Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood
It’s not horrible at all. You should have whatever type of birth you think you’d be most comfortable with. The combination of giving your body up to another human during pregnancy, being touched in a clinical manner in the same areas the abuse likely took place, and potentially feeling a loss of control in medical settings can equal a birth experience ripe with triggers and anxiety. It can also bring up fear of receiving treatment from a male doctor, nurse, or ultrasound tech. It’s a complex path to navigate.
Adding to this complexity is the lack of energy many women have for managing their anxiety during pregnancy and childbirth. Because the coping skills developed after surviving sexual trauma often require significant strength to implement, the energy that pregnancy and childbirth siphon away can leave a woman feeling vulnerable to triggers and all the resulting emotions and physical responses. One survivor I worked with said pregnancy made her feel like she was on an out-of-control rollercoaster of joy, fear, sadness, excitement, anxiety, and anger — until she took the steps listed below.
What to do
Take it one step at a time. Even women who haven’t experienced sexual trauma can find pregnancy and childbirth overwhelming. When you’re
managing the added weight of being a survivor, the process can feel defeating. But if you focus on one empowered action at a time, you can navigate your way to a space of calm and trust that can carry you through a positive birth experience. Here are some ideas to get you started:
Rest. This is always important, but it’s especially so when navigating the added anxiety of past sexual trauma.
Find a care provider you trust implicitly, then share your story. After you’ve interviewed various care providers and have found one who makes you feel safe, tell them whatever aspects of your story you’re comfortable sharing. (It may take many visits before you trust them enough to share this information.) They should then offer clear ideas on how they’ll adapt their care to honor your needs. They should also be open to hearing how you want to be cared for. It’s important that this feel like a collaborative relationship, and not one where they’re the authority figure and you’re the passive recipient of what they deem “right” for your body. They should involve you in every decision, continually reassuring you that you’re in the position of control — they’re just there for guidance and to provide the support you deem necessary. If they don’t make you feel this way, I urge you to find a new care provider.
Request female care providers. If you think being touched by men will trigger you, add to your birth preferences that you would like to be cared for only by women, and discuss this preference with your primary care provider. While this might not always be possible (for example, there might only be a male anesthesiologist available if you’re getting an epidural), identifying this preference gives you a better chance of creating an environment that facilitates optimal comfort.
Ask for comprehensive communication from care providers. Survivors I’ve supported felt anxious during prenatal visits and childbirth because they never knew when they would be touched. Some were so uncomfortable with surprise touch that they dissociated from their bodies and felt unconnected to their pregnancy and birth experiences. You can prevent this by telling all your care providers (e.g., doctor or midwife, ultrasound techs, nurses, assistant midwives, etc.) that you need them to inform you before touching you, and to fully explain what they’re doing and why.
Speak up when you feel uncomfortable. Even when you make it clear you want thorough communication about required touch and you want that touch to be gentle, you might still get a care provider who isn’t respectful of your requests. If that happens, don’t be afraid to speak up, and if possible, ask for a different care provider.
You might also have the experience of someone fully honoring your needs, yet still making you feel uncomfortable. If this happens, you have every right to ask them to cease touching you until you feel comfortable resuming.
Make it clear that it’s imperative you don’t lose your voice during the birth experience. I’ve attended the births of survivors who had care providers who made them feel safe…until labor and delivery. These care providers assured the women that they wouldn’t be pressured into decisions they weren’t comfortable with and they would be treated with the same level of respect they’d received during pregnancy. But then labor began, and the promises dissolved. This resulted in the women feeling like they were no longer in control of their birth — like they were being silenced. This doesn’t have to happen to you. See “Essential Tips for the Journey” on page xx for more information on how to maintain your voice during birth.
The importance of speaking up throughout childbirth is reinforced by an article published in BMC Pregnancy Childbirth that found (not surprisingly) that the most effective guide on how to support a survivor of sexual abuse through childbirth is the birthing woman herself.
Ask yourself whether a vaginal or a cesarean birth seems more triggering. Ask your care provider or childbirth preparation educator to walk you through what you can typically expect during a vaginal and a cesarean birth. As you hear about the components of each experience, take note of what raises your red flags. For example, I worked with a survivor who didn’t like the idea of having an oxygen mask on her face during a C-section, while another was terrified of the idea of a vaginal tear. While it’s impossible to know exactly how you’ll handle a vaginal or cesarean birth, this mental mapping can help you determine what type of birth could be best for your unique needs.
Consider hiring a doula. Regardless of the type of birth you select, a doula provides an additional layer of support that can soothe many of your fears and anxieties before, during, and after birth. If you’d like a doula, do as you did with care providers and interview many candidates until you find one you trust enough to share your story with. From there, be clear about the type of support you want, and what you anticipate being difficult. For example, if you’ve selected a C-section but are nervous about feeling out of control while under the influence of opioids, brainstorm ways your doula can create a safe container for you.
Think about the birth positions that might trigger you. Certain positions can bring up memories of abuse, which is why it’s important to learn the most common birth positions, and let your care providers know if there are any you do not want to be in.
Think about phrases that might trigger you. Much like the birth positions, there might be phrases you associate with abuse. For example, if phrases like “Just relax” or “Don’t worry, it will be over soon” have negative connotations for you, tell your care providers not to use them, and add these requests to your birth preferences.
Read Penny Simkin’s book When Survivors Give Birth. This extraordinary book dives into the complexities of giving birth while managing the PTSD caused by sexual trauma.
Select a childbirth preparation class that provides tools for managing fear and anxiety. While many classes provide excellent tools for pain relief, few go deep into how to manage the fear and anxiety that can arise during the journey to and through childbirth. In my biased opinion, the HypnoBirthing and Birthing from Within modalities provide the most effective techniques for this emotional support. You can supplement these classes with my online course on Udemy, “Childbirth Preparation: A Complete Guide for Pregnant Women,” which provides over fifteen relaxation recordings and an entire section on fear release. It can be found here: http://www.udemy.com/course/ childbirth-preparation-a-complete-guide-for-pregnant-women.
Create a list of your go-to relaxation tools. If you’re triggered during birth, it will be helpful to have a list of calming techniques. To create this list, practice the techniques offered in your childbirth preparation class, and note which ones are most effective. Provide this list to your birth companions, and explain how they can lead you through the techniques.
Help your birth companions pull you out of dissociation. Dissociation — feeling disconnected from your body and the here and now — is something many survivors experience. It’s a common coping mechanism, and it could occur during birth if you’re retraumatized. However, your birth companions can pull you out of it with a few simple techniques.
First, it’s important for your birth companions to understand the signals of dissociation. For example, your eyes might “glaze over,” or you could start moving or responding in a spaced-out manner. Essentially, you start to act really different — like you’ve checked out. Discuss this with your birth companions before birth, and ask the person you feel safest with to do the following if they think you’ve dissociated:
- Ask everyone to leave the room.
- Hold eye contact with you. If your eyes are closed, they can snap their fingers or say your name in a strong voice. They can then instruct you to open your eyes if you don’t open them during the initial prompts.
- Figure out a phrase you want them to use to help you acknowledge what’s happening. For example, they could say, “It seems like you went somewhere else for a while. You’re safe to come back to the room.”
- Once you seem to be coming back into your body, they can ask you where you are and what you’re doing. They can also ask you to explain what your five senses are experiencing.
- Finally, they can strengthen your connection to your body and the present moment by giving you an essential oil to smell, placing a cool compress on your forehead, or pressing their hands down on your shoulders.
Take heart that you could have a new relationship with your body after childbirth. While it’s not a given for all survivors, many report having a transformed relationship with their body after birthing their baby. The experience might help you to see your body in a new light (it’s a vessel for new life!) and connect with it in ways that evoke feelings of pride, gentleness, and nurturing. Birth certainly won’t erase the atrocities you experienced, but the experience can allow you to have a fresh beginning with your body.
Note: If you feel that pregnancy and preparing for childbirth could bring up intense emotions and memories, consider working with a trauma therapist.