Supporting survivors of sexual abuse to give birth

I took part in a study day for midwives recently and each of the speakers gave a different statistic for just how many of us in the UK were abused or assaulted in childhood. Some said 1 in 5, some 1 in 4, some 1 in 3. It seems, the data around this is so difficult to accurately collate because of a culture of silence, secrecy and shame. It's fraught with problems, because our abusers are often people close to us, and disclosing their behaviour can have a ripple effect, causing the fabric of a family, friend group, community or neighbourhood to rupture. So the subject stays underground - and what was a childhood secret can in turn, become an adult one.

I'm still surprised and shocked when I find out when some of my female friends and peers have been victims of abuse, because perhaps they seem so confident, vivacious, outgoing, bubby and full of life. Traditionally, you might expect the abused to be agoraphobic, timid, nervous, or show some visible signs of their experiences. It just goes to show that us survivors have developed different strategies to cope with our trauma.

It's taken me a long time to feel comfortable about sharing my own status as a survivor of childhood sexual abuse, but the time has passed where I feel the benefits of staying silent outweigh the benefits of helping others by being more open about this.

So how can a doula help someone giving birth, who is a survivor to feel more confident and safe?

What surprises me is how often people are completely unaware of their right to have more agency over their body and decisions. "First do no harm" and "No decision about me, without me" are the most important tennets of good care that we explore in my Go With The Flow Holistic Birth Preparation course and which any doula worth her salt will also teach. Many birthing people are unaware that vaginal examinations are considered by a growing body of midwives and obstetricians to do very little good, and can in fact be harmful. They may not be presented as optional, so one wouldn't always know that they can say 'No'. These can be particularly triggering for survivors of abuse, yet people rarely know that they don't have to consent to them if they don't want to. If a client of mine states that they do want vaginal examinations, I let them know that they can ask for a female to examine them if they don't want a male to do this, or a different female, or if the abuse was committed by a woman, that they can request that a male examines them.

I've found that birthing folk tend to have a more private and less intrusive experience when choosing a home birth, since there will generally only ever be one or two midwives in the space at home. But this may not be everyone's ideal choice. If having your baby in hospital, a doula can help you to put a birthplan in place that helps you to feel more in control, no matter how things are unfolding. It might list or identify some triggers that are a big deal for you. A doula can gently remind staff to refer back to the birthplan if they do not seem to have grasped something that will put you in a spin and cause your body to 'shut down' and go into "flight or fight" mode - which can disrupt your birth hormones to flow smoothly. As a guardian of the space, a doula can quietly be available within whispering distance if you need to disclose anything that's triggering you unexpectedly, or causing you pain or upset. A doula can soothe you while midwives are busy taking down notes on their ipads - a job which seems to take up more and more of their time these days, or when they are out of the room altogether.

Some birthing people may not have disclosed an earlier traumatic sexual experience to their partner, and may not want to now. Having a doula by your side who knows about your experience can be a major source of comfort. Someone who sees you and can be a witness and can use a carefully placed word here or there provide softness and calm in the face of what might seem to others as odd behaviour in the birth room, but will make perfect sense to the doula.

In some scenarios, a person who has been abused may go even further and choose to freebirth. I was one such woman. Given the option of going to hospital to give birth to my fifth child and risk being manhandled, or give birth at home without NHS midwives supporting me, I chose to give birth at home anyway. The only reason I chose a freebirth was because the homebirth service had been removed. Ordinarily I would never choose this.

Worryingly, I'm hearing about patchy and very unreliable homebirth provision being given to birthgivers across the region. Particularly at one hospital in Norfolk, which shall remain unnamed, where half the time when one phones for a homebirth, they are told that that a midwife isn't available and they will have to come in to have their baby. What staff perhaps cannot appreciate, is just how upsetting this might be to a survivor, who has spent their whole adult life trying to recover and create a sense of safety in their daily lives and routines, and how re-traumatising it can be to be told you have to go in and be seen by a team of unknown staff, who can walk into your room with just a few seconds notice by way of a knock on the door.

Being in a busy ward is scenario in which a person giving birth can quickly feel outnumbered, and that their voice holds little sway over the team of (well meaning and probably individually lovely) people surrounding them - in uniforms no less. These people's involvement is also more likely given the cascade of interventions that are statistically more likely to occur whenever you set foot in a hospital to give birth. As the cascade rolls along and further and further interventions are needed, a person's voice can start to feel smaller and smaller. This is where a doula can really help.

Coming back to homebirths for a moment - the situation of peek-a-boo homebirth services really is unacceptable, and this is where having a doula on the end of the phone can help you to plead your case and assert your rights so you do not have to fight yourself whilst in labour - she can also act as both a witness to their neglect in coming out to you and a reminder of their moral duty. 

Whatever setting you choose to have your baby in, having a doula by your side who is employed by you and answers only to you, is a good way to ensure your wishes and needs are truly understood by someone you have built up a relationship with over several months, and someone who is invested in seeing you thrive no matter how shitty the environment or situation is that you find yourself in. My role as a doula is to help the magic, love and laughter to flow even if things are going seriously tits up. Because at the end of the day, although we can't fully control birth, we can control who gets to come along for the ride with us. A doula helps your team to be stronger no matter how and where you have your baby. 

She will help you to not only survive.... but her goal is to see you positively, actively, thrive.