It is estimated that 1 out of every 5 women in the United States has experienced childhood sexual abuse, and a similar proportion have experienced sexual assault as an adult.  Despite the high prevalence of sexual trauma among women, specific guidelines for the care of birthing individuals with histories of sexual trauma are sparse.  

Many pregnant patients with a history of sexual trauma may have concerns about routine obstetric care and childbirth.  During labor and delivery, survivors of sexual trauma may experience anxiety, flashbacks, or feelings of loss of control that can trigger traumatic memories. The pain of childbirth, invasive procedures, and the power dynamic between patient and medical staff can all act as potential triggers. Some women may dissociate and may have difficulty fully participating in the process and may not be able to effectively communicate their needs, which can complicate labor and delivery.

While the American College of Ovstetricians and Gynecolgoiests recommends universal screening for history for sexual abuse, many healthcare providers feel uncomfortable screening for history of sexual trauma and do not feel adequately prepared to provide trauma-informed care in the obstetric setting.  Thus, many women with histories of sexual trauma report feeling retraumatized by the birthing experience.  

In this setting, a comprehensive, trauma-informed approach is essential. For women with a history of sexual trauma specifically, a trauma-informed approach emphasizing control, safety, and trust is crucial.  Implementing trauma-informed approaches in the obstetric setting can significantly improve the birthing experience for survivors of sexual trauma.

1. Control and safety: Survivors often emphasize the importance of feeling in control and safe during pregnancy and childbirth. When these needs are met, it can lead to more positive experiences.

1. Supportive providers: Women feel safer when they trust their health care providers. Staff who are knowledgeable about trauma, able to clearly explain procedures, and responsive to survivors’ needs can contribute to better outcomes. 

1. Personalized birth plans: Creating tailored birth plans that address specific concerns and preferences of survivors can help them feel more empowered and in control during the birthing process.

1. Supportive partners: The presence of supportive partners or chosen support persons can significantly improve communication and the overall birthing experience for survivors.

1. Doulas and midwives: Specialized support from professionals trained in working with trauma survivors can provide continuous advocacy and support during pregnancy, labor, and delivery[4].

1. Addressing trauma before pregnancy: Some women who confront and work through their trauma before becoming pregnant may acquire new tools for managing distress and may feel more in control of the childbirth experience.

1. Medication options, if necessary: For severe anxiety or PTSD symptoms, selective serotonin reuptake inhibitors (SSRIs) may be considered, weighing the potential risks and benefits during pregnancy. In addition, benzodiazepines may be used as needed to alleviate distress during certain procedures.

While specific success stories are not provided, these elements suggest that with proper support, understanding, and trauma-informed care, women with a history of sexual trauma can indeed have positive birth experiences. 

While no large-scale studies have yet assessed the specific benefits of trauma-informed care for survivors of sexual trauma in the obstetric setting, preliminary research and clinical experience suggest that with proper support, understanding, and trauma-informed care, women with a history of sexual trauma can have positive birth experiences.  It is important to recognize that each woman’s experience of trauma is unique, and what works for one may not work for another. A personalized, compassionate approach is key to supporting survivors through pregnancy and childbirth.

By implementing trauma-informed strategies, healthcare providers can help create a safe and supportive environment for sexual trauma survivors during pregnancy, labor, and delivery, potentially transforming a potentially frightening experience into one where the individual feels safe and supported.

References:

Lissmann R, Lokot M, Marston C. Understanding the lived experience of pregnancy and birth for survivors of rape and sexual assault. BMC Pregnancy Childbirth. 2023 Nov 16;23(1):796. 

When Sexual Abuse Survivors Give Birth

Pregnant and Parenting Survivors