|July 4, 2001|
Volume 3, Issue 27
|Midwifery Today E-News|
“Caring for Sexually Abused Women”
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In 10 years at the Coombe hospital in Dublin, Ireland there were 15 cases of uterine rupture in 65,488 deliveries. Thirteen of the 15 were in women with a previous cesarean and 13 had had oxytocic drugs to induce or speed up labor.
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Helping Women with a History of Sexual Abuse
Q: I am currently supporting a close friend in the beginning stages of her first pregnancy. She has a history of severe childhood physical and sexual abuse and finds it very difficult to be touched, massaged, or otherwise physically cared for. This is totally understandable. However, I am having a hard time figuring out what to offer when the usual physical comforts provide no comfort. Midwives and doulas, do you have advice in terms of what I can try or other avenues to take?
A: Know that you are touching her with your eyes, with your presence, with your soothing voice. Sing to her. There are wonderful songs and labor chants that can help you light up her labor path with sound, direction and strength. Work with her prenatally to find out what places or images are the most soothing, or the most empowering to her personally, then do guided imagery during labor to take her to those safe, strong realms. Or have her identify one or a few pictures, paintings, photographs, drawings to use as focal points, then draw her attention to them while she labors. And always be ready with an outstretched hand, in case she wants to reach out and hang on to you.
- Karen Ehrlich, CPM, LM
A: I am a doula and a past sexual abuse sufferer. For me, birth itself was not as bad as one might think. If she allows touch keep it firm, not stroking movements. Sometimes just a hand on the shoulder or a massage on the head may work. Always ask her permission before you touch her. Verbal encouragement is absolutely necessary.
A: I loved being sung to during labor. Try reading scripture or some poetry during contractions. Try good relaxation videos from Moody Press (beautiful and majestic scenes with hymns and calm reading of verses from the Bible).
- Jennifer Crowley, CBE, aspiring midwife
A: Find someone experienced in gentle bodywork and trauma healing, such as aquatic bodywork if your friend is open to that idea. I am a survivor of sexual child abuse as well and I do aquatic bodywork with pregnant women. I am a mother of a 4-year-old boy. It is enormously helpful to dissolve the traumatic patterns before giving birth and aquatic bodywork is the most noninvasive and gentlest way if she comes to a point of allowing gentle touching.
There are some great exercises you can do with your friend that are playful and don't involve touch, like humming, sitting and rocking her body gently from side to side and back and forth and vice versa, singing according to Leboyer, etc. She can do some of the exercises also in a bathtub if she enjoys being in water (some survivors do not because that may have been the place where the abuse took place. She could do humming and Leboyer singing while taking a shower) or simple swimming and playing in water. I use a wide range of alternatives without any kind of physical but more energetic contact.
- Sabine Neumann
A: The best gift you can give your friend is the support she needs to explore for herself what is most helpful and healing. You can be a safe haven for her to discover her own voice and her own strength, which is what she will need more than anything. Power was taken from her in her abuse. Let her find within herself what she needs to take it back.
A: Read "Pregnancy as Healing" (Vol I) by Gayle Peterson and Lewis Mehl to start your search. They suggest that by "walking through" or visualizing the desired birth, the mother will come closer to realizing her goals. Other techniques are explored in Peterson's books. I am fascinated by her creative approaches and encourage you to look into them to help your client achieve her desired birth experience.
A: I have been a midwife for 11 years, and my husband and I also minister to wounded people. By simply going back to that time and allowing them to express bottled-up emotions, and working through all of the pain, that woman can work out all of the bottled-up aggression and fears she has. But by the grace of God, she can also forgive that person, and speak a blessing over them. It releases her from holding a judgment over that person, and it also heals her as well. So when she thinks about that situation or is reminded of the incident, she can have better peace with it. Yes, the person who did it is still guilty and is not free from judgment, but it releases her from the bondage of all the pain and emotions that keep her from receiving anything good from those who would not hurt her....
She is not having a reaction to your touch, but to those done inappropriately. Her body is having a memory connection. You must be careful to not do things that will cause her to want to crawl out of her skin either. The inner healing is the only way to really set her free.
I am speaking from experience, having been abused badly when I was younger. It was intense for me to release all the pain and emotions that were keeping me from openly loving others, even my family. But the freedom comes from the releasing the person who has made you a victim, and turned you into a victor!
A: There are plenty of nonphysical ways to support a pregnant friend and some ways to care for her body that don't involve body contact. For example:
But even if none of this is useful, as a close friend you should be able to ask her what she wants or needs you to do to support her during her pregnancy and get an honest answer. Simply loving and caring about her is probably the most important thing you can do.
- Ellen Harris-Braun, AAHCC
A: I was raped when I was 12. In all the care I have received in health, and in my relationships this has been an issue. For me, ABSOLUTE CONTROL is important. I want no surprises. I do not want to feel like my trust or personhood is being violated. Ask before touching. If something has to be done, tell me what and why before starting; talk me through it. I had one practitioner who had me touch her the same way before touching me. This was the first person who examined me after the rape. She was wise enough to have another person enter the room, and because I was a nursing student she had them walk me though an exam of her. Although very unorthodox, it was probably the experience that helped me heal the most. If there are choices, tell me. Reassure me of your intentions. Once you start to touch me leave your hand there. Don't make sudden movements, disconnections, or progressions to areas not discussed.
A: Many victims of childhood physical/sexual abuse have extreme difficulty
being in situations where they feel they are not in control of physical contact
that is occurring. Particularly for victims of sexual abuse, there is a connection
between a "comforting rub" and subsequent abuse. You need to break this
connection, otherwise there is no relaxation in the mother's mind associated with
the touch made by you. Instead it evokes the opposite reaction: fear and apprehension.
A: I am a doula, mother of five and also a molestation survivor. I have also worked with women who have endured horrific abuse and had issues with touch. I think the most important thing is to help empower the woman to make decisions about her pregnancy, labor and delivery. Ask her what kinds of things feel good to her, what she would like to try. A foot massage is often a good place to start, then rubbing her shoulders, etc. Everything else will follow.
- Amy, doula, CBE, CBSP
A: At times just the sound of your voice can be helpful. I was just with a woman who wanted me to explain to her what her body was doing during each contraction. "The muscle cells are pulling together to open up your cervix. The hormones are relaxing ligaments so that your pelvis can open up and make room for the baby." This kind of talk may help her focus on the task at hand and steer clear of bad memories.
Is she open to visualization? Could she take a walk on the beach during contractions? Can she describe the scene to you? Perhaps it would give her a feeling of control if she were the one painting the picture--she could go where she wanted to. Lack of control is part of the fear that accompanies abuse. Does she believe that she is strong and able to birth this baby? Does she see the strength in her survival? Remind her of her tenacity and strength in daring to not only survive, but to LIVE life. Encourage her. Build on her strength. Look her in the eye and tell her that she can. There may be those moments when she needs someone to be strong for her, but she must also see her own strength.
Pray for her. Pray with her. Has she (or you) considered that this birth can be a redeeming experience, changing her entire perspective of who she is? There is no guarantee, but the potential is there. It's great that she is daring to even reach out for support. She must be a courageous woman. Remind her of that.
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