July 4, 2001
Volume 3, Issue 27
Midwifery Today E-News
“Caring for Sexually Abused Women”
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"It is our destiny to flower full and female in birth and in love; it is our calling to be powerful and free as women."

- Leilah McCracken

The Art of Midwifery

I birthed one of my children in a birthing center and the other at home. Both times the most invaluable thing that got me through was laughter. Either my husband or my midwife would make me laugh or giggle and it really helped keep the mood light. We all need to be reminded, especially during long labors, that laughter truly is the best medicine.

- Shelbi Cassel

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News Flashes

In 10 years at the Coombe hospital in Dublin, Ireland there were 15 cases of uterine rupture in 65,488 deliveries. Thirteen of the 15 were in women with a previous cesarean and 13 had had oxytocic drugs to induce or speed up labor.

- AIMS Journal, Vol. 9 No. 2 Summer 1997

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Helping Women with a History of Sexual Abuse

Q: I am currently supporting a close friend in the beginning stages of her first pregnancy. She has a history of severe childhood physical and sexual abuse and finds it very difficult to be touched, massaged, or otherwise physically cared for. This is totally understandable. However, I am having a hard time figuring out what to offer when the usual physical comforts provide no comfort. Midwives and doulas, do you have advice in terms of what I can try or other avenues to take?

- A.C.

A: Know that you are touching her with your eyes, with your presence, with your soothing voice. Sing to her. There are wonderful songs and labor chants that can help you light up her labor path with sound, direction and strength. Work with her prenatally to find out what places or images are the most soothing, or the most empowering to her personally, then do guided imagery during labor to take her to those safe, strong realms. Or have her identify one or a few pictures, paintings, photographs, drawings to use as focal points, then draw her attention to them while she labors. And always be ready with an outstretched hand, in case she wants to reach out and hang on to you.

- Karen Ehrlich, CPM, LM

A: I am a doula and a past sexual abuse sufferer. For me, birth itself was not as bad as one might think. If she allows touch keep it firm, not stroking movements. Sometimes just a hand on the shoulder or a massage on the head may work. Always ask her permission before you touch her. Verbal encouragement is absolutely necessary.

- Shannon

A: I loved being sung to during labor. Try reading scripture or some poetry during contractions. Try good relaxation videos from Moody Press (beautiful and majestic scenes with hymns and calm reading of verses from the Bible).

- Jennifer Crowley, CBE, aspiring midwife

A: Find someone experienced in gentle bodywork and trauma healing, such as aquatic bodywork if your friend is open to that idea. I am a survivor of sexual child abuse as well and I do aquatic bodywork with pregnant women. I am a mother of a 4-year-old boy. It is enormously helpful to dissolve the traumatic patterns before giving birth and aquatic bodywork is the most noninvasive and gentlest way if she comes to a point of allowing gentle touching.

There are some great exercises you can do with your friend that are playful and don't involve touch, like humming, sitting and rocking her body gently from side to side and back and forth and vice versa, singing according to Leboyer, etc. She can do some of the exercises also in a bathtub if she enjoys being in water (some survivors do not because that may have been the place where the abuse took place. She could do humming and Leboyer singing while taking a shower) or simple swimming and playing in water. I use a wide range of alternatives without any kind of physical but more energetic contact.

- Sabine Neumann
Aqua natale, Germany

A: The best gift you can give your friend is the support she needs to explore for herself what is most helpful and healing. You can be a safe haven for her to discover her own voice and her own strength, which is what she will need more than anything. Power was taken from her in her abuse. Let her find within herself what she needs to take it back.

- J.S.R.

A: Read "Pregnancy as Healing" (Vol I) by Gayle Peterson and Lewis Mehl to start your search. They suggest that by "walking through" or visualizing the desired birth, the mother will come closer to realizing her goals. Other techniques are explored in Peterson's books. I am fascinated by her creative approaches and encourage you to look into them to help your client achieve her desired birth experience.

- Luna

A: I have been a midwife for 11 years, and my husband and I also minister to wounded people. By simply going back to that time and allowing them to express bottled-up emotions, and working through all of the pain, that woman can work out all of the bottled-up aggression and fears she has. But by the grace of God, she can also forgive that person, and speak a blessing over them. It releases her from holding a judgment over that person, and it also heals her as well. So when she thinks about that situation or is reminded of the incident, she can have better peace with it. Yes, the person who did it is still guilty and is not free from judgment, but it releases her from the bondage of all the pain and emotions that keep her from receiving anything good from those who would not hurt her....

She is not having a reaction to your touch, but to those done inappropriately. Her body is having a memory connection. You must be careful to not do things that will cause her to want to crawl out of her skin either. The inner healing is the only way to really set her free.

I am speaking from experience, having been abused badly when I was younger. It was intense for me to release all the pain and emotions that were keeping me from openly loving others, even my family. But the freedom comes from the releasing the person who has made you a victim, and turned you into a victor!

- Chantel

A: There are plenty of nonphysical ways to support a pregnant friend and some ways to care for her body that don't involve body contact. For example:

  • Arrange for her to go swimming or soak in a pool (great especially late in pregnancy!).
  • Go for walks with her to help her stay in shape.
  • Help her learn good exercises to do in pregnancy.
  • Later in pregnancy, help her learn relaxation exercises (practice with her).
  • Help her find good maternity clothes. Together, this can be fun!
  • If she's having trouble with nausea, help her try ways to alleviate it (do the research, procure the ingredients/equipment).
  • Help her learn about the process of labor and birth so that it won't be so scary (very important for people with sexual abuse in their background)
  • She may be most comfortable with a midwife and natural childbirth since it involves much less intervention/touching by others (OBs, nurses, etc.). You could help her think this through.
  • Make time to listen to and talk with her about her fears, worries, concerns about pregnancy, labor and birth, and parenthood.

But even if none of this is useful, as a close friend you should be able to ask her what she wants or needs you to do to support her during her pregnancy and get an honest answer. Simply loving and caring about her is probably the most important thing you can do.

- Ellen Harris-Braun, AAHCC

A: I was raped when I was 12. In all the care I have received in health, and in my relationships this has been an issue. For me, ABSOLUTE CONTROL is important. I want no surprises. I do not want to feel like my trust or personhood is being violated. Ask before touching. If something has to be done, tell me what and why before starting; talk me through it. I had one practitioner who had me touch her the same way before touching me. This was the first person who examined me after the rape. She was wise enough to have another person enter the room, and because I was a nursing student she had them walk me though an exam of her. Although very unorthodox, it was probably the experience that helped me heal the most. If there are choices, tell me. Reassure me of your intentions. Once you start to touch me leave your hand there. Don't make sudden movements, disconnections, or progressions to areas not discussed.

- Anon

A: Many victims of childhood physical/sexual abuse have extreme difficulty being in situations where they feel they are not in control of physical contact that is occurring. Particularly for victims of sexual abuse, there is a connection between a "comforting rub" and subsequent abuse. You need to break this connection, otherwise there is no relaxation in the mother's mind associated with the touch made by you. Instead it evokes the opposite reaction: fear and apprehension.
Breaking this association is understandably a very difficult process. I would begin by reversing the roles and getting the mother to touch me. Ask her to massage my hand/foot/back, etc. In that way she is in complete control of the touching and she can stop whenever she chooses. To begin with it may help allow her to touch you through another object (such as a small wooden hand-held massager) rather than direct skin to skin contact. Use massage oils to work up to direct skin contact. Allow her to choose. When the mother is comfortable with this direction of touching, gradually introduce reciprocal touch--you will touch her while she is touching you. Finally she may progress to being comforted when you touch her alone.
Be open about the process and explain that the objective is for her to come to an understanding that she is the one in control, and you will always only ever touch her with her permission. The aim is for the mother to be comforted by and trust you - if she manages to derive this from your presence alone and never gets to comforting touches, so be it. Keep in mind that you are not responsible for her emotional recovery. Any progress she makes beyond this point is a bonus for you and her.

- Anon

A: I am a doula, mother of five and also a molestation survivor. I have also worked with women who have endured horrific abuse and had issues with touch. I think the most important thing is to help empower the woman to make decisions about her pregnancy, labor and delivery. Ask her what kinds of things feel good to her, what she would like to try. A foot massage is often a good place to start, then rubbing her shoulders, etc. Everything else will follow.

- Amy, doula, CBE, CBSP

A: At times just the sound of your voice can be helpful. I was just with a woman who wanted me to explain to her what her body was doing during each contraction. "The muscle cells are pulling together to open up your cervix. The hormones are relaxing ligaments so that your pelvis can open up and make room for the baby." This kind of talk may help her focus on the task at hand and steer clear of bad memories.

Is she open to visualization? Could she take a walk on the beach during contractions? Can she describe the scene to you? Perhaps it would give her a feeling of control if she were the one painting the picture--she could go where she wanted to. Lack of control is part of the fear that accompanies abuse. Does she believe that she is strong and able to birth this baby? Does she see the strength in her survival? Remind her of her tenacity and strength in daring to not only survive, but to LIVE life. Encourage her. Build on her strength. Look her in the eye and tell her that she can. There may be those moments when she needs someone to be strong for her, but she must also see her own strength.

Pray for her. Pray with her. Has she (or you) considered that this birth can be a redeeming experience, changing her entire perspective of who she is? There is no guarantee, but the potential is there. It's great that she is daring to even reach out for support. She must be a courageous woman. Remind her of that.

- Anon.

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Question of the Week

What is the cause of swollen legs post-delivery? One would think, were they swollen before hand? Could it be: preeclampsia, too much intravenous fluids, inactivity? This problem seems to be more in the ladies who have cesareans, forceps or ventouse, but I have seen it in normal births.

This time around a planned homebirth, mother had a two-day latent phase of labour and around 20 hours of active phase of labour. She managed to get to second stage but did not seem to have the energy to push baby out. After trying a number of things with no result, we transferred to hospital. The mother was given a litre of Hartmans IV to replace fluids and a mild mod ketones. While this did improve her powers of pushing it did not shift the baby (in a good position, and so far down I felt it would fall out with a good push).
Because there was no progress and four hours or so of second stage and a tired mom (babe fine), mom requested a ventouse, which was obliged. An episiotomy was done because the tissues were swollen and tight from pushing. Unfortunately a tear extended to the skin of the anus. Healing appears to be good while uncomfortable. She was only in hospital for four hours total and home two hours after birth. She is taking a variety of homeopathics and herbal remedies, on day four her legs have puffed up, every thing else appears to be fine, she is taking tissue salts, massage and acupuncture for sciatic pain.

- Terry, homebirth midwife

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International Connections

Please send me any research-based knowledge on the subject of the role of endorphins in natural childbirth. I am specifically looking forward to knowing about quantities of endorphins in relation to the natural pain-releasing techniques, in relation to weeks of gestation, ethnicity.

- Maria Papadopoulou
Reply directly to: mapapa@spidernet.com.cy

Dutch authorities make it extremely difficult for midwives from other countries to register and practice in the Netherlands. Even midwives from within the European Community are given a hard time when they try to register. So we--two Dutch midwives--have set up a website that offers information and help to foreign midwives trying to register in the Netherlands. This website also serves as a watchdog committee that gathers information to convince members of parliament that the present procedure is counterproductive. The website's URL: http://go.to/BIGproblems


INTERNATIONAL MIDWIVES, please direct your questions, comments, and needs to "International Connections." We're here to help you!

Are you interested in connecting with birth enthusiasts and midwives around the globe? Join IAM!
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My baby boy was born with a unilateral cleft lip and palate. Neither my husband nor I have a history of clefts in our families. It's my understanding that clefts form because of a combination of genetic and environmental factors. I know folic acid deficiency has been shown to contribute to the development of clefts. I was taking a prenatal vitamin for several months before conception, so I had ruled this out as a possibility. However, I was still nursing my 2-year-old daughter during the first trimester of my pregnancy, so perhaps that was using up my reserves as well. Should nursing mothers planning to get pregnant take a higher dose? In the Summer 2001 Midwifery Today, I read that women who have spina bifida or have had a child with it are advised to take 4000 micrograms of folic acid a day. Are there any risks for the average person taking this large a dose? Does anyone know of any such recommendations for prevention of clefts?

- Anon.

It seems more and more women with hormonal imbalances are helped by natural progesterone creams. I personally have had much help by simply taking wild yam. I have read that wild yam can prevent pregnancy and on the other hand some herb books say small amounts of it in early pregnancy can eliminate nausea. My books don't say how much is "small amounts."

Also, if a woman uses the creams before pregnancy, should she continue after conception? If she is not producing sufficient progesterone before pregnancy, will her body produce the elevated levels occurring with conception/pregnancy? Is it safe to continue using the creams, and how much is a safe level of wild yam? Will this possibly cause miscarriage?

- Elaine
Reply to: auntie-freeze@juno.com

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