CSA #6 : Pregnancy, Birthing & Postpartum

This sixth post in this blog series about Childhood Sexual Abuse will cover content about how CSA relates to pregnancy, birthing, & postpartum.

This information I’m giving is one fraction of what is out there. I am in no way an authority on this topic. This writing is the tip of some possibilities. This content is so complex. These are SOME of the things that could possibly come up. My intention with these writings is not to tell you what is or is not true, but to spark a dialogue and ask “what does this mean for you?” I am definitely not an expert in Childhood Sexual Abuse, I am saying “here is one piece, where will you go with this? Let’s get ourselves talking about it.”

Much of this information on birthing is taken from Selena Shelley, a leading trainer in the Rocky Mountain area on pregnancy / birthing / postpartum & childhood sexual abuse and how they relate to each other. The statistics are still not entirely clear. One in four, one in three, one in five? All we know is that childhood sexual abuse is shockingly common and many people who are pregnant, birthing, and raising their own children are impacted by the psychosocial effects of this life experience. Many of us care for people in our lives, whether it’s known or unknown, professionally or personally, whom have this life experience. When birth experiences come into the picture, things get complex for anyone. With this life experience, things can get extra complex. Penny Simkin, a leading childbirth educator, relates that abuse survivors often vividly describe the connection between their history of abuse and their birth experiences. Panic, “body memories”, flashbacks, and dissociations during labor can interfere with confidence, tolerance of sensation, and the ability to trust and work with caregivers.

Childhood Sexual Abuse & Domestic Violence
Domestic violence is a pattern of abusive behavior in any relationship that is used by one partner to gain power and control over another intimate partner. DV can be physical, sexual, emotional, economic, and psychological. 85% of DV victims are women and 30% of DV begins in pregnancy. Sometimes the physical abuse may not be as regular or may change to emotional abuse once a partner is pregnant, due to the dangers of physical abuse while someone is carrying a child. Pregnancy increases change in control, change in the sexual dynamics of the relationship, and can activate DV to become more intense or to begin.

Here are some of the considerations for pregnancy:
– fear of damage during birth
– focus on sexual parts of the body being disturbing
– phobias of needles, vaginal exams and other invasions
– exaggerated symptoms of pregnancy
– rejection of bodily changes in pregnancy (an evidence of sexuality)
– repeated miscarriage
– fertility problems or preterm labor
– trouble bonding
– desire for abortion
– strained relationship with family members
– the baby perceived as an invader / parasite
– difficulty with a caregiver (mistrust or overly dependent)
– fear of being out of control
– fear of birth pain, not being a good parent
– flashbacks or recurrent memories of past abuse
– anxiety & depression

Considerations for Birthing:
Power differentials when it comes to birthing are incredibly important when it comes to working with survivors. If we consider the simple realities below, we can start to see how birthing may be impacted by CSA:
– the caregiver is upright and the laboring person is often lying down
– the caregiver is clothed and the laboring person is partly or entirely naked
– the caregiver is strong and the laboring person may feel weak and tired / hungry
– the caregiver may do things that feel painful / stressful to the laboring person’s body and the laboring person often has to submit
– the caregiver has knowledge, is an “expert”, uses medical language, has tools, and discusses risks / benefits in an impersonal way, and the laboring person has less knowledge, does not understand certain concerns or language, depends on the caregiver’s explanation, and may responds with emotions and worries
– the caregiver is not in pain and the laboring person is
– the caregiver is not in physical danger and the laboring person is
– the caregiver is in control and the laboring person feels under the power of the medical staff
– the caregiver remains composed and the laboring person does not have their usual composition of makeup / clothing / ability to regulate emotions / sounds
– the caregiver is independent and the laboring person is vulnerably and dependent

Considerations for birthing
– fear of medical caregiver / power role
– vaginal instruments and exams as rape
– induced and augmentation of birth (cesarean, interventions)
– excessive pain and tension
– control issues (management and self control)
– passivity, submission, an “easy, good patient”
– abandonment and isolation feelings
– lack of cooperation with staff, pushing, and positions
– fear or repulsion of blood & bodily fluids
– fear of danger and the unknown
– fear of invasive procedures or automatically wanting interventions to avoid experience
– panic, dissociation / withdrawal, fainting, PTSD symptoms

Considerations for postpartum
– sexual repulsion at the idea of breastfeeding, of the parent’s body having to be available “at all times” or “whenever the baby needs”
– worry about touching baby’s genitals
– loss of appetite
– prolonged recovery
– newborn having physical difficulties
– feelings of failure about the birth
– anger / blame at caregiver and staff / partner
– self-image as incompetent and unable to parent / bond
– baby seen as perpetrator / at fault for pain & difficulty
– fear of or desire to hurt the baby
– exaggerated relationship stressors with partner
– problems with baby’s family / grandparents
– PTSD, retraumatization (old trauma that was “resolved” can surface in birth & postpartum if not addressed)
– anxiety & depression, postpartum psychosis or other mood imbalance

What To Do ? All of these considerations may feel overwhelming! With knowledge and finesse, a lot of care can be given:
– helping the parent understand that breastfeeding can feel good, that it is ok to feel pleasure with birth and breastfeeding. The same chemicals that give us pleasure (ex: oxytocin) are released when breastfeeding and bonding occur. Helping the parent understand that it can feel pleasurable but it’s not sexually abusive, that it’s ok to feel good but it’s different than sex.
– helping them understand that all families have different norms about touch and when it’s right to have sex again. Encourage them to feel into what is right for them and consider their body
– encourage healthy bonding with the child as the parent is ready
– encourage them to discover if they really WANT to breastfeed. Some parents just don’t get there and it is ok! The ultimate healthiest option for both the parent and the child can be a compromise. If the parent will be so stressed out by the difficult or emotional pain of breastfeeding, then they won’t be a healthy and available parent. The health of the parent is what is most helpful to the baby
– the parent always have more of a chance of success if they have choice. If they disclose a history of abuse it is helpful to know, but if they don’t and you have a sense or question about it, being extra cautious about these pieces can help the process
– respect their preferences! ALWAYS
– normalize the experiences of being a new parent
– help them learn the developmental pieces about the baby’s behavior, give psycho-education and encourage the parent (s) to be educated BEFORE the labor
– develop strategies, options, and solutions with the parents
– remind the parent (s) about boundaries and self – care
– teach relaxation methods and visualizations (or whatever works best to resource them)
– provide resources and unbiased opinions / names for support professionals and educational materials
– refer them to a support group if they could benefit. There are many breastfeeding support groups, emotional process groups, CSA survivor groups, and more. Refer them to therapy if they need 1:1 attention with a trained professional. Refer them to acupuncture and bodywork if they can afford it and are having physical difficulties. They need a TEAM of support around them as much as is possible!

If you want to know what’s coming or what I started with, these are the topics I have / will cover in entirety with this series:

  • The effects in current time. Click here to read this post on the effects
  • Gender and sexual orientation stereotypes. Click here to read the post on gender and sexual stereotypes
  • Click here For partners Part A
  • Click here For Partners Part B
  • Click here to read the post on Sex
  • The institutional piece (often missing from the CSA conversation)

Thank you for reading! Stay tuned for the last post and then I’ll be starting a different blog series topic next ! With love, Alicia


About Alicia Patterson

Alicia Patterson is a Psychotherapist / Dance Movement Therapist, Birth Doula, Energy Worker, Dance and Yoga Facilitator in the Boulder / Denver area.
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