“When Survivors Give Birth”
Penny Simkin, PT, & Phyllis Klaus, MFT
A review by Jenn Fontaine CD/PCD/BDT(DONA), LCCE, FACCE, CLE
This is a book about information, strategies and hope for the sexual abuse survivor and those working with her in the birthing communities. The unique needs and feelings brought up in the childbirth experience is one that has not been explored in this way. With Phyllis’ understanding of the mind as a psychotherapist and counselor and Penny’s understanding of the birth process and how to support birthing people throughout pregnancy, childbirth and the postpartum period the need for someone to explore and help others support women that have been sexually abused through pregnancy was apparent. Being who Phillis and Penny are they realized “that our best and really our only source of knowledge was the women themselves.” (Pg. xvi)
This book starts with teaching us that “Many of the same anxieties and self-protective reactions that were caused by early sexual abuse are rekindled during pregnancy, maternity care, and parenthood, perhaps more that during other periods in life.” (Pg xvi) In the foreword by E. Sue Blume there are many nuggets of wisdom that show the above statement to be true. “Pregnancy vindicates the truth of memories of childhood sexual trauma. The survivor may not remember her abuse, but her body tells her story.” (Pg xxi) Abuse Survivors have been taught that she can not trust her own perceptions, she doesn’t have a sense of her own empowerment or boundaries in her life. This often brings up negative feeling about themselves as they are in adulthood.
The overwhelming strong theme in this book is treating survivors (all birthing women-all women- all people) with respect, dignity, and involve them in all decision making.
The book goes on to define what is childhood sexual abuse and breaking down the physical, psychological, verbal and ritual, or cult abuse. The shocking amount of women that experience childhood sexual abuse is listed (25-40 percent of girls) (pg, 4-5) and how in 80% of cases, the perpetrator is known to the child. There are levels of remembering and the complex, self- protective, psychological mechanism that banishes the reality from awareness. “During severe trauma the victim’s ability to remember can shut down and the experience becomes set apart or dissociated from ordinary consciousness. It may remain hidden from memory for years or exist as fragments of memory at a semi-conscious level.” (Pg 13)
The ways that this can be seen is so important for us to know. “Numbing out”, hypervigilance or hyper-alertness, an obsessive need to maintain order and predictability in their lives. The four broad categories seen in childhood that could be indicators of sexual abuse if unresolved can present in more adult forms including bodily complaints, medical problems, changes in personality, self-destructive behaviour, thoughts of suicide, phobias, psychological disturbances, sexual dysfunction and difficulties in relationships.
We must recognize that many illnesses have emotional and physical components. And that chronic severe childhood abuse results in alterations in brain development. Childhood sexual abuse is listed as one of the possible causes of post-traumatic stress disorder by the American Psychological Association.
Pregnancy is a time of openness and vulnerability and being pregnancy causes memories of one’s own childhood to surface. (Pg. 33) For Some survivors pregnancy can represent a confirmation of normalcy. And others this pregnancy and birth can bring up unexpected issues and feelings related to the abuse. This can be a challenge for survivors. How she is treated by her loved ones and professional caregivers can make the difference between confirmation of her self- worth and retraumatization. The book goes on to explain how being pregnancy may effect the survivor both physically and mentally. How common procedures during this time can be triggering. It gives practical ideas on what women can do and shares some stories. It explains the risks and benefits of desclosing abuse. The thoughts about power and how the birth plan may indicate the survivors need to be in control is such a revelation. The hope being that “if recognized and handled appropriately, there is great potential for healing.”(pg 57)
As pregnancy is a challenging time for some survivors, labour and birth are the “climax of the entire process.” Many of the events of labour and birth bring up lack of control, fear and uncertainty as well as the actually procedures and routines that are commonly done. The book goes into detail about the procedures and how we can reduce the chances of triggering these women using explication, kindness, communication skills and respect. We know from Penny Simkin’s other work that this period of time can be remembered for the woman’s lifetime.
Then the book moves on to the postpartum period. With the enormous changes in the women’s body, emotions and her relationships can be overwhelming for the survivor. It shows how negative self-image, fears, higher risks of problems with physical health etc can effect this time as well of course with how the birth is perceived by the woman. Postpartum mood disorders, ptsd and breastfeeding challenges are also discussed in a respectful way.
Part II: Communication, Help and Healing. These chapters offer so much wisdom, insight and practical advice for the woman herself and for doctors, midwives, doulas, nurses, childbirth educators, breastfeeding consultants etc.
It explores the power dynamics, “survival” instincts, safety, and again reminds us the regardless of our knowledge of sexual abuse empathy, kindness flexibility, listening skills and respect are what is needed for every woman. As well as suggestions for survivors for good communication with her care providers. I think I highlighted the entire chapter on communication skills! This is such a missing thing in the North American culture. Directive and non-directive communication is clearly defined and given guidelines on how to use. How to allow the woman to feel heard, validates and understood! As well as benefiting the care provider as well.
“For the victim of childhood sexual trauma, the child birth experience can take on the three directions in the healing process: a negotiate direction, a neutral direction or a positive direction” (pg 124-125) How to appropriately react to a woman disclosing sexual abuse is also discussed which is such an important piece.
There is helpful tips and insight for different professionals (childbirth educators, doulas etc). How what is “normally” done can be triggering and how to see things through the survivors eyes. Many practical ideas and thoughts for supporting women and questions that the women themselves can consider. Our understanding about the impact of early abuse can make such a difference to these women.
The chapter in self-help methods to prevent and manage distress during childbearing was another chapter that I have all highlighted! Many different strategies and how they can be used are discussed. As well as helpful personal stories. The levels of emotional safety was enlightening. “Mastery of self help methods is essential to a survivor’s well being” (pg231)
Birth counseling explained with the advantages and disadvantaged being discussed as well as outlines for effective counseling sessions with a foundation of trust. Specific counseling techniques for specific problems and working on triggers are invaluable parts of this book. The importance of a birth plan and how that can be a positive communication tool is explained. The dream interview is something new to me and I can see how this can be helpful for some women. Counseling after a traumatic birth and the methods are talked about. The end of this chapter sums it up so lovely, “such counseling may enhance the women’s satisfaction and self-esteem, and promote long-term healing from the debilitating after-effects fo childhood sexual abuse.” (Pg 293)
Psychotherapy goes much deeper than the scope of the birth worker and dives into wonderful information for the therapist.
The last section of the book- part III: clinical challenges and solutions is filled with practical information! Such great team approach, informed dedication making and flexibility strategies.
The primary goal of this book is listed as “to provide practical information and guidance to survivors, their healthcare providers and psychotherapist to minimize or eliminate the negative impact of early sexual abuse on childbearing and parenting”(pg 284) I believe this book has met its goal.
Jenn Fontaine is a Certified Birth and Postpartum Doula as well as a Birth Doula Trainer with DONA International, a certified childbirth educator and Program Director with Lamaze, a certified Hypnobirthing Instructor and "When Survivors Give Birth" Instructor. Jenn has been teaching doula & childbirth classes since May 2008, with community organizations, and independently. She teaches Childbirth Classes, breastfeeding support, newborn classes, offers Doula services, and a variety of other services for childbearing families. She is a sought after expert travelling all over the world to teach doulas, educators and families