A Surge of Pain

Image result for woman in labour

 

I’ve written before about language, birth, and women survivors of child sexual abuse. I’ve mentioned how words matter, and certain words are very upsetting for those of us with a history of child sexual abuse.

Earlier this week, I had the privilege of sitting with a pregnant woman and her husband. As a survivor herself of child sexual abuse and multiple rapes in her teens (sadly, revictimisation is a phenomenon that is not uncommon), she’s doing all she can to prepare herself for her impending birth. Part of that preparation included having a chat with me. We spoke about language and how words matter in labour. She used the word ‘surges’ and I had a reaction to it that I didn’t quite understand. Until now.

 

‘Surges’ is a word that is used to describe uterine contractions in labour. It was popularised by Ina May Gaskin and adopted by many in the birth community in the past few decades. It is deemed more ‘positive’ than using ‘contractions’, and sold as a reframing of the pain of labour, and it’s never sat comfortably with me. Here’s why:

As abused women, we had our experiences – our lived, physical, experiences – ‘reframed’ by our abusers. They would touch us and say things like ‘That’s nice, isn’t it?’, ‘You like that, don’t you?’, ‘I would never hurt you,’ etc.  Their words were incongruent with our experiences and that – in and of itself – is damaging and needs work to undo. Telling abused women that calling contractions by another name will make them a more positive experience isn’t helpful. For the vast majority of women, labour hurts. That’s the bald truth of it. The extent to which it hurts, and how we deal with the pain, is individual. Personally, viewing labour pain as ‘pain with a purpose’ helped me. It wasn’t like a migraine (migraines are more painful), where pain doesn’t produce anything except more pain for at least 24 hours.

I think that midwives and doulas working with women who have a history of abuse might want to discuss the merit of using ‘surges’ instead of ‘contractions’ with their clients. Then, the women themselves should use the word that suits them best;that they are most comfortable with.

Labour hurts, and it doesn’t do women who have experienced abuse any good to tell them otherwise. What is helpful is talking about how to get through the pain, how to be present for it, and how the best thing about labour is that it ends. And that it ends with a baby in your arms. The wonderful woman I met with earlier this week also made the point that there is a difference between ‘pain’ and ‘harm’. As abuse survivors, we associate pain in our bodies with (often long-term) harm, yet the pain of contractions is not harmful, and reminding ourselves of that can be hugely helpful in getting through it while still remaining present, grounded, and participative in our own labours.

Breastfeeding After CSA

Breastfeeding Awareness Month 2018

The first week of August was World Breastfeeding Awareness Month, but in the US, the United States Breastfeeding Committee has declared the whole month of August Breastfeeding Awareness Month. In honour of that (not in the least because I didn’t blog about the issue during the first seven days of August!), I wanted to share a few thoughts on breastfeeding after child sexual abuse (CSA).

While so many of us want to breastfeed, and spend our pregnancies imagining doing just that – and, indeed, preparing for it, it’s not always that easy. Aside, altogether, from the issues and difficulties that many women without a history of CSA encounter, there are additional difficulties that may manifest if the new mum such a history.  I’ve enumerated a few of them here:

  • If our breasts were a focal point of our abuse, we may be reluctant to offer, or share them, with anyone else – even our own babies. The physical contact may be just too much.
  • Dissociation is something I’ve discussed on this blog before – it’s often a huge part of our experiences when we are being abused. Dissociation, sadly, can also be part of our experiences when we’re breastfeeding – which can effect the mother-child bonding that is a much-mentioned positive element of breastfeeding. This, in turn, can lead to further shame and guilt around our bodies.
  • There are three kinds of touch that can be difficult for a woman with a history of CSA: self-touch, touch of another, and medical touch. Breastfeeding is, often, comprised of all three: The touch of the mother’s own hand on her breast – before, during, and after, a feed; the touch of the baby on the mother’s breasts; the manipulation of the mother’s breasts in order to assist with a latch etc.
  • Bodily fluids – even her own breastmilk – may be disgusting to the new mother who associates such fluids with abuse.
  • The shame that CSA visits on a woman, on her body, on her sense of self, can be mirrored in the shame that attaches to ‘bodies on display’ in many parts of the world. Then, there is the fact that  many societies visit shame on women who breastfeed in public, so this adds to the difficulty.
  • The mouth of her child on her breast can be triggering for the new mother with a history of CSA. It may remind her too much of her abuser/s slobbering all over her breasts.
  • If her birth didn’t go how she planned, the new mother may well have the old tape of ‘I can’t do anything right’ playing in her head. This may mean that she is convinced she can’t breastfeed her baby, either – so she may not even try.
  • If breastfeeding is difficult – or impossible – for the survivor of CSA, it can add to her feelings of guilt, and of the fact that her body is ‘failing’ her.

It’s not all bad, though. For many women with a history of CSA, managing to breastfeed successfully can be an hugely healing experience for women. It is a(nother) example of her body ‘behaving’ properly; of her body doing what it’s supposed to do.

If you are supporting a new mother who has a history of CSA, there are things you can do to help:

  • Reassure her that her choices are valid.
  • Reassure her that she is not being judged.
  • Reassure her that there are myriad other ways to love her baby.
  • If she really wants to breastfeed, discuss using a pump and expressing milk for her baby to exclusively feed breastmilk to her child.
  • Help her to see her milk as a ‘good’ / ‘useful’ fluid.
  • Remind her that she birthed beautifully, and that she can breastfeed beautifully, too – with help and support.
  • Encourage her to attend La Leche League, or Cuidiú meetings while she’s still pregnant.

The transition to motherhood is a monumental one for every woman, but it can be harder for those of us with a history of CSA. Ditto breastfeeding. Being sensitive to the possibilities can make the experience so much easier, and empowering, for these women.

Birth Trauma Awareness Week

Traumatised Woman Eyes - Edited

Content Warning: Sexual Assault / Sexual Abuse / Incest

This week is Birth Trauma Awareness week.

For many women, the birth itself is traumatic because of how they are treated during labour and birth. For women who have been sexually abused as children, however, labour and birth can compound the trauma they have suffered.

While she was growing up, Orla’s* father ‘played’ with her by playing ‘tickling’ with her. He would chase her, catch her, and then hold her down tickle her, kiss her, and – as she hit puberty –  touch her breasts, buttocks, and genitals.

Like many people who are abused over a period of time, Orla started to recognise the ‘cues’ from her father that an abusive incident was coming. She would try, desperately, to get away from him, but she was never successful. Orla felt helpless, but still, when he tickled her, she laughed. This would result in him calling her ‘a little flirt’ and saying things like ‘you’re just pretending you don’t want me to do it.’

Orla couldn’t get away from her dad because he was too strong. Her laughter would give away to tears, and then to crying, and eventually to screaming. Finally, he would stop.

When Orla grew up, she did not look back on her father’s actions as abusive, because it was labelled as ‘play’, and she remembers laughing at the time.

Years afterwards, however, when she was in labour with her first child, she was hooked up to a foetal monitor, had a canula inserted, and a blood pressure cuff. She had a panic attack on account of the restrictions on her movements. Her reaction seemed disproportionate until later, when Orla connected the events during childbirth with being restrained while her father abused her.

Like Orla, many women are surprised by the degree of their distress over routine aspects of maternity care. For abuse survivors, distressing or traumatic events can bring up the same feelings of helplessness and fear that they felt with the original abuse. It can be difficult to understand, however, why seemingly innocuous or helpful interventions can also bring up feelings of helplessness and fear. If the trauma of the original abuse was never correctly addressed, they are at risk for re-traumatisation, and may end up  suffering from chronic post traumatic stress disorder (CPTSD).

Much of this distress can be alleviated for pregnant women survivors of CSA if, before labour, they have an opportunity to explore some of the features (events, procedures, and care policies) of childbirth that might bear similarities to their abuse, and to plan strategies for avoiding, or coping with, them.

Women often dread the prospect of deeply exploring the origins of abuse-related symptoms. Once they do take that step, with the support of understanding health-care practitioners / birthworkers, they usually feel relieved and unburdened of guilt and responsibility. Our capacity for healing is enormous, through it requires hard work perseverance, and courage. Finding the time, and the energy, for that is hard at any stage – harder again when you’re pregnant. A birthworker who brings compassion, and understanding of the trauma of CSA will make the biggest of differences to her client.

 

*Not her real name

CSA Disclosures In Pregnancy: Why Women Don’t Tell

Zipped Mouth

With more than 25% of women reporting that they have been sexually assaulted, every midwife and birthworker will encounter a survivor of child sexual abuse (CSA) several times in her / his career.

Not everyone who has been abused will disclose to their midwife. Given that, I advise midwives, and other HCPs to treat all women as survivors until, and unless, they are told otherwise.  There are a number of reasons why a woman might be fearful of disclosing to her midwife: Depending on where she is in her recovery, the woman may feel guilty about the  abuse – victim-blaming is so common in society that it’s not unusual for a woman to feel this way. Often, we feel that we need to protect people from our reality, and don’t want to upset or shock our lovely midwives. There is also the additional concern that we will be labelled as ‘difficult’ or ‘needy’ or ‘defective’.

A survivor can also feel that her trauma will be minimised, misunderstood, or ignored. She may also worry that she will be told it ‘makes no difference’ or ‘it’s not relevant’. This is particularly likely if she has had these reactions on previous occasions when she has disclosed.

 

Pregnant women may also worry that their history of child sexual abuse will be recorded on their charts, viewed by many other people and discussed without her knowledge or permission. These days, with a mandatory reporting obligation on caregivers, women may be concerned that their abuse will be ‘broadcast’ and that they will be called upon to revisit it with other agencies. The stress of this may be something they don’t want to think about – especially not while they are pregnant.

Sometimes, a pregnancy might feel like the first time that a woman’s body has done something ‘right’ or ‘normal’, and the woman may be striving really hard to be treated as ‘normal’ throughout her pregnancy. There is always a possibility, too, that the woman may not have disclosed to her partner that she has a history of CSA. She may also be afraid of bringing up the emotional pain and stress of her abuse by mentioning it to her midwife.

 

Women may already have experienced reactions that left a lot to be desired with regard to the amount of empathy they were met with. Whether or not her midwife will be empathetic or knowledgeable is hard to tell on first meeting her. It can feel like a huge emotional risk for a pregnant woman to disclose her history of child sexual abuse to a stranger, even if that stranger is a medical professional. If a woman doesn’t get a sense that her information would be treated sensitively, indeed, that she wouldn’t be treated sensitively upon disclosure, she may feel safer keeping that information to herself.

 

(If you are a midwife or birthworker interested in learning more about how to support women who have been sexually abused, check out the details of this course, which will be available in May:  http://bit.ly/2E9Be9p).