Midwifery Today E-News, August 30, 2017 • Volume 19, Issue 18
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One in four girls will experience sexual abuse by the time she is sixteen, and 48 percent of all rapes involve a young woman under the age of eighteen. It’s not surprising then, that in a society where sexual abuse of young women is rampant, many women never share their stories. They remain hidden and invisible.”
―Patti Feuereisen, Invisible Girls: The Truth About Sexual Abuse—A Book for Teen Girls, Young Women and Everyone Who Cares About Them
Inside this issue:
- Conference Chatter: Supporting Survivors Session Offered at Finland Conference
- Sexual Abuse Q&A
- Website Highlight: Mount Laurel, New Jersey Conference
This issue is brought to you by:
- Jones & Bartlett: Electronic Fetal Heart Rate Monitoring
- Connecticut Institute For Communities: Job Opening
- Jones & Bartlett Learning: A Guide to Women’s Health
Learn how sexual abuse affects women during pregnancy and childbirth and what you can do to help.
Survivor Moms: Women’s Stories of Birthing, Mothering and Healing after Sexual Abuse was written to help break down the isolation pregnant women and their caregivers often feel—as though they were the only ones having to cope with these challenges. You’ll be able to read excerpts from 81 women’s stories of birthing, mothering and healing after childhood sexual abuse. The book also includes some complete narratives, discussion of implications of women’s experiences for their care, suggestions for working together during maternity care and beyond, resources to consult, and information from current research. Suitable for both caregivers and pregnant survivors, Survivor Moms will help anyone whose life has been touched by sexual abuse. Order your copy here.
Supporting Survivors Session Offered at Finland Conference
An important issue for birth practitioners to focus on in their continued efforts to provide the best care possible for women during the childbearing year is how to effectively and positively support sexual abuse survivors.
Midwifery Today has long made an active effort to provide birth workers with a variety of opportunities to increase their awareness, education and learning opportunities around sexual abuse and how it affects women in relation to pregnancy, birth and breastfeeding. Whether in our magazine through articles and book reviews, this issue of E-News, online articles on our website or at our national and international conferences, we will continue to place importance on providing you with resources on this important topic. We hope our efforts will help you increase your skills and knowledge in working with survivors so women have the opportunity to work with practitioners who are skilled in creating safe and supportive environments.
During our upcoming October conference in Helsinki, we are very pleased to offer a special opportunity addressing this subject during our roundtable session. Joy Horner, an experienced and well-respected midwife in the United Kingdom, will lead one of 12 roundtable sessions that offer a variety of topics relevant to the childbearing year and specifically geared for birth practitioners. Joy’s session, “Supporting Survivors throughout the Childbearing Year,” will focus on effectively supporting women who have experienced past trauma. Joy will draw on her years of experience and will offer participants not only her perspective, but specific techniques that she has found successful in her practice as both a midwife and an educator. This roundtable session will be offered on Saturday, October 7, 2017, from 4–6pm.
If you want to learn more about how to positively support sexual assault survivors, please join us in Helsinki! There is still time to register online here.
Join us in Finland this October!
Plan to attend our conference in Helsinki, Finland, 4–8 October 2017. “Trust, Intimacy and Love—The Chemistry of Connection” will offer over 40 different classes, including a full-day session on Midwifery Skills and two full-days on Rebozo Techniques and Practice. Hurry! The in-office pre-registration deadline is September 15! You will find more information here.
Photo by Lynsey Stone
Join us for a one-day conference on November 10!
Plan now to attend our Mini-Conference/Retreat in Troutdale, Oregon. Classes will include “Miraculous Beginnings” with Fernando Molina, “Understanding Preeclampsia” with Gail Hart and “When the Healer Is Healing, Too” with Maryl Smith. For the lowest price, be sure to register by Oct. 2. You’ll find more information here.
Photo by Shea Hardy Baker
New Edition of Parer, King, and Ikeda’s Essential Electronic Fetal Heart Rate Monitoring Resource
Electronic Fetal Heart Rate Monitoring: The 5-Tier System, Third Edition reviews the practice of fetal heart rate monitoring. Beginning with a description of the anatomy of fetal circulation, placental function as a respiratory organ, and acid-base balance, it also presents normal fetal cardiovascular and cerebral metabolism. Save 25% with coupon code EFHMT when you order online here.
Community Health Center Certified Midwife Wanted
Connecticut Institute For Communities, Inc. / Greater Danbury Community Health Center seeks full-time midwife, certified / licensed to practice in the State of Connecticut. Under the direction of the Chief of Women’s Health, this position is responsible for providing outpatient ambulatory Ob & Gyn care, including making appropriate referrals and follow ups. No deliveries. Bilingual candidates strongly encouraged to apply. Competitive compensation, plus comprehensive fringe benefits package including health care coverage and retirement program. Send resume and letter of interest to: Connecticut Institute For Communities, Inc. By Mail: Attn: HR Manager, 120 Main Street, 4th Floor, Danbury, CT 06810. By Fax to HRM at 203-743-3411. By Email: DaniseH@CT-Institute.org
Closing Date: Open Until Filled
Sexual Abuse Q&A
Have you found prior sexual abuse to affect pregnancy, birth or postpartum? If so how?
For some women it can be a healing experience that helps them reclaim their body. There are a lot of co-occurring issues that play a factor in that as well.
Yes! [I]t can be a healing experience, but many times a past abuse causes problems from communication style, decisions being made, people involved, place of birth, pp depression, breastfeeding—and the list goes on.
It took me years to realize that my postpartum depression had spiraled into PTSD. Now I am just completely focused on getting to a place where I can put all of my energy into postpartum care for other women. Thank God I have a patient husband [who] saw me through all the ups and downs of dealing with it and getting to the root. And the blessing and the testimony of the test is that now I can teach about conscious conception and conscious birth and the things that we need to clear out of our system and our nervous system before we conceive.
I’ve been a midwife for 39 years next month. The longer I live, the more I realize how much I don’t know about women and their cycles and their hormone balance or unbalance. Cell memory and how our bodies remember is quite amazing. I always think or say out loud “Baby, what are you telling me?” or “Body, what are you saying to me?
—Mary Cooper Mackenzie
All kinds of sexual abuse show in labor and delivery. If someone “sticks” at 6 cm, I often find sexual abuse is the call. [The same is true of] unproductive pushing, even if just a suggestion from the mom that it is going to hurt to let the baby out. So few women cop to sexual abuse even when asked in a private prenatal time. Once a woman was 10 cm for two hours, not pushing, not progressing. Everything was fine all the other ways and she simply could not bring herself to push the baby out. Midwives conferred and she was an honest-thinking woman, so we hit it head-on and said, “We think something happened to hurt you and your vagina that perhaps you can’t even remember. Please trust us and we will work on this with you. She said, “I remember; I’ve just never told anyone.” Baby moved down and out but it was very traumatic for them both .
As a birth psychologist, I always tend to work on this subject before birth … it may affect the labor. For instance, not letting the doctor do a vaginal check, fear of birthing or being scared to give birth to a girl who may be abused in the future. She can stop labor subconsciously … lots of trust issues.
Prior sexual abuse, particularly childhood sexual abuse, can cause women to be triggered during the childbearing year. Identifying potential triggers can be very useful in providing strategies to minimise risks of being triggered. Trauma release work, ideally, before pregnancy, is also very important. As can be imagined, childbirth has a huge potential to re-traumatise women. Ideally, all care providers should be sensitive and compassionate to all the women in their care, but we all know that this is simply not the case, particularly within obstetric settings. It’s even more important that survivors are treated compassionately and sensitively.
After completing the two study days with Penny Simkin, called “When Survivors Give Birth,” I agree that previous sexual abuse can greatly affect a birth experience. A majority of my independent midwifery caseload had suffered previous sexual abuse. This is why they chose a model of midwifery where they had continuity of midwife and had time to build a trusting relationship before the birth. I use Penny’s sheet of potential triggers to help my clients avoid unnecessarily stressful situations and come up with coping strategies ahead of the birth. When women disclose and are open to working through it, the births are on the whole positive and healing. I’ve also looked after women who’ve said that they’d never been abused but clamped their legs shut for the birth. One curled up in a fetal position and started rocking. Because not every woman will disclose, we need to treat every woman as if she has been abused, or we risk re-traumatising the woman we are trying to serve. The rate of abuse survivors is quite high, so we need to be aware of how it affects births, breastfeeding and relationships with caregivers.
As a doula, I always enquired about prior abuse. It became apparent as labour unfolded whether there was abuse or not. The fear was so pronounced.
This is something I definitely detect on a regular basis. It can seriously affect their belief in their ability to birth. My job is to direct them to a counselor if they ask, and to teach them how to make the birthing room more comfortable. I wish more women would talk to their care provider about their past experiences. If a midwife knows ahead of time, she can be more proactive about assisting the woman to birth confidently.
—Amy Vater Haas
As doulas we speak of this but, for the person who can’t put words to it or even remember, it all can come pouring out during labor. I always go with my gut and support her and give her power without ever saying XYZ happened didn’t it?
My personal experience with this was very healing. With my first birth, I felt empowered. I had a homebirth and was able to feel 100% in control of my choices, my body, my environment and who was allowed into my personal space. There was no pressure to be touched or examined because it was totally up to me. It was me alone who called the shots and it was life-changing. I’ve had four homebirths now and each one built my confidence and my self-esteem, and brought me closer and more in touch with my own body. I didn’t feel like it was a separate entity anymore. There was no disconnection anymore. Now when I speak to survivors gearing up for birth I try to focus on their ability to see the control they have and how they can get rid of the dissociation from their body and reconnect—physically, mentally, emotionally. It’s a very powerful time when handled correctly.
My mother was having flashbacks during my birth … she had PTSD from her experiences growing up, which included emotional, physical and sexual abuse.
I have seen this several times, including with someone who didn’t remember the abuse or even understand what she was recalling as she recalled moment by moment.
—Nicole Franklin Morales
Sometimes, yes. Sometimes immensely, but other times not at all. Best to be prepared for everything.
It can affect the ability to breastfeed or put baby to breast.
—Judy McClennen Schneider
They can get stuck at some point, certain actions may trigger issues, etc. I always open a discussion prenatally, make it safe. I ask about triggers and make notes to not do that action. I had one client who was open about her past and told us she might disconnect. She did, and we knew it was her coping mechanism and didn’t panic. She had a lovely birth and came back into herself afterward.
Once had a client who had been habitually sexually abused by her stepfather, so bad it caused her to have a multiple personality. The birth went pretty well except that her perineum would not stretch because of all the scar tissue. It was the only time I’ve ever even considered doing an episiotomy. But I waited and finally she ripped, the baby came out and she got a lot of stitches. I often wonder which would have been less traumatic for her: getting stitched or getting cut? I would love feedback on what others did with their survivors at birth.
For me, births were the door to my healing. I experienced on a cellular level, the ongoing childhood sexual abuse that I did not yet remember. As a birth worker, I did not know what to do with that, because I knew the terror I felt did not match the birth I had, although on the outside all was peaceful. (I had dissociated.) Next baby, I experienced it on the outside and everyone there saw and heard my 5-year-old [self]. Still no story to tie it to. Three years later the truth of my story began to be birthed. I believe it was able to come so freely because my midwife held me so safely in that space. She knew! Next baby was incredibly redemptive. No one touched me, and I birthed into my own hands. We are the “they.” It is our stories that often draw us to birth work or other healing arenas. As midwives, we have the privilege of holding “her-story” even if she cannot yet name it. That is truly holy ground.
When we did a conference on this subject many years ago, everyone was asked to anonymously write on a paper “yes” or “no” to whether they had suffered abuse. Out of 50 people only me and one other person wrote no. Of course, this was likely a very self-selected group who joined us in this conference. I believe it was something like 50% of midwives, doulas etc., had suffered it. Midwifery must be a healing process!
I set up a poll on All Doulas many years ago and found that 50% of the doulas had endured sexual abuse. I suspect:
1. The rates are much higher than the well-publicised 1 in 4.
2. There are spiritual forces out that target those with certain gifts and attack them in ways that might sabotage those gifts being realized.
3. Hurt women are drawn to healers. They are then healed and then inspired by the healers and wish to become like them.
The intensity of transition—the fullness in the pelvis and the surge of hormones—definitely brings a lot of drama if the woman is a survivor. Double the drama/trauma if she has not revealed her hurt to anyone in the room. There is always a “holding back” that we might mislabel as a stalling. They rarely “want” to push. I have more who did not self-identify, than those who did. (Due to the Amish culture—once the perpetrator is forgiven, it is never spoken of again.)
The past stories from the pelvis are a dominant factor in how we birth. I was with a dear woman having a waterbirth. Suddenly she wanted to get out of the water and was very agitated. A little forensic conversation recovered a memory when as a child she had pooed in the bath and was chastised by her parent. With that realization she got back into the water and pushed her baby out.
I was at a birth once of a mother and childhood abuse issues came up. I believe I unconsciously became her mother figure/perpetrator for the scenario, so I left the room as requested and played with a child in the backyard. So many things were going through my mind as I did and could hear laboring. But I also knew that it wasn’t about me and that not pushing back was the potential healing needed for that particular moment. I knew to wait until I could smoothly transition back into the space. Eventually I eased back. We transferred for an epidural which still wasn’t magic in this scenario. So many triggers. The nurse wondering why the doulas were in the corner across the room with the dear husband soon figured out she too had to stay clear and support from afar. The mother got her VBAC.
—Nicole Franklin Morales
When my midwife attempted to check for a cervical lip, my body wouldn’t let her in. I wasn’t present in my mind. She had to get my attention. She touched me (I think on my arm.) “Anna. It’s me.” I came back to my body. I saw it was her and not my then-husband who was right beside her and who had forced me open on many occasions. My body opened up, she moved the lip out of the way, and baby was born. I also had a code word between us for if I needed my family to leave and she’d ask them to go. She also knew not to use the word “relax.” It was the only birth where I truly felt that I had someone 100% in my court, providing exactly the care that I needed.
Yes; that’s why I got my midwifery license! I was working with women in recovery from substance abuse—they have these issues, often from childhood. A stranger standing over them, touching thighs, telling them to relax, triggers body memories of terror, making normal birth and bonding impossible! Midwifery care is the perfect solution; it worked for 18 years in my program and I wrote about it in A Midwife’s Tale of Hope and Help for Drug Addicted Pregnant Women.
I was doula at a homebirth. I got to know a client well during her pregnancy, and was aware of issues and trauma of sexual abuse. She went through labor so beautifully and gracefully up until pushing. Then she locked her legs together and insisted we transfer to the hospital so she could have a cesarean. We tried our best to help her, but after a little while had to respect her desire to go to the hospital. The OB on call told her she didn’t need surgery and that she could push baby out, but she absolutely refused.
My take is that there are so many ways women cope and integrate their trauma. I have had women who manifest through birth, during prenatals, before conception and even postpartum. Some have long births with stalls and others have quick births—possibly so they won’t relive the trauma. Sometimes confrontation is key and other times eyes locked with a whispered knowing. I myself have been molested and/or raped numerous times—from a young child to a postpartum woman. Mostly by people I thought I could trust. Once I was almost killed. It forms a whole different paradigm for you. This was during a time when it was always “the woman’s fault”—no matter what! I knew no one would believe me when my most traumatic experience was perpetrated by a well-respected cop. I’m thankful that I can see beyond the obvious at times because of it and understand and often know what to do or how to be for women because of it. I know I don’t have the answers for all but I can read the soul of the individual at times and they have at times fallen into my arms and wept.
They don’t always tell us, but we can reassure them they are safe. Quietly.
One of the questions I ask during the first prenatal, the history-taking, is the development of the mother’s sexuality. It is getting to the point where I am surprised when a woman tells me she has not been sexually abused. It is pandemic. Some women are going through therapy while pregnant to work through the trauma before the birth. Every little bit helps. Compassion and empathy on my part for mama and baby.
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A Concise and Easy-to-Use Quick Reference for Women’s Health
A Guide to Women’s Health, Second Edition is a practical and multidisciplinary text that enables students and clinicians to identify and treat conditions quickly and effectively. Completely updated and revised to reflect current research findings and diagnostic approaches, it explores the impact of culture, spirituality, and intimate partner violence on women’s health. Save 25% with coupon code GWHMT here.
The Mount Laurel, New Jersey conference program for April 18–22, 2018 is complete and registration is open!
Photo by Monet Moutrie
Read about occiput posterior position
Our newest e-book, Posterior, is a collection of 12 articles previously published by Midwifery Today magazine. You’ll be able to read helpful information from Diane Goslin, Gail Tully, Mary Cooper, Elizabeth Davis, Valerie El Halta and other midwives and moms. Get your copy on Amazon.
Are you ready for birth emergencies?
As a home or birth center midwife, you may rarely encounter emergencies, but when they do happen, you need to know what to do. Birth Emergency Skills Training: Manual for Out-of-Hospital Midwives gives you the information you need. It takes you from the initial steps of intervention though definitive care, balancing a friendly tone and visual appeal with authoritative and clinically useful information. This book belongs on the shelf of every practicing midwife. Order your copy.