Guest post by Ngozi D. Tibbs BS, CD, LCCE, IBCLC

Some days I find it hard to watch the news. We are bombarded by stories of child neglect and abuse. The stories that are particularly disturbing involve sexual abuse. It causes one to wonder, is sexual abuse occurring more often, or is it the reporting of sexual abuse that has increased? Whatever the reasons, the stories appear to be everywhere. I, who like you, care about families, am disturbed by the reality that children are not being protected. We have heard recently in the media where coaches, teachers, trusted neighbors and clergy are sexually abusing our children. Scary movies are about running from the boogeyman. What happens if the boogeyman lives in your house and comes to your room every night? What if he is your father, brother, uncle or babysitter?

Our daughters and sons who survive sexual abuse grow up broken and scarred. Trust has been stolen and shame is internalized. Children grow into adults and many adults become parents. How do we help our mothers who come to us for guidance and support as they navigate through the sacred experience of birth?

Penny Simkin writes:

'One in four, one in three, or one in five? Who knows the actual frequency of childhood sexual abuse in our society? All we really know is that it is shockingly common, meaning that many women in midwifery or obstetric practice or in a childbirth education class are burdened with the psychosocial after effects of victimization'.

'Surprisingly, with all the sexual connotations of pregnancy, birth, and breastfeeding, virtually nothing is published in the social science or medical literature on the possible effects of childhood sexual abuse on later childrearing. Even mental health publications have failed to address this grave issue. Eating disorders, chronic pelvic pain, severe premenstrual syndrome, sexual dysfunction, various phobias and other psychosomatic disorders are known to be associated with childhood sexual abuse, but what about disorders in childrearing?'

(Simkin, 1992, 2006)

Asking a woman directly regarding being a sexual abuse survivor is not the best approach. We must be sensitive to her desire to keep that part of her life hidden; or in some cases, a woman may not even have conscious memory of abuse (Simkin, 1992, 2006). According to Simkin and Klaus, (2004), a few symptoms that are common to survivors (but not necessarily to all) are:

• Fears of male caregivers (or in some cases female)
• Vaginal exams as instruments of rape
• Nakedness or modesty issues
• Excessive pain and tension
• Passivity, submission, or the 'easy, good patient'
• Lack of cooperation with staff, pushing positions
• Dependency on partner, doula, caregiver
• Fears, repugnance of blood, secretions
• Fear of the unknown
• Dissociation

In a childbirth education class, we may notice the woman who is, perhaps, very uncomfortable with lying on a mat on the floor in front of strangers, or having her support person touch her in front of others. When we introduce ourselves at the beginning of class, we should also include that all of the activities are optional and no one should feel obligated to do them if not comfortable. Comfort techniques can be practiced at home. We should also remind our participants that we are available to discuss things privately if they so choose. We can also provide a box in the front of the room for participants to write down their questions. This can be a wonderful, non-threatening anonymous way for women to share their concerns. If appropriate, those questions can be brought to the class for further discussion.

We should familiarize ourselves with local resources, which would include support groups, mental health professionals and women's shelters. We can keep a resource list on a table in the front of class which can include additional resources such as where to purchase baby slings, nursing bras etc... as to not single out the issue of abuse. We may have women in our classes who are not only survivors of childhood sexual abuse but who are currently in an abusive relationship. It is within the scope of the childbirth educator or doula to connect her with community resources.

In our classes, we can find creative ways to address our understanding of this issue by weaving it into our curriculum when we discuss different comfort techniques. We can be careful to use language that is more inclusive and sensitive such as 'partner' or 'support person' not 'coach'. Phrases such as 'listen to your body' or 'surrender to your body' can be triggering (Simkin, 1992, 2006). It is understandable that pain in labor can cause feelings of being out of control or evoke feelings that something is wrong. Maintaining control and feeling safe are important to all mothers in labor, but especially for the survivor. As Doulas, when we help a mother write her birth plan or birth wishes, we should be mindful of those words or procedures that may involve surrendering control to others. We can help a woman regain some of the sense of control by encouraging her to express her needs in language that feels safe to her.

As I prepare to teach at my local hospital this spring, I have consulted my thesaurus to find different ways to say common words. For example, one survivor shared her discomfort with the word 'contraction'. It reminded her of the physical sexual abuse pain she suffered. Often following an assault, she was plagued by a 'knot' in her stomach and a strong presence of nausea. Sometimes she would even vomit. As a result, she had grown up with a 'nervous stomach' and suffered abdominal pain for many years. As her Doula, she preferred I use words such as 'intensity', 'strength' and 'rushes' to describe the feeling of the contraction.

As educators, we should familiarize ourselves with respected books and articles on the subject of abuse. Our mothers are looking to us for guidance and support. We may be the only person in the room who understands her needs. April is National Sexual Violence Awareness Month. Let's do our part by becoming advocates for children, mothers and families.

Sources:

• Simkin, P. (1992, 2006) Birth 19(4). Excerpts adapted from When Survivors Give Birth Workshop February 2012.

Some valuable books on the subject:

• Simkin, P., Klaus, P. (2004). When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women. Seattle: Classic Day Publishing.
• Sperlich, M., Seng, J. (2008). Surivior Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse Eugene: OR. Motherbaby Press.

National Resources:

• RAINN- Rape, Abuse and Incest Network 1-800-656-HOPE
• NSVRC- National Sexual Violence Resource Center
• CDC- Centers for Disease Control

Ngozi is a Doula, LCCE, and Lactation Consultant in Pennsylvania.

Tags