Abuse victims during labor

  1. I am curios to know if you all have been trained in any kind of special care for sexual abuse victims who are in labor? I am not only talking about those who may be having a child as a result of the abuse but also those who were abused as children and then got pregnant later in life.

    I ask this for this reason: I was abused as a child by two people I trusted. It went on for 12 years and no one ever knew until much later. When I got pregnant, they asked me my history of course so I told them about my abuse. I didn't think much of it but then decided to do a search online and there was a Canadian nurse who had worked with abuse survivors that were pregnant. She had a whole article about how to approach survivors when they are in labor. She made a point of saying that vaginal exams or the mom being exposed (any part of her body) may be exceptionally uncomfortable. No one at my hospital had ever been trained in any of this. Luckily, I had a fabulous woman that was also the childbirth educator at our hospital supporting me. When she found out I was in labor, she brought a copy of the article in and put in on the nurse's station and told them all that they DID NOT come on shift until they read the ENTIRE article. She also explained to them that I have panic attacks (though I haven't since I had my firstborn) and that I needed some special emotional care.

    My labor was still very, very hard....40 hours, not progressing, pit then epi very early. I also had panic attacks, etc. This childbirth educator even came in to see me and rubbed my tummy, etc, while my husband went for something to eat. Then, I pushed for three hours. Unfortunately, the dr. on call was not completely aware of my circumstances and I had only seen him a couple times during the pregnancy. Fortunately, my dr. called and spoke with him while I was in labor.

    I am just really curious to know if your hospitals have any sort of special training for OB nurses in this area and if you have ever cared for a woman that had been abused?
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  2. 7 Comments

  3. by   nurseunderwater
    My friend is an anthropologist and used this topic for her master studies....she's now going phd w/ baby # 3 on the way soon. I will email her if you want and you can contact her if you would like. She's an awesome woman! LMK.....Kate

    PS: What a godsend you will be to the mama's who's babies you catch. Your clients will be blessed to have you
  4. by   fergus51
    I was taught it's simply how we should treat ALL patients. Things like being sensitive to exposing body parts, asking permission before any physical contact, providing as much privacy as possible, letting them know that they are the one in control of their birth experience, asking them what they want from their nurse, etc.

    While sexual abuse survivors certainly need some special emotional support, the majority of what we do with them we should be doing with all our patients (especially considering the fact that 90% of the time we don't know who has been abused and who hasn't).
  5. by   CatskillsRN
    HI Kim,

    Just go to google and type sexual abuse and labor, you will find a lots of tips and sites as well as papers written on the subject giving you suggestions and why their labor differs sometimes.
    Doulas and CNM are generally more aware of labor dysfunctions resulting from abuse but as a Psych nurse (I have 2 hats) I can tell that this is the only area that needs to be cared for.
    Yes Nurses need to be trained and aware of this but its also to the manager to change things.

    Good luck!
    Ginny


    [QUOTE=CNM2B]I am curios to know if you all have been trained in any kind of special care for sexual abuse victims who are in labor? I am not only talking about those who may be having a child as a result of the abuse but also those who were abused as children and then got pregnant later in life.
  6. by   Energizer Bunny
    Quote from fergus51
    I was taught it's simply how we should treat ALL patients. Things like being sensitive to exposing body parts, asking permission before any physical contact, providing as much privacy as possible, letting them know that they are the one in control of their birth experience, asking them what they want from their nurse, etc.

    While sexual abuse survivors certainly need some special emotional support, the majority of what we do with them we should be doing with all our patients (especially considering the fact that 90% of the time we don't know who has been abused and who hasn't).
    VERY good point. It is very hard to tell anyone, especially strangers, about abuse.
  7. by   Energizer Bunny
    Quote from nurseunderwater
    My friend is an anthropologist and used this topic for her master studies....she's now going phd w/ baby # 3 on the way soon. I will email her if you want and you can contact her if you would like. She's an awesome woman! LMK.....Kate

    PS: What a godsend you will be to the mama's who's babies you catch. Your clients will be blessed to have you
    Thank you Kate. I appreciate the compliment but I honestly think that if it had never happened to me, I wouldn't be as concerned as I am. Now, I really try to look outside the box to other issues that could affect the woman.

    I would love to hear from your friend. It would be great to learn more and talk with someone who has done extensive research on the topic. My email is bryanandkimlawson@yahoo.com (just because my other is not working right!)

    Thanks a bunch!

    (and I'd still like to hear from others out there)
  8. by   BabyRN2Be
    Hi CNB2B,

    I'm a certified labor doula and during our training, we were given tips on how to deal with a woman who had gone through abuse, sexual or otherwise. I would suggest for anyone who is in this situation, find a doula who has had training in this area. For example, someone mentioned that vag exams and exposure is very difficult for some. Also, some women might have reactions to the placement of the epidural because they are afraid to be approached from the back.

    I'm currently working with a woman in this situation. She called me to say that she wanted someone to be with her, to know what she is going through, and to protect her modesty, talk to her during epidural placement. A doula will sit down with the woman beforehand, discuss what she is fearing most during her labor and what the doula can do to allay those fears. I'll tell you that modesty goes out the window in L&D and that's something that the staff may not think about. The other day I was walking with a client in the hall and we passed a room in which the woman had just delivered. One of the nurses, walked out of the room, left the door wide open and didn't think to draw the curtain. The woman was fully exposed to everyone in the hall.

    I do understand that nurses have a lot on their minds, and I don't know what could have been going on in the room. As a doula, I would have seen that the curtain and door were open for a period of time and gone over myself to close them. The curtain and door aren't the top priority for the staff understandably. This is how having a doula can help out - just an extra hand willing to do things that might have escaped the staff's mind.

    Find out about doulas in your area. They might be able to help out in situations like these.
  9. by   Energizer Bunny
    Quote from BabyRN2Be
    Hi CNB2B,

    I'm a certified labor doula and during our training, we were given tips on how to deal with a woman who had gone through abuse, sexual or otherwise. I would suggest for anyone who is in this situation, find a doula who has had training in this area. For example, someone mentioned that vag exams and exposure is very difficult for some. Also, some women might have reactions to the placement of the epidural because they are afraid to be approached from the back.

    I'm currently working with a woman in this situation. She called me to say that she wanted someone to be with her, to know what she is going through, and to protect her modesty, talk to her during epidural placement. A doula will sit down with the woman beforehand, discuss what she is fearing most during her labor and what the doula can do to allay those fears. I'll tell you that modesty goes out the window in L&D and that's something that the staff may not think about. The other day I was walking with a client in the hall and we passed a room in which the woman had just delivered. One of the nurses, walked out of the room, left the door wide open and didn't think to draw the curtain. The woman was fully exposed to everyone in the hall.

    I do understand that nurses have a lot on their minds, and I don't know what could have been going on in the room. As a doula, I would have seen that the curtain and door were open for a period of time and gone over myself to close them. The curtain and door aren't the top priority for the staff understandably. This is how having a doula can help out - just an extra hand willing to do things that might have escaped the staff's mind.

    Find out about doulas in your area. They might be able to help out in situations like these.
    I am so glad to hear that it is at least being discussed elsewhere because at the time (1999) the nurses didn't even know how to approach me here. Now, the midwives are absolutely fabulous and we had discussions prior to me delivering my last two. They had obviously been trained for these situations and I did not have one uncomfortable moment with those deliveries and for the most part, all went smoothly. I also was told that counseling prior to labor (especially for first time moms that are abuse survivors) is a huge help. I went once but was very uncomfortable talking about it at the time (as you can tell, I'm not now! LOL!)

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