Violence and Abuse

The Effects of Sexual Abuse on Pregnancy and Birth

Some of us have experienced sexual abuse in childhood or as adults. The aftereffects of abuse vary in severity, but they can last a long time. Abuse issues are sometimes triggered unexpectedly during pregnancy, labor, and birth, in the form of conscious memories or flashbacks to the abuse, or unconscious body memories (tension, anger, sick feelings, or other discomfort) when a woman is reminded of the abuse in some way.

Common triggers for those of us who are survivors include vaginal exams or other invasive procedures, and pain during or after childbirth, especially in the vagina, but also in the abdomen, back, breasts, and perineum. Our interactions with our care providers—authority figures who may expect compliance and trust— may remind us of our perpetrator or perpetrators, with whom we may have felt helpless, unequal, submissive, or overpowered. Control— over our bodies, our contractions, or the emergence of the baby—and being controlled by the baby, whose needs come before our own, can be major issues for us. We may associate a lack of control with being abused. We may have learned that remaining in control is essential to safety and being out of control is threatening.

Reminders during pregnancy or labor to “relax and it won’t hurt,” to “yield” or “surrender” to the contractions, to “trust your body” or “do what your body tells you to do” may have an effect opposite to the one intended, if we have learned to guard against giving up control in abusive situations. Abuse experiences may also leave us feeling that our bodies are damaged and untrustworthy.

HOW TO RESPOND TO THESE CONCERNS DURING CHILDBEARING

1. Recognize and accept that some fears and concerns make sense. Sexual abuse (or any other abuse) rarely leaves the victim free from aftereffects. Give yourself permission to be afraid or concerned.

2. Try to separate your present pregnancy and upcoming birth and parenthood from your past abuse. Now you are older and more able to bring your wisdom and self- knowledge to these new challenges. Consider working with a trauma therapist or counselor who is knowledgeable about childbearing, or reading books for survivors that contain suggestions for dealing with triggers and reducing your concerns. (For help in locating resources, see “Hotlines” page 330.)

3. Decide whether or not to disclose your abuse history, along with issues it has brought up for you, to your care provider. Some caregivers are interested in emotional issues and are both willing and able to respond to your needs, while others may not have the skills needed to help you. If you are comfortable disclosing your history to your midwife or doctor, you can work together to plan your care so that it will be sensitive to your history. If you are uncomfortable with your provider, you may want to change to another person with whom you can establish a trusting relationship.

4. If possible, have a doula (birth assistant) at your birth, one whom you trust. Share your fears or concerns with her, so that she can help you deal with them. She does not need to know about your abuse history in order to provide emotional support and help. (To learn more about doulas, see page 33.)

5. Write a birth plan that is friendly and flexible yet clearly explains your preferences and fears. (To learn more about birth plans, see page 37.)

6. If you have a partner or other support person, enlist his or her support in dealing with this. You may want to tell your support person about specific settings or examinations that make you uncomfortable and work with her or him ahead of time on some ways to help you in these situations.

With good communication, self- help tools, and caring support from your loved ones, doula, and health care providers, your chances of having a rewarding pregnancy, birth, and postpartum experience are greatly increased.

End of excerpt
Excerpted from Chapter 6: Relationships, Sex, and Emotional Support in Our Bodies, Ourselves: Pregnancy and Birth  © 2008 Boston Women's Health Book Collective