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.

 

Are you at risk for a postpartum mood disorder?

It's a little bit of a trick question because postpartum depression can affect any new mom. But it's important to note that there are some populations that are at a higher risk for postpartum mood disorders in general.  Here are some of those groups:

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Women who have had health-oriented /physical challenges in their past:

  • Survivors of intimate partner violence;
  • Survivors of sexual assault, rape or childhood sexual assault*;
  • Women who have suffered / suffer from disordered eating behaviors;
  • Women with a history of depression;
  • Women with a history of bipolar disorder;

Women with the following specific social or economic challenges:

  • Women with limited family support;
  • Women who are poor or lower income;

Lastly, there are factors related to the baby that put some women at a higher risk:

  • Special needs babies;
  • Colicky babies;
  • Chronically ill babies or babies with life-threatening illnesses.

[Author, IBCLC and speaker Dr. Kathleen Kendall-Tackett talks about all of the above challenges and more in greater detail in her book, Depression in New Mothers. I highly recommend it if you are interested in reading more about postpartum mood disorders.]

I would also add women who have suffered from chronic pain, after reading this article.  This is just my opinion but I can't imagine how suffering from constant pain wouldn't make you predisposed to a postpartum mood disorder. Finally there is a new study out that says that women who fear childbirth are also at greater risk for postpartum mood disorders.

With all of these risk factors, I can't help but wonder why more women aren't diagnosed with a postpartum mood disorder.  But of course, as we know, postpartum mood disorder screenings aren't thorough, perfect or even often enough.  The onus is, once again, on the new mom herself to come forward.  But when you're in a haze of confusion, pain, sleeplessness and perhaps anxiety, it can be hard to sort through whether your feelings are normal.  Also not helpful is the fact that you don't see your OB until six weeks after you have your baby/babies.  That may not be early enough (postpartum depression can happen anytime in the first year) or it may be too late. 

Here are three things you can do, if you happen to fall into any of this categories of higher risk:

  1. Make finding a good local new moms group, like mine, a priority for yourself before the baby arrives.  Good social support is ESSENTIAL as a new mom.  You will need to know that you aren't alone, that you (and your worries) are normal and that many new moms share your fears, wants and concerns.  . 
  2. Consider hiring a postpartum doula.  They have the distance and the expertise to recognize problems before they arise.  Postpartum doulas are trained in, among other things, recognizing signs that mom gives...whether spoken or unspoken.  Postpartum doulas aren't counselors but they can refer out to a qualified professional.
  3. Speak up.  If something is upsetting to you, talk with your partner, friend or another trusted mom about it.  If you need something, ask for it.  Too many of us suffer in silence, or just as damaging resentment, when it would be better for our physical and emotional health just to talk about it.

A postpartum mood disorder isn't a life sentence or something to be ashamed of.  Let's keep the conversation going so we can all stay better informed and in doing so, be better advocates.