I'll be discussing sexual trauma and how it can impact pregnancy, birth and the postpartum, so consider your own needs as you're reading this.
On my intake forms, and when I do a midwifery health history interview, I always ask about whether my clients have experienced abuse, or if they were ever touched in a sexual way without their consent. There is also a question about the age of first intercourse. You are free not to answer questions, if that feels right to you. That said, I want to take a moment to share how knowing people's histories impacts the way I care for them.
What you disclose is entirely up to you. It could be as simple as acknowledging sexual abuse in childhood, or having left a relationship because of abuse, and saying that you'd rather not go into any more detail. That's totally fine. What you tell me is completely confidential, including from your current partner if you prefer. If there is information you would prefer to discuss one-on-one, please let me know.
On your medical chart--unless you tell me not to--I would write, for example, "client has a history of sexual trauma in childhood". The reason for this is that if you were to transfer from midwifery care to a hospital, there is value in your provider having that information (I would also, with your permission, inform your doctor or midwife because I want you to have care that is sensitive to your needs). What I want to get across here, however, is that I respect your information.
I also value the information because it helps me to serve you. Pregnancy, birth and the postpartum bring up all the feels because they touch on so many aspects of family dynamics, responsibility and care for a tiny helpless person, being in the body, issues around control and vulnerability, and lots of physical sensation in the lower abdomen, vagina, and breasts, to name some of the big ones. This can be triggering, and knowing that it's triggering helps me to tailor my support to ensure that you have what you need to feel safe and respected.
If I can offer anything to you, it's that I invite you to show up with all of your history and life experiences. I do not assume that I have more power or authority over your body and your health than you do (and I reject health care models that concentrate power in the hands of a provider). I always want you to feel comfortable in making your own decisions, because ultimately you know what's best for you and for your family. The way I see it, you've hired me to help you feel safe (whether you have a trauma history or not) and to make empowered decisions.
I can help a client move through their pregnancy.
It's not unusual for people with a trauma history to feel overwhelmed in pregnancy, whether it was planned or unplanned. You might feel uncomfortable with tests and procedures; I can help you to understand what they're for and whether you feel like they're right for you. You might feel uncomfortable about weight gain or your body changing shape. However, pregnancy can also be incredibly empowering and an experience of the body as being whole and generative.
I can help a client prepare for labor.
You may be uncertain as to how to cope with the experience of labor. It might be scary to feel like you don't have control over your body. Labor becomes progressively more intense, and the sensations can be triggering.
Knowing that you have a history of sexual assault informs how I touch your body. I always ask permission, including for routine and repetitive actions (like listening to the baby's heartbeat in labor). I don't routinely offer vaginal exams, but if I suggest it, you could decline it. If you wanted an exam, I remind you that you’re in contrl and can end it at any point.
You might have phrases that are particularly triggering that you'd like the birth team not to use. You might have phrases that we could say that would make you feel safe. You might want to be reminded that your body is doing what it was made to do. You might want us to remind you that it's okay to express yourself.
You might want to discuss ways that you can feel safe if a transport for medical care were required. What would help you feel grounded if you needed surgery? What would help you feel connected to your support team if there were people you didn't know who had to be involved in your birth?
And one final word: trauma shows up. Not always in the same way, not always in a big way, and not always in a way that points directly to a history of trauma. However, I've been to quite a few births where undisclosed trauma manifested in how the birth played out and how the parent experienced their labor and birth. Sometimes it's appropriate to acknowledge it in labor, but even if I didn't, I would offer that person trauma-informed care.
I can help a client prepare for their postpartum.
You might not want to breastfeed. No judgment. You might need extra postpartum support. You might need techniques for remaining calm with an upset baby. You might just need me to know what's coming up. I might help you plan by having a postpartum doula in place, or a therapist, or thinking about strategies to get donor milk for your baby, or whatever would help you to feel supported so that you can step into being a parent.
I can help people through wellness care.
As above, knowing that you have a trauma history informs how I touch your body, and I want to find ways for you to feel more in control of any procedures. For a pap, for example, I would invite you to insert the speculum yourself. We go as slow as you need, on your own terms. I want to always approach bodies with respect and consent, regardless of someone's experiences, but when I know that touch is a trigger then I am going to be especially sensitive to what you need.
I can connect people with resources.
Maybe you already have resources, and maybe you're not interested, but if you are, I can refer you to therapists, trauma informed yoga programs, groups, and other possibilities.
What about current situations of abuse?
I want you to know that I can hold space for all the things that can come up in pregnancy, including current experiences of intimate partner violence and sexual assault. My role is to listen. Please contact me to schedule a time when we can speak solo to discuss ways that I can support you or connect you with resources <3
Recommended reading:
When Survivors Give Birth, Penny Simkin & Phyllis Klaus
Survivor Moms: Women's Stories of Birthing, Mothering and Healing After Sexual Abuse, Mickey Sperlich & Julia Seng
More resources on my pregnancy and trauma Pinterest board here
