We designed a study to explore the relationship between a history of childhood sexual abuse and birth outcomes. Data was collected retrospectively on 400 births that occurred through a clinic in Portland, Oregon between January 1990 and January 1996. Obstetrical care was provided by four naturopathic physicians/midwives. To be included in the study, patients had to be seen in the third trimester and had to have planned an out of hospital birth.
Approximately half the births were planned for home and half for an out of hospital birthing center. The average age of the mothers was 30. Payment for services included 71 percent self-paid, 21 percent insurance and 8 percent welfare. Thirty-eight percent were primips and 62 percent were multips.
Patients were asked during a routine prenatal history if they had a history of childhood abuse. Identification of survivors of child abuse (SOCA) was based on self disclosed memory of abuse. If the patient answered "no," the chart was marked accordingly. If the answer was "yes," the patient was asked to specify if the abuse was emotional, physical, sexual or a combination. By using self disclosure it is possible our identification of SOCAs is low, thus if there is a bias in our findings it is on the conservative side.
Using this method, 136 patients (34 percent) were identified as SOCAs and 264 (66 percent) were non-SOCAs. These percentages are consistent with other research reports on general populations. By including all forms of child abuse we are reflecting our belief that focusing exclusively on sexual abuse overlooks a substantial amount of damage to the human psyche. Of the 136 SOCAs, 12 percent reported emotional abuse only; 16 percent physical; 40 percent sexual; and 32 percent emotional, physical and sexual abuse.
Of the 400 births studied, 336 (90 percent) had out of hospital births. Twenty-six (7 percent) had a third trimester change of attendant, 77 percent of which were for medical reasons. There were 33 (9 percent) intrapartum transports and 5 (1 percent) out of hospital births which were transported postpartum.
When comparing the SOCA population with the non-SOCA population, there were a number of significant findings. SOCAs were almost three times as likely to have a third trimester change of attendant (11 percent of the SOCA population versus 4 percent of the non-SOCAs, p=0.00835. Statistical significance (p) is achieved when values are less than 0.05 and is considered highly significant when the value is 0.01 or less.) SOCAs were twice as likely to be transported intrapartum as non-SOCAs (13 percent of the SOCA population versus 6 percent of non-SOCAs, p=0.05462). The SOCA population was also twice as likely to utilize hospital pain medications (12 percent SOCAs versus 6 percent non-SOCAs, p=0.011342). The impact of an abuse background was also reflected when reviewing primip and multip outcomes. Of the eight multips transported, six were SOCAs. The difference is further emphasized when considering that 8 percent of the SOCA multip population versus 1 percent of the non-SOCA multips were transported. In the primip groups there was a marked difference in the cesarean rate. Eighty-two percent of the primip SOCAs who transported ended in cesareans versus 29 percent of the primip non-SOCAs.
-excerpted from "Child Abuse and Its Effect on Birth: New Research" by Nora Tallman and Cammie Hering, Midwifery Today Issue 45, March 1998
Reprinted from Midwifery Today E-News (Vol 1 Issue 52, Dec 24, 1999)
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