Program

Nurse-Midwifery M.S.

Year Approved

2020

First Advisor

Wu, Katrina

Abstract

Background/Purpose: The purpose of this literature review is to determine how a past history of sexual abuse impacts labor and birth and what strategies can be used to help mitigate retraumatization. The desire is that this review will encourage further studies and the creation of guidelines and interventions to be used in maternal care settings. Theoretical Framework: The Neuman Systems Model is a theoretical framework utilized in this paper. It provides a framework for identifying stressors, assessing a patient's response, developing strategies/treatments to move women back toward stability, and adapting practices to reduce triggers from occurring in the first place (Neuman, 1996). It can be used in both patient care settings as well as research to evaluate how an individual responds to stressors in their environment and the impact of primary, secondary, and tertiary prevention strategies on their overall wellbeing (Alyward, 2005). Methods: An initial search was conducted using Bethel University’s Online Library with the PubMed MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Google Scholar databases. 20 articles were selected that met the inclusion criteria of sexual abuse and the intrapartum period. Each of the articles identified effects of sexual abuse on the intrapartum period and posed questions and suggestions regarding what types of interventions may help to address adverse birth outcomes and women’s perceptions of their experience. Results/Findings: Two themes identified: Outcomes and interventions. Outcomes were further broken down into physical obstetric outcomes and psychological outcomes. Physical obstetric outcomes include an increase in prolonged labor, risk for low birth weight, risk for preterm birth, antepartum bleeding, labor inductions, operative vaginal deliveries, and medically necessary and elective cesarean births. Psychosocial outcomes include symptoms of post-traumatic stress disorder (PTSD), increased maternal stress during labor, and an increase in intense fear of birth. Interventions were broken down into two groups: personal coping skills and professional interventions. Personal coping skills include a need for control over who the provider is and physical exams, ability and freedom to “take charge,” engagement in counseling, and forgiving perpetrators or forgetting abuse through suppression of memories or substance use. Professional interventions include routinely screening patients for abuse history, developing a therapeutic patient-provider relationship, discussing triggers and avoiding them when possible, giving patients control, practicing shared decision making, and antenatal counseling. Implications for Research and Practice: Implications for practice include ensuring that all maternity care providers are screening patients for a history of sexual abuse, universal precautions for all patients regardless of stated history, empowering women through shared decision making, discussing triggers and avoiding them, and encouraging antenatal counseling for those who disclose a sexual abuse history. More research, including larger studies with diverse patient populations is needed to establish a causal relationship between sexual abuse and poor birth outcomes.

Degree Name

M.S. Nurse-Midwifery

Document Type

Masterʼs thesis

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