A conceptual framework for research on lifetime violence, posttraumatic stress, and childbearing

The objective of this theoretical article is to describe a conceptual framework for research on effects of past and current abuse and posttraumatic stress on childbearing women. The proposed framework builds on an earlier framework proposed by the Centers for Disease Control and Prevention (CDC) for research on violence occurring around the time of pregnancy. Two main adaptations are suggested. First, cumulative lifetime history of abuse trauma is added to the framework in addition to violence occurring around the time of pregnancy. Second, posttraumatic stress disorder (PTSD) is given greater emphasis as a potential factor contributing to adverse maternity outcomes based on the theoretical proposition that PTSD could be a plausible mechanism for adverse outcomes via both behavioral and neuroendocrine pathways. More research is needed on the effects of violence and PTSD on childbearing. This framework for research could be used to facilitate design of studies in which investigators want to consider PTSD as a potential mediator between lifetime exposure to violence and negative childbearing processes and outcomes. It is congruent with a CDC framework for research and could be incorporated into studies designed to meet their recommendations. (C) 2002 by the American College of Nurse-Midwives.