Kathy Morelli, perinatal mental health expert and S&S contributor is sharing information about the impact of childhood sexual abuse on women during the childbearing year. Tuesday, in Part 1, Kathy discussed the brain changes that can occur as a result of such abuse and today, Kathy shares the impact during the childbearing year and the role of the childbirth educator. - Sharon Muza, Community Manager, Science & Sensibility
How do these underlying biological changes affect a woman during the childbearing year?
Childhood sexual abuse (CSA) and a woman’s subsequent reproductive life, including menstruation, pregnancy, birth and ongoing sexuality, occur at different times, maybe even in different decades, in a woman’s life. Yet, in clinical practice and in the research, these issues are intertwined.
In general, the research indicates that women who experienced childhood sexual abuse have more emotional distress in pregnancy, which directly impacts their physical health, which then impacts their pregnancy and leads to more medical interventions (Lev-Weisel, Daphna- Tekoah, and Hallak, 2009).
The somatic, body-based feelings in pregnancy can be re-triggering to a woman who has deep, non-verbal somatic memories of childhood sexual abuse. It’s important that women receive sensitive reproductive care, both physically and emotionally. An unaccepting attitude from her healthcare providers can trigger deeply held feelings of helplessness, fear, low self-worth and shame and actual flashbacks, symptoms of post-traumatic stress disorder (Lev-Weisel, Daphna- Tekoah, and Hallak, 2009).
The obvious sexual themes resonate on multiple levels: body-based, emotional and psychological. Yet, there hasn’t been lot of research about how a history of childhood sexual abuse impacts a woman’s mental health during pregnancy and postpartum. However, what research exists, finds that women who suffered from childhood sexual abuse have an elevated risk of postpartum depression (Lev-Weisel, Daphna- Tekoah, and Hallak, 2009).
There are a lot of body-based feelings in pregnancy that could be re-triggering to a woman who has deep, non-verbal somatic memories of childhood sexual abuse, even if she is being treated with respect and kindness in the present day.
Prenatally, simple things such as the position of a woman’s body as she lays on her to be checked vaginally can bring back non-verbal emotional memories of past abuse. The baby moving inside her body might cause intense joy, but might also create an underlying, non-verbal uneasiness.
Childbirth is an intense experience; a time of hormonal, physical and emotional exertion. Due to the pre-existing priming of early trauma memory networks – an intense distressful emotion, a particular scent, or a body position – can trigger flashbacks to earlier traumatic experiences. Feeling powerless, not heard, or disregarded by healthcare providers during childbirth, can activate the symptoms of post-traumatic stress disorder. Her present day feelings of powerlessness and fear are amplified by pre-existing traumatic memories (Beck, Driscoll & Watson, 2013).
Remember the disregard by the medical professionals may just be due to the rush of the medical team as they attend professionally to a medical emergency. The medical protocol doesn’t have a person assigned to talking and listening to the mother during the event, so she feels disregarded (Beck, Driscoll & Watson, 2013).
However, even if she is being treated in a kind way, your client’s body positioning or a scent can recollect something from her past trauma. In an uncanny and timeless way, her body and mind remember the past and take her back to feelings of fear and helplessness. She may wordlessly freeze or panic, for what seems to be no present day reason.
Postpartum, there are physical, emotional and psychological factors feeding emotional health. As has been noted over and over again, a pre-existing personal depressive or anxiety disorder (PTSD is in the spectrum of anxiety disorders) will set up the body up for another episode postpartum. Drs. Deborah Sichel and Jeanne Driscoll (2000) say the brain chemistry “remembers” its previous old depressive pathway and finds its way back there. Plus, there’s a major swing in hormonal activity in your body as you adjust from high levels of pregnancy and birth hormones to pre-pregnancy levels. This adjustment is different for all women, depending on whether or not they are breastfeeding and on their individual differences in metabolism and individual sensitivity level to their own hormonal shifts (Sichel and Driscoll, 2000).
For new parents who grew up in an abusive home, there’s the added challenge of the emotional and psychological work required to examine and modify negative repetitive childhood patterns. It’s not an easy task for your client as she evaluates her past behavioral, emotional and psychological patterns and replaces them with new and more positive patterns about family life and parenting. This adds another level of complexity to parenting a newborn, itself a major lifestyle adjustment.
Adjusting to a new lifestyle with an infant and baby care is physically and emotionally challenging. Feelings of frustration emerge as your client adjusts her schedule yet again to accommodate her baby plus the endless touching and carrying may leave her feeling like her body isn’t her own anymore. Breastfeeding may feel triggering to some women if it invokes past experiences.
A Childbirth Educator Can Help
Childbirth educators can play a key role in helping a woman who has survived childhood sexual abuse to proactively manager her experience of pregnancy, birth and postpartum.The good news is that, even with all these challenges, it’s important to realize that your client’s childhood sexual abusive does NOT define her. There are many aspects of the self that compose her constellation of self-definition.
The human mind and body are plastic, so the past isn’t destiny. Remember to factor in the resiliency of human nature. With patience and perseverance, human beings can move beyond survivorship, learn to bloom and move into the “thriving” phase.
However, learning to thrive is not an easy task. There are no “five steps” here! Managing the effects of an abusive childhood is an ongoing, deeply personal experience. It’s honorable life work, and highly individualized. As your client moves along her healing path, she’ll choose what feels right for her.
She can work positively on herself and experience post-traumatic growth. Post-traumatic growth is inner growth through personal development. It’s possible for her to experience this growth arising from her painful experience, with her own inner work.
Below are some positive ideas you may want to keep in mind as you teach your childbirth education curriculum to a diverse set of families. Your raised consciousness will help create an inclusive space for women survivors CSA to enhance her experience of pregnancy, birth and postpartum.
Be sensitive to the emotional aspects of working with someone recovering from CSA.
Help her honor the importance of pregnancy, childbirth and motherhood
- Encourage women to honor their experience of childbirth as the important developmental life passage it is. CSA survivors may tend to dissociate and dismiss their experiences
- Encourage women to interview some providers. Have a list of referrals of gynecologists/obstetricians/midwives that you know are open to and sensitive to working with women recovering from CSA
- Encourage women to give themselves the respect of investigating the hospital or birth center where her provider practices
- Allow women to have the freedom to have a personally honorable birth experience, in any manner that birth happens
- Allow women to feel that they are not less of a woman or a mother, however the birth experience happens. Each woman gets to choose her path in childbirth. Not other people or the unseen, but felt, social pressures.
- People heal individually at their own pace.
- Don’t pressure women to use her childbirth experience as a healing ritual. Childbirth is a life-changing experience, and each woman gets to choose how to experience this. If she wants to explore the idea of birth as healing, encourage her to be open to many options. But birth is unpredictable, don’t put this out there as the only way to define healing. There are many paths to healing.
- Help her by doing what you’re best at: demystify childbirth while accepting her choices. Don’t impose your personal agenda about what is right and wrong for her birth experience
- If she has alot of anxiety about childbirth, honor her by encouraging her to put in the emotional work with a mental health professional. Childbirth education, while important, may not be enough to manage anxiety, depression and post-traumatic stress symptoms. Prenatal fear of childbirth increases the likelihood of postpartum depression.
- Encourage her to develop a daily, holistic relaxation practice to counteract the effects of stress imbalance
Discuss postpartum planning in your curriculum
- Have a babymoon/postpartum plan in place
- Encourage women to practice self-love by allowing time to rest
- Encourage women to gentle with themselves – pregnancy and childbirth puts body and mind through a lot of hormonal changes!
- Educate her about hormonal changes. Hormonal balance takes at least three months to come back to pre-pregnancy levels. The hormonal adjustments are individualized; it also depends on if the mother is breastfeeding or not.
- Educate women to protect her fourth trimester, and help her body shift to-wards balance:
- Rest; develop the mindset of being, not doing
- Practice good nutrition with whole foods and good supplements
- Get help: If she can afford it, time with a postpartum doula or a baby nurse will help her achieve balance and rest
- Don’t underestimate the power of sleep; discuss sleep planning
- Practice mindfulness and relaxation to counteract the inevitable chal-lenges of caring for a new born and the emotional change of identity in motherhood
- Complementary care is nurturing, safe touch helps rebalance the body and mind
- Social support is important. Have resources available. Women who “Tend and Befriend” in real life and online help mothers feel supported, Women and birth circles are important resources.
- Expect emotional ups and downs
- De-stigmatize professional help; there’s a lot of professional help available. If she feels very sad or anxious, it’s ok to seek help.
As a childbirth professional, you can positively affect your clients and their families. Know that childhood sexual abuse, though prevalent, doesn’t define people, they can work through it to experience positive personal growth, through resilience and post-traumatic growth.
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