Becoming aware that abuse you experienced as a child could have an impact on your labour and birth can bring up a whole range of emotions, such as sadness, fear, grief, anger and rage. You might feel that the person(s) who abused you have already taken so much away from you and fear that they will rob you again of something sacred: your birth experience. However, if you become aware of this before you go into labour, you are able to make decisions that can help you minimize the extent to which your past plays a role in your childbirth. Some women have actually felt that the birth of their child was the most profound healing experience of their lives. You can reduce your anxiety and feel more in control if you have the opportunity to explore the possible ways in which your past abuse may be triggered and to make plans accordingly.

Survivors have shared some of the following concerns related to labour and birth:

• the feeling that they would be "out of control" and would say and/or do things that would embarrass them
• they were afraid that their bodies were not "healthy" enough to give birth
• they were unsure how their partners would feel about their behaviour in labour
• they did not trust that the hospital staff would listen to their concerns or answer their questions honestly
• they were afraid people would see scars from cutting and/or picking
• they were worried that they would be judged, that hospital staff would feel that they shouldn't be having babies
• they weren't sure if they would dissociate
• they were afraid the pain would remind them of past abuse
• they wanted to avoid an epidural so that they could remain mobile
• they did not want to be touched by multiple caregivers or be "test" subjects for students
• they were uncertain that they would be able to push when the time came

Having your concerns acknowledged and normalized may be all you need. For many of our clients it is just enough to know that their thoughts and fears are quite common, even for women who haven't experienced abuse. Sometimes survivors start thinking that all of their apprehensions are due to their abuse history and it can be reassuring to know that many pregnant women feel just like you do. What might be different for you is knowing that there is a history of abuse and not knowing how this might "present" itself in labour.

Many women who have given birth previously without the opportunity to discuss their concerns beforehand, have felt frustrated, sad and resentful that they did not know past abuse could specifically impact them in labour and birth. It is to help you understand that impact and be prepared that we have provided the information on these pages. Birth counselling before the birth can support you in more personal ways.

It might be reassuring for you to know that the abuse survivors we have worked with rarely had any issues or concerns surface for them in labour... they expressed that, through careful planning and learning tools to work with their fears, their labour and births were surprisingly positive experiences in their lives.

Becoming a mother is a process... something that develops over time and hopefully with the caring and compassionate support of family, friends and various community service providers. Unfortunately many women do not have appropriate postpartum care — care which offers a balance between empowering them to follow their own mothering instincts and providing them with non-biased information about breastfeeding, newborn care and other issues which may arise in postpartum. It can be difficult for any new mom to find her voice and sort out her personal preferences against the onslaught of opinions from those around her and it can be even more challenging for survivors, who tend to doubt their capacity to "mother-by-instinct" even more so than women who have not experienced abuse.

On the other hand, many of the women we have worked with had very definite ideas about how they wanted to mother their children, in response to how they felt their own mothers either protected or violated them. With this awareness, some survivors are able to seek out supports that will validate and encourage their autonomy in making informed decisions.

There are common themes that arise in postpartum for women who have survived abuse:

Postpartum Depression

You may be thinking about the likelihood of having postpartum depression. Unfortunately it is very difficult to identify during the prenatal period who will experience postpartum depression (PPD) and who will not, but you may want to consider some of the risk factors:

• a history of depression before or during pregnancy
• a lack of support from family and friends
• a family history of depression
• stressful recent events in your life (death of a loved one, marriage breakdown)

If you are concerned about the risk of developing PPD please speak with your care provider. There may be things you could be doing during your pregnancy, such as educating yourself around warning signs, things to think about for labour and birth (like hiring a doula), or consider your options for postpartum, such as in-home care or follow-up home visits with a public health nurse.

Newborn Feeding

Whether or not you want to breastfeed your baby may be directly related to ideas you have about your breasts stemming from abuse. For some women the thought that nursing a baby can be a pleasurable experience is revolting and completely unfathomable. It can be possible for you to breastfeed if you are supported in learning to put some parameters and boundaries in place. For instance, if nighttime is a trigger, then perhaps you can find ways to distract yourself (watch T.V., turn on the lights) or pump and offer your baby a bottle during the night. There doesn't need to be an all-or-nothing approach to breastfeeding, and you can feel good about any attempt you make at offering your baby your breastmilk.

For other women, breastfeeding is a way of reclaiming their breasts for themselves. As one survivor told us, "when my baby breastfed for the first time, I realized that they [my breasts] weren't a source of shame for me any longer." It can take a lot of time, education and patience for you to learn to nurse your baby, but it is possible. For most new moms it can take anywhere from days, to weeks and even months to feel fully confident in their breastfeeding relationship.

You may never learn to "love" breastfeeding and that's okay. Commend yourself on the courage it takes to initiate breastfeeding and recognize that you and your baby will benefit enormously from your efforts.

PLEASE NOTE: If breastfeeding makes you feel angry, frustrated or resentful towards your baby, as is sometimes the case, it is time to talk to someone about the alternatives. Speak with a lactation educator or breastfeeding counselor about options available to you.

Bathing or Diaper Changing

Learning how to clean and care for your baby's genitals can be traumatizing for an abuse survivor. You may be afraid of harming your child or overstepping their personal boundaries. Ensure that you have a health professional or trusted friend demonstrate care techniques before you leave the hospital or within a day or two of discharge. You may want to practice with their guidance if you need some support for the first few baths or changes. You also may want to look into hiring a postpartum doula who can assist in role modeling newborn care and help you develop the confidence to care for your baby.

Bonding and Attachment

Women who have experienced abuse can have a very difficult time forming healthy attachment with their babies. You may find it difficult to know what is "appropriate" touch and be worried that you touch your child too much or not enough. Touching your baby is very important for his/her physical and emotional health and well-being. By gently holding your baby's hands or rubbing the top of his/her head you can start to feel comfortable touching your baby. There are many simple ways in which you can encourage a strong attachment with your baby:

• Talk to your baby... if you don't know what to say, read them a book or sing them a song. Just the soothing sound of your voice can bring comfort to your baby and studies indicate that from a very early age they can tell your voice from others.
• Make eye contact when you are nursing or feeding your baby.
• Smile at your baby.
• Take an infant massage class where you can learn tips on how to touch and care for your baby — also a great tool for soothing colic.
• Respond to your baby's cries... they are trying to communicate their needs to you. If your baby does not get a response from their initial cries, they will often start crying harder and more disturbingly.

For breastfeeding education and peer support in a safe and welcoming environment, contact your local La Leche League leader. www.lalecheleague.org

For more information about attachment parenting, please refer to:

The Attachment Parenting Book: A Commonsense Guide to Understanding and Nurturing Your Baby.
Sears, William and Martha Sears. ISBN: 0-316-77809-5

Attachment Parenting International (API)
A non-profit member organization, networking with parents, professionals and like-minded organizations around the world.
www.attachmentparenting.org

Survivors of childhood sexual abuse: page 1 - page 2 - (you are on page 3) - page 4