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Therapeutic Perinatal Research With Low-Income Families: Leveraging Benevolent Childhood Experiences (BCEs) and Fathers’ Perspectives to Promote Resilience
by Angela J. Narayan, Victoria M. Atzl, Jillian S. Merrick, Laura M. River, and Rachel Peña
In this resource
Clinical research during the pregnancy period is maximally beneﬁcial for participants if it is positive, inclusive, and therapeutic. We describe our ongoing study of ethnically diverse, low-income pregnant women and fathers-to-be that leverages participants’ benevolent childhood experiences (BCEs) and promotes insight to counteract mental health and relationship problems before babies are born. Although many participants report extensive childhood trauma, cumulative stress, and elevated depression and posttraumatic stress disorder (PTSD) symptoms, most also report high levels of BCEs, which show promising associations with well-being. Participant reﬂections at the end of the study illustrate that they feel their stories are valued, learn to connect past experiences to present functioning, gain insights about their romantic relationships, and enjoy the research experience.
Although the pregnancy period is often joyful and hopeful, it can also be a complicated transition marked by heightened psychological distress, particularly for individuals with childhood trauma. For women with histories of childhood maltreatment and other dysfunction in their families of origin, a pregnancy may summon emotions and memories of negative and abusive caregiving, leading to heightened symptomatology. Indeed, pregnant women often have higher rates of posttraumatic stress disorder (PTSD) than their non-pregnant counterparts with similar trauma histories, in part because becoming pregnant may evoke recollections of unresolved childhood trauma as women consider the type of mothers they want to be (Seng et al., 2010).
Because pregnancy elicits reﬂection on one’s childhood, it also represents an important window to build insight and foster resilience. Many pregnant women intentionally consider how to avoid falling into the dysfunctional or abusive patterns of their parents and instead draw on childhood experiences of love and kindness as templates to re-create in the next generation (Slade & Cohen, 1996; Sperlich & Seng, 2008). In this way, the pregnancy period is a double-edged sword, during which trauma-related distress and hopeful optimism co-exist to portend both risk and resilience for the mother and the new baby.
Research studies and clinical practices that harness resilience processes for pregnant women with childhood trauma are scarce. A recent systematic review found only 18 empirical studies that identiﬁed promotive or protective factors to buffer against effects of childhood trauma on the well-being of pregnant women and their infants (Atzl, Grande, Davis, & Narayan, 2019). Further, rather than assessing and leveraging women’s strengths, coping strategies, and resources, most routine prenatal care only screens for current distress and stressors that may harm the woman or fetus, such as prenatal depression symptoms or the presence of intimate partner violence victimization. To date, uncovering resilience processes among pregnant women with trauma histories has not been a priority, but it is key to promoting better outcomes for families during the pregnancy period and beyond.
In 2015 in San Francisco, CA, we conducted an empirical study using a trauma-informed model of clinical research, combined with therapeutic assessment of risk and resilience during pregnancy (Narayan et al., 2017). This study gathered rich data while simultaneously affording participants opportunities to reﬂect on strengths in addition to stressors, become more intentional about their plans for parenthood, and connect with referrals for mental health care and concrete needs. In this context, women felt comfortable disclosing very high levels of contemporaneous and childhood trauma, and they expressed gratitude that they had participated and shared their stories.
Major insights from the San Francisco study included the need—for us as researchers and for pregnant women—to not only focus on hardships, but to draw upon assets and resources during pregnancy. Indeed, the ﬁrst empirical report from that study documented that pregnant women with higher levels of benevolent childhood experiences (BCEs), which are individual, relational, and contextual supports and resources, had lower PTSD symptoms and exposure to fewer stressful life events during pregnancy, even if they had extensive childhood trauma (Narayan, Rivera, Bernstein, Harris, & Lieberman, 2018).
In this article, we describe the success of this trauma-informed, therapeutic research model in a separate sample of pregnant women from Denver, CO, and emphasize that the beneﬁts of therapeutic assessment during pregnancy can also extend to low-income, ethnically diverse fathers expecting a baby. Fathers-to-be, particularly those with childhood trauma histories, are vastly unrecognized as needing resources to support their resilience during the transition to fatherhood, yet they make up half of the caregiving equation (Cabrera, Karberg, & Kuhns, 2017; Lee, Knauer, Lee, MacEachern, & Garﬁeld, 2018). Moreover, unresolved experiences of childhood maltreatment and other interpersonal trauma are likely to similarly haunt men and threaten their psychological well-being as they consider their identities as fathers either for the ﬁrst time or for a new addition to the family. More attention is needed to help fathers share and recover from their trauma histories, particularly during the vulnerable yet hopeful period when they are expecting a baby (Astone & Peters, 2014). The aims of this report are to
describe the life experiences and mental health of the ﬁrst 101 pregnant women of the 200 we plan to enroll in Denver, in comparison to (a) 101 pregnant women from San Francisco and (b) 72 fathers-to-be from Denver;
highlight promotive effects of BCEs in fathers-to-be compared to pregnant women; and
share the reﬂections of participating families in trauma-informed, resilience-based perinatal research.
Of note, we refer to the pregnant participants as women and their partners as men/fathers-to-be because that is how the vast majority of participants identiﬁed, but we recognize that this may not align with all gender identities and family structures.