EXECUTIVE SUMMARY

Some maternal injuries are caused by accidents and intimate partner violence. Case managers should be alert to signs and symptoms and educate about prevention.

  • The biggest causes of maternal trauma are motor vehicle accidents and domestic violence.
  • Risk factors can be assessed with a screening questionnaire that asks whether the woman feels safe at home.
  • Women sometimes avoid wearing seatbelts out of concern for the fetus, and case managers can show them how to wear seatbelts safely.

Hospitals should be prepared to deal with pregnant trauma patients, and some may not have best practices in place due to the low incidence.

“When a pregnant trauma patient comes into the hospital, you need to have an obstetrician, EMS team, a trauma team, a multidisciplinary team, and have everyone working together,” says Christy Pearce, MD, MS, director of maternal fetal medicine at Centura Health and Southern Colorado Maternal Fetal Medicine in Colorado Springs.

The major causes of maternal trauma are motor vehicle accidents and domestic partner violence. Even when the cause appears to be an accident, such as a woman falling down the stairs, it could be related to domestic violence, Pearce notes.

“If a woman has fallen down three times in pregnancy, then maybe she’s not falling,” she explains. “Domestic violence is so difficult and a tricky situation.”

One in four women experience intimate partner violence, and this does not stop during pregnancy, she adds.

Hospital nursing staff and case managers should be alert to risk factors of maternal trauma. They can give women a screening questionnaire and ask them if they feel safe at home, she says.

Domestic partner violence often escalates in pregnancy. The intimate partner feels less in control and increases violent behavior, she explains.

“And these women don’t have control over their lives or pregnancy,” Pearce says. “So you have to be careful how you screen for it.”

For instance, one strategy is to place domestic violence literature in the women’s restroom. Also, healthcare providers can give women a small card with numbers and helpful information that they can place in their shoes, she adds.

“I try to screen pregnant women when I’m alone with them,” Pearce says. “You educate women that violence might escalate during their pregnancy.”

Clinicians also can educate pregnant women about how to position seatbelts. Some women may believe misinformation that says seatbelts could hurt their babies and will not wear one, which could cause major trauma in the event of a collision.

Case managers and nurses can teach pregnant women how to wear the seatbelt over their hip bones and over their breast and shoulder, keeping the lap belt beneath the abdomen.

“Data show you have an 84% reduction in morbidity and mortality if you are in a car wreck and are wearing a seatbelt,” Pearce says. “People forget to address the basic things.”

Other traumas that pregnant women may face include opioid addiction, overdosing, and mood disorders, she says.

“You have less control over those as a clinician,” she says. “You can screen for them, but people might not listen to you.”

People suffering from addiction, including pregnant women, may not have the necessary coping skills to handle abstinence and stay clean, Pearce says.

“You can counsel them on how to stay safe, but there are many things you cannot affect from a case management perspective,” she adds.

The same is true when it relates to domestic partner violence. A case manager can provide a woman with resources and information.

Clinicians can counsel women on how the violence is not normal or their fault, but they cannot make decisions for women, who might be experiencing psychological manipulation by their partners and living in fear.

“There is so much programming by these partners to make them believe it truly is their fault that they’re in that situation,” Pearce says. “It takes a long time for people to realize they are worth more than that.”