This week I am honored to feature a guest post by Rachel E. K. Freedman, Ph.D. Rachel specializes in reproductive psychology and has an expertise in trauma. In her post today, she addresses the challenges involved in navigating pregnancy and childbirth after trauma. Recent statistics reported by RAINN and the National Center for Victims of Crime suggest that 1 in 5 girls is the victim of sexual abuse, and that 1 out of 6 women will be the victim of attempted or completed rape at some point in her life. Given the disturbing prevalence of sexual violence against women, Rachel’s article is especially pertinent.  Rachel’s words are below.

Pregnancy and childbirth can feel daunting to those women who are survivors of childhood sexual abuse or other sexual trauma.  Because they may or may not identify themselves as survivors to their health care providers, it is of utmost importance that healthcare providers be sensitive to the ways in which trauma may manifest and to adopt practices that address the needs of survivors whether or not women disclose their trauma history.

There are many facets of pregnancy and childbirth that can be triggers for women with trauma histories.  Having a caring and informed obstetrician or midwife and doula can help a survivor get through these difficulties in the face of a medical establishment that is often untrained and ill-equipped to know what to ask, say, and do when someone in their office has needs that are different from those of the “typical” patient.  It should be noted that a trauma history is a much more frequent occurrence than many providers realize.  However, due to fear, shame, and stigma, it is vastly underreported.

There are common practices that trauma-informed doulas may use to help empower women who are laboring.  These things may include helping the mother use active birthing positions, assisting the mother in staying grounded and present, and helping the mother maintain privacy and modesty while undergoing a medical examination.  For more suggestions, see Kenya M. Fairley’s With Harp & Sword—A Doula’s Guide to Providing Trauma-Informed Birth Support.  Feeling safe with her birth team is perhaps the most important condition for a positive birth experience.  It is even more important than any specific technique the survivor or her team can employ.  If trust can be established at an earlier point in the pregnancy, then later obstacles can be more easily overcome because the survivor feels she can rely on her team to know how to help her through challenging situations.

Therapy with a trauma-informed professional is a good option for those women who need extra support during this time or for survivors who have not addressed their abuse history in the past.  In some situations, a survivor may not have been aware of any past trauma until something in pregnancy or childbirth serves as a trigger.  Ultimately, having a team of professionals who work together may be the best solution.  The key to helping survivors in pregnancy and childbirth is to be empowering and to allow the woman as much autonomy as possible.

For most survivors who are pregnant, the primary goal is the same as most women about to give birth—having a healthy baby.  An unexpected (and positive) outcome following a survivor’s pregnancy is often increased comfort and skill being a self-advocate.

For other books on this topic, I highly recommend Penny Simkin’s When Survivors Give Birth and Survivor Moms:  Women’s Stories of Birthing, Mothering, and Healing After Sexual Abuse by Mickey Sperlich and Julia S. Seng.

Rachel E.K. Freedman, Ph.D. is a licensed psychologist in Bethesda, Maryland who specializes in reproductive psychology.  She sees women and couples in any stage of the family building process and focuses her practice on issues such as perinatal loss, infertility, postpartum adjustment, and the transition to parenthood.  She also writes and speaks on topics pertaining to grief and loss, mood disorders, trauma, and women’s issues.  She can be reached at [email protected]