Hi, I'm Sarah Lavonne and I'm so glad you're here. Here at Bundle Birth, we believe that your life has the potential to make a deep, meaningful impact on the world around you. You, as a nurse, have the ability to add value to every person and patient you touch. We want to inspire you with the resources, education, and stories to support you to live your absolute best life both in and outside of work. But don't expect perfection over here. We're just here to have some conversations about anything birth, work, and life. Trying to add some happy to your hour as we all grow together. Bye nurses for nurses. This is happy hour with Bundle Birth Nurses. When I started into nursing, I knew I wanted to do labor and delivery, but I also had an interest in addiction medicine and sexual I'm going to say sexual trauma um as a specialty and something that I wanted to learn about and be a part of. And it's not something that I have gotten into yet other than I did do the when survivors give birth training with Penny Simkin and Phyllis Claus. And that was before Penny Simkin passed away. And so I got to learn from the two of them and have this whole conversation surrounding sexual trauma in particular amongst the population of pregnant people and how that affects our job. And so I um this has always been an area of interest for me. I actually started putting together a training for nurses after becoming an educator through them. And then life took off and this was amidst bundle. This was only a few years ago. and um and it just hasn't come back around quite yet except for today we are going to have that conversation with Morgan who is a sane nurse and talk about sane nursing forensic nursing what we can do to support this patient population wherever the conversation goes with a greater look on bringing awareness to the fact that these are some hard things if you haven't listened to episode 1 and two with Morgan on near fatal strangulation in our pregnant populations. Please go back and listen to those two episodes because I'm sure we are going to reference some information that was spoken to in the last couple of episodes because these two issues from what I'm learning are are closely related slashtied and it's hard to talk about one without talking about the other. And so today, if we are going to, again, this is my like alert to all of us that the topics that are going to be talked about in this episode are mature topics. And so if there are young ears within earshot of this episode, you probably want to put headphones on. And then my ask is just to be mindful of yourself um that we know that especially we will be talking about sexual abuse, sexual assault, and trauma in this episode. And so this is your note to just pause in yourself and say, "Does this feel like something that I can go into today that I can listen about?" And if it's not, just move on. And you can come back or not, but that we would all just be mindful of our nervous systems. And if there are moments during this episode where you're feeling like mm too much, that the best thing you can do for yourself is to pause the episode, go do some do some walking, um some bilateral stimulation, some grounding techniques, and um and come back if and when you're ready. And if not, that's okay as well. And so, um that's my sort of like heads up for this episode. But I want to talk about all the things. And offline, we were saying that some of these topics certain people are just not ready for. they don't want to hear about. That was interesting to me because that is not what we're about here at Bundle birth. And so we're going to talk about it uncensored um if possible today in in wherever that goes. So welcome back Morgan. Thank you for being here and lending your experience back to this audience. And so I want to start with just talk to me about what sane nursing is/forensic nursing at its core. What does it look like? What's the certification? Because I'm not going to lie, I did look into it a couple days ago and was like, "Oh, oh, wait. This is like this is like a thing." Like, I can't just go to a day training. That was my stupid brain. Um, I still might, but you know, um, what does it take and what what what does it mean? Um, so specifically, so SAN stands for sexual assault nurse examiner. These are specifically the forensic nurses that are specializing in doing what we call the rate kit. Okay? So, we are there to help someone after they've experienced a sexual assault. But um forensic nursing is so much more than that because as a forensic nurse, I specialize in the field that intersects with health care in the legal system. And I'm there to provide compassionate and comprehensive care for a person who's experienced violence, abuse, neglect, rape, any of these things. Um near fatal strangulation. Um, so you know, it's it started out where I thought I was just going to help women who'd experienced rape and then I learned, nope, no, you don't. It's men and women and I I don't do pediatrics. Um, but there is a whole another subsection of pediatrics. Um, and so, um, but when you start doing that, then you realize it's not just one thing. These people experience violence. they experience near fatal strangulation. Um it could be neglect or abuse at home. Um it could be substance abuse. It is such a it's so much more like um so to just say that I'm a sane is and and I do I identify as a sane but now as a community we're starting to say more no I'm a forensic nurse with a subset specialty in sexual assault. Um there's training. So because the laws are different in different states, um there's some laws that are pretty universal, right? Like they match up very closely in all the states, but um you can take sexual assault training and um the Academy of Forensic Nurses um is where I would send you for this or where I suggest going. The other thing is you can look in your state. Sometimes states have a particular need and they offer free training. Um so I was actually trained for free here in the state of Georgia because we needed sexual assault nurses. So um for us it was our criminal justice coordinating council. They actually have a same coordinator for the whole state and that's how I got trained. Now, um there are certifications. Again, the Academy of Forensic Nursing is where you would go and after you've done some training and done some time, you can actually sit for one of these. And so, their forensic nurse generalist is usually like the first step. And then they have like these more specific ones that are, for example, um the strangulation one. They have one for um you know for for sane nurses, nurses that specialize in sexual violence. Um so but that is where you would go. Um it used to be there was um the uh international association of forensic nurses or IAFN. Um, but that got dissolved and became part of the Emergency Nurse Association. And I'm waiting to see if they're going to put out um the the SANE certification again because that's kind of where that SANE certification was owned. So now um sexual violence forensic nurse certification is kind of the new the new saying, if you will. Okay. Sexual violence forensic nurse certification. when you say sexual violence and specifically for the sane side of things for when discussing rape, what have you found to be and what do we know as some of the misconceptions about what rape is? Because I think societywise a lot of times we think it's like somebody, you know, going on a run in the fields and somebody pulls you into a bush. Um, what is Lake and Riley? Do you remember her case? Yeah. The nurse. Yep. Yep. So, what is what is considered rape? So, there's the legal definition um which varies just a little bit, but it's essentially when someone who didn't want to have sex or did not consent to have sex and they have sex forced upon them. right now. You can have other types of like sexual assault, sexual battery, and that's when you get into the touching and the different other sexual acts. Um, but the main thing is that it's nonconsentual. Okay? So, you have this being forced upon you and then there's other different forms of sexual violence and then um all of these things, you know, get listed as different crimes, you know, and how they're defined within your jurisdiction. They're not the the reason I say it like that is the definition, you know, if someone for male to female, right? If a man puts his penis in a vagina and it is unwanted and you whether you said no or not, but it was unwanted, um you did not consent, that is rape. And then based on the definitions, if he were to do something else, touching genitals, touching putting things in your mouth, things like that, putting things in your anus, those get different definitions legally. So, can we talk some statistics here? Because depending on your life experience, depending on like where you're at, we've all lived different lives. When we say rape, that feels like, woo, you know, like a big one. And I think it's easy to picture what that looks like and say like, well, it wasn't me and or maybe it was. And so, how prevalent is this this day and age as far as what we know? And therefore I think we also are starting to think through the patient lens that like of the number of patients that we see this percentage will have experience some form of sexual violence, rape, assault, etc. The statistics say nearly every minute someone in the United States is sexually assaulted. Okay? And then every nine minutes that someone is a child. And if you were listening to one of the previous episodes, we talked about one in every um four women at some point experiences some form of intimate partner violence in their lifetime. Right. But one in six women in the US has experienced attempted or completed rape in her lifetime. I actually think that's too low. I would agree. I would agree. and and and and but that's like unreported and I think you know to be honest I cuz it's one in 33 men and we we know it's more we know it's more for sure but even then the fact that we have one in 33 reporting um and you know about 3% of men in the US have experienced either attempted or completed rape and that is that's a lot you know that's you know, but um we say that the majority of our rape victims are female, but I think a lot I I do believe that, but I I know a lot of it has to do with reporting, too. Sure. I think men are definitely under reportported and our LGBTQIA+

are 100% under reported. Mhm. So for all of us to know that like these stats are under reportported that that's an that's a that's a safe assumption to say like you know one in six is under reportported and I think part of that to me goes alongside the the fact that I think societywise we are not very educated on what rape is and we also aren't very compassionate about consent. Um, that's I have a lot to say about that at another time. But for instance, literally last night, this is this is wild. I had a conversation with a friend whom I hadn't seen in goodness like a year and she is younger than me. She's living her best life. And she disclosed um that and it came out and the moment she started talking about it, I was like, "Oh, I know where this is going." And she said that she went to someone's house and well I went to their house and I you know I should have known better and I this and that and you know and then it you know very quickly uh it turned into something where I just laid there and I just sort of but I didn't say no explicitly but I also slightly resisted with my body language and I didn't participate back and it felt bad. And as she's telling me, she's getting teeyed. And you know, and I just listened and she said, "So it it felt it felt like it felt bad. It didn't feel right." And I said, "Did it feel like rape?" And she like looked at me with tears in her eyes and said, "Yeah, that's what it felt like." And I said, "Well, that's what it was." And you know, this was literally last night. And I and I didn't even com I didn't even think about the fact that I was having this conversation today. But I think that story is a representation of because I have a lot of understanding of this. I've done a lot of work and I will just say in this episode, this is all I'm going to go into, but I am also a um survivor of rape myself. And so, you know, I have a level of compassion for these scenarios and being able to call what it is what it is. And in her case, well, but I didn't say no. But I didn't say no. And the amount of shame that women in I'm going to speak to women because I'm a woman and that's who I talk to about this. um that women feel about well but well but and the conversation that was had was I said she's like well but I you know I'm going to own that I and listed off all these things and I said you could lay there with your legs open wanting it and then he approached you and you decide that nope actually I'm not okay with this you should be able to say no and it should be a non-negotiable and if you have lived in the world and experienced I'm going to say much you know that that just is not the reality of our day. And so when we when we level set for this episode what I want to bring is that rape is rape whether you say no or not. And the goal is that you decide that it's what you want. And if you feel like, and in this case, you know, she had a hard time calling it what it was, but she said that's so validating when we actually had that conversation. Um, it's a scary word to say. It's Yeah. And it has It's a Yes. Um, there's a reason you can't say it on social media without getting your videos banned or we have to, you know, use symbols and things because this is a conversation that's I don't I don't want to say society doesn't want to have it, but it is definitely one that is not welcome. This is this is taboo. Um she had a very normal response and I when when you share with these people the one thing that whether they say no or not it's a normal response. the the five trauma responses. We always talk about fight or flight, right? But there's, you know, freeze and fawn and flop. And you know, we don't talk about that, right? And we don't, you know, there's so many more responses to trauma and the just laying there, the just flopping over and just and or freezing, the inability to form the words to say no. Um, there's a great YouTube video I think every teenager, every person that is before they start having sex should have to watch it. And it's about consent and a cup of tea. And it talks about, you know, like giving someone like a hot hot tea, like a cup of tea, and what consent is. And one of the parts of the video is like if your friend has passed out and they are passed out, you would not pour tea down their throat. You would not make them have tea. They did not consent to the tea, you know, and it but it goes through all the layers of what is consent and how and and of course if your friend is passed out, you would never pour tea down their throat, but you really want them to have a cup of tea. They might have asked for a cup of tea last week, but they don't want tea this time. And that's okay. They're allowed to say no thank you to your tea this time. You do not just ask once. And um but it puts it in a very real way that people can understand, right? cuz I wouldn't pour hot tea on you. And now you take that same principle and you apply it to sex or sexual acts, touching, bodily autonomy. I love that. And also like for all of us again level setting is like consent is consent and we talk a lot about consent at Bundle Birth nurses for shared decision-making model at the bedside and giving offering control and it's no different in a sexual situation as well. The other thing too is remember you can be in the act and um you can say okay I'm done. No like now like like you can withdraw consent. Um one of the things that we deal with a lot and this is confusing. This is really confusing for women and it makes it really hard for them to report. Um I consented to protected sex. I consented to this. I did not consent for him to remove the condom and go for round two. And now they're scared to report because they're like, "But I did consent to this, but I didn't consent to this." Like, "Is this still rape?" That like it's very confusing and um that is a very difficult one to to for legal reasons and things and um the legal system is not nice to rape survivors that seek justice. It's a very hard process. It is not. And I I want justice for all of my patients if that's what they want. But I approach sexual assault nursing like I do labor and delivery nursing. Maximum self-determination. I'm going to give you all the facts and all the information and you're going to tell me what you want to do and then I'm going to support you in the best way possible in what you want to do. So I don't ever shame them if they don't want to report to police. Um, so in my world working at a sexual assault center, and this could be different in other states, so please make sure you check the laws and things in your state. Um, if they come to us at the sexual assault center, I am not mandatory required to report their sexual assault to the police. Now, if you go to the emergency room or something like that, those are mandatory reporters. It is a violent crime. So, what would happen is the police would come and say, "Hey, do you want to report this?" And the victim does have the right to say, "No, thank you. Um, I'm not But I don't have to do that step if they come into the sexual assault center. Um so they are allowed to come and get help get um STI prophylaxis. We can also take the forensic kit and all the things and it it actually will buy them a little bit of time to think about if they want to report, let them settle a little bit. Um but that in and of itself has its own implications. Yeah. Yeah. Well, and speaking of the criminal justice system, it's like I think it's easy to hear about or somebody disclosed to you that they have experienced sexual assault in whatever format. And the natural thing that we say is, "Well, did you report it?" And why not? You should report it. You know, even for myself, I wasn't really planning on talking about myself, but it's hard not to because I like have lots to say about this personally and someday I will. Um, but even myself, like one of the number one things that I hear if I'm ever going to share with someone about what happened is like, "Well, did you go to the police?" And I did not. And that was a conscious choice. Um, and the amount of not getting it or well, but you should, and well, can't you now? And I understand that it comes from a place of like wanting justice and it's hard to hear and you want to fix it and you think that the criminal justice system will fix it, but the reality is what? like even people who do report, how often does that actually amount to a conviction? So, that is a difficult number to pull out and here's why. Okay, the reality is nationally we say fewer than 10% of reported rates actually result in a felony conviction. So like that's that's kind of um very means that 90% of rapists are still walking these streets. Yes. Um yes. Uh but but the reason I put a tiny pin in that is they can plead to lesser charges. They can make a deal. So rape is a pretty big felony. um and prison culture, things like that, do not take kind to rapists. So, um which is good. They shouldn't be kind to rapists. But, um that being said, being able to if if you're in a situation where it's he says, she said, right? Because we always hear about that situation where it's someone's word against the other, right? Um we'll use the example of I consented to this, I didn't consent to that, right? That's still rape. like she did not consent to unprotected sex. You decided to take that. That is rape. So there's there's DNA there. So the forensic kit like there's she consented to having sex. I'm going to get his DNA. We know this, right? That is a very hard case to prove. So they might make some type of negotiation to a lesser charge, maybe a misdemeanor, something like that, which is why those numbers I I'm I think that's why those numbers are so low. Yeah. But I think that's because we I don't want to say we don't have the right laws. I think we haven't figured out how to address this appropriately to get justice the way it should be served. And that is part of the problem, right? So they might only spend three years in jail on like a battery charge like you know or something else or they might not get jail time at all or um they'll negotiate to get off of the sex offender list or you know so that affects those numbers that affects that statistic pretty heavily. And when someone is choosing to report to the police, what does that mean for their future of what they're agreeing potentially to for the criminal justice process? Means you don't get to move on with your life is what it means. Um I say that because I don't know what other states look like. I am really speaking from the lens of my practice. um it can take years before they go to trial and then you know so imagine this awful thing has happened to you and two years of your life pass you're growing you're moving you're trying to live your life and move on do better things and now you have to go back and be questioned by most likely a not very nice defense attorney because I mean their job is to make you look bad make make a mockery of you and the person has a right to confront their accuser. So, you're accusing someone. Um, trials can be long. They can be grueling. You can be stuck on the stand for a long time and then there's still no guarantee you're going to get justice at the end. You know, you might go through all of that and then they get let go or, you know, I've seen it go where like we get all the way down to the last witness and then they take a plea deal and so you just sat there being tortured that whole time. The other thing too for our, you know, um I don't want to say victim anymore. I'm going to try to say survivor, you know, because you know what, you you're not a victim here. Um you're not. And the other women are not. You survived something. You survived something awful that you shouldn't have had to experience. But our other survivors, when you get into that courtroom, when they make those plea deals, you don't really have a say in it. You know, sometimes the DA will ask you your thoughts or this or that, but I mean, the reality is all of that is kind of out of your hands. So, you're this pawn, so to speak, in a chess game that is the legal system, and they're going to emotionally use and abuse you to make their case, hopefully to put this person off the streets, hopefully to make the world a safer place. Like, that is the goal. I really don't feel like the DA is doing anything like to purposely harm our survivors, but you know, when you get up there and you're your emotions and the things are on display and that defense a bunch of strangers sitting there ready to judge you. Imagine when I have to get up there and I might have a picture of your vulva. Like if there was a tear, if there was damage, now your vulva is on display. No. Yes, ma'am. So, imagine now they will not put it on the projector for the whole gallery. The there's usually a screen at the attorneys and then the jury and the judge, but all those people in the jury. Yeah. So, when you're having a baby, right, those women get used to it. They're like, uh, everybody has seen it, you know, because they had a baby. Sure. the women or in and men anybody because for men their penis gets put on display, right? Um one of the hardest Oh my gosh, this person lives in my brain forever. Um he came in and he had been raped. He had met someone on Grinder and when we started doing the exam and started doing the things and that um please understand when I'm when I was doing this kit we we have made changes to things. At the time I didn't ask sex assign at birth or pronouns. We have since changed that. Yeah. Um, I felt ridiculous when we got to that portion of the exam and he didn't have a penis and like we got well like we you know they were giving me their story and all the things and they were talking about anal rape and things and it made sense and then um when we got to to that portion and I was like this is a trans man and I had to shift a little bit and cover them back up for dignity and then ask more questions. And since then we've made changes to our forms and things. Yeah. Um, but I learned a lesson that day because I needed to be better about the care that I gave because I I assumed he presented as a man, answered all the questions as a man, the the assault and all the things. Um, but I learned that day the effects of testosterone and transition and what happens to a vaginal rate. And it was um could you and that person eventually ended up saying they didn't want to report because their vulva would have been on display as a man and emotionally they just could not and and I understood entirely. Yep. Yep. But imagine that for for for those people, right? for for the the people that experience this and something that is definitely deeply intimate and and more so because now there's a whole other mental health layer added to that and then to have that be on display. Yes. Yeah. Well, no wonder people don't do rape kits. Yes. You know, and mind you, most people I would say that if they go in to have a kit done that they're not fully aware of what this could mean. They have no idea. Um, but you know, I think going back to the what I originally said of like when somebody talks about their experience that it's like unless you have been there and even if you have, we've got to really do better at just taking in what is being told with compassion and curiosity and care and um really non-judgment. We talked about that in the last episode, but especially in these circumstances that the question I will say even for myself, the question of like, well, did you do a rape kit and almost like some in some way that proves that you were raped um is just not helpful. Um, and those that do, I'm thinking about that, I'm like, how brave. And there there's a part of me that even is like, no, I wasn't about to like go tell the whole world and do the whole thing. And I know what's a part of a of a you know a s a is it a sane exam? Is that what it's called? Yeah, a sexual assault exam because it's it's more than just the kit. The kid's a tiny part to it. So it's a full like forensic exam. Um so we as nurses, we can start if we're trying to engage in that conversation. If someone is telling you that they experienced an assault that you instead of saying, "Well, did you get a rape kit?" You can ask, you know, oh, were you reporting or did you report? And if they say no, you can go, I understand. I understand how incredibly difficult that would have been. Okay? And if they say yes, you know, then you can go down that road of, you know, is it still going on? Is there any way I can emotionally support you? Is there anything I can do for you? Or, oh, no, it's it's it's all done. Everything's sealed. and be like, "Wow, you are so incredibly brave and if you ever want to share, I would love to hear about your experience." So, it leaves the power in their hands. It's not shaming them in any way. And it definitely brings to light, "Wow, you're an incredibly brave person." And I understand and support both of those decisions because it's a hard decision. Yeah. Um, rape kits are very traumatic on their own. Yeah, I think that that response is like literally the easiest, most simple practice change that we all can make whether you're in as a nurse or just as a friend or whatever of just like that that's the response in general and and leaving it open and and again everything's about control, right? So giving control back where it is due. Um, so if someone were to go through a sexual assault exam, what is involved in that process for you from like a nursing standpoint? So at our center, we get patients through different avenues. Okay. So I'm going to talk about a patient that's coming into the sexual assault center versus doing something like in the ER or anything like that. Okay. So there's, like I said, there's different avenues on how we get patients through either law enforcement, we have a hotline, different things. But once they've made like, hey, I want to come in. This is what I want to do. And we're like, okay. And before they come in, I try to have some conversation, not so much about what happened to them, but set some expectations of like this is what's about to happen. but they'll come in and I want to say thank you to all the advocates in the world because I cannot do my job without an advocate. Okay, you guys are very very important and what because I think when I went into sexual assault nursing, I really thought that I was going to be doing that same emotional support like I do in labor. It is very different. It is very very different. And this is not the same type of nursing role because I thought I was going to be doing that hands-on like emotional like all the things. That's really the advocates. Okay. Now, I still connect with the patient. I still, but I only see them this this really small window to collect evidence and I almost need to keep a little bit of separation just because I'm going to be testifying to that evidence and I don't want an emotional connection or anything like that to cloud any of that judgment or any of the objectiveness of my data. So, you know, of the evidence. So, that is what you're signing up for is testifying because now you become a witness to the crime. Yes, because um you so you are now a cog in the wheel. Okay. And we do reporting and non-reporting kits. So when you come in, we're going to sit down and I'm going to first establish are you medically safe? Okay. Are we in a hypertensive crisis? Are we having a mental health crisis? What's your blood pressure? What's going on? Like are we medically safe and sound? Are you bleeding? Yeah. Is something bleeding? You know, um do we need stitches? like how bad is it? So, first off, your medical safety is always first and foremost and there are times um that we have to transfer to the hospital because like this is this is big enough that I can't do my exam and then send you like you got to go. Now, if the person is um now they might have some injury, but if we are medically stable and like mentally we're we're good, we're sober, all the things. And sobriety is a big part of this because you have to be able to consent to the exam. Okay? So, if somebody gave you something, we need to wait until that's out of your system enough so you can consent to the exam. Or let's say you were consensually drinking at the bar and something happened. you need to be sober for us to do this. And that's a big piece. So, um I'll talk about um your medical history with you. This is all covered in the medical part of your chart and it I'm bound by HIPPO with that. Okay. And we at our center, we fight tooth and nail to make sure that that doesn't go into court. But I do need to ask some medical questions, right? I need to know if you're pregnant. I need to know, you know, did you have surgery recently? Did you have a baby recently? Did you? So, all of that goes in a medical side. On the forensic side, um the first thing I'm going to do is I'm going to go talk really slow so I don't have to stop you every few minutes. And do me a favor. Try not to use words like eggplant. Say penis. You know, where do you touch you? Say, you know, if you tell me, oh, you touch my peach. I'm like, I have to stop you and go, nurse clarified. Peach means patients butt or bottom or you know um and and I I tell the patients that before they start because we don't we don't record ours okay um because we don't that it could be used against you in the wrong way and there's more tone but so that I don't have to stop you because we are going to go to court with it so I can't get on the stand and say pat I'm exempt from hearsay patient told me that the suspect put his eggplant in her peach. That means nothing in court. So, I have to clarify, you know, if they use any kind of terms, if they use anything. So, I try to let them know before they start. I'm going to type everything in their words. Um, and I skipped typing class in nursing school, so I'm like, I don't know. I'm typing like uh mad woman trying to get everything in their own words. Your words are important. Your words are powerful. Yeah. Um, but we do type them um versus recording them. I did have a patient once, she had been held hostage for a couple days and she audio recorded her rape and she couldn't talk about it and she asked me if I could just listen to it and make notes and so she started playing it and I said, "No, I'm sorry I can't." But um I I let it play for like 30 seconds, you know, just just long enough to have some idea of what was going on and what I was dealing with. And when I was like, "Okay, I'm so sorry. Like, if now is not the time to talk about this, let's make sure that you're medically safe." Because it was the most horrific thing I had ever heard. Um, but after so my my exam after that is going to be heavily catered to what you tell me. Okay? Every place that he touched you, licked you, kissed you, hit you, burned you, all the things. I'm making a mental list. And if it's going to be a long list, I will get out a separate sheet of paper and I will start making all the places that I'm going to swab for DNA. Okay? all the places that I you know if you have for example a bruise on your neck right how do I know the difference between a bruise and a hickey well you know a suction injury is what we call it you know I'm going to swab it and when the kit goes if it comes back positive for amalayise for saliva then it's a hickey you know if it comes back and there's no saliva then it's trauma it's bruise it's you So, these are things um that if you tell me like, you know, and he bit down and sucked on my neck, I'm I'm proving the steps of your story. I'm moving through with you. Um the other thing that nurses forget, pain scale. So important. So important. Get a number pain scale. I cannot show your pain. We do like a pain inventory. Tell me we and I I do a full body scan with my patients. I'm like, "All right, we're going to start at your head." During the course of the events, did anything on your head hurt? What about your shoulders? Anything on your back? Everything that hurt, that is trauma and things that this person needs to be held accountable for that I can't necessarily take a picture of and show. Sure, it can be rough. You know, it can be long, three hours or more. depends on how beat up they are. Yeah. If the patient gets emotional, we take a we take a deep breath. We take a break, right? We take a moment. Yeah. So, it a lot of it too is where is my patient at emotionally? How much can she handle or him? But after we go through the longest part is the paperwork part, the story part. And I mean, it gets deep. I'm asking now. I do listen. So, like if you already told me he pulled your hair, I'm gonna I'm not going to ask that again. But after they give me the story, I'm going to ask like, okay, did he put anything over your nose or mouth? Could you not breathe? Did he put anything his hands around your neck? Did he burn you, bite you? Did he take any of your stuff? Did he take a trophy? Was any of your clothing ripped? Anything missing? You know, these are the the checklist things, right? that unless you do this, you wouldn't think to ask somebody if and it could be something little like, oh yeah, my keychain like he took or he took my underwear or he took, you know, my underwear is missing. I don't or this is missing, right? Unless you worked in the space, you wouldn't think to ask if he took a trophy. These are these are things um that you learn doing this job. Um so after we go through all the talking that is the most that is it is daunting for them. Um then we get into the photography and the physical exam. If my patients consented to photography I I never want to push them into anything. But it is definitely a hard one especially when you tell them you're going to or you want to ask to take pictures of their vulva. Yeah. Um, we have very cool cameras and I can take a picture of a cervix so good that I can see your IUD strings. Oh yeah. Oh yeah. We have amazing. Oh yeah. Because if there's trauma, if there's bruising, if there's damage, is there petiki eye? Like if there's something going on inside that happened to you. I'm documenting it. And yeah. So yeah. So after you've gone through a sexual assault, unfortunately um you you we offer a speculum exam. Yeah. So you know that is very difficult for a lot of women. And I'm going to do a head to toe. I'm going to look at you and then that list of places depending on where what you've told me. I take a buckle swab or bugle um depending on what part of the United States you're from to get your DNA, right? Because as I'm swabbing you, I'm going to pick up your DNA too. So, we needed your DNA for sure. I know that this is my patient and we put that in there. And then all the other places that I swab, I you know, they're looking for something that's not yours. Um, and again, that list is depends on what you've told me like what happened. Then there's the speculum exam. you know, that that's usually one of the last things, but it's one of the harder pieces to do. Um, if I have a male patient and I need to examine the anus and for my women too, um, putting so men think that they're never going to get into the stirrups and we call them foot pedals because that is a less traumatic verbiage. So, the foot pedals will put men in the stirrups. You don't ever ask a man to lean over a table or a woman to do an an anogenital exam, right? Because think about how traumatic it would be if that's how they were assaulted. So, this is trauma-informed care. It's moving at their pace. After that part of the exam, after the the speculum exam, a lot of times I just I I try to keep them as covered as possible. The advocate is with them the whole time, holding their hands. The advocate's really the one building that emotional bond, holding hands. We have fidget toys for them. of things, talking about different things, um just anything that we can to help get them through this part. And then you have to read the patient. Sometimes they want to jump off the table and like run to the bathroom and hide. And that's normal. That's totally normal. And if that's what they need, I make space for that. Okay. But sometimes they need a minute and they I sit I get I cover them up. I sit them up. We get them like reestablished. And I I have I will lower the bed all the way down and get both of their feet on the floor cuz our um gynecological table will go really low. I instead of pulling the table out because everybody knows that little extra foot table, right? Yeah. No, I lower it all the way down so that when they're sitting their feet are on the floor to ground them. I ground my patient and we take a couple deep breaths and I let them know, okay, this part of the exam is done. You did it. That was incredibly brave of you. And you know, I am so proud of you for finding that little bit of courage to be able to do this with me. And thank you for letting me be here to take care of you. You know, I always I always want to thank my patients for allowing me to be here to take care of them. Um, and then when they're ready, they get to So, we have a full shower, full bathroom, all the things. Because if they come in and they were in the clothes they were assaulted in, and they let me take their clothes, they don't they don't get those back. So, we have clothes to give them. I have underwear to give them. I have whatever they need. And thank you to all of our community resources and donations and things that make this possible for our center to do this because without you, we would be lost. Okay. So, I mean, think about how many single serve toothbrushes and mini deodorants and feminine care supplies cuz sometimes they're on their period and all of these things. So, we have a full shower, full towel service, all the things for them. They can go shower cuz ideally we would get a hold of them before they shower or anything when they've got all the DNA and all the grossness on them. That's when that's what I want, right? So now she's just gone who knows how many hours without self-care, without feeling clean. So they can take advantage of those services if they would like. And then after that, um, we will offer we'll talk about medications for STI prophylaxis if that's something that we they would like. We do offer plan B or a plan B like alternative, you know, but we do have that to if if we're worried about pregnancy. And then after that I don't get to see them anymore. They stay with the advocate. That is the end of my journey with them. So I will dry and package their kit and it will get picked up by police and it goes off for me. It goes to the GBI. So my state crime lab. If they are a non-reporting kit, so if they came in and they are not filing, then they will never know what's in their kit. It will never be tested.

non-reporting sexual assault kits stay. We have to keep them for a year. Now, I will say that our center has some from well over a year. So, if something were to ever pop up, we could go back pretty far, but we are required to keep them in storage for a year in case they decide to report. But they will never know. They will never get answers if they don't report. Huh. Yeah. Is that why there's like millions of rape kits sitting somewhere untested? Is that where that comes from? Um, so where that I believe comes from, and I don't know the true origin, um, there was a time in Georgia where there were tons and tons and tons of rape kits from reporting kits that weren't getting tested. We did not have the capacity or the money. Um, and yeah, the the district attorney of New York sent money and they started testing all these old kits. So, we're talking kits that were over 10 years old. So, all of a sudden, people had like moved on with their life and they're like knocking on the door like, "Hey, by the way, we tested your kit and blah blah blah." Um, so that's where all that came from. And now we have a mandatory tracking system. And there are like there are hard limits. It has to get picked up in a certain window of time. It has to be sent to the GBI in a certain amount of time. Now once it's there it does have to get tested and but how it moves through the court system there is a little bit of backlog which is why it can take a while for things to get tested and go to trial but it's not 10 years on testing anymore but because of the overwhelming number of reporting cases a non-reporting case does sit untested because they have to prioritize the resources for those cases that are being tried. How much does doing a rape kit actually help your case? Sometimes it can be what make or breaks things, right? Like it really can. I think it depends on the case, right? But then there's also these moments of, well, why wasn't there any DNA there? Well, I didn't swab in the exact spot, you know, that he like especially if they use a condom or this or that. Like, there's so many explanations. Like, she had already showered. It was 3 days out. We tried, but it happens. The vagina in and of itself wants to be clean. Someone else's DNA and cells on us is foreign matter. Our body's going to instantly start working to get rid of it, right? Like, our body doesn't want that there. So call into question things, but the rape kit, the swabs themselves are a small piece. What I do as a nurse is your story, your pain, your physical injuries, the photos, that is so much more than the swabs of the rape kit. I am I am so much more for you as an advocate in the courtroom because I can truly convey to the jury the pain that was in your eyes, the distress, the like you came to me wanting help and you you can tell you know you can see it. As nurses we are trained to do a headto toe and part of that is assessing someone's mental status, right? Are they alert and oriented? Are they withdrawn? Are they, you know, and I I write a note to that like what is your demeanor? Some people are very like hyperactive. This is their response like and these are all normal responses, right? And we'll we talk about that, you know, when we get to trial, right? These are normal responses, you know, and I'm there like this person probably wouldn't have been behaving in this manner had they not experienced something traumatic. I would love to know from you how your work as a forensic nurse informs your practice as a labor and delivery nurse. My entire practice changed when I learned this trauma-informed care and maximum self-determination, right? Like how I approach my patient, you know, I almost stand guard. Not in a in a bad way like I'm not the I don't want to be the problem but in if I know that my provider for example wants to come and check their cervix and whether they have disclosed or not right I just take the stance that every woman has experienced something unwanted at some point in her life whether she's disclosing or not that's and I will if they're like let's say the provider is like putting on the the one glove and you see them start to reach for the covers I'll I'll kind of put my hand on the cover. So like they can't just trick the cover back and say, "Is it okay if we go ahead and uncover you?" I started uncovering bottom to top. Never top down. Never. I like changed that and I stop my providers when they go the other direction. You don't do that in the office. Don't do it in labor and delivery. Give her some dignity. Keep her covered. You know, um now I understand when we're having a baby, it's got to come off. Okay. But if given the situation, I can keep a sheet over them. If that's what's appropriate in the moment, that's what I do. Um, I am purposeful. I explain everything differently. I purposefully stop checking the boxes on the computer with some of those questions because don't get me wrong, I'm still in the hospital with you and I'm having to make the man happy and check all the boxes. But there's definitely certain questions that I stop and I sit down or I stop and I turn and I make sure that my patient sees my face sees that I'm genuinely here and I'm genuinely asking not to check a box. Which ones? Okay. I mean all the intimate partner violence ones. Um, tell me when I when I do their obstetric history, I turn and like look at them because when you talk about a fetal loss or anything like that, like until I know that this is a first baby, like I am 100% engaged in offering trauma-informed care cuz I have no idea what she's about to tell me about her obstetric history. the intimate partner violence ones. Um, I also will ask, you know, if there's anything that I can do to make their stay or their time during labor and delivery more comfortable. And I and even though it's not the check boxes, I do ask if there are any cultural things that I can do for them while they're here. Um, different communities, you have different and you get to know some of the like pocket religious communities around you. We have a very large Jewish and Muslim population around here like Orthodox Jewish and they um it took I had to learn their traditions and their things to understand and not be judgmental but also to offer comprehensive care. Um again, if they say I don't want any men to do the, you know, um cervical checks or no men in the room, right? If I don't obviously know that it's a religious thing, like if it's, oh, it's for my religion or oh, it's for this, that is another segue for me to ask. I totally understand. We will and I do my best to accommodate whatever that is, but I will probe and ask why. How would you say that? How would you say that? If it's I don't want any male healthcare providers, sometimes I can make that happen, sometimes I can't. And I educate to that effect, right? Um if it's something that I can't, you know, then we talk about what we can do. And then I'll ask, okay, if you don't want a male healthc care provider, may I ask why? I don't want him touching my vagina. This and that. Totally understand. And again, we've established it's not a religious thing. I'll go, is did something happen? Is there a reason? Is there something you would like to share with me? You know, and and and yeah, I I I go pretty direct with it, but in in a sitting down, if it's appropriate, you read your patient either on the side of their bed like some of the providers will when they're checking them or in a chair. And sometimes you'll see tears form, you'll see this and that. Um read your patient, know your boundaries, but sometimes it's appropriate to reach out and touch their hand. Sometimes it's not. just know like they're asking that for a reason and that trauma-informed care I've had more patients from the point that I became a like so the labor and delivery journey before saying I felt like nobody ever disclosed like everybody was fine once I started doing this trauma-informed care the connections that I made with my patients and the number of women that disclosed anything it's astronomical it it changed how I connected with my patients, but also it's a healing journey for them to go through labor and delivery with someone that is on their side, someone who understands, someone who can be there and support them. If I know that that check, even if it's going to be a female that's checking them, is going to be traumatic. Would you like to hold my hand? Let's hold my hand. Visual guidance, you know, like where do you want to go? Are you a beach or a mountain girly? Where are we going? Let's go together. You have no idea how many like mental journeys I've taken with women during those cervical checks because they're not alone. I'll go with them. Are we standing there on the beach looking at waves while we're contracting? I stand there right with them. One of my stances and one of the phrases I use is we don't need to know why, but I'm sure they have a good reason for whatever the response is. like whether it be related to a cervical check or not or something else. And so I I'm curious to you how when someone discloses to you that they have a history, what changes for you in your care of them and how does that disclosure actually impact the rest of their labor, your shift, etc. I do put it in their chart. Um, so I will chart it in their history. Um, I because I'm a forensic nurse also I will establish are we safe now? Is it our current partner? Like I will I will ask those probing questions that I am trained to ask in because of that because again safety first. Yeah. Is it the person that's in the room? Is it what? Like you know safety first. Um then once I've established like we're safe and we're good chart what I need to chart the next thing is the health care team is made aware. Okay the health care team needs to know that the way you approach this patient you need you need to pause at the door. You need to pause at the door. You cannot come in here because if you're like hyped up and amped up, she's going to get more amped up. We're going to ruin the hormones. Yeah, this is a very specific physiological process we have to go through and we need to preserve that mental space for her. So, we are mindful. Uh we do not say open our legs and I have definitely looked at some residents and been like, hey, you know, this person has experienced sexual assault. I want you to be mindful of your words. Do not tell her to open her legs. If she is having trouble relaxing, do not tell her to put her bottom down or relax. Say, hey, okay, this is this seems like to be a lot. Do we need to take a moment? you know, is there something I can do to help you through this process? Okay, we are not going to use the same language and the same things that they probably heard from their rapist while you have your hand inside of them. Okay? And I like I will like so I will I am very very mindful of that when I'm aware. Um and that's the one thing that kills me is open your legs like oh my god don't please don't ever say that. What other things should nurses never say? um telling people to relax. It'll be okay. It's almost over. Like just you don't know. So, you know, instead use empowering things like let's take a deep breath. You are doing amazing. The baby is almost here, right? instead of it's almost over or you know stop screaming or you know I understand we want them to relax but instead of saying just relax like because that works here you know be happy you know that works what can I do to help you relieve the tension in your legs and pelvis let's take a deep breath right bring your feet together and then I want you to take a deep breath and release like a butterfly allow your knees to butterfly out. The other thing that we'll do is with the backs of your hands, because the backs of your hands are safe, you can hold your hands out wide and say, "When you're ready, bring your knees to meet the backs of my hands." And that would then have them open their legs to meet you. A and that's remember touching happens with the insides of our palms, the backsides of our palms. That's safe touch, that's good touch, right? And we say that, "Hey, this is me." And when you touch your patient, remind them, hey, this is me. I'm touching you here. This is my touch. And start with the backs of your hands. Oh, start with the backs of your hands and go, hey, okay. And like if you need to walk in their thighs purposefully, not ridiculously slowly, but you'll see some providers do the the thigh walk. And some of them will be like, touch, touch. Now I'm like inside of you. And I'm like, that is not how that's supposed to go. But yeah, you know, it's supposed to be purposeful, safe touch. Okay. Hey, this is my touch. I'm right at I'm right, you know, at the apex of your thighs. You know, are you ready for the, you know, the cervical check, the exam, and then the patient can go, yes, okay, I'm ready. And then you get, all right, this is my hand. You're feeling my touch. And then you check the cervix. And it's allowing them to be used to the touch, right? Sensory sensory overload. Yeah. Right. And it reminds them, you are here. You are safe. This is my touch. It's not someone else's touch. You're not reliving something. This is me and my touch here with you. And reminding every patient because especially those when you when I see my patient lay their head back and close their eyes, those are the ones I get scared with because I don't know where she's going in there. Yep. She could be she could be going anywhere in there. It could be a positive place, right? And as long as it stays positive and I that that's fine. But if she goes in there and it goes somewhere negative, she just went by herself. Is it just cervical checks or are there other instances in labor that we need to be especially aware of? I mean, it's everything, you know, think about the control aspect, right? It's a loss of control. It's a loss of bodily autonomy when it comes to rape and assault and unwanted touch. It's the same. We already talk about these things like women feel out of control. You know, team underwear. Do you want your underwear? What do you need to feel safe? Y and I understand it might be inconvenient and I women ask, "Do I have to wear your gown?" You can wear whatever you want as long as you're okay with me cutting it off in an emergency. I will do my best to remove your your beautiful labor gown and you know and just know it's going to get messy. But yeah, wear whatever you want. You know, can I keep my underwear? Absolutely. Just know that we may ask or if this baby is imminently coming, can I cut it off? You know, yeah. And as long as you're okay with all of these things, I am down with that. Breasts while they are there to feed the baby, they can be sources of trauma, you know, so many different things. How we expose our patients. I say this because when we go to do skin-to-skin, if mom says, "Yes, I want to do skin-to-skin." And then as nurses, we're like ripping the gowns off and trying to shove the baby in. I'm like, "Whoa, whoa, hey." You know, like, and I I get it. We have a wet baby. We're trying to warm the baby. We're trying to do so many different things, but I'm like, "Whoa, slow it down, Tanto." Like, "Hey, you would like to do skinto skin? May I go ahead and uncover your breast and let's put the baby on?" Okay. Yeah. Because they I know when we say skinto skin for us, it means I'm going to lay this baby on your bare chest. Yeah. But that might mean something different to someone else. like making sure that they understand in that moment, you know, like what does it mean? Or, you know, because as soon as you start tugging at their clothes, that can be traumatic for them. Someone pulling at your clothes. Yeah. Yep. And I understand we have emergencies and we and we have things that happen that like we act quickly. This is why debrief for nurses as well as patients is so so important because, you know, I understand we might have had to cut whatever that gown off, do this, do that. We were in an emergency. It happens. I'm sorry that that took place. Do you want to talk about it? Is there anything I can help you better understand? Yeah. Because that's how we're going to prevent the next problem. There is so much more that we could go into and again like we can bring you back. And so if you have questions for Morgan, if you have follow-ups, please email us. We see every email that comes in. You can email nurses@bundlebirth.com and I will start a running list of those questions and then maybe next season if there's a list of questions or if just like other conversations come up, we will have you back because you know I think this is one of those things that like we we don't actually talk about but we imply so much and we know is happening and yet it's it is it's it's for me it's not taboo whatsoever. I'm like let's go there. let's have the conversation, but it's harder to talk about and it is slightly taboo and there's lots of layers involved and all of that. So, that being said, you uh work with people and end up in these scenarios where you are with them on potentially one of the worst days of their lives. What have survivors taught you about healing or life that most people maybe don't understand? there's always another day. I learn from those things, but I don't look back. I, you know, those things are the foundations of who I am, and I'm not going to feel shame in them. Survivors have taught me not to feel shame. It might not be the the thing that you want on the billboard. It might not be the thing that you want to talk about, you know, or want everyone to know about, but I will not be ashamed of the things that have made me who I am. But my life forward, I I look forward to tomorrow and what is the next thing? And I can go into it with tears or I can go into it with a deep breath saying today is a new day. And if I can do that and survive that, I can handle whatever else is coming my way. The other thing that I learned from survivors and in this community and I have to tell myself often is I'm not alone. And going through this and working with these people, you are not alone. There are communities like bundle birth like just move in and of itself just expanded my universe and at any point you can be out there and there's someone going through those same things those same feelings and you are not alone and it's like when I I mentioned in one of the previous podcasts when I had a student who was a patient and I said how are you? And she's like, "One day at a time and I'm going to do something better today." She's in nursing school. She's in the beginning, like the very beginning. And I'm like, "This is amazing. This young woman is coming out of the darkness and stepping into the light and is not going to let that stop her from shining. She's not going to let her stop that from living." And that's what we do. So sometimes people are still in the dark. So when they come to me at the sane center, they're still in the dark, but I'm like the little light that's like, "Come this way. Come this way. Step back into the light with me. It's okay." Thank you once again. I've said that at the end of every episode, but especially now, I just feel like so grateful that you would be willing to share your experience and your knowledge and your expertise and all of that with this community. If you want more from us, head to bundlebirthnurses.com, subscribe to our newsletter. Um, follow us on Instagram and also I have dropped a link down below. If you want more related to this particular topic from the last three episodes, just drop your name and email and we'll keep you on a list and keep you updated as we continue to have these conversations because I think, you know, while this might be the first I I hope it's not, but for many of us it will be the first time we've heard these types of conversations addressed and it's not the end. And if we are going to be top of our practice, excellent, full scope, game changing nurses, we've got to have the courage to have these conversations and push into the darker places so that we can also be the light. This is the time where you take everything that you've learned today and you be the light in the labor room. We'll see you next time.