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).

 

Children First? Don’t Hold Your Breath.

Yesterday, the Department of Children and Youth Affairs was delighted to announce the publication of the Children First Bill.

There was much self-congratulation as Minister Frances Fitzgerald and her department tried to tell us how this would make life so much easier for children in Ireland.

Well…..I’m calling bullshit.

The new act is a toothless instrument of the law. It’s all very well to say that reporting is mandatory; but if there are no sanctions against those who choose not to report, then what good is such a mandate?

I would suggest that a change in the culture is what’s needed before we can hope for a law that actually makes a difference. Naively, you might question what kind of person would choose not to report a crime of abuse against a child? Surely, if a person- particularly a person in authority – knows (or even suspects) that  a child is being abused, that person would report it? Even without a law dictating that they should? You might think that, but I recently got sight of documents which blow that theory right out of the water.

I do think those involved should be named and shamed – but have been advised against so doing for the time being. (Patience was never my strong point. This is a hard lesson for me).

Without naming names, then, let me give you the broadstrokes:

In the early 1990s, a woman (let’s call her Deirdre, because that’s not her name) was in her mid-teens. She was being treated at a centre for the effects of sexual abuse. During this time, the psychiatrist under whose care she was (lets call her Dr C), asked Deirdre if she was still being sexually abused. Deirdre revealed that her father was still sexually abusing her.

What did this doctor do? Did she call the Gardai? No. What? Not even anonymously? No. What she did was seek a meeting with the paedophile in question. At this meeting (documented by the doctor herself), she confronted him with the information she had regarding the allegations Deirdre had made. Did he deny abusing her? No. Sure why would he? What he did, instead, was tell Dr C that ‘there (was) nothing sexual’ about his sexual abuse of this child. Instead, he averred, he was doing it ‘to comfort’ her because he was aware she had been sexually abused by other people as well. Doctor C’s response? She told him to ‘be more sensitive’.

I mean, seriously, what does that amount to? Isn’t that the same as saying ‘Rape her more gently’?!

Of course, you can say that this is a case of historic abuse, and no one would behave in such a way in this day and age. If you did say that, I would like to agree with you.  Unfortunately, I couldn’t. When these documents surfaced (as the result of an FOI request Deirdre made), Deirdre met with a representative of the centre where she had been ‘treated’ (Dr C was on holiday – though she still works in the centre).  Dr C’s colleague confirmed that, were the same set of circumstances to arrive in front of Dr C today, she would act in precisely the same way because that is the policy of the centre. To do otherwise would be a ‘breach of confidentiality’.

What does this tell you? It tells me what I already know:  Children don’t come first in this country. We do not have a culture (yet) that puts children at the top of the pile. We do not have a society that cherishes, protects and loves its children. Every time I say that, people (women, usually) respond indignantly telling me how much they love their children. Sure, individuals among us may cherish our own personal children – but what about the snotty child at the end of the road, whose parents are drug addicts? Do you love that child? Really? Would you step in to help that child if he or she were being hurt? Would you? Would you really?

We, in Ireland, do not have a culture that views children as precious. We really don’t.

No law will make any difference if there are no sanctions against those who do not obey it. It is ludicrous to suggest otherwise. And, unfortunately, no law will make any difference if the cultural attitudes of the nation enacting it are not in-step with the letter and the spirit of that law.