I have started writing a book on creating a safe space for pregnant, labouring and birthing women who have been sexually abused.
I don’t claim to be an expert on this very sensitive subject matter. Nor do I claim to have covered every aspect of it in this book.
For a very comprehensive and thorough analysis on this subject matter please read When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse in Childbearing Women by Penny Simkin and Phyllis Klaus.
I am putting this book for numerous reasons. I am putting this book together because I live in a country where women are more likely to be raped than literate. A country where, according to the Medical Reasearch Council, one in three girls under the age of 18 has been sexually abused.The MRC’s study also states that by 2009, 40% of all victims who reported rape to the police were under 18 and 15% were under 12 years old.I am putting this book together because of my own personal experience. I am putting this book together because abuse is so prevalent in our birthing facilities. I am putting this book together because I see what a difference knowledge, skills and the correct language can make. I am putting this book together because of my mother. I am putting this book together for all the women out there who have, or will still some day, give birth.
This book springs forth from a series of tutorials called Compassion tutorials started by midwife Robyn Sheldon. They are a series given to the 4th and 5th-year medical students at the University of Cape Town during their Obstetric and Gynaecology rotation. I teach these tutorials along with Robyn, Caitlyn Collins and Alexia van der Velde. We teach at Groote Schuur hospital, Mowbray Maternity hospital and New Somerset hospital. These tutorials were started to address the high incidents of abuse from caregivers towards women birthing in the labour wards.
With the 4th years, we focus primarily on the concept of compassion in the context of the labour ward. Often students are rather traumatised from attending births and how women are treated and this is very much the focus discussion amongst meditation, learning skills when attending women in labour and understanding better the emotional and psychological aspects of labour and birth. These tutorials are usually well received and have been deemed a success.
By the time the 5th years are in their gynaecology rotation, the students have hardened from their experiences, sometimes the Compassion tutorials fell a bit flat because they seemed not to deal with the real issues the students were faced with.
One day, I decided to tackle the subject of compassion from the perspective of working with women who had been sexually abused.
Something shifted.
The feedback was very positive from the students.
I have now been regularly speaking on the subject matter for the nearly two years.
Over and over again I hear the words, “I wish I had had this information sooner – it will certainly change the way I work with women in the future.”
That feedback is enough to make me want to spread this message far and wide.
I will touch on two aspects of what I share with them here today:
- I emphasise the prevalence of sexual abuse in South African society. As mentioned previously, 1 in 3 girls will have experienced some form of sexual coercion before the age of 18.
Let that sink in.
These statistics made me think that we needed some sort of sexual abuse universal precautions in place around working with pregnant and labouring women.
As caregivers, we ensure our own safety, by having universal precautions in place. We assume that all bodily fluids we come into contact with, may potentially carry some form of bloodborne pathogen. And therefore, we protect ourselves from them.
These statistics around sexual abuse made me think that we needed to have universal precautions in place for pregnant women also and almost assume that every pregnant woman who comes to see us, or who we care for in labour, may possibly have been sexually abused.
This is not to say that she should be treated as a victim, or assumptions made but that we need to be aware of the care we provide and the language we use, because we as caregivers during this time, could potentially be part of either the healing from or the perpetuating of, the abuse.
This leads me on to the next thing.
2. Possible triggers in labour and birth
- Sometimes sexual abuse memories can be triggered by the uncontrollable sensations of labour and could be linked to previous experiences of sexual abuse in the same parts of the body.
- The lack of control over the process could also be a trigger.
- The sensation of the baby moving through the birth canal and vagina.
- How we touch a woman speaks volumes and we must always ask permission to touch, even touch that is meant to be caring and calming could be a trigger.
- The feeling of the baby on her chest. There is such an emphasis on the benefits of skin to skin contact immediately after birth and yet, all too often, I have seen, especially young teenage mothers, put their hands up, or have a very strong negative reaction when the baby is thrust onto their chests without permission. Waiting a few minutes until the mother is ready to receive her baby, will be a more gentle transition and less likely to trigger the mother if she has been previously sexually abused.
- Some birthing positions, especially lithotomy, with its accompanying feelings of disempowerment. Also, hands and knees, squatting and pulling a woman’s legs apart.
- The environment she is birthing in could also be a trigger.
- The lack of privacy.
- Lack of respect for her modesty.
- Being left alone.
- Vaginal exams.
- Any medical procedure, like being monitored or having blood taken.
- Being watched and questioned by strangers
- Language is a big one. Saying things like, ” Open your legs,” “Relax your bottom,” “This will only hurt a little,” and “Relax and it won’t hurt so much,” may make sense in the context of a labour ward but these words could also have been used by her abuser.
Remember, that many women do not remember that they have been abused. They may have been too young when it happened to remember, or they may have blocked out these memories.
Just because she does not remember having been abused, her body may.
