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).

 

Twelve Tips For Maternity Care for Survivors of Sexual Abuse / Assault

Pregnant Belly

About a month ago, I posted on Twitter using the ‘Me Too’ and ‘Maternity Care’ hashtags. Quite a few people got in touch to say that they found the advice I offered useful. A number of women contacted me privately to say that they found my tweets validating and reassuring. A few fathers also sent me messages to let me know that they witnessed the mothers of their children experiencing issues around their treatment and they realised, having read my tweets, that these reactions and issues were directly related to the abuse they had suffered as children.

In the hopes that these words will reach – and help – more people, I’m posting them here, as well.

  1. Sexual abuse is endemic. Treat ALL women as survivors until they tell you otherwise. Err on the side of caution.
  2. Continuity of care is best for women in order to build trust. We are extra vulnerable when pregnant, birthing, and in the peri-natal period.
  3. Before labour, ask if we have special requests for during labour – places not to touch, words not to use, etc.
  4. Call us by our names. Not ‘Love’ or ‘Sweetheart’. Abusers rarely use our names. Don’t diminish our personhood.
  5. Never, ever use the phrase ‘good girl’. We’re not girls. We’re women. Most of us were abused by people who used the phrase ‘good girl’ while they were abusing us.
  6. Don’t use nursery / childish language around us. That can be triggering.
  7. Don’t tell us to do something, eg ‘pop up on the bed’. Ask if we’d like to – explain why.
  8. Accept ‘no’ as an answer – don’t try and cajole or persuade us to turn our ‘no’ to a ‘yes’.
  9. Never tell us you’re going to do something. Ask permission. Our bodies belong to us, even when we’re birthing.
  10. Never perform a VE unless it’s necessary (hint: it’s *never* necessary.
  11. Be aware that our physiological responses may be different. EG we often pause dilation at about 4cms. Don’t rush with interventions because we are taking ‘too long’. Trust us. Trust our bodies.
  12. After birth, breastfeeding – no matter how much we want to – may be extremely triggering. Have compassion.

I offer workshops based on trauma-informed care to birth workers, based on my own experiences, and my academic research, (and the fact that I was Ireland’s first practicing doula!). If you’d like details, please get in touch.