Many survivors of childhood sexual abuse report that their experiences of pregnancy and giving birth are very difficult and re-traumatising.
Having consulted those who attend Break the Silence, a charitable organisation supporting survivors of rape and childhood sexual abuse, this article will explore the effect of their abuse and how this affected their birthing experiences.
Sexual activity can cause challenges for survivors. Many survivors have reported feelings of shame, guilt and blame associated with sexual activity and related to their abuse. Due to certain physiological defence mechanisms to protect against harm, such as lubrication, survivors often experience feelings of self-blame and these feelings may be reinforced by the perpetrator's coercion (with comments such as ‘you must have enjoyed it’). When survivors are visibly pregnant, they may worry that other people are aware they are sexually active, triggering feelings of guilt, shame and self-blame stemming from their abuse, which is often hidden, kept secret and private.
Physical body changes and lack of control over their bodies as a baby grows can also be triggering and emotionally distressing for survivors. The loss of control over their appearance can lead to an increase in survivors' anxiety and unhealthy coping strategies, such as eating disorders and self harm.
Many survivors avoid appointments with doctors and dentists and at hospitals, especially smear tests, due to the personal nature of the examinations and potential for invasive procedures or touching, and so the environment where appointments are held can also present obstacles for survivors. In pregnancy, intimate procedures and check-ups are usually performed in clinical settings, with staff who are not known to the survivor. The anticipation of these appointments can lead to high levels of anxiety and fear and can result in re-traumatisation, which is detrimental to the health and wellbeing of both the mother and the child. Male survivors observing or attending appointments with their partners may also be affected.
The use of technical medical equipment or implements can also cause anxiety and distress and it may help reduce fear and anxiety if the survivor is being advised what the instrument is, what it will be used for and how it will connect or touch specific parts of the body. Examinations can be a trigger for both male and female survivors, who may have experienced forensic examinations as a child or where abuse has involved the use of foreign objects.
Jargon used in medical language also enforces low self-esteem and confidence, as a survivor may not understand what has been said or feel comfortable enough to ask questions. In previous experiences when dealing with medical professionals they may have asked questions and been treated in a patronising manner, all of which increases levels of anxiety that could result in disengagement with support services.
Survivors may fear the birth process and how they think that they might behave. The sight of blood and the smell of medical facilities may be a trigger, and survivors know that midwives may see something in their behaviour that indicates that they may have experienced childhood trauma.
In these situations, a direct question about this might be helpful, as survivors often find it too challenging to verbalise their experiences. When a midwife makes sensitive enquiries with the survivor, this often results in the survivor feeling more confident and understood.
Many survivors fear that their baby will be sexually abused, and they have extreme anxiety about how can they possibly keep their child safe, knowing the dangers that exist in our world.
They may also fear being a perpetrator due to social stigma and misunderstanding around childhood sexual abuse. One woman felt fear and anxiety around changing her baby, for example, and worried that people would perceive her to be touching the child inappropriately, or that because she had been abused, that people would think she was a perpetrator of abuse to her own child. This resulted in considerable anxiety and loss of confidence, and affected the attachment that she had with her child. This fear is also very strong in male survivors who are becoming fathers.
Skin-to-skin contact has a huge bearing on attachment between mother and child; however, survivors often report feelings of exposure from being partially naked or undressed. By placing the baby onto the mother skin-to-skin, the baby is also close to the breast area, adding to the feelings of anxiety and vulnerability. It follows therefore that breastfeeding is also a challenge for survivors. Rather than being a pleasurable, nourishing and personal connection with the baby, it can be extremely difficult for a survivor, triggering flashbacks that make it a negative experience.
Many survivors, of all genders, have successfully overcome and moved beyond the challenges they experienced through pregnancy and childbirth, going on to be amazing parents. However, this journey can be less traumatic with improved understanding and by being sure to treat survivors with consideration, dignity and respect.