There has recently been a trend going around Facebook, where women who have been sexually assaulted share a simple two-word phrase to identify themselves as survivors -- "Me, too." My heart is shattered as I realize the sheer volume of people I know that have endured this experience. It's not surprising, considering that 1 in 6 people in the US are victims of sexual violence. But it is heart-breaking to see these secrets surface among those I know.
But it's also bringing something else to the surface: the need to discuss how this can and does affect pregnancy and birth for survivors.
94% of women experience symptoms of post-traumatic stress disorder during the two weeks directly after being raped (D.S. Riggs, T. Murdock, W. Walsh, A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress 455-475 1992). 30% of women report PTSD symptoms 9 months after the rape (J. R. T. Davidson & E. B. Foa, Posttraumatic Stress Disorder: DSM-IV and Beyond. American Psychiatric Press: Washington, DC pp. 23-36). And approximately 70% of rape or sexual assault victims experience moderate to severe distress, which is a larger percentage than any other violent crime (Department of Justice, Office of Justice Programs, Bureau of Statistics, Socio-emotional Impact of Violent Crime 2014).
When women with this past experience walk into the labor space to give birth to their baby, it is often an unexpected and rather unpleasant surprise to find these feelings of trauma re-emerging. It's not often talked about. In OB care, the question is typically asked on the intake form, not usually ever to be discussed again. I know, factually, that many expecting moms even lie for this question, often because the weight of shame they carry is simply too heavy, and they don't want to address it with the stranger sitting behind the desk for their intake appointment.
As a birth doula, I ask these hard questions on my intake forms as well. And I ask again as we review the questions together. Those who have had this meeting with me will confirm that I will look the mother in the eye and ask for complete honesty and vulnerability. It is then that I explain my reasoning for asking.
As we prepare for your birth experience, I try to do all that I can to find out what I need to do and be aware of in order to make your experience as happy as possible. And a large portion of that is knowing how you may be affected by the process. Many times, I will see a mom start to become on edge, agitated, or even combative, without an obvious cause. This is common in those who have not reported sexual abuse in their background. And it can tend to hit when the frequent cervical exams start, and the caregivers require constant or intermittent monitoring, or when they are asked to use the restroom and the bathroom door is left open, or when they labor naked in the tub and have random/different staff walking in and out of their private space. It can hit when contractions leave you feeling like you've lost control of your body. It can hit when a provider does a rough cervical exam and reprimands the woman for jumping or yelping in pain, stating she "doesn't have all night" and to "hold still." It can hit when your emotions are downplayed, and you are told "women do it all the time." It can hit when you are given an open-back gown to change into, which leaves your back side completely exposed when you need to get up to move. It can hit when you are given an oxygen mask, and you feel like you are being "shushed" and held down again.
I will see labors stall from this occasionally, and especially in situations where this history had been hidden from me. It is not uncommon for me to ask again in labor if there is anything that needs to be talked through, and dig and search until I find the root of the emotional block that is responsible for shutting things down. It is especially important to note here that labor is 80% emotional, and 20% physical. Emotions in labor are powerful! There have been times where the mother knew what it was and would pour out her heart and share her past, finding release and moving forward with the labor freely. There have also been times where the mother didn't really even know what the block was, and she was able to come to her own realization that her unspoken history has resurfaced. Tears are usually shed, and I always welcome their flow. Grief must be given space and trauma acknowledged. Then...we process. Together.
You are safe here.
It is also important to note that this can also begin during the pregnancy. The nausea. The stretching. The movements of another person in your belly. Again, feeling like you have no control over your body. This can be so re-traumatizing. And it is perfectly okay to feel these things. But it is important to not give these feelings the power to ruin your birth experience, and to address them and to process them. Sometimes this may require the help of a friend, partner, or qualified professional.
It is important to be honest with your care provider. If you have a doula, this is even more important to bring up to, so that we can best help support you emotionally throughout your pregnancy and labor/birth. That's what we do--physical, informational, and emotional support. Your providers care about these things, but it's not their main job. Their job is mostly to focus on the safety of you and baby. Their job is mostly in the clinical area. So it is important to be open with your care team. And it's important to acknowledge the role your history may have in your birth experience. This helps me communicate with the labor staff things like your need to be asked before having a cervical exam performed, the need to have the curtain pulled, the need to have a sheet draped over your bare bottom as you labor however necessary, or the need to keep the bathroom door closed while you use the restroom. It helps me to be able to communicate the need for you to feel like you are in control and that nothing happens without your consent, and that your right to privacy is fully respected and protected.
I know the shame you carry is great, and often why it is not shared with your care team. Sweet mama...please know that the shame is not yours to bear. What you've experienced is not your fault. Your experiences do not define who you are. You were not to blame. Let us walk beside you and help carry your load, so that you might be able to let go and welcome your little one in freedom.
You are safe here.