In honor of April being National Sexual Assault Awareness month, I conducted two interviews: one with a psychotherapist that specializes in supporting women through pregnancy and birth who have been affected by sexual trauma. The second is an [anonymous] interview with a Survivor. I hope their words and experiences provide you with strength and further liberate you to find the healing you or someone you love needs.
Selena Shelley - Psychotherapist and Passionate Supporter of Survivors
1. What are some ways that sexual trauma can affect labor and birth?
I think you did an excellent job outlining some of the most prevalent ways that a history of sexual abuse or assault can affect labor and birth. I could add a few more, but the truth is every woman has her own experience of what we call “maternity triggers” so let me instead outline six trigger themes that provide an umbrella for the many possible triggers:
- control and loss of control (over what is done to her, or self-control over her own behavior and reactions), fear of restraint;
- pain, injury, damage to, or invasion of her body;
- vulnerability and dependency on others (partner, friend, doula, care provider) for protection and safety;
- distrust of strangers, authority figures;
- shame, humiliation, being judged on body appearance, behavior, weakness, secretions, “mess;”
- exposure (modesty, people staring, looking and feeling inside).
Most survivors will resonate with two or three of these themes, in terms of how their triggers tend to manifest. These themes compiled by my mentors Penny Simkin, PT and Phyllis Klaus, MFT, who have been working with pregnant and birthing childhood sexual abuse survivors for decades. If your readers want more information on the trigger themes, I highly recommend the book When Survivors Give Birth, written by Penny and Phyllis.
2. What are some ways a survivor can help her birth team better support her in labor and birth?
For women who are comfortable disclosing their history, I often recommend that as one of the best ways to garner additional support during her pregnancy and birth. This can be achieved through a verbal disclosure at an appointment, or through writing a disclosure at the top of their birth plan (and bringing that to their provider prenatally and to their nurse in labor). A written disclosure can look something like, “Due to my history of childhood sexual abuse, the following is especially important to me during this birth…”
If a woman is not yet ready to disclose her history, sometimes just saying “I have some things in my past that may require some additional support…” can be enough for a skilled provider. Truthfully, I don’t think a woman should have to say anything at all! Rather, I believe a lot of the onus for garnering good support in labor is on the providers; it’s why I spend a lot of my time training doulas, midwives, nurses, and doctors on how to work with survivors – if they can increase their sensitivity and treatment of all their clients (survivor or not) I think birth will change for the better!
3. What are some practical first steps for someone who is pregnant and experienced sexual trauma and wants to begin the healing process?
I agree with what you said in the article – if a woman has the time and resources, seek out professional counseling, preferably with someone trained in working with survivors who can help them explore what may be arising during pregnancy. If professional counseling isn’t an option, then getting support from a trusted friend, partner, or support group can be really great options. Here in Colorado, we have an amazing organization called WINGS Foundation, that provides low/no-cost support groups for childhood sexual abuse survivors, and I imagine most states have something similar. And then, of course, I believe every woman should have access to doula care – even doulas who aren’t specifically trained in how to support a woman through her trauma healing journey can hold space and help a woman find her voice during birth. And sometimes, finding that voice during an intense time such as birth can be one of the most repatterning parts of her healing journey.
4. For women who had childhood sexual trauma and their memories are repressed, what are some ways they can help find healing even if they don’t remember the experience?
My sense is this goes back to the idea of having an empowering, repatterning birth experience, which is something every woman – survivor or not – deserves. I work with plenty of women in the postpartum period who are not survivors (or at least don’t have recall about a traumatic history); over and over again the thing I witness is that women who felt supported and empowered during their birth experience fare better in their motherhood journey. This isn’t to say they need to have an all-natural, vaginal birth – for some women that will be really healing, for other women being able to find their voice and ask for help (of pain medications) is where the healing exists.
So I would say, a woman with repressed memories can heal and transform through her pregnancy and birth by feeling heard, respected, and cared for. Which is, again, what we should be striving for in every woman’s birth!
5. What additional advice to you have for survivors who are pregnant as they prepare for birth?
That’s a hard question to answer… it varies so much by the woman, but in general I would say find a provider you trust and make sure everyone in the labor room is someone you feel safe with. Obviously, in hospital birth that can be a bit challenging since you’re just meeting your labor & delivery nurse; but even then, if your nurse doesn’t feel safe to you, ask for a different one. (Same rule goes for your provider – if you don’t feel safe or heard or respected at your prenatal visits, find a different provider.) Birth is a really intense – wonderful, but intense – experience and you want to make sure you feel really contained and supported throughout.
And then, on a related note, remember that it is your body and your birth. For a lot of survivors, who may never have learned autonomy over their body, labor and birth have a lot of potential for either healing or retraumatization. So, for instance, don’t be afraid to ask your care team introduce themselves every time they walk in the door, or ask for permission every time they touch you, or whatever else will help you feel safe and respected. That is, again, what we should hope for in every woman’s birth, but for a survivor it holds even more importance.
Lastly, if your birth doesn’t go as you hoped, and you are left with symptoms of post traumatic stress (flashbacks, intense anger towards your provider, inability to bond with your baby, insomnia, etc.) reach out for help. There is nothing shameful about struggling as a new mom and there are many resources out there for help. Two I would be amiss not to mention are: Postpartum Support International or Solace for Mothers.
Thank you for this opportunity to speak to your audience; my hope is it provides even one more woman with additional healing during her pregnancy and birth journey.
Selena Shelley, MA, CD, LCCE, CHBE is a Colorado-based psychotherapist and doula who specializes in working with childhood sexual abuse and other trauma survivors during pregnancy, birth, and the postpartum period. Because she believes in survivors receiving especially sensitive and compassionate care, she also trains other professionals in how to better serve survivor clients. For more information on Selena’s work, you can find her website here.
A Survivor's Story: How Sexual Assault Affected My Birth
My sexual trauma affected my labor and birth in many ways. I'll start by saying that had I been able to labor and deliver at the birth center I had planned to be at, I am not sure any of these issues would have arisen. My son was diagnosed with a heart defect during an ultrasound scan and that led to me having to deliver at a hospital that I did not like.
1. In what ways did your sexual trauma affect your labor and birth?
Mentally: Because my labor and birth were not at the place I felt comfortable and safe, I was flooded with uncomfortable feelings resembling those that led up to my sexual assault incident. As soon as I recognized the similarities in emotions, the battle began. During my labor, I was constantly fighting flashbacks to the time when the actual incident happened. The moments between contractions were not filled with peace like I had hoped. I remember telling my husband multiple times that he had to do something if all the female doctors were taken when it was my turn to deliver. It was very hard to keep my focus on the baby and laboring when my biggest fear was having to have a male doctor touch me and deliver the baby. It made staying focused during my labor nearly impossible.
Emotionally: It wrecked me. I was not expecting the feelings or memories to come up at the intensity that they did. I was completely unprepared for that battle. I felt so guilty during my labor for even having those thoughts since this was supposed to be one of the most exciting days of my life. How could I let *him* take this day from me!? I just had constant feelings of regret as I labored and delivered since I didn't feel like I was giving my son the birth he deserved.
Physically: It affected me in minor ways. Because of my son's heart defect, I had to be induced because they "needed to get him out for his safety.” That being said, without the constant flow of pitocin, I believe my body would have had major lulls in progression due to the flashbacks and me not handling them well. The feelings and memories made me feel nauseous, but I was already nauseous from the pitocin so the physical complications paled in comparison to the mental and emotional aspects.
2. Did you anticipate you would have this response before you went into labor?
I did anticipate some issues coming up and talked them through with my husband, but that was not nearly enough. I was not prepared for the degree of intensity that the feelings and memories would come back. Looking back, there weren't many signs that they would come up at all. I think if I would have read an article like the one that was posted yesterday I would have known to take more action. I guess I was just naive.
3. Did postpartum counseling help? If so, in what way?
Postpartum counseling was THE BEST! I kept putting it off because I felt that it was my fault for experiencing the feelings I did and letting them affect my labor, so in a way I deserved to be punished by my feelings since I wasn't able to give my son the labor and birth he deserved. (So stupid, I know!) BUT- once I spoke with a birth trauma counselor I felt this huge darkness lifted and I was able to sort through my feelings so much better! I really needed someone to validate me, my experience, and my feelings, and then lead me to a healthy path to start processing and healing from it all. Seeing a counselor postpartum was the best choice I made for myself! And it was fun! Counselors are awesome. No matter how my next birth goes, I will see a counselor after it anyways!
4. What advice would you share with survivors who are pregnant as they prepare for birth?
I would tell them to be proactive and really look into your options for labor/birth. Make sure your choice is one you feel completely comfortable with. It's totally okay to switch doctors/midwives until you find one that makes you feel right! And then let that doctor/midwife know what issues may come up and how you would want them handled. I would also look into seeing a counselor before your birth if that's an option for you!
I'm not sharing these parts of my story to bring fear to Survivors, but rather to show Survivors that they don't have to have their births happen like this! They are in control of their birth, and they have the power to make it exactly what they want it to be! If I would have known what I know now, I would have seen a counselor beforehand, understood what to expect and heathy ways to handle those situations, and then shared with my doctors what I needed from them due to my situation! I know those things would have led to a much better experience for me!