Not sure if others have, but I have been following quite closely the recent news about rape allegations at the University of Virginia. Today’s news stated that Rolling Stone magazine retracted their article which featured the horrible account of one student’s sexual assault in 2012. As shocked as I was to hear this, I have found myself reading several articles about the situation which led me to start thinking about how this might relate to our class. We are all aware of sexual violence and I’m sure this topic has been addressed in classes we have taken or has affected us to some degree in our lives.
As I started looking around for “sexual violence and birth”, I found that it is common that sexual violence survivors will have symptoms of the trauma re-emerge during labor. I want to clarify that this is not directed specifically at women having babies that resulted from sexual assault, but, in general, sexual violence survivors who later in life go through labor. There are many factors of the experience that can trigger memories or nightmares of the prior attack from vaginal exams to constantly rotating hospital staff. Some have described their experience of labor in hospitals as “strangers standing over them.” Whatever it is, the personal care (or lack thereof), the painful experience (pain that might be similar to the traumatic experience), or the exposure of a woman’s body and her vulnerability, many sexual violence survivors go through this experience without the support or recognition of this re-traumatization.
While we addressed obstetric violence in class and have touched on sexual violence in general, I think its interesting to think about how prior events could be triggered during the experience of labor. It brings me to wonder about how this affects populations around the world. I guess I wanted to share my findings and see what others have to say about this topic. There’s a great article below from a nurse who did a study on helping survivors of sexual abuse through labor. Thoughts?
Burian, J. (2014) Gentle Birth. Helping Survivors of Sexual Abuse Through Labor. Retrieved from http://www.gentlebirth.org/archives/abuselbr.html.
I had no idea about this phenomenon, and it sounds truly terrifying. It is really upsetting when looking at the statistics that one in five women will be sexually assaulted in their lifetime (http://www.nytimes.com/2011/12/15/health/nearly-1-in-5-women-in-us-survey-report-sexual-assault.html) and that the trauma will spill over into all aspects of their lives, apparently including child birth. I am curious if the stress on the woman will affect the child’s health outcome. I know this would be difficult to study considering the sensitivity of sexual assault and unwillingness of survivors to report and relive their experiences, but considering the effects of stress on other studied groups, it would be interesting to see how the stress of sexual assault affected the health outcomes of their children.
Elizabeth, you make very important points. I just finished my psychiatric rotation, and it is reiterated that post-traumatic stress can manifest itself in many different ways at different points in time. Obviously, reactions vary from person to person, situation to situation.
I can certainly envision a woman wearing a “mask” of strength until she is in an intimate relationship and/or becomes pregnant. Don’t we all want to walk around like “normal” people when something crazy is happening or has happened in our lives? While you touch on the experience of birth as traumatic for the woman, I think that even prenatal visits can be difficult as well. If a survivor now has a wanted pregnancy, it may be emotionally hard to attend any prenatal appointments that are suggested in order to keep mother and baby healthy. This can possibly affect outcomes of the pregnancy. It is similar to women and adolescents who are less likely to have health visits if they have experienced IPV in the last 12 months (Chamberlain & Levenson, 2013, p. 11).
My best friend published this past May as part of her WHNP program. As Alyssa noted, there are quite a lot of women out there who are affected by sexual violence (just look at our campus alone!). Laurie notes that the most important thing we can do as nurses is build rapport and provide a comforting environment in order to decrease anxiety (Ray & McEneaney, 2014, pp. 47-48). Pelvic exams are not fun for most; they are even less fun for survivors. It drives me nuts when fellow nursing students are so narrowly focused on technical skills and experiences like catheters, IVs, and wound care that their relationship with the clients are not developed properly. We can make all people more comfortable with seeing providers if we take the time to talk and get to know them, listen.
My argument here is that all persons who come into contact with the woman who is delivering in the facility should introduce themselves and really get to know the woman. This might help if she builds really strong rapport with one nurse and is introduced to the rest of the team through that nurse (helps build trust). I do not advocate the typical “Hi, my name is so and so and I’m going to be doing your blah blah blah”. It’s a little impersonal, but yes, I understand it works in some situations. Greater care should be taken with these wary women. Hopefully this will alleviate any stranger standing over her feeling.
Chamberlain, L., & Levenson, R. (2013). Addressing Intimate Partner Violence Reproductive and Sexual Coercion: A Guide for Obstetric, Gynecologic, Reproductive Health Care Settings, 3rd Ed. American Congress of Obstetricians & Gynecologists. Retrieved from http://www.communitysolutionsva.org/files/E.16-IPV_and_Coercion_Guide_for_OBGYN_and_Repro_Health_Settings.PDF
Ray, L., & McEneaney, M. (2014, May). Caring for Survivors of Sexual Violence: A Guide for Primary Care NPs. Women’s Health, 2(2), 42-49.
[Note: I can’t italicize my titles since this is a response and not an original post…sorry if it looks weird.]
Hi Elizabeth,
This is very interesting! In my research about birth and domestic violence (which includes sexual violence), I did find that flashbacks or replaying the events are indeed symptoms women can experience after being abused. However, I did not know that labor could trigger these types of traumatic flashbacks as well! I wonder what the approach would be for mothers who experience these flashbacks? It’s difficult not to stand over a woman while she’s giving birth! But more than likely, something could definitely be done about the “stranger” phenomenon. Very interesting indeed.