Childhood sexual abuse can play a key role as a risk factor for postpartum depression. Kathy Morelli takes a look at the impact of this horrible childhood event on a woman during her childbearing year. Today, in Part 1 – we learn how the brain actually undergoes changes as a result of the trauma experienced. On Thursday, Kathy Morelli will discuss how the woman who has experienced childhood sexual abuse (CSA) and what affect that has on her during the childbearing year,(pregnancy, birth and postpartum) along with information and tips for what childbirth educators can do. Join us on Thursday for Childhood Sexual Abuse as a Risk Factor for Postpartum Depression – Part 2. – Sharon Muza, Community Manager, Science & Sensibility.
Woman to Woman Support
As I’ve said in my previous articles about Perinatal Mental Health, Lamaze childbirth professionals are very often the first point of contact for pregnant and new mothers. You’re an important resource in your community about pregnancy and childbirth, so becoming educated about the signs of perinatal mood/anxiety disorders and having an awareness about the prevalence of childhood sexual abuse (12% -20% of women) is an important aspect of your knowledge base. This article is meant to:
- Increase awareness about the emotional aspects of surviving childhood sexual abuse (CSA)
- Present a broad overview about the research regarding CSA
- Present how CSA impacts a woman holistically, over her lifespan
- Present how CSA impacts a woman specifically during childbearing
- Discuss the complex recovery process from CSA
- Generate ideas about whom to add to your community resource and referral list
- Encourage being effective and supportive while preserving your own personal, certification and/or licensure boundaries
Remember, you may be the first person with whom she feels safe enough to discuss her personal history, even before her healthcare provider and sometimes even before her family. You can help out by being positively aware, being appropriately supportive and providing a list of contacts in the community and online.
Holistic View of a Woman’s Emotional History
Whenever a woman comes into my office for help for feelings of emotional and somatic distress during her pregnancy, childbirth experience and postpartum, I look at her life holistically, across her lifespan. I don’t assume, but I wonder, if she might be in that estimated 12% – 20% of women who have been sexually abused in their lifetime.
Is there a likelihood that past abuse affects how a woman feels about herself during pregnancy and childbirth and can be an underlying causative factor for antenatal depression or anxiety?
The research literature about the link between a woman’s past childhood sexual abuse and distress during pregnancy is scarce, but emergent research does show a connection.
How does a history of childhood sexual abuse (CSA) intersect with postpartum depression? This is a complicated question, but I’ll try to list some influential factors.
The HPA Axis is Modified: Fear and panic of CSA alters internal stress response
In general, research shows us that people who suffered from childhood sexual abuse (CSA) have a higher incidence of emotional, psychological and social distress, in addition to post-traumatic and physical, or somatic, symptoms. Specifically, research shows us that adult survivors of CSA suffer from higher rates of diabetes and cardiovascular symptoms (Plaza et al, 2010).
Women who have suffered past childhood sexual abuse suffer more unexplained gynecological symptoms, such as recurrent pelvic pain and more painful periods and sexual dysfunction than women who don’t have a traumatic sexual history (Lev-Weisel, Daphna- Tekoah, and Hallak, 2009). The stress and fear from childhood abuse manifests later on in adult life on all levels: body, mind and spirit.
What are some of the physical processes underlying this distress on the body and mind levels?
Researchers believe that long-term negative emotions, such as fear, panic and pain, cause an over-activation of the neural pathways in the brain associated with these strong emotions. The internal production of neurotransmitters, which affect mood, is affected. So chronic emotional stress impacts brain health.
The brain communicates with the pituitary and adrenal glands via the feedback loop called the Hypothalamus-Pituitary-Adrenal Cortex Axis (HPA Axis). The pituitary and adrenal glands are responsible for hormone production, which, in turn, affects the brain and our emotional state (Plaza et al, 2010).
During long-term childhood sexual abuse, the HPA Axis is continually activated and, with overactivation, the stress response becomes chronic, persisting throughout a lifetime. Thus, the chronic over-activation of the fear and pain response underlies anxiety disorders and chronic pain syndromes across the lifespan (Plaza et al, 2010).
During pregnancy and postpartum, hormonal changes are very dramatic, so there’s an additional adjustment for the mind and body to cope with. Thus, the hormonal changes during pregnancy also impact brain health via the pituitary and adrenal glands feedback loop.
Brain Development is Modified: Fear and panic of CSA can inhibit encoding of memories
Research shows that chronic fear and stress in childhood can actually inhibit the growth of some brain structures. In fact, some parts of the brain, such as the hippocampus, which is in charge of memory, are smaller in CSA survivors than people who were not abused in childhood. So, recollection of childhood memories is impaired.
In addition, brain imaging shows brain development is hindered in that there are less robust connections between the emotional part of the brain and the upper part of the brain (Plaza et al, 2010).
How do these underlying biological changes affect a person’s emotional health?
Survivors of childhood sexual abuse survivors are known to suffer from post-traumatic stress disorder, which has a constellation of symptoms on many levels: depression, anxiety, panic attacks, somatic pain, flashbacks and dissociative episodes.
Events that occured long ago in a woman’s life can still play a large role in her mental and physical health when she is pregnant, birthing and in the postpartum period. Join us on Thursday for Childhood Sexual Abuse as a Risk Factor for Postpartum Depression- Part 2: The Childbirth Educator’s Role.- SM
Beck, C. Driscoll, J., and S. Watson (2013). Traumatic childbirth. New York: Routledge Press.
Lev-Weisel, R., Daphna- Tekoah, S., Hallak, M. (2009). Childhood sexual abuse as a predictor of birth-related posttraumatic stress and postpartum posttraumatic stress. Child Abuse and Neglect, 33, 877-887.
Perez-Fuentes, G., Olfson, M., Villegas, L., Morcillo, C., Wang, S. & Blanco, C., (2013). Prevalence and correlates of child sexual abuse: a national study. Comprehensive Psychiatry, 5(1), 16-27. http://www.ncbi.nlm.nih.gov/pubmed/22854279
Plaza, A., Garcia-Estave, L., Ascaso, C., Navarro, P, et al. (2010). Childhood sex-ual abuse and hypothalamus-pituitary-thyroid axis in postpartum major depression. Journal of Affective Disorders, 122, 159-163.
Sichel, D. & Driscoll, J. (2000).Women’s Moods. New York: Harper Paperbacka.
Yampolsky, L., Lev-Wiesel, R., & Ben-Zion, I. Z. (2010). Child sexual abuse: is it a risk factor for pregnancy?. Journal of Advanced Nursing, 66(9), 2025-2037. doi:10.1111/j.1365-2648.2010.05387.x