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Abuse Issues in Pregnancy and Labor

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Resources



When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women (2004)
By Penny Simkin, PT, and Phyllis Klaus, CSW, MFT

"The only book of its kind, When Survivors Give Birth provides survivors and their maternity caregivers with extensive information on the prevalence and short- and long-term effects of childhood sexual abuse, emphasizing its possible impact on childbearing women."


Notes from a talk about the book "When Survivors Give Birth"


Survivor Moms: Women's Stories of Birthing, Mothering and Healing after Sexual Abuse by Mickey Sperlich and Julia Seng


Abuse Self-Assessment Tool - offers a realistic assessment of severity of abuse.

Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study


Shekinah Birthing offers EFT for Survivors of Abuse/Sexual Abuse: Preparing To Give Birth - 1/14/08


Rape-Related Pregnancy and Pregnancy Loss



For women with a history of sexual abuse, the challenges of pregnancy and childbirth can be overwhelming so that they may shut down or not resist further victimization.  Sometimes it's easier to work on healing sexuality as a first step in preparing for an empowering birth experience.

There's a great DVD, 'Healing Sex: The Complete Guide to Sexual Wholeness,' by Staci Haines, that is very powerful. The approach to
healing is somatic in nature.  It is a straight-forward and gentle and compassionate approach to exploring how to heal fully (body, mind and spirit). I consider this an extremely helpful resource and hope you find it helpful as well.  There is also a wonderful diversity among the couples and singles represented in the DVD.

Staci authored a related book, The Survivor's Guide to Sex: How to Have an Empowered Sex Life After Child Sexual Abuse which is also a
very helpful resource.


Enchanted Beginnings for Pre-Pregnant and Pregnant Couples - course offered by Karen Melton

This course is one of the few focused on emotional transformation during pregnancy.

"If your mom was stressed throughout her pregnancy, you may be too. It is not that we are making a conscious decision to be stressed, it is an unconscious imprint stored in our energy, our cells and our limbic brain. These imprints are stored in our body, and that’s why we don’t remember them cognitively. They are present in our daily life, but especially so when we contemplate, or enter into, parenthood. Often they are expressing themselves in relational behaviors and patterns, fears, anxieties and terror, bodily aches, pains and dis-eases, blocks and stuckness, an inability to feel at home in our body, feeling unsettled or anxious, and in many other ways."


A Safe Passage: Supporting Women Survivors of Abuse, Through the Childbearing Year, Advanced Practitioner Training - This site is dedicated to childbearing women survivors of abuse, their family and friends impacted by the abuse, and care-providers looking for information and training so that they may better meet the needs of pregnant women in their care who have experienced childhood sexual abuse, woman abuse, sexual violence or trauma from a previous pregnancy.


Surviving Child Abuse - Recovery & Research, Exposure  Disclosure (SCARRED).  Catharsis Foundation is a non-profit incorporated in Calgary Alberta in 2004 for survivors of ALL forms of child abuse — internationally.


Medicine and the past. Lesson to learn about the pelvic examination and its sexually suppressive procedure


MEDLINE Abstracts - Sexual Abuse [Medscape registration is free]


Sexual History Taking from The Association of Reproductive Health Professionals (ARHP)


'Parratt, J. (1994). The experience of childbirth for survivors of incest. Midwifery, 10(1), 26-39', it is a bit old now but should still be a little helpful and it has quite a few references.

Rhodes, N., & Hutchinson, S. (1994). Labor Experiences of Childhood Sexual Abuse Survivors. Birth, 21(4), 213-220.

Roussillon, J. A. (1998). Adult survivors of childhood sexual abuse: suggestions for perinatal caregivers. Clinical Excellence for Nurse Practitioners, 2(6), 329-337.

Smith, M. (1998). Childbirth in women with a history of sexual abuse (II): a case history approach. Practising Midwife, 1(6), 23-27.

Smith, M. (1998). Childbirth in women with a history of sexual abuse (I). Practising Midwife, 1(5), 20-23.

Buist, A., & Janson, H. (2001). Childhood sexual abuse, parenting and postpartum depression - a 3-year follow-up study. Child Abuse and Neglect, 25, 909-921.

Buist has done a lot of work in the area but it is more focused on postpartum than the birth experience.

The RCOG Press published a book called Violence Against Women which contains four chapters on models of specialist and gynaecological practice in relation to abuse, rape etc.....Edited by Bewley, S., Friend, J. and Mezey, G. (1997):

25 Domestic violence and reproductive health care in Glasgow
26 Rape - including examination and history
27 Sensitive vaginal examination
28 Models of specialist and gynaecological practice - discussion

There are also some research papers which discuss the implications of caring for pregnant women with child/adult experiences of sexual abuse which have some recommendations, highlight concerns of women etc..... hope both of you find it helps.

Lent, B., Morris, P. & Rechner, S. (2000) Understanding the effect of domestic violence on pregnancy, labour, and delivery.  Canadian Family Physician, 46: 505-7.

Bohn, D.K. & Holz, K.A. (1996) Sequelae of abuse.  Health effects of childhood sexual abuse, domestic battering and rape.  Journal of Nurse-midwifery, 41(6): 442-56.

Seng,J.S.; Sparbel,K.J.H.; Low,L.K.; Killion,C. (2002) Abuse-related posttraumatic stress and desired maternity care practices: women's perspectives.  Journal of Midwifery & Women's Health, 47(5): 360-370.

Seng,J.S.; Low,L.K.; Sparbel,K.J.H.; Killion,C. (2004) Abuse-related post-traumatic stress during the childbearing year.  Issues and Innovations in Nursing Practice, 46(6): 604-613.


This brief article on Deep Tissue Vaginal Massage has some really good information for women experiencing physical or emotional pain in their genitals after birth; it's also very valuable for a pregnant woman who wants to reclaim genital sensation so that her birth experience doesn't become a re-victimization. [currently unavailable]


Announcement Concerning the "Survivor Moms Speak Out" Book Project [currently unavailable]


Let the Truth Ring Out! - (The Survivors WebRing)


Abuse Bibliography


I am reading a book titled "Rebounding from Childbirth Toward Emotional Recovery" by Lynn Madsen.  In chapter four there is a section about sexual abuse and it includes a birth story.


Childhood Sexual Abuse and the Potential Impact on Maternity by Andrya Prescott from the Radical Midwives in the UK


Birth Resources with Gayle Peterson


BirthWorks Reading List - books to help women overcome the negative effects a difficult past can have on pregnancy and birth [currently unavailable]


Midwifery Today Conference audio tapes - search for the section on "Sexual Abuse and Violence "


A Burden To Share
A Personal Account of the Effect Of Childhood Sexual Abuse on Birth
by Christine


Childhood Sexual Abuse and Its Effects On Childbirth


Many Teen Moms were Abused


Many Teen Pregnancies Caused By Rape


Notes from Sheila Kitzinger Talk - "Crisis in the Perinatal Period".


From One Survivor to Another

Use your birthing and breastfeeding experience to regain your power as a strong woman, don't let the person who abused you continue to have control and power in your life. This is the chance to break the cycle of abuse, don't let the perpetrator win, re-discover your power in any way that you can, and use that power to heal yourself and to teach and protect your children. One place that was helpful to me in my learning was a local coalition of women's services, rape crisis/shelters/CHC's. Some of the standard healing books, like The Courage to Heal, and Scream Louder, may be useful for you to read. Many pregnant women find that intensive work is just not feasible at the time, so short-term problem-solving may be in order. I try to help my clients identify things that scare them, physically and emotionally. Sounds, smells, people, places, touches, you name it, and it may trigger a physical or emotional stress response. Then we try to come up with ways to avoid the stressors and methods for dealing with unavoidable triggers. Standards like visualization, relaxation, aromatherapy, herbs, acupressure, may be adapted to help mom cope. I have found it to be a very individual process.

Resources for Overcoming Past Abuse in Future Birth Experiences

Recently, someone asked about references for books that deal with the effects of sexual abuse on pregnant and laboring women. I happened to run across the book, "Creating a Joyful Birth Experience" on my shelves and note that they reference sexual abuse ten times in the index. It seems that they've woven the issue throughout the book, in addition to having about four pages specifically about sexual abuse.

With my 2nd pregnancy (probably my last), i discovered a fantastic book called, Creating A Joyful Birth Experience, written by Lucia Capacchione and Sandra Bardsley (ISBN 0-671-87027-0) $13.00 US Funds. They use a variety of imagery and visualization exercises.


I too have this book and have found its exercises an absolutely /wonderful/ addition to pregnancy! It is great for any woman but especially good for those in recovery and others who have extra emotional needs aside from those "normally" (what's normal anyway?) encountered during pregnancy. Another really good one that does some of the same things, and that I really enjoyed with my last pregnancy is /Nurturing the Unborn Child/ by Thomas Verny and Pamela Weintraub. While I don't actually know how much we can truly communicate with and nurture our unborn children, the exercises in this book certainly made me feel closer to my baby.



Creating a Joyful Birth Experience is out of print and difficult to find.

You might also try Spirit-Led Birth and Parenting Supplies
Birth@Sierratel.com
209-683-2678 for questions
888-683-2678 for orders
They have an Appletree Ministries position paper written by Helen Wessel, a
Christian writer and author of The Joy of Natural Childbirth, called Inner
Healing, or Healing of Memories.  They also have Oil and Wine for the Wounded
by Bruce and Jan Wilson. It's a resource to help women recover from past
abuse, especially sexual abuse and its possible negative effect on
childbearing. It is a Bible study workbook that can be used by lay people or
professionals for one-on-one counseling or group support.

Pregnant Feelings by Baldwin and Richardson is a workbook for pregnant women
and their partners to help release their emotions about pregnancy and birth to
give them confidence and power.


Birthing from Within addresses birth as an emotional and spiritual process.



Tight Back and Butt Muscles



An abuse survivor writes about her labor:   "I had severe back labor unexplained by the position of my baby.  Years later, I realized this was because I had "pelvic muscle spasm" syndrome (A syndrome fairly well recognized in the medical literature).  This was causing my sacrum/coccyx to be clamped down by chronic muscle spasms and narrowing the birth canal.  (This also explained why I have had a "flat butt" since childhood)."

"It is a static, chronic spasm, so the treatment seems to be "all or nothing".  I have been able to release it once after days of releasing the many "knots" on both sides of the area and even working intravaginally and using magnets (and could for the first time feel my butt cheeks as two separate cheeks when I walked), but this only lasted for a few days.  One other time a guided mediation on the first chakra focusing on the perineum amazingly released it, but for only a few hours.  I still have it - I'm now 57.  I hope to deal with it someday when my life is more calmed down.

"In hindsight, I think it would have helped if I not been in the traditional "on my back" position when I was in labor.  It seems like anyone who is having 'back labor' should be helped to be either on hands and knees or squatting.

"I hope this helps others.  Thank you for your web site."



Working with Abuse Survivors



Client Handout


Helping Survivors of Sexual Abuse Through Labor


Notes from Penny Simkin's Video


Notes from Abuse Workshop with Penny Simkin


Some of my clients have expressed that it felt traumatic to have suffered memory loss during labor; for these women, it may be really helpful to have a videocamera set up in the labor room just to record the general happenings.  Then they can go back and look what was going on, even if they experienced memory loss from the labor hormones.


When I'm working with a laboring woman who may have an abuse history, I start to say things differently during labor like...you are safe...no one is going to harm you...your baby is coming out there is nothing going in.  Now this may sound crazy but I can't tell you how many women have calmed down and pulled it together.


Many pregnant women find that intensive work is just not feasible during pregnancy, so short-term problem-solving may be in order. I try to help my clients  identify things that scare them, physically and emotionally. Sounds, smells,  people, places, touches, you name it and it may trigger a physical or  emotional stress response. Then we try to come up with ways to avoid the  stressors and methods for dealing with unavoidable triggers. Standards like  visualization, relaxation, aromatherapy, herbs, acupressure, may be adapted  to help mom cope.


One of the shortcomings of hypnotherapy in general is that it tends  to be a short-term fix, but I think that makes it almost ideal  as a "solution" for labor and birth, which is a short-term situation.

Gayle Peterson is the only person I know who combines hypnosis  with abuse work.  She's got several books out.


For a handout for a training program, Penny suggests the articles published in "Birth" 19:4 December 1992, beginning with "Effects of Childhood Sexual Abuse on Childbirth: One Woman's Story" by Anna Rose and ending with Penny's response article "Overcoming the Legacy of Childhood Sexual Abuse: The Role of Caregivers and Childbirth Educators." You would need to check with "Birth" about permission to reproduce the articles.


I work as a social worker with women who have been abused. The numbers (at least in the States) are staggering and unrecognized. The birth process is highly traumatic for many of these women. Some points to consider:

  1. Many of the examination procedures are identical to the actions of the perpetrator. The invasion of the body, the control, lie down and be naked while I stick something in you, all of that can bring flashbacks during examinations and during birth.
  2. Post-Traumatic Stress Disorder (exhibited in 90%+ of survivors of sexual abuse) creates heightened sensitivity and hyperacute vigilance to accompany it. It may hurt more, even during an exam, than you realize or is "normal."
  3. Many will "dissociate" as a coping mechanism during stress. That means you may "lose them" as they turn inwards during the birth process. They may not be able to hear or follow directions.
  4. Make sure that you recognize the "triggers"! Certain colors, smells, people will bring back all of the memories and feelings and fears in a rush. KEEP THEM AWAY! (This means probably NO MEMBERS OF THE FAMILY OF ORIGIN AT THE BIRTH!!!!!!!!!) See if they can name the perpetrator so you can be sure to keep them away. (Not that ANYONE should ever be present at the birth without the express consent of the mother!!!)
  5. Above all, empower the women. Be gentle, kind, and comforting. This is a very scary process, as all things sexual, sensual, and physical can be. Spend extra time before the birth to establish secure links of trust.
  6. Read about sexual abuse. Go to conferences and workshops. Get trained in the issues. Somewhere between 15-25% of your clients will have been sexually abused before seeing you.
  7. Encourage, if appropriate, therapy to accompany the pregnancy experience. There are a lot of issues here (including the feelings of dirtiness, powerlessness, victimization, etc.) You can't handle them all yourself.
Good luck to you! Recognizing the issue is the greatest battle.


Date: Thu, 05 Oct 1995

I think how you ask the initial question will affect how/whether a woman chooses to respond. I've seen some forms which just flat out ask "Do you have a history of sexual abuse/incest?" And not all women will chose to answer this... I generally try bring up the subject by asking something like.... "Birth is such a personal, and very private thing, some women are very modest and uncomfortable about it--- especially if they were abused sexually or have painful or unhappy memories. Is there anything you would like us to do, or not do in your labor or birth? Do you have any special needs we might help with or is there anything you think we should know about you"?

Putting it similarly, explains just why you are asking the question. Another thing: This doesn't necessarily need to be asked at the very first prenatal, or when the woman's husband/boyfriend is present, and (I think) should be asked by a woman --not a man; if you want honest answers anyway. (Some will refuse to respond to that question under those circumstances --- though maybe it wouldn't bother others). Also, I think it's important to ask if a woman "wants" to be touched in labor/birth --- a back rub may be heaven to some women but just make another more tense. -- Always ask first!

In one of my own births, I was EXTREMELY UPSET that someone kept lifting my gown to stare at my bottom while I was pushing -- I kept pulling it back down and telling them I'd let them know when there was something to see! But it kept happening... and I eventually l went into the bathroom with the door closed for privacy -- ended up delivering in there ( I did let others come in[Grin]). Don't bug a woman who has been "messed with" before! Let her labor at her own pace and don't rush, stare at, direct her -- any "bossing about" may be quite resented... ask her, advise her, but don't tell her what to do! Give her privacy and as much dignity as you can -- let HER do the choosing!

I follow this advice with those clients who (have let me know) they were abused...... I've seen better labors, less stalling out, better second stages since.


I have done much research on past abuse and birth and have interviewed many survivors. You should ask directly, but in the context of, "I need to ask some things so that I know more of how to help you. If some things come up in birth, I need to know where they are coming from." Then ask, do you have any health problems? Do you have any history of drug or alcohol problems- previous addicts might want to avoid narcotics in labor, have you ever been forced to have sex without consent, been hit by another person, etc. This is a little less threatening. If you, yourself, are a survivor, you may possibly want to reveal this if you have some clients that you suspect, but are not opening up to you. You might also say, that birth has been known to bring up things from the past that may not be expected.

Not all survivors are at a place where they can accept and reveal. Do watch for triggers- do they freak when a culture is taken, pelvic exam is done, etc? Also, watch your language- don't call women honey, sweetie, watch whispering or approaching unsuspected from the back.


Many of you have reservations about asking. My personal, and professional experience is, that asking is the thing to do. Often, survivors can't wait to tell someone. They often throw out signals, hoping someone will bite. If they tell you, no, they weren't abused, then maybe they have not acknowledged it, and you let it go. Just be careful during the births. Do not whisper in their ears, or call them sweetie/honey. Always bring them back to focus on why they are there-- you are giving birth to a beautiful baby, call her by name, remind her this is not forever, and, if she has confided in you but feels she is "over it"- remind her that this is not the abuse- that this is a beautiful time in her life. The body fluids are her own- responding to her birth, not anything sexual, ugly or abusive. It is a very fine line to walk- the best thing is to follow your instincts.

One more thing- they may not confide if they think you will be sharing this with others or putting it on her chart. Be sure to tell her and keep her confidence. If the doctor/midwife is performing something traumatic, or is about to- say something like, "Dr. so and so, there are some issues that "Kim" is dealing with. It would probably be best if we could do without ____."


If a woman indicates on a history questionnaire that she has a history of abuse, it definitely should be followed up. I'd suggest a different approach than asking her if she thinks her abuse history will be a problem in birth. Closed (yes or no) questions tend to stop discussion. The caregiver might tell her she's glad she indicated the abuse on the form. Then explain why the question is on the form ("sometimes a history of abuse can come up unexpectedly during birth, but by discussing it beforehand, the abuse effects can often be minimized.") Then ask if she would like to discuss her own abuse or explore it further. If she says no, you respect her wishes, with the statement that if she'd like to talk about her abuse history or any other concerns at any time, you'd be glad to do so. If she says yes, then be prepared.

  1. Be well-read. See the bibliographies that Lechia Davis and I sent out. The articles I and some others have written are directly related to the impact of childhood sexual abuse on a woman's later childbearing. Other articles and books are about other aspects of abuse.
  2. Be prepared to listen to some upsetting, shocking, or depressing stories.
  3. Be able to respond in a helpful way. I'm attaching a description of helpful and non-helpful responses when a woman discloses her abuse.
  4. Have resources available for referral.
  5. Be willing to modify routines and practices to respect her needs.
  6. Remember that above all, your interest and caring are the most important messages you can give.

When your client discloses her abuse history, what do you say?

Non-helpful responses:

Helpful responses: Adapted from the book, by Claire Burke Draucker, Counseling Survivors of Childhood Sexual Abuse, London: SAGE Publications Ltd, 1992.

Many of you are wrestling with the decision of whether to discuss abuse issues in childbirth class or whether to ask a client (or "patient") if she has ever been abused. I have several thoughts on this:

First, I would advise you NOT to discuss it unless you have helpful services/referrals or reading materials to offer AND unless you can react appropriately when she discloses her abuse. If you do have helpful referrals and can react appropriately, then consider how to bring it up.

Someone on the list wonders "if it is really appropriate to 'stir up this can of worms' when she is pregnant, fearful." Sometimes the "can of worms" is already "stirred up" and if you raise the subject appropriately it will be a relief to the woman. In a childbirth class, it is better to bring up the subject to the entire group than to single out a particular woman. People then can decide whether to speak with you privately. If it is not safe for them to come to you, they won't. If you single out someone whom you think may be an abuse survivor, she may be devastated or ashamed that her abuse is so apparent, or she may be angry with you that you would make such an assumption. I usually bring up the subject in childbirth class when discussing the second stage and "holding back." After normalizing the tendency to hold back, I say that, "for some women, those who have been sexually abused, holding back may be due to body memories of the abuse. The actual birth and many other features of childbirth can be problematic for sexual abuse survivors. If anyone has such a history, I'd like very much to get together one on one, because there is a lot you can do to deal with abuse issues before labor." Then they can decide if they want to pursue it. Readiness to confront these issues varies and I believe it cannot be rushed.

I believe all doctors and midwives should become comfortable enough with these issues that they are able to ask individual clients about abuse as one of the many family/social history questions, to respond in an empathic way, and to offer helpful resources because there are important clinical and emotional implications.

What about the doula? Should she ask? I do not ask my doula clients about sexual abuse specifically, partly because our relationship has a different basis than counselor or clinician. I ask generally about her concerns, fears, or worries, telling her it is helpful for both of us if I know of these things. Then I trust her to reveal to me those things she feels ready to discuss. I would rather work with her at a level where she feels safe. We can work on her fears without her revealing the reasons.

Lastly, what if a woman has several of the characteristic issues associated with a history of sexual abuse, but she does not disclose it (either because she has not been abused or she has no memory of being abused or she chooses not to disclose it)? In such a case it may help you to understand her and provide better care if you ask yourself, "Would everything I see and hear from her make more sense or seem more understandable if she were in fact a victim of childhood sexual abuse?" If the answer is yes, then, whether you are right or wrong, the possibility that she has experienced such trauma may lead you to listen more empathically, to take some otherwise "unreasonable" requests more seriously, and to avoid reacting defensively. If she questions your authority or is hesitant to trust you, you will understand. In fact, recognizing possible abuse should lead us to give our clients the kind of respect and individualized care that everyone deserves. Later, I'll try to write about how to react when someone tells you she's been abused.


Remember that she may not know, she may be completely blocking. Don't push too hard...it's obvious by now that she's not ready to talk!


YES! Someone finally said what was in my head as I read this thread! Thank you.

As an incest/rape survivor and my experiences with women such as myself, I really encourage you to stop asking for information she probably has no recollection of. (oh, and I know it is said gently and with love... but I promise she is seeing it as pressing... and you risk losing her if it continues.)

I would explain (and have) that all women (I know, most) have pelvic exams during pregnancy and birth. I let them know when and how many standard vag exams women have and then explain that many women, however, choose to have two... one for the PAP and one when the membranes rupture. I let her decide how many she wants, but that two is the minimum. I also explain that someone will be with her, holding her hands (a Doula, perhaps?), that she can let me know when to move forward and when to stop, but that it has to be done to protect the health of both she and baby. (I am assuming no cultures have been done, either? We all know that if she is sexually active she must be tested... does she consent to bloodwork?)

If there is the remotest possibility for the pediatric speculum to be effective, I use it (although it might be difficult on a multip). As we all do, show her an identical speculum, let her touch it, hold it, even open it for her so she knows the noises... all very, very slowly.

For some, the lying back is a trigger... and you might see how raised she could be (with pillows) and still allow you to do what you need to do. In the same vein... I would offer her a gown, allow her to keep her shirt on, whatever feels safest for her. You might ask her to bring her own music, if that would help. I would ask her if she wants you to talk to her through the exam, or do the exam in silence. Offering her a mirror to watch, asking her if she would be more comfortable sitting in a chair, reminding her there is no rush, but it will be done today... speaking in a gentle manner, but not condescending.

I have used some or all of these ideas on women. I learned that offering as many choices to control the situation as possible helps the most frightened women.

Even though I share some heavy things here... I would encourage making the exam kind of a non-issue... matter-of-fact even, if that is possible. The rest of the visits upbeat and friendly, focusing on how it will be to have two children in the home, teaching life skills, stress reduction, etc.

During the 3rd Tri, reminding her again about the vaginal exam when her membranes rupture (or if she chooses, when she arrives, when membranes rupture, urge to push, etc.). If she looks like she is going to leave your care due to stress... a gentle reminder now and then that most people will not care what she wants and might even tie her down... (and it isn't an exaggeration, as we know) and how glad you are to have her with you so you can respect her rights and desires, etc.

One last thing... be prepared for another cesarean. If a woman does not want a baby vaginally, we all have seen how they create it so they don't. She doesn't sound ready to birth vaginally... but she will (I pray), someday, recognize how incredibly lucky she is to have such loving and caring midwives surrounding her during this most painful period in her life.


Initially a mom I was working with would tense up so tightly and become so fearful that she would scream out in pain.  Working with her, ahead of time if possible, on relaxing and breathing in the typical pelvic exam position, fully clothed, could help.  Helping her understand that she is safe now during the exam and helping her understand that relaxation will dramatically decrease the discomfort can make a difference.  This mom could not believe the difference it made for her and was so proud of her ability to change this for herself.  During the labor exams she would chant out loud, "Relax, relax, relax".


Avoiding Vaginal Exams for Hospital Birth

One of my doula clients suffers from vaginismus.  Any suggestions we can pass on to the nurses to help assess dilation from external signs and avoid vaginal exams?   We would like to give the nurses other options should they become insistent on knowing how far along she is.

I hope you get lucky and get a terrific nurse - I've sometimes had good luck asking for a nurse with particular sympathies for a special client.

However, in general, hospital nurses are clueless about external signs because they're not used to watching the labor progress. They arrive and leave at random points in the labor, and they only know how to assess dilation by checking the cervix.

When I'm labor coaching at a hospital birth, where cervical exams are generally off limits to me as the labor coach, I look first at the contraction pattern, then dilation bleeding, then early decels to reflect coming up against the resistance from the pelvic floor, then movement of the location of the heart (having a mechanical fetoscope is best for this) to reflect descent/rotation, and then expect an urge to push.

I'll be very pleasantly surprised if any of the L&D nurses have any interest in going along with any of this because it's something they can't really chart.  And, if you can't chart it, it didn't happen.

I would be prepared to study up on the alternative techniques and then bluff your way like crazy that you really can assess dilation that way, start your estimate on the low side, make regular progress, and do everything you can to make sure she gets to the "urge to push" phase before they get too curious.

And remind the client that she can always say no.  Ideally, she will have discussed this with her care provider and it will be charted that no vaginal exams are to be done for the first twelve hours, or something like that.  Get clear guidelines from your client, and remind them that touching her without her consent is criminal assault.


1.  I'd recommend Birthing From Within classes for preparation, to address things more wholistically if she is at all inclined that way.

2.  My client with vaginismus worked with an Epi-No (the inflatable balloon-like device for stretching the perineum to prepare for birth and for re-strengthening the muscles after birth) and had great success.  She used it for a while before becoming pregnant, in order TO become pregnant, and continued during the pregnancy.  She pushed for 2.5 hours, but did not experience any unusual pain (she had no pain medications) nor did the midwife feel there was an extraordinary resistance in the tissues one might expect for a woman with vaginismus.  She did have a moderate perineal tear.  Considering her history, she considered it all a major triumph and had her second baby just less than 2 years later.

I would highly recommend the Epi-No, because she can control it herself (like perineal massage, but not so hard to reach around the belly and gives more quantitative feedback for those who want that, and gradually work her way up to increased stretching and most importantly, *increased confidence* along the way that it will NOT be a problem or interfere with her birthing vaginally.

Incidentally, vaginismus CAN BE, but is, of course, not always, an indicator of past sexual abuse, either in childhood or later.  If this is the case for her, it may help her enough to work with the Epi-No, or she might also benefit from thinking and talking about what things about her history might also come up emotionally in birth, in addition to the physical.

A client I had who had such a history was able to talk with me about it so we could plan on what things I could do during the labor to avoid the triggers of her past experience...things like always looking at her face, so she'd know people were paying attention to her and she wasn't powerless to communicate her needs or requests, always letting her know when something was about to happen (even more than usual) or before anyone would touch her, reminding her that all of the sensations were produced BY her body, FOR her benefit, and weren't things being done TO her....this one applies to any woman with vaginismus, with or without a history of abuse.



Importance of Informing Caregivers



I was interested to see the message about the Survivor of childhood abuse expecting a first baby. I too am a Survivor, and I'm expecting my third baby. My older two are twenty and eighteen, and came before i really had come through my healing. It's very different now! It feels like starting something completely new. My two older children are thrilled about the baby, and so am I and my new partner. i have had to be very up front with the medics though about my history, so that they don't unwittingly cause me the kind of distress that can happen with insensitivity in intimate situations.

 




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