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Feeling safe: a metasynthesis of the maternity care needs of women who were sexually abused in childhood.

BACKGROUND
The impact of childhood sexual abuse on birth experiences was highlighted 20 years ago in Birth. Subsequent accounts in the midwifery press testify to the emotional trauma that women who were sexually abused as children may suffer during childbirth and the potential for caregivers to make the situation worse. This study synthesizes research on the maternity care experiences of women who were sexually abused in childhood to answer the questions: what do women need during their childbearing experiences and what can health care practitioners do about it?


METHODS
A metasynthesis was conducted to integrate the findings of several qualitative studies. The eight eligible studies identified by database searches were closely read, recurring themes were extracted and compared across studies, and core themes were identified by means of an interpretative process of synthesis.


RESULTS
The key themes identified were control, remembering, vulnerability, dissociation, disclosure, and healing. If women were able to retain control and forge positive, trusting relationships with health care professionals, they felt safe and might experience healing in the process. "Safety" requires that women are not reminded of abusive situations. In the absence of control and trusting relationships, maternity care can be experienced as a re-enactment of abuse.


CONCLUSIONS
During their maternity care experience women who were sexually abused in childhood need to "feel safe." Health care professionals can help them achieve this feeling by seeking to ensure that those experiences do not re-enact abuse.