Giving birth as a survivor of abuse

There are some things that can be particularly difficult to talk about. They can be repressed and not in our conscious memory, but still playing a significant role in our lives.  Sexual abuse and assault is more prevalent than we like to think and we will probably never know the exact numbers as many survivors are shackled by shame and fearful of the consequences of speaking out.

Sexual abuse is when you are:

  • Being touched in a way you don’t like without giving permission or consent.
  • Being forced to have sex (intercourse).
  • Being forced to look at sexual pictures or videos.
  • Being made or forced to do something sexual.
  • Being made to watch someone do something sexual. This can include someone flashing or exposing themselves to you and can also happen online.

These are the latest statistics on sexual violence in England and Wales from 2013 that I found on The Rape Crisis website:

  • 1 in 5 women aged 16 – 59 has experienced some form of sexual violence since the age of 16
  • 31% of young women aged 18-24 report having experienced sexual abuse in childhood

When you realise just how common these incidents actually are and the number of survivors of sexual abuse out there, it is surprising how little specialised support and help is available for women who are pregnant and survivors.  It is so important for women to have a safe space to share their experiences if they want to, as the effects of sexual abuse and assaults can have an impact on the birth experience.
 
What areas of childbirth could be more challenging for survivors?

  • Sexual abuse and childbirth, in most cases, involves the same areas of the body and survivors may experience flashbacks or even post-traumatic stress during the birth of their baby.  She might not always know why she is reacting the way she is as childhood abuse can often be hidden in the depths of our memory.  These strong emotions can be surprising and frightening. 
  • As the birth process unfolds and there’s a need to surrender to the sensations in the body, it can feel like the woman is losing control.  Many women who have experienced sexual trauma feel that they don’t trust their body, let alone have any control over it.  This feeling of losing control is frightening and can bring back memories.  Telling a woman who is a survivor to ‘trust her body’ will most likely not be helpful.
  • The relationship with the care providers can be difficult and survivors are often labelled as ‘difficult’ or ‘unreasonable’.  Survivors may feel like they don’t have the power to make decisions about their bodies so they will either feel totally helpless and unable to say ‘no’ or fight to get their voice heard.  There can also be a real trust issue with anyone in authority as if they were abused as children the likelihood is that the attacker was someone they knew and trusted.  She may feel more vulnerable with male care providers.
  • The language used during childbirth, such as ‘try and relax’ or ‘lay still and I’ll be quick’ can trigger memories to the extent that the woman could dissociate, which is a coping mechanism that survivors of trauma use in threatening and stressful situation.  This means they are no longer consciously present and whatever is taking place in the room and to their body could re-traumatise them.   It’s important that a woman is not forced into any position which might remind her of her abuse and that her privacy is respected at all times.  Women should be well covered up when different care providers enters the room. 

What can survivors do to prepare for childbirth?

  • The most important avenue for pregnant survivors to take is to seek out a professional who specialises in sexual abuse and get their support.  This could be a counsellor or midwife or doula who have had specialised training to support survivors of abuse.
  • There are practical strategies that will help prepare survivors for potential triggers and individual support to build confidence in the body again.  Books such as When Survivors Give birth by Penny Simkin and Phyllis Klaus can be a great resource.  Penny Simkin’s website has a great area of resources that can be found here: https://www.pennysimkin.com/articles-resources/
  • It is important for all women to feel safe when they give birth and especially for survivors.  It is a good idea to look at all the options available i.e. home birth, birth centre birth or hospital birth.  It is also important to choose the right care providers that a survivor can feel confident with, even if she is unable to disclose her history of abuse.  Being treated with respect and autonomy is important and should, in truth, be expected from maternity care.
  • Writing a birth preference that reflects the care expected and highlighting any areas that are important can be powerful.  Putting into words how important it is to be informed at all times of any procedures or examinations before they happen and to have everything explained in detail.  Women have the right to decline vaginal examinations and should not be coerced into having them or denied care if they don’t. 
  • Reading positive and empowering birth stories as well as watching natural, straightforward birth videos can be helpful.  Especially if the survivor watches them with someone that is knowledgeable in the birth process so she can ask questions about what is happening when she needs to. 

If you are or know someone who is a survivor of abuse I hope you have found this short article helpful.  Much can be done by the woman herself with the use of self-help techniques to calm and comfort herself and the use of good communications skills to get the support from loved ones as well as maternity professionals.  Childbirth can be an extremely healing experience for a survivor, with the right support and preparation.