When Nicole* came to see me, she was pregnant with her second child. Nicole, a survivor of childhood sexual abuse, was terrified about giving birth again. And she felt completely alone with her fears and feelings.
Twenty percent of women are sexual assault survivors. Another 20% are survivors of childhood sexual abuse. More than 80% bear children. There is significant overlap between these demographics, and the numbers cut across all racial, ethnic, and socioeconomic groups.
But there is a lack of quantitative research about how sexual trauma affects people’s childbirth experiences; issues that primarily impact women regularly receive less scientific funding than those that impact men. The limited literature that does exist suggests that the overlap carries unique risks during the childbirth process. The changes to childbearing bodies during pregnancy, the frequency of invasive prenatal exams, the loss of control and the pain of labor can cause dissociation, flashbacks and re-experiencing the original trauma (LoGiudice, 2017).
Twenty percent of women are sexual assault survivors. Another 20% are survivors of childhood sexual abuse. More than 80% bear children. There is significant overlap between these demographics, and the numbers cut across all racial, ethnic, and socioeconomic groups.
Pregnancy and labor are arduous — and, potentially, traumatic — enough without bringing past horrors into the mix. That’s why it’s time to establish cross-disciplinary universal guidelines around providing trauma-informed obstetric care to survivors of sexual assault. That means medical and mental health professionals need to work together to create and maintain evidence-based best practices that will keep survivors from being triggered or retraumatized while giving birth.
Before we can create these guidelines, we urgently need to devote more resources to learning about how a sexual trauma history can reappear pre- and postpartum, and about the risk and protective factors for survivors. We also need to know more about how to prepare survivors for pregnancy and childbirth, and how to interact with them to help them stay calm enough to engage consciously in the labor process without experiencing retraumatization.
Nicole, a survivor of childhood sexual abuse, was terrified about giving birth again. And she felt completely alone with her fears and feelings.
Here’s what we do know: Women with childhood sexual trauma are more likely to find childbirth terrifying (Leeners et al., 2016), which can re-trigger the emergency survival strategies — fright, freeze, flight, or fawn — that helped them cope with their original trauma as it happened. The nervous system may go on alert, causing the person in labor to experience hypervigilance and stress about every unfamiliar sensation they feel; or they may dissociate from the situation altogether, checking out of their bodies in an attempt to psychologically escape.
These nervous system responses can happen in people with known trauma histories, but the birthing process can also cause unconscious memories of sexual violence to reemerge.
As an EMDR therapist who works frequently with perinatal parents, I teach survivors how to stay in what is called the “window of tolerance,” where they can stomach being in the present moment rather than responding with either an over- or underactive nervous system. Together, the client and I focus on resourcing, a stabilization process that involves accessing internal strengths, allowing someone to tolerate remaining present and “calm enough.” This sort of cooperative strategizing is crucial to prepare childbearing individuals for the emotional labor of birth.
For example, Nicole told me she wanted to feel confident and present, and to believe that she would be “OK” when she is giving birth. Since she mentioned her sister as someone who embodied these characteristics, we resourced this for her in our work together. I prompted her to imagine her sister in her mind’s eye, to note all of her senses as she held this image of sister in mind. Keeping this image in mind during the treatment process allowed Nicole to internalize the sense of calm and solace that she associated with her sister to bring into the birthing process. It’s a concrete, repeatable process that minimizes anxiety for many of my clients.
Every professional who comes into contact with pregnant or perinatal people should approach their patients through a trauma-informed lens, starting with sensitively, carefully assessing patients’ history during the very first visit.
How to help pregnant people access inner strengths is the sort of knowledge that shouldn’t — but currently does — start and stop in the mental health community. The relationship between patients and prenatal providers is essential, because negative reactions to trauma symptoms from an authority figure can cause a further psychological injury. Every professional who comes into contact with pregnant or perinatal people should approach their patients through a trauma-informed lens, starting with sensitively, carefully assessing patients’ history during the very first visit.
The best solution to grappling with sexual assault and abuse, of course, would be to eliminate it altogether. But in the meantime, protecting new parents from older traumas needs to become the standard of care, incorporated into everything pre- and post-partum caregivers do.
*This is a composite of multiple clients over multiple time periods to protect client confidentiality.
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