A practical approach to clients who are survivors of childhood sexual abuse

Approximately 30% of all women have experienced some form of sexual abuse in childhood or adolescence. This abuse may result in serious long-term sequelae for the survivor, such as depression, low self-esteem, post-traumatic stress disorder, and addictive behaviors. Nurse-midwives are uniquely equipped to provide health care to survivors of childhood sexual abuse because of their commitment to thorough, sensitive health education. This article draws on current literature and the clinical experience of a nurse-midwife who has cared for many survivors of sexual abuse. It offers suggestions for incorporating identification of survivors into the initial health assessment. Interventions are reviewed including how to approach the physical examination of a survivor and how to provide appropriate care in the intrapartum and postpartum period. Emphasis is given to the development of a referral network.