"It is often claimed that traumatic events are repressed, yet it appears that the trauma more often strengthens memories due to heightened emotional or physical sensations.[1]" A classic visual image of repression is the image of one trying to hold a tennis ball under water. All of your physical and mental energy is focused on keeping that ball down and as soon as it is released it resurfaces. The same is similar for memories, events, habits, etc. that we try to submerge in our thought lives. Often these memories resurface like the tennis ball and usually when we least expect it.

For years due to public awareness we are more educated on how abuse on children, adolescents and later on adulthood. "The effects of sexual abuse extend far beyond childhood. Sexual abuse robs children of their childhood and creates a loss of trust, feelings of guilt and self-abusive behavior. It can lead to antisocial behavior, depression, identity confusion, loss of self-esteem and other serious emotional problems. It can also lead to difficulty with intimate relationships later in life." [2] (My emphasis).

One in four women is estimated to have been sexually assaulted at least once in her life. This statistic is derived from two large-scale national studies that show the incidence of childhood sexual abuse to be 27%, with a further 17.6% of women reporting adult rape (attempted or completed), half of whom were also survivors of childhood sexual abuse.[3] That is quite sobering especially if you are hearing this while sitting in a room with a group of women. The effects of sexual or child abuse has on a women during her childbearing years, especially during labor and delivery has been overlooked, however awareness is starting to be raised. Unfortunately, because it wasn’t often discussed during prenatal visits or during childbirth education (or the woman does not feel safe to discuss it or has repressed it so deep) the doctor, midwife, nurses, and labor companions assume that the expectant mother couldn’t handle child birth and are labeled as such. Because of this their specific needs and concerns are not addressed.

If you have given birth to a child you can attest to the fact that it is one of the most vulnerable times you will ever experience in your life. The double-sided coin is that to possess complete control during the process a woman must give up complete control. She must trust and work with her body, baby and the process. The end result is the same for all women as it has been since the beginning of time, a baby will be born. However, the difference in how that mother receives that baby can range depending on the circumstances. If not handled correctly instead of feeling empowered and confident as a woman, new mothers are often left having to relive traumatic experiences and feeling victimized all over again.

With the above stats it is more likely than not that I will come across more and more clients who have experienced some sort of sexual abuse trauma. I am fully aware of my scope of practice and that I am not a therapist or counselor, but it doesn’t release me from the responsibility of being aware of how a mother is reacting to pregnancy, labor, delivery, post-partum and motherhood. During prenatal visits I try to build a relationship with all my clients by educating them as well as spending time learning about their experiences and expectations. Sometimes the subject may come up during our visits; other times intuition and experience will be my guide. During labor and delivery I am to adapt my response to these mothers so that I may not cause further harm. I need to be mindful of words used that can encourage your average mom but can make a survivor mom completely withdraw or become defensive. A touch that can sooth and comfort most women may send a survivor mom into a cocoon or worst have her completely shut down prolonging her labor.

With all of the literature, education, training for professionals and counseling for survivors have become available as awareness for this subject continues to bring healing to women and mothers. I admit that I am still resolving to learn more so that I may better assist and be a better and comfort and support to survivors of abuse.

Resources

References:

1. ·  ^ NPR: Why It's Hard to Admit to Being Wrong

2.      Besharov, D. J. (1994). Responding to child sexual abuse: The need for a balanced approach. In R.E. Behrman (Ed.), The future of children, 3 & 4, 135-155. Los Altos, CA: The Center for the Future of Children, The David and Lucile Packard Foundation.

Bottoms, B., & Epstein, M. (1998). Memories of childhood sexual abuse: A survey of young adults. Child Abuse & Neglect, 22(12), 1217-1238.

U.S. Department of Health and Human Services, Administration on Children, Youth, and Families. (2007). Child maltreatment 2005. Washington, DC: U.S. Government Printing Office.

3.      National Research Council. 1993. Understanding Child Abuse and Neglect. Washington, D.C.: National Academy Press; Tjaden, P., and N. Thoennes. 2000. Full Report of the Prevalence, Incidence, and Consequences of Violence against Women: Findings from the National Violence against Women Survey. National Institute of Justice: NCJ 183781. (www.ncjrs.gov/pdffiles1/nij/183781.pdf)

 

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In my last post I spoke of the possible influences that affect the way women and society view childbirth. In this post I would like to help from a different angle. We’ve heard that knowledge is power. I wonder if we’ve really grasped the meaning of this, or is it just another inspiring quote. One way to combat fear head on is to know your enemy or the perceived enemy in most cases.

I am going to use a job interview as an example of having fear and anxiety about the unknown and methods to overcome them
that can be applied to childbirth. When you are interviewing for a job it is not uncommon to begin to have some anxiety about
the interview itself and the outcome. Sometimes we begin to play in our mind all the negative possibilities that can take
place only paralyzing us all the more. There are several books and websites dedicated to preparing potential job hunters for
their interviews. One in particular allbusiness.com has helped me compile this list which I will apply towards childbirth.

1) Do your homework.  Although childbirth is a natural process which a woman’s body is designed to achieve most people do not understand the physiological, psychological and emotional components that go along with it. Childbirth classes help expectant parents learn about and prepare for labor and birth. There are several kinds to choose from. In childbirth classes you will learn about the labor and delivery process, how your body is working with you (not against you), ways to manage pain and other information that will help you feel more comfortable about the process and knowing what to expect. Research them as much as you can to become familiar with each technique until you find an course that seems right for you.

2) Know where you’re going. Are you having a home birth, birth center, or giving birth at a hospital? Will your health care provider be an obstetrician, a midwife or your family practitioner? Each option has their strengths and weaknesses and it is best to know beforehand who you’d like to be involved with the delivery of your child.   

 

3) Look the part. Well, your body is already taking care of this one. I would add that it is not only important to take care of yourself physically during this time but your overall well being is important as well. If you exercised before baby keep at it (with doctors guidance). In fact, if you abruptly stop your routines it may cause some stress and anxiety.  If you did not exercise regular before baby, I don't believe doctors recommend starting up a program, but Pilate's, walking, stretching, etc. not only benefit you but baby as well.  There are (thank God) a lot of great maternity clothing now. Have fun, enjoy this time, get a massage, a facial, be pampered. This is your time, in a few months it wont be so much.

4) Rehearse beforehand. Is there a breathing technique or hypno birthing method you would like to use? Most people make the mistake of skimping on the practicing; they figure they can wing it. The problem is with most methods and techniques they benefit you the most with when you put in the work before labor starts. Many times someone will try something and say it didn’t work,  in reality they really didn’t commit to learning it completely. What are some ways you relax, distress? This is the time to practice some comfort measures to see what helps and what would irritate the daylights out of you.


5) Secure your references. Build your support system. Women who labor and deliver alone tend to have less than ideal birth experience. When I say alone, keep in mind that most obstetricians are either taking care of several patients at one time, and most only want to be called to come in when delivery is very near. Most labor and delivery nurses chose that profession because of their sincere desire to serve and comfort women during their most vulnerable time. Unfortunately they also juggle several patients and have to follow procedures and monitors which keep them from the one on one experience with expectant mothers. Midwives can vary depending on if it’s a hospital, home or birth center delivery. They can be more attentive to the laboring mother but as delivery become closer their role rightfully changes from solely nurturing the mother to making sure that a safe delivery is the end result. Whether it’s your best friend, your partner, mother or doula, you will want to consider who you will want with you as each person brings along their experience, fears, and expectations which can positively or negatively influence your birth experience.


6) Arrive early. Or maybe not. Most women (and the fathers-to-be) have anxiety about her water possibly breaking at the movies or trying to determine if she’s having real contractions, Braxton hicks or gas. You will want to discuss with your caregiver at what point you should contact them and head to the hospital, birth center, or should expect them to come over if you are having a home birth. Often women have reported being in labor and rushing to the hospital only to have labor slow down or stop, and this may be due the change in environment, paper work, unfamiliar faces, etc. Whatever the plan is make sure you have it and contact numbers close by and that your support person(s) have access to it a well. Also, taking a tour of the hospital before, finding out their procedures for admitting, labor, delivery and recovery is a good idea.

7) Bring necessary documentation.  Make a checklist of everything you will need to bring to the hospital. Toiletries, music, comfort and focus items to name a few. Consider getting a new robe, a new night gown as a gift for yourself, any medications you take, journal, camera, whatever you can think of. This is helping you to be proactive. Being unprepared can caused unnecessary stress to an already potentially stressful situation.

8) Sell yourself. You have to advocate for yourself. This is your birth experience. Work with your doctor, midwife or doula about the benefits of a birth plan. The great thing about creating a birth plan is it causes you to learn about the pros and cons of interventions, how you would like to handle situations as they arise, etc. The process of creating a birth plan empowers you to take responsibility for your birth experience and may ease some fears of the unknown by leading you to search for more knowledge to make informed decisions. Don’t forget to present a copy to your doctor and discuss it with him and also the nursing staff when you are admitted. Be advised that like weddings, things do not always go as planned. Your birth experience may not go exactly as planned but you will have the information to discuss any changes so that you can make an informed decision that you can live with.

9 Don’t neglect to ask questions. It doesn’t matter if it’s your first baby or fifth, there are no dumb questions. If your doctor or midwife responds impatiently or negatively to your questions, it may be time to look for a new one. If you are hiring a doula she can be a wealth of information and resourceful as well. Connect with mothers who have succeeded with the birth plan you desire. Another warning: stay away from people who only want to tell you horror stories. You’d be surprised (especially as an expectant mom) how things stick to you. Before you know it, you’re staring at the ceiling at 3 am wondering if you will have a 46 hour labor that will end up in a c-section because you were so exhausted and you had a small pelvis and the baby’s shoulder got stuck and they ran out of cranberry juice!


10) Follow up. After your delivery it can be helpful to find out from those involved what they experienced. As you mentally are revisiting your birth experience (journaling is great too) their feedback can help fill in the gaps of things that were missing from your story. It’s not uncommon to hear about things that happened that you didn’t notice because you were so focused and tuned in to your body.

 Please keep this in mind: Every birth will be a different experience. Your level of enjoyment with each experience will be determined on how prepared you are for the journey. Knowledge is power. You will have the power to allow your fears to influence your birth experience or to face them head on and use them to push you to the birth you’ve always wanted.