Impact of #domesticviolence or sexual assault on #pregnancy

Refreshing as it is (well, kind of) to hear domestic violence and sexual assault talked about more frequently in the media today, there is an aspect of that violence that is long-lasting and sadly, seldom mentioned. That is how the violence of an assault can impact a woman during pregnancy.

Pregnant survivors of violence have more challenges during their childbearing years than non-survivors do. Those challenges not only depend on the kind of abuse that the woman suffered but also when the abuse happened. Let's look at two examples of how this might look-

• An adult survivor of childhood sexual abuse becomes pregnant and decides to keep the baby. She learns the baby is a boy. She starts finds herself repulsed by the baby. She cannot stop thinking about how she has been abused by men and begins fixating on how this future man might end up hurting her too. Although she originally wanted the baby, the idea of something growing inside her is beyond horrifying. She is ashamed to tell anyone of these feelings but starts (often unconsciously) to make decisions that reflect that disengagement like skipping her prenatal appointments and not talking about the pregnancy with anyone.
• A domestic violence survivor who was abused by much older men including her father is untrusting of anyone and has difficulty maintaining relationships. She becomes pregnant and finds herself at a ob/gyn practice where there are older male doctors. At her appointments, she is unable to advocate for herself and ask questions when it comes to routine care. Or perhaps the exact opposite: she is very high maintenance, demanding with a highly detailed birth plan, only to turn around and at the next appointment announce that she wants to schedule a csection. 

A background of abuse has a huge impact on how a pregnant survivor thinks about herself and how she sees/thinks about others. This is not something that can be disregarded, either by the pregnant survivor or practitioners, friends, or family who interact with her. 

One of the issues that I work on with Trauma Counseling survivor clients is identifying the core issue for their visit and developing supportive tools to help them as they move through their pregnancy with confidence. We also work together to talk about what she might expect as her pregnancy continues. An adult rape survivor, for example, might call not because she's having fear around a vaginal delivery, although she really wants to "go natural". 

Emotional and physical changes as well as socioeconomic issues can complicate how any pregnant woman copes on a regular basis. But all of those are compounded and amplified in scale for the pregnant survivor who is already less emotionally equipped to deal with her changing identity. 

This is the first in a series that will look at how abuse impacts a woman in her childbearing years. 

Thank you for reading.

{new post} #bookreview _Survivor Moms_

This Wednesday 10.29, I am hosting a Twitter Chat for #survivormoms from 8-9 pm EST. I'm a little nervous since it's my first one (will anyone show up?!) but I feel compelled to do it because not only is October domestic violence awareness month (DVAM) but because while DV in general has been so much in the news, how DV and sexual abuse affect childbearing women in pregnancy, childbirth and the postpartum period is not. So, a Twitter Chat and a book review of the landmark book, Survivor Moms by Mickey Sperlich and Julia Seng seems to be in order!

From what I have seen online and heard anecdotally, the survivor response to Survivor Moms is mixed,  Some survivors reading it have shared how triggering it was for them.  And I completely hear that. Sperlich and Seng’s work is very through. As a tool for professionals who deal with survivors, however, Survivor Moms is indispensable. {I'll share a bit about why below.} And if you are a survivor looking to understand a bit more about how your past abuse will affect you in pregnancy, childbirth and the postpartum period as a new mom, check out this book. There is literally nothing else like it. Just be aware that it may be triggering for you.

Survivor Moms begins at the beginning: before the survivor is even a mom. The authors look at the range of affects that trauma can have on the woman in adulthood (PTSD, substance abuse issues, disordered eating, etc.) leading up to pregnancy. The book ends with hope and tools for healing setting the stage of recovery as a “lifelong process” (208). That phrase along with many interspersed in this book really underscore the many valuable messages in this book which often come from primary sources, which makes the book all the more powerful. Recovery was a "lifelong process" is hard to accept, for many survivor moms. Survivor moms that I work with often speak of being angry or frustrated because they have "done the work" to put the abuse behind them, only to be re-triggered by their pregnancy, childbirth or breastfeeding. 

Survivor Moms is extremely well researched and offer up the voices of many survivors as testimonials to that research. Those stories are what truly make this book both accessible and unique. I appreciate that the book includes a broader look at sexual abuse in general and doesn't  doesn’t limit it’s scope to childhood. (Penny Simkin & Phyllis' Klaus fantastic book, When Survivors Give Birth, focuses exclusively on childhood sexual abuse, for example). 

What is missing in my mind, though, in Survivor Moms is the linkage to domestic violence or intimate partner violence. Not only would that be helpful for survivors to understand but for professionals as well. Sexual assault doesn’t happen in a vacuum;  it is part of the power and control dynamics of intimate partner violence.  Sexual abuse is planned and purposeful, unless it is perpetuated by a stranger. (Which is more rare). Threats, intimidation, scare tactics like harming beloved pets or siblings are hallmark indicators of intimate partner violence.  They are classic tools of control used by an abuser.  “Even” if those were the only tools used in a “relationship”, educators and advocates would still qualify that relationship as abusive. These scary pieces are often part of the survivor stories in Survivor Moms. Linking sexual abuse to the bigger picture of intimate partner violence feels essential.

That said, I think Survivor Moms is a hugely positive step toward helping educate the public, and survivors themselves, about the prevalence of sexual abuse and its impact on women and mothers.

Have a suggestion for November's book review? Leave me a comment below. Thanks for reading.