1. Wisner, Kirsten PhD, RNC-OB, CNS, C-EFM

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Many women in the United States have experienced sexual violence. Nearly half (43.6%) of women surveyed reported some type of contact sexual violence in their lifetime, and approximately one in five women reported an attempted or completed rape (Smith et al., 2018). These rates are higher among younger women, minorities, and female veterans (American College of Obstetricians and Gynecologists [ACOG], 2019; Smith et al.). Victims may suffer numerous consequences from such trauma, including unintended pregnancy and both short- and long-term physical, emotional, and mental health issues. These consequences can present in phases. Initially, the victim may have generalized physical pain, disturbances in their eating and sleeping patterns, and feel shame, fear, anxiety, or anger. Over the next few weeks or months, the woman may experience phobias, flashbacks, and nightmares as well as physical symptoms. Months and years later, the woman may suffer from posttraumatic stress disorder (PTSD), which is associated with avoidance, reexperiencing the trauma, and hyperarousal (ACOG).


Survivors typically do not report a sexual assault history, but instead may present with physical complaints such as pelvic pain, dysmenorrhea, or sexual dysfunction (ACOG, 2019). During the peripartum period, PTSD symptoms may include extreme anxiety with intravenous (IV) starts or vaginal exams, hyperemesis, chronic pelvic pain, or diminished perception of fetal movement or trance-like behavior resulting from dissociation (Association of Women's Health, Obstetric and Neonatal Nurses [AWHONN], 2017). All women should be screened for a history of sexual assault. When identified, an examination should be performed by someone with specialty training, such as through the Sexual Assault Nurse Examiners (SANEs) or Sexual Assault Forensic Examiners (SAFEs) programs to ensure that necessary evidence is collected and documented. If no resources are available, a protocol is available from, titled The National Protocol for Sexual Assault and Forensic Examinations of Adults and Adolescents.


Without specialty training, perinatal nurses will probably not be involved in the care of a woman in the acute phase of a sexual assault. However, given its prevalence, it is important that perinatal nurses understand and incorporate the concept of trauma-informed care (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014) to sensitively support and care for women with a history of sexual assault. In addition to recognizing, understanding, and responding to the effects of trauma, this framework emphasizes six key principles: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues (SAMHSA, 2014).


Women are particularly vulnerable during the peripartum period and this may be heightened in those with a history of abuse. A trauma-informed framework emphasizes the concept of avoiding retraumatization, and creating an environment that enhances physical, psychosocial, and emotional safety to support a sense of control and empowerment. This includes being cognizant of power differentials between clinicians and patients, deliberately engaging the woman and her support persons in shared decision-making, and advocating for her autonomy and control over choices during care (SAMHSA, 2014). Additional considerations should include providing ample explanations of care, asking for permission before starting an IV or performing a vaginal exam, providing privacy, and minimizing extra personnel in her room (AWHONN, 2017).


To provide better support for women who have experienced sexual assault, perinatal nurses can learn more about trauma-informed care from:




American College of Obstetricians and Gynecologists. (2019). Sexual assault (Committee Opinion No. 777). Obstetrics and Gynecology, 133(4), e296-e302. doi:10.1097/AOG.0000000000003178 [Context Link]


Association of Women's Health, Obstetric and Neonatal Nurses. (2017). Providing care for survivors of sexual abuse during childbirth. Retrieved from Accessed May 1, 2019. [Context Link]


Smith S. G., Zhang X., Basile K. C., Merrick M. T., Wang J., Kresnow M., Chen J. (2018). The national intimate partner and sexual violence survey (NISVS): 2015 data brief-updated release. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. [Context Link]


Substance Abuse and Mental Health Services Administration. (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach (HHS Publication No. [SMA] 14-4884). Rockville, MD: Author. [Context Link]