Women who have been raped have much more difficulty in childbirth than their peers who have never suffered sexual abuse or violence, a new study shows.

“The challenging part seems to be in the second stage, when the baby is to descend and the woman should start pushing,” Dr. Lotte Halvorsen of the University Hospital of North Norway in Tromso, who helped conduct the study, told Reuters Health in an email.

“A possible explanation may be that the physical pain when the baby is descending activates flashbacks of the rape and the resistance to the traumatic experience,” the researcher said.

Based on the findings, she adds, doctors, midwives and nurses helping women in labor and delivery need to know if that woman has a history of rape, so that they can assist her during labor without re-traumatizing her. “A previous rape is a shameful and therefore often a silent and unprocessed negative experience in life that women do not bring up themselves,” she added.

Halvorsen and her team decided to do the study after observing that women who had been raped had longer second-stage labors and were more likely to need C-sections or assistance with forceps or a suction device to deliver vaginally.

They compared 50 women who had been raped at or after the age of 16 to 150 women who had not been raped. Birth attendants did not know about a woman’s history of rape.

Forty percent of the women who had been raped had C-sections, while another 40 percent had vaginal deliveries assisted with a vacuum-like device or forceps. This translated to a 16-fold greater likelihood of having a C-section for rape victims, and a 13-fold greater likelihood of assisted vaginal delivery.

And while the women who had not been raped spent about an hour in the second stage of labor, on average, duration for the second stage of labor among the rape victims averaged two hours.

The women who had been raped were heavier, more likely to smoke, more often unemployed, and more likely to be single. They also had experienced more abortions and miscarriages. But the researchers adjusted for these factors in their analysis.

In Norway, Halvorsen noted in an email, birth attendants “surprisingly often” do not have information about a woman’s rape history. Typical aspects of labor and delivery, such as vaginal exams and having strangers in the room, may be traumatizing for women who have been raped, she added.

“Women who have experienced rape need a birth attendant who patiently can support birth with as few interventions as possible as well as to help the woman to keep focused at the birth,” Halvorsen said. They may also need more time in the second stage of labor, she added, in order to deliver vaginally.

SOURCE: British Journal of Obstetrics and Gynecology, January 2010.