pregnancy

Suggestions for sensitive care

  • Provide an emotionally and physically safe environment for survivors
  • Establish an unhurried open an atmosphere
  • Be aware of discomfort of body exposure
  • Assure the patient that she is safe
  • Affirm her strength through labor and birth
  • Ask all women during prenatal care about a possible history of sexual abuse either
    by directly asking or through a questionnaire. If found, discuss how these experiences may affect her pregnancy 44 34
  • Consider what your response would be if a woman disclosed a history of sexual abuse to you.
  • Be aware of your language. False intimacy in a soothing voice may trigger memories of a perpetrator's demeanor during the original abuse.
  • The provider should be aware of the circumstances that might provoke traumatic memories and anxious feelings, and then by knowing and anticipating these triggers give better, individualized care during pregnancy and delivery. 44
  • Above all, honor the emotions that she is feeling. 35

Breastfeeding

Although breastfeeding can be difficult for some survivors, others report that it provided them a way to “reclaim their bodies and their identities as women.” 30

  • Sensitivity to the potential for CSA histories among mothers can facilitate infant feedings as a source of positive interaction, contribute to mother-infant relationship building, and to successful parenting. 26
  • Mothers should not be discouraged from breastfeeding or encouraged to formula feed. Rather, they should receive equivalent amounts of information about both the pros and the cons for each feeding method.
  • Neutrality is important because breast-related information may be emotionally charged for the mothers with CSA histories.
  • Mothers should be encouraged to make their own feeding decisions and choose the feeding method with which they feel most at ease. However, mothers with CSA histories may find it difficult to explain the reason behind their feeding preference. 26
  • Because night-time breastfeeding may be difficult for some survivors, especially if the woman was typically abused at night, the provider can suggest pumping and then having someone else feed the baby at night. 50

GYN exams

  • It is important to provide reassurance that anxiety about gynecologic exams and the embarrassment surrounding the secrets of their past sexual abuse are common feelings. 18
  • It may be a good idea for survivors to begin with an interview only and reschedule the examination portion. This approach can be extremely beneficial in increasing trust and adherence over time. 18
  • Whenever possible the health care provider should avoid doing a gynecologic exam when a patient is suffering emotional stress and instead empower her to choose a time when she is ready to participate in the gynecological examination.
  • Remember, a vaginal exam can feel like a repeat of the abuse. Let the woman choose the timing and talk her through it, stopping if she appears at all physically and emotionally unable to continue.
  • If the patient is very nervous you can offer for her to help insert the speculum or to have a mirror available.
  • It is very important NOT to just tell your patient to relax, but to provide her with specific ways to do so, such as:
    • Ask the patient to take slow deep breaths or count her breaths.
    • You can also ask the patient to tell a story, or to blow bubbles, which help her to breathe.
    • Laughing together is a great way to reduce stress.
    • You can use guided imagery (talk her through a series of images, such as being in a forest with the sounds of birds chirping, the feeling of thick leaves underfoot, etc.)
    • Centering and the use of classical music (avoid music with words) are also options.18
    • “It can’t be something done to them… it comes down to working from our hearts or places of compassion.” 18