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It's important to recognize that there are many routine medical procedures in the childbearing year that may be reminiscent of past sexual abuse
Anxieties about this aspect of the upcoming labour and birth can be experienced during the whole pregnancy. Survivors are often concerned about "triggers" causing events from their past to resurface through labour, birth and postpartum. During labour women tend to be concerned about being exposed to strangers, having their genitals touched by caregivers and being confined to bed. They are frequently concerned that the birth of the baby through the vagina will bring up memories of pain from their abusers and are worried about crying out in fear.
Women who did not have mothers who were able to provide protection from their abusers, may lack awareness about personal boundaries and the role of a mother. They may be afraid that they too will be unable to protect their baby or may not have good boundaries in place to help keep their child safe. Normalizing these fears and providing education around early attachment, boundaries and self-care can help reduce a woman's anxiety and provide her with some tools. A woman whose mother was an abusive person in her life can have an even greater sense of bewilderment or concerns that she may not know how to care for her baby, and can present as ambivalent or highly agitated about the idea of becoming a mother. Patience, understanding and a referral to a good early parenting program, therapist or counsellor can assist her in making important community connections before the baby's birth.
Remember that, as a survivor, there was a time in her life when her body was used against her will, without consent neither asked nor given. It is important that she be able to articulate her consent and decline touch when she is not feeling safe. As her care provider, it is your obligation to follow her lead and not pressure her into procedures that she is not absolutely comfortable with, or else you risk causing her further harm. She may feel safer if there is another person present during physical exams and be in a reclining position rather than lying down for pelvic/cervical assessments.
If working with survivors of childhood sexual abuse is outside your scope of practice, you should have a list of community services you can refer her to. These resources should be listed among other services, such as well-baby clinics, play groups etc., so that she is not taking something home specific to abuse if it is not safe for her to do so. She should also have an idea as to follow-up support. If she is put on a waiting list for services, what can she do in the meantime if she needs to talk? Can she connect with you; will you call in a few days, weeks? What are the local crisis line numbers? If she is in a remote area, provide a 1-800 number to a provincial or national support line.
Believe her and listen... this may be the only thing she needs to begin a path towards healing.
Remember, behaviour is the voice of the repressed or suppressed emotions... aggression or non-compliant behaviour can often be masking extreme fears and anxieties.
Remember that, as a survivor, there was a time in her life when her body was used against her will, without consent neither asked nor given. It is important that she be able to articulate her consent and decline touch when she is not feeling safe. As her care provider, it is your obligation to follow her lead and not pressure her into procedures that she is not absolutely comfortable with, or else you risk causing her further harm. She may feel safer if there is another person present during physical exams and be in a reclining position rather than lying down for pelvic/cervical assessments.
Woman who have survived abuse can have a difficult time trusting caregivers and may experience anxiety if they are exposed to changing hospital personnel throughout their labour and birth. Physical exams should be provided by the same nurse or doctor/midwife where possible and students kept to an absolute minimum.
Phases such as "good girl" are demeaning to a labouring woman and can remind her of a time when her abuser used this language. Also phrases such as "open your legs, feel me touch you, bend over, don't move, this will only hurt for a minute" may have sexually abusive connotations and can upset or trigger her.
During postpartum there are triggers associated with survivors having their breasts touched or exposed.
A survivor may feel that she will be unable to place her baby at her breast because of the physical and sometimes sexual feelings that a baby nursing can elicit. She will need your complete understanding, patience and problem-solving skills.
Provide her with alternatives, choices and suggestions for making these common concerns more comfortable for her. For instance, some women are able to nurse during the day but are unable to nurse at night. You could discuss with her ways to express her breast milk and bottle feed during the evening or ways to distract herself while nursing at night (watch television, keep the lights on).
The idea is not to portray an 'all or nothing' idea about breastfeeding but to be knowledgeable about all the ways in which one can combine breast- with bottle-feeding. Offering this information will optimize the possibility that she will feel empowered in whichever decision she makes around feeding her baby.
Some women are not comfortable cleaning their babies' genitals and may need some support around the difference between healthy touching and abusive touching. As she physically cares for her baby, a woman survivor may remember incidents of her abuse that she had repressed. She may feel shame, or fear that she may become abusive to her child. You can help by allowing her to express her fears and by normalizing her concerns.
www.asafepassage.info - About survivors of childhood sexual abuse: page 1 - page 2 - page 3