sexual abuse question on history form

[novadoula]

Sorry if this topic has been covered before. I searched the threads but probably not doing it right Most prenatal history intake forms have included a question asking if there is a history of abuse sexual or physical. If the statistics are correct; one in four women are affected. How do you find this helps to know? What about the moms who do not feel free to divulge this information? I guess I am asking what changes about the way you treat mom prenatally and in labor? this is why I ask... years ago I had a client that was severely abused as a child and then while she was pregnant she was being stalked and sexually harassed by a co-worker ( legal action was taken). She hired both me and my back-up for our full fee each. There were many things she needed; no men in the room except her husband, a private tour of the facility,had to have the bed facing the door, someone had to walk behind and in front of her, she had to know every detail about everything..... the list and her folder were thick. Her needs were met because she was open about the abuse, she was highly educated and her job demanded respect. What if she wasn't comfortable exposing herself in that way? What if she was an uneducated,young unmarried mom? The nurses treated her with compassion where I have seen them treat others as a problem if they have a quirky request. I know they can leave the question blank. Someone without that history may just skip right over it no problem...and someone else with a history may attach all kinds of meaning to the question, whether they answered or not. anyway, I have contemplated this for years and have not come up with an answer that satisfies me. So I thought I would throw it out to the collective wisdom of this forum.

Thanks Marilyn

[doula Michele]

I am taking a course in this right now. The biggest thing is that IF you ask this question, you have to be prepared to deal with the answer.
Are you qualified to offer councelling, advice etc..
Are you prepared to deal with any legal obligations that may come from disclosure
Do you have a list of resourses readily available.

[1stimestar]

Oh let me find you some of links. We have had some great in depth discussions about this WITH experts in the field.

[1stimestar]

Here's one where Jodi, from A Safe Passage chimes in.
Supporting Survivors of Abuse

[doulajamie]

It's really important to recognize that substance abuse and sexual abuse are very correlated. At both treatment facilities I have worked at, the rate of admitted sexual abuse is around 90% and we found that the local maternity homes have around a 75% rate of admited sexual abuse, with a majority of these women having a substance use issue. Michelle makes an important point of being able to manage the answer if you ask the question. I also find this is a question that is better asked by the doula to the client rather than just asking her to check a box on a piece of paper, ditto for a question about substance use/abuse. It's really frightening to see numbers this high, even those who have been in this field for quite a while feel that the numbers are going up significantly. Some reports are showing an overall rate of 1 in 3 women and possibly as high as 1 in 2 due to the fact that many women never admit or acknowledge their abuse (this is in the general population). Those are some scary numbers!!!!

I think it is important to understand the impact of sexual abuse on birth but it is also important to recognize our limitations as doulas, both ethically and legally. As a doula, if you ask the question you need to have an idea of where to take the answer without overstepping your abilities and scope of practice into a counseling role . Having community resources available is important. It is really easy to get into a situation where you are in over your head if you try to counsel a client on these very sensitive issues. Having general information and community resources available for the client allows them to decide how ready they are to confront these issues in preparation of labor and birth.

[doula Michele]

Quote:

Originally Posted by doulajamie It's really important to recognize that substance abuse and sexual abuse are very correlated. At both treatment facilities I have worked at, the rate of admitted sexual abuse is around 90% and we found that the local maternity homes have around a 75% rate of admited sexual abuse, with a majority of these women having a substance use issue. Michelle makes an important point of being able to manage the answer if you ask the question. I also find this is a question that is better asked by the doula to the client rather than just asking her to check a box on a piece of paper, ditto for a question about substance use/abuse. It's really frightening to see numbers this high, even those who have been in this field for quite a while feel that the numbers are going up significantly. Some reports are showing an overall rate of 1 in 3 women and possibly as high as 1 in 2 due to the fact that many women never admit or acknowledge their abuse (this is in the general population). Those are some scary numbers!!!! I think it is important to understand the impact of sexual abuse on birth but it is also important to recognize our limitations as doulas, both ethically and legally. As a doula, if you ask the question you need to have an idea of where to take the answer without overstepping your abilities and scope of practice into a counseling role . Having community resources available is important. It is really easy to get into a situation where you are in over your head if you try to counsel a client on these very sensitive issues. Having general information and community resources available for the client allows them to decide how ready they are to confront these issues in preparation of labor and birth.

I totally agree with you Jamie. I know that this is a topic that I am really enjoying learning about, and I am in the process of getting more involved with the sexual assult center in addition to training with Jodi from A Safe Passage. It something that I know I am encountering more and more as a doula and women are disclosing this information, even though I do not have a check box on my intake forms.

[doulajamie]

Michelle:

I have written 3 papers on this topic in my Master's program, and I still have so much to learn. This will be a large part of my Integrative Paper (my final paper for my program which is an integration of all the things I am supposed to have learned!). I think one of my biggest frustrations is that women often do not come into substance abuse treatment until they are 6-9 months pregnant and we hardly have time to work with their traumatic pasts. This means that epidurals are often a good choice because of the limited time factor and the extensive abuse that some have suffered. It can be quite challenging and frustrating because I know that our program has some wonderful options for working with women who have this history but it all takes time. The additional challenge is that if it is unresolved, the mother's risk is increased for perinatal mood disorders which increases the risk of a relapse (a return to substance use), and child abuse/neglect.

[doula Michele]

The recovery center may be another place I will target and do some training with. It all seems inter related..most substance abusers have sexual abuse in their past. I do find this whole other area to be very interesting and challenging to work in.

[AmandaLow]

I once had a client who did not tell me about her abuse, and while in the hospital she had unusually negative reactions to two vaginal assessments. When it was just myself and her partner in the room, she quietly said that she had something she wanted to tell me, and at 6cm dilation she went into the details of her abuse. She asked me to inform the medical staff as she felt neither she nor her partner would be able to discuss it. The change in the medical staff's treatment of her was immediately visible, and she did not have another exam until she was fully dilated. One dilated, she was unable to push, and it was somewhat apparent that there was a mental block holding her back. I believe that had she had the appropriate counselling during pregnancy (she had never had any therapy at all) or had done some reading on her own about birthing after sexual abuse, she would have had a different delivery. Her c-section was upsetting and she found herself blaming herself for it. In our postpartum visits we discussed her need for professional counselling and I referred her to some community resources. I also suggested that journalling and birth art may help her to express her feelings, but reiterated that she needed to talk about her feelings with a professional.
I guess my point is that I feel it is important to ask the question, not only on a piece of paper, but face to face as well. Alone, if there is the opportunity, as some women don't feel comfortable discussing abuse in front of others, even their partners. Although we as doulas are not the ones to fill the role of therapist, we are able to guide these women in the right direction so that they can have a birth where they feel as safe and calm as possible.