The statistics (Statistics Canada, 1999):

• More than 50% of women experience some form of unwanted or intrusive sexual experience before reaching the age of 16
• 17% of women reported at least one incident of incest before age 16
• 29% of women have experienced a physical assault by a partner

Childhood sexual abuse can be defined in the following way:

"Childhood sexual abuse takes place between a child (anyone under 16) and an adult or someone close in age, whom the child perceives as more powerful...any activity—physical, psychological or verbal—that the abuser expects to cause sexual arousal in the abuser or someone else..." (Simkin, Penny)

Woman abuse is generally defined as:

"The intentional and systematic use of tactics to establish and maintain power and control over the thoughts, beliefs and conduct of a woman." (London Abused Women's Centre)

Woman abuse tactics during pregnancy may include, but are not limited to the following:

• Limiting partner's access to prenatal care
• Increase in physical assaults aimed at abdominal area
• Derogatory/insulting comments directed at the woman's changing body
• Restricting her choice of caregiver
• Preventing partner from obtaining information related to pregnancy and birth
• Threatening to leave her if she does/doesn't terminate pregnancy

While these tactics have been separated into categories, they actually overlap and work together to create an atmosphere of fear and isolation for the abused woman. Sometimes a man may stop behaving abusively in one particular way, for instance he may stop physically assaulting his partner (because he doesn't want to face jail or probation again), and he will adopt new strategies to maintain power and control in the relationship. It is important to remember that because the abusive partner knows his partner so well, the tactics he chooses to use are catered to her, to create the greatest impact on her and are deeply personal. We cannot compare tactics and place more weight on one type over another. Each form of abuse is corrosive to a woman's self-esteem, her sense of autonomy and her emotional and physical well-being.

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Women who have experienced childhood sexual abuse, sexual assault, victimization and woman abuse have unique emotional, psychological and physical needs related to the abuse. Trauma from the abuse can manifest itself in a variety of complex thoughts and behaviours through the childbearing year, which may pose particular challenges for primary caregivers.

At the same time, the caregiver has the opportunity to be a catalyst for healing through appropriate responses to the "disclosure" and by working collaboratively with the client to devise a plan of action for coping with her potential triggers.

Women survivors of abuse may engage in behaviours that are difficult to empathize with and complex to understand, especially in the childbearing year. As a means to cope with their abuse/abuse histories, women may be using drugs or alcohol, may engage in high risk sexual behaviours, may have eating disorders or may practice other self-harming behaviours, such as cutting themselves. In order to fully support women who have experienced abuse, it is helpful to look at survivors who are engaging in these behaviors as women who are attempting to survive, instead of as women who are intentionally causing harm to themselves and their unborn babies.

As her care-provider it is useful for you to provide her with a balance of information about ways that she may be able to minimize her baby's exposure to the harmful by-products of her high risk behaviours, while respecting her autonomy and decision making power. For instance: does she have access to clean needles, condoms, could she use some strategies to reduce her alcohol or nicotine consumption. Remember to offer a variety of suggestions and validate her for any attempt she makes at reducing harm.

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Accept... by working with survivors of abuse, we accept that we will experience changes in our thinking and our lives will be impacted.

Balance... recognizing that doing trauma work requires us to find balance in our lives by finding other outlets in our lives that are not related to our work with survivors.

Connect... by staying connected to other people, we can ensure that we are receiving support, reassurance and guidance in our work and personal life. Friends and family can help us reduce our own isolation and minimize the impact that trauma work has on our wellbeing.

When working with women abuse survivors, we can also take care of ourselves in the following ways:

• Recognize the potential for healing in abuse survivors.
• Be emotionally and intellectually prepared to hear trauma stories.
• Get peer support and/or consultation when you begin the work.
• Be mindful of the signs of vicarious trauma — fatigue, unusual fears, over/under eating, anxiety, substance abuse.
• Be aware of your potential triggers... have you experienced events in your life that may make you more vulnerable to other people's abuse trauma?
• Have realistic expectations of yourself.
• Know your limits.
• Maintain your boundaries.
• Address your own needs.
• Keep yourself safe.
• Remind yourself that she has a very good reason for behaving this way but you are not the reason.
• Get as much training as you can on topics related to abuse, such as: substance use, mental health issues, homelessness.
• Become an activist and work for change!