title: Birth experiences in adult women with a history of childhood sexual abuse.
abstract: OBJECTIVE
  Although childhood sexual abuse (CSA) may seriously impair childbirth experiences, few systematic evaluations on associations, mediating influences, risk and protective factors are available. As such information is mandatory to improve obstetric care, the present study aimed to provide such data.
  
  
  METHODS
  The study compared childbirth experiences from 85 women after CSA and at least one pregnancy resulting in a life birth with those from 170 control women matched for nationality, personal age and children's age. Trained specialists from support centers investigated CSA. Obstetrical data were collected from the official personal clinical record of each pregnancy (Mutterpass) and data on CSA as well as childbirth experiences were examined by questionnaires.
  
  
  RESULTS
  Childbirth was more often highly frightening (24.7 vs. 5.3%; p<0.01) and a negative experience (40.7 vs. 19.6%, p<0.01) in women with a history of CSA than in controls. Multivariate regression models support the hypothesis that at least part of this association was mediated by covariates (specifically, birth preparation classes, presence of a trusted person, participation in medical decision-making, pain relief, emergency during labor and extreme duration of labor), which represent important resources in improving obstetric care. In 41% of women with CSA, memories of traumatic experiences intruded during childbirth, whereas about 58% experienced dissociation. While dissociation may result in loss of contact with obstetric staff, it was also used to reduce labor pain.
  
  
  CONCLUSIONS
  Childbirth following a history of CSA is associated with particular challenges. Creating a trusting environment by evaluating and integrating individual needs could ameliorate birth experiences.
authors.affiliation: Clinic for Reproductive Endocrinology, University Hospital Zurich, Switzerland. Electronic address: Brigitte.Leeners@usz.ch.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Leeners
authors.affiliation: Support Center Frauennotruf, Aachen, Germany.
authors.forename: Gisela
authors.initials: G
authors.lastname: Görres
authors.affiliation: Private Office, Aachen, Germany.
authors.forename: Emina
authors.initials: E
authors.lastname: Block
authors.affiliation: Department of Applied Psychology, Zurich University of Applied Sciences (ZHAW), Switzerland.
authors.forename: Michael Pascal
authors.initials: MP
authors.lastname: Hengartner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D005239:Fear; D005260:Female; D006801:Humans; D036801:Parturition / Q000523:psychology*; D011247:Pregnancy; D057566:Self Report; D035502:Trust
keywords: Childhood sexual abuse; Dissociation; Fear; Labor experiences; Trigger