When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women, by Penny Simkin and Phyllis Klaus. Seattle, Wash: Classic Day Publishing; 2004. 450 pages, soft cover, $32.95.
Written for a combined audience of women who have been sexually abused, as well as physicians, midwives, nurses, and mental health workers, this book explores with great insight and compassion the clinical, physical, and emotional challenges that a woman's sexual abuse history may cause. Such a history may affect a woman's relationships with her family and healthcare providers, contribute to her fears and anxieties of labor and birth, affect her ability to attach to her newborn, and challenge her on issues of feeding and parenting.
This book includes numerous compelling stories of women survivors of sexual abuse, self-help measures to allay fears and tensions, counseling and psychotherapeutic techniques to minimize the effects of abuse on childbearing and to promote healing, communication skills and exercises, and suggestions to modify clinical practices.
When Survivors Give Birth is divided into 4 parts: The Long-Lasting Impact of Childhood Sexual Abuse; Communication, Help and Healing; Clinical Challenges and Solutions; and Appendices and Resources.
Chapter 1 identifies the prevalence and nature of childhood sexual abuse in North America. Various types of abuse are illustrated with stories that show its long-lasting impact. A brief history of attitudes toward childhood sexual abuse in the 20th century traces its culmination in today's more supportive approach to abuse victims.
The meaning of sexual abuse for the child and how it causes lasting psychological, social, and physical costs is examined in Chapter 2. Common triggers of repressed memories and the development of posttraumatic stress disorder are illustrated in stories of women.
Chapters 3 and 4 discuss the impact of childhood sexual abuse on pregnancy, labor, and birth. Survivors' fears about invasive tests and procedures, choice of caregiver, disclosure of abuse, and issues of control are addressed. The emotional and physical challenges inherent to labor and birth are illustrated in stories of women, along with factors that can contribute to a woman's satisfaction in childbirth or to disappointment, anger, or shame. Clinical challenges are outlined in table format including suggestions for the caregiver and staff to minimize the likelihood of retraumatization.
Postpartum issues for the survivor of childhood sexual abuse are presented in Chapter 5. Distress over their birth experience, low self-image, breast-feeding complications, fears about their infant, or trust issues with family may further complicate the woman's postpartum course by triggering past abuse memories, mood disorders, or posttraumatic stress disorder. Stories of women and helpful strategies to ease these stresses are presented.
Chapter 6 highlights the unique relationship between the woman and her physician or midwife. Differences in power and values and shortage of time may create a barrier between the woman and her caregiver. However, skillful communication can enhance both the client-caregiver relationship and the psychological outcomes for the woman and her family. Examples of both skillful communication and unhelpful responses are presented in narratives and case histories.
Essential communication skills for survivors and their caregivers are highlighted in Chapter 7. Active listening, unconditional regard, reflecting feelings, paraphrasing, clarifying, open-ended questions, and constructive feedback are demonstrated. Client-caregiver conversations illustrating poor and effective communication are presented.
Chapter 8 explores how childbirth educators, doulas, breast-feeding consultants, and massage therapists can tailor their services to accommodate the varying needs of survivors of sexual abuse. Suggestions for choosing and working with these paraprofessionals are given.
Chapter 9 offers a variety of self-help techniques for enhancing women's abilities to cope with stress, tension, self-doubt, distressing memories, and negative feelings, with guidelines on developing personally meaningful techniques. Self-care, creative problem-solving, visualization, guided imagery, reframing, containment, anger and panic attack management, journaling, the use of art are discussed.
Birth counseling to explore psychological issues related to childbearing and develop strategies to prevent posttraumatic stress disorder and retraumatization is the focus of Chapter 10. By anticipating and exploring events during labor and birth that may "trigger" or elicit memories of abuse or trauma, and then discovering the personal meanings and emotions connected to these "triggers," a woman and her counselor may develop effective strategies for avoiding or minimizing these triggers. Additional counseling techniques described are the dream interview and counseling after a traumatic birth experience.
Chapter 11 illustrates how psychotherapy uses in-depth methods and techniques for healing that can help the survivor as she goes through the childbearing experience. Suggestions for choosing the right therapist and a description of what happens during a psychotherapy session are included. Psychotherapy therapeutic processes, such as EMDR (eye movement desensitization and reprocessing) and ideomotor signaling are explored with stories of women illustrating their application.
Chapters 12 to 14 present clinical challenges and solutions for healthcare providers. Chapter 12 offers the practitioner step-by-step guidance for doing a pelvic examination with a woman who has experienced sexual abuse. Written by a certified nurse midwife, these guidelines aid the practitioner in doing a sensitive, nontraumatizing, even empowering pelvic examination. In Chapter 13, 2 perinatal clinical nurse specialists present practical and realistic guidelines on how to individualize nursing care plans to accommodate the unique needs of survivor clients. Using case study format, nursing care plans of several clients are presented including identified concerns of the women, desired outcomes of nursing care, and strategies planned to achieve those outcomes. Finally, in Chapter 14, an obstetrician discusses the principles of informed consent and informed decision making. The author shows how the clinician can accommodate the client while protecting his or her professional obligations.
Appendices 1 to 6 contain useful resources and tools: a self-assessment tool of unhappiness after childbirth; forms for Trigger Work and a Birth Plan; case histories; additional information on postpartum mood disorders and resources.
When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women is a "must read" for both survivors of sexual abuse and their healthcare providers. This book not only is sympathetic to the challenges facing survivors at an intensively vulnerable time, but also remains sensitive to their healthcare providers, who may often be puzzled or frustrated by the unique needs or actions of their clients.