Purpose for the program: The Survivor Services program is designed to facilitate a positive birth experience for survivors of childhood sexual abuse (CSA).  CSA survivors are at increased risk for a traumatic birth experience which has been documented to increase the risk of postpartum depression (PPD) and post-traumatic stress disorder (PTSD) in new mothers.  Women who experience PPD and PTSD have an increased risk of costly postpartum care, hospital readmissions, and increased rates of perpetrating child abuse and neglect.  They may also avoid or delay medical care for themselves and their children.  Prenatal counseling and planning for labor can have a positive impact on how women perceive their birth.

Proposed change: A nursing intervention was created with the goal of helping to facilitate a positive birth experience for this population.  Participants come to the unit during their pregnancy and receive a tour; verbal education about labor and birth; and a written resource list.  The participant fills out a brief intake form that asks about her fears/concerns about birth and her typical ways of coping with stress.  Common PTSD triggers are reviewed and coping strategies are discussed.  The Resource Nurse creates a nursing care plan that addresses the woman’s specific concerns and outlines planned strategies.  The plan is reviewed/revised by the patient and distributed to her provider and her labor nurse.

Implementation, outcomes and evaluation: Current literature was reviewed and a need identified.  A proposal that included the risks for this population, the desired outcomes and projected costs of the program was presented to leadership.  It was agreed that the opportunity for increased quality and patient satisfaction justified the need for this program.  Education of the region about this high risk population was facilitated by securing a grant to fund a regional conference with nationally recognized experts in the field.  Focus then shifted to educating individual providers about the program.  A dedicated phone line and an intake and interview process were established.  Patient, physician and nurse feedback about the intervention have been very positive.  Still in process is a quantitative and qualitative evaluation system to track outcomes and a formal education program for Resource Nurses.  

Implications for nursing practice: This program is an example of how nurses can implementing an Evidence Based Program for a high risk population with the potential to improve patient satisfaction.

Keywords: childhood sexual abuse, birth, survivor services program, birth plan