bad it takes so damned long to figure out what's going on.  

The period of pregnancy may be an appropriate time to ask questions about a history of sexual and other traumatic experiences, in particular if a woman/teenager have denied their pregnancy. This may prevent them to repeat at birth the violence/neglect suffered, for example: neonaticide and abandonment on publics roads. This is facilitated in France by the right to choose giving birth anonymously. Women who are afraid to say they are not happy to become a new mother and do not wish to keep the baby are less shy to speak then. I have observed this in a study 1987-1987: http://www.ncbi.nlm.nih.gov/pubmed/8402253 and in my clinic until 2002.

I was very interested by the ACEs publication which demonstrated in 1999 a strong relationship between unintended pregnancies and traumatic experiences of childhood: Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood..

I shall be happy to discuss further with you. I only have an English publication but for  French reader, there are papers and a book: Geste d’amour, l’accouchement sous X