I just finished watching a video of Penny Simkin's 2/95 presentation on
"When Survivors Give Birth" which is now a book co-authored with Phyllis
Klaus and am psyched to share some very good tips with y'all.
I thought these were some great tips for any doula to better serve a
client (or answer for yourself why you reacted this way) who is a survivor
of abuse.
Signs she was abused:
fears vaginal exams (tries to avoid them altogether)
fears blood draws
fears ultrasounds w/vaginal probe
hates breast exams (feels voyeuristic, etc.)
extremely modest of her body
presents frequent medical complaints; chronic vaginismus with no apparent
underlying disease
general angry/abrasive personality
fears labor & birth - truly believes she may die
demands c-sec to not violate her vagina or to maintain her control over
her body (deciding when and how the baby comes)
wants immediate epidural upon arrival at hospital
fears loss of control, is a control freak
very unyielding in her birth plan/very long birth plan or is very passive,
low self-esteem, feelings of worthlessness, has "given up"
labor progression stops for no apparent medical reason - woman's mind-body
connection is not allowing herself to feel out of control in 2nd stage
(doulas - you can start up a stalled labor by getting her to talk about
her "issues" if she is willing and able - for some women this is not an
appropriate time to broach such subjects, but for others, this does the
trick! Ina May Gaskin has a great example of this)
demands pain meds. then screams and resists when they are given
she brings many people with her (including a doula) to be her "protectors"
against the "strangers" (doctors/nurses)
is angry/distrustful of medical staff for no apparent reason - may chose
homebirth for this reason
higher risk of pregnancy induced hypertension - is hypervigilant
higher rates of eating disorders
substance abuse
mental disorders: depression, anxiety/panic attacks, nightmares, fear of
invasive medical procedures (phobic), other phobias, dissociative disorders,
blacking out, PTSD, multiple personality disorders, obsessive/compulsive
disorders, psychosis, psychosomatic illnesses etc. dysfunctional relationships
dates/marries much older man (fitting with profile of her perpetrator)
rejects changes in her body during pregnancy and postpartum; may not allow
themselves to breastfeed
repeated miscarriages
frequent preterm labor
desire for abortion
strained relationship with partner
fetus seen as a parasite/invader sucking away her energy
strong gender preference for baby: wants male - so a daughter wont go through
what she did or wants girl because she hates males now
strong gender preference for care provider (wanting a woman)
fear of not being a good mother
morbid fear of childbirth pain
bad reactions to strangers (hosp staff) coming into her room
feelings of mutilation by episiotomies or tears
a lot of vomiting with labor
dysfunctional/non-productive labor
fighting against staff during labor
strong abandonment issues - not allowing husband to leave - needs to be
"protected" from the strangers
ambivalence towards anesthesia (compliant/passive, given-up, defeated)
labor may produce for the 1st time in her life body memories of abuse that
she has repressed
repressed memories may occur
when she first enters a monogamous relationship
when their own child/grandchild is the age when her abuse happened
when perpetrator dies (now she's "free")
when she feels vulnerable/loss of power (i.e., labor)
wants to wear full make-up, hair-style, not get all sweaty - trying to
maintain control over her body
Remember her partner may be a survivor himself
Some suggestions to doulas from Penny's talk:
Remember that an angry/hostile client has very good reason that she's become
this way. Realize that even though she may be directing her anger at you,
that it is not about you, and to be a successful doula for her you must
deflect that anger and realize it comes from her life experiences.
You don't have to approach her about possible abuse issues, many will deny
it or not see it as abuse. Just offer a simple sentence of support that
you are available if there is anything she wants to talk about.
Be aware that commonly used words and phrases by doulas during labor may
be triggers of her abuse, such as "Surrender" (to the contractions) or
"Yield" or "relax and it won't hurt so much" or "sweet talk" that her perpetrator
may have used.
She may have been raped from behind, so administering an epidural or anyone
behind where she cannot see is very threatening/traumatic.
Good questions to ask a client at an initial intake evaluation:
Is there anything about the development of your sexuality that you'd like
to discuss?
Have you ever been in an abusive relationship, including now?
Have you ever had sexual activities against your will? (some women will
answer yes to this, even if they don't consider it rape)
Validate what she is experiencing through reflective listening and provide
support and referrals as needed.
Listening to your clients: Find out where the client is and take her
to where she wants to go.
Teach clients "I messages" to effectively communicate with the staff
her wishes, needs, fears, issues, etc. (also great for everyday communication!).
This opens up effective problem solving for them with their caregivers
instead of getting off to a wrong start.
