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Issues That May Arise During Pregnancy For People With A History of Sexual Trauma
- Fear of losing control of their body, either because of normal pregnancy changes or during labor and delivery itself
- Need to ask a lot of questions or have a very detailed birth plan
- Using dissociation as a coping mechanism, particularly during labor and delivery
- Feeling numb or ambivalent about the pregnancy
- Difficulty tolerating vaginal exams
- Discomfort having genitalia exposed during exams or labor
- Feelings of panic or anxiety being triggered by the act of birth or breastfeeding
Tips For Providers Working With Pregnant Survivors of Sexual Trauma
Nicole Durel, MBA, MSW, Program Coordinator of Signature Medical Group in St. Louis, says that the goal of the physician-patient interaction should be to "foster an atmosphere of safety, trust, and empowerment." Her tips are based on the Substance Abuse and Mental Health Services Administration's Trauma-Informed Approach[1].
- Maintain eye contact and face your patient during interactions.
- Ask permission before touching the patient.
- Explain the steps for all internal and external exams so the patient knows what to expect and end the exam if the patient feels overwhelmed or upset.
- Ask their partner to leave the room when taking a medical history.
Lynn Simpson, director of maternal-fetal medicine and chief of obstetrics at Columbia University Medical Center, said physicians should look for "subtle hints" that a patient may have a sexual abuse history even if they don't disclose it, so that they can respond with the appropriate support. She recommends providers do the following:
- Let the patient know that you care.
- Take extra time to ensure they feel safe and comfortable, if needed.
- Explain everything that is going to happen during an exam.
- Involve the patient in the process as much as possible.
- Offer the patient a mirror so they can see what's happening during an exam.
- Allow them to guide your hand during an exam to give them a sense of control.
- Listen in terms of what they're nervous about and try to engage them.
- Don't push. If it's something that can be delayed or postponed, do the test or exam at a later visit so they have time to process it.
Resources and Support
- "When Survivors Give Birth[2]," by Penny Simkin, P.T., and Phyllis H. Klaus, C.S.W., M.F.T.
- Prevention and Treatment of Traumatic Childbirth[3] (PATTCh)
- Signature Strong Start For Mothers and Newborns[4] Program, St. Louis
- Seleni Institute[5], New York
- "The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions[6]" by Penny Simkin, P.T.
References
- ^ Substance Abuse and Mental Health Services Administration's Trauma-Informed Approach (www.samhsa.gov)
- ^ When Survivors Give Birth (www.amazon.com)
- ^ Prevention and Treatment of Traumatic Childbirth< /a> (pattch.org)
- ^ Signature Strong Start For Mothers and Newborns (www.signaturemedicalgroup.com)
- ^ Seleni Institute (seleni.org)
- ^ The Birth Partner: A Complete Guide to Childbi rth for Dads, Doulas, and All Other Labor Companions (www.amazon.com)
