Psychosocial functioning and childhood sexual abuse

The importance of considering a woman’s history in her antenatal care is evident given the intimacy involved in pregnancy and childbirth, which in itself may be anxiety-provoking. Further, given that it is estimated that 36% of pregnant women are sexual assault survivors, antenatal care and childbirth may be significant areas of concern for some women. Indeed, research shows that women with a history of trauma (i.e., sexual abuse) experience birth more negatively, report more intense fear of delivery, fear internal examinations and nakedness, and the presence of male staffers, more so than women with no such history. In some cases, pregnancy and childbirth, and related procedures (e.g., internal examinations), may remind survivors of the prior assault and associated powerlessness. A large proportion of women (41%) with a history of sexual abuse stated that memories of the abuse disturbed the process of delivery. Given these considerations, this chapter has both a research and clinical focus. First, recent research in this area is reviewed to provide an understanding of the correlates of having a sexual abuse history and pregnancy (e.g., greater fear of childbirth, increased alcohol consumption). Second, we consider the clinical considerations in this area, including current screening recommendations and how best to identify abuse survivors in pregnancy.