Impact of childhood sexual abuse on childbearing

Overview

The prevalence of childhood physical or sexual abuse has been increasingly recognised over recent decades. Many more women (as well as men) are now able to recognise, admit and get help and support for their previous experiences of childhood abuse. Many therapists also offer therapeutic support in helping survivors recover from abuse experiences.

Though acknowledging and owning a previous abuse history continues to be a challenge for many survivors due to continuing adverse social or interpersonal responses there appears to be a general trend towards greater support and understanding from other sources.

The field of fertility and birthing is becoming increasingly aware of the long-term effects of childhood abuse - particularly childhood sexual abuse - on childbearing women and this is evident in the work of informed childbirth educators such as Penny Simkin, Andrya Prescott and others.

The impact of childhood abuse

It is generally recognised that abuse survivors may present with a myriad of emotional, physical and psychological effects from the abuse:

anxiety disorders,
post-traumatic stress, PTSD (post-traumatic stress disorder) or complex PTSD (a categorisation that encompasses the many interpersonal and behavioural responses to chronic, persistent abuse - See Herman (2000) for full definition)
depression
health problems: chronic pain, somatization
effects on behaviour and relationships

See Physiological effects of trauma and abuse

Abuse survivors, sexuality and childbirth

There is also often a long-lasting, negative and damaging effect on the survivor's sense of their own sexuality and their sexual response. A lesser known and recognised impact of abuse however is its impact on maternity: fertility, pregnancy and childbirth. The impact of childhood physical or sexual abuse or other trauma can have profound effects on a woman's childbearing ability and functioning.

Many women abused as children develop negative and distorted beliefs that they have been 'damaged' and/or are 'unworthy' and will be unable to experience the 'normal' female experiences of sex, pregnancy, childbirth and motherhood. Reclaiming their sexuality and their body through conception and birth is an act of empowerment and of reclaiming their life from the abuser and the act of abuse. Positive birthing involves a profound experience of letting go and surrendering to her birthing body which is particularly challenging for an abuse survivor who may have disassociated, numbed or disowned and lost touch with her body in order to survive.

The courageous woman who is a survivor of physical or sexual abuse and who seeks to conceive and birth her baby accepts either knowingly or unknowingly a challenge which may bring up previously buried feelings, body memories and responses to previous abuse. She may also temporarily revisit abuse issues which have already surfaced - even if they have been mostly dealt with. If she accesses the support and care she needs to take care of herself however a positive birth experience can be profoundly healing and empowering.

Preparing for maternity and childbearing

A Survivors Guide: reclaiming a sense of power and control

Changes to a woman's body and sense of identity during pregnancy can bring up insecurities, anxieties and feelings related to abuse -whether or not the woman has worked through and resolved her abuse experiences. This can present an unwelcome challenge. It is essential, to maximise the chance of a positive birth experience and to open up an opportunity for healing, that an abuse survivor be proactive in identifying and accessing the support she needs.

The work of Andrya Prescott shows that many midwives and obstetric caregivers are aware, or becoming more aware, of the impact of childhood abuse on pregnancy and birthing therefore this gives an opportunity for a survivor to access a caregiver who can understand the challenges she faces and can support her in achieving a positive birth experience.

Steps to a positive and healing birth experience

Finding caregivers with whom she feels safe and respected is paramount. She needs to know she has choice, power and control over her body and can say 'no' to unwelcome interventions and investigations - including choosing a supportive caregiver. Accessing appropriate help and co-operation from informed, understanding and supportive caregivers will enable her to look after herself and her baby appropriately and avoid the potential for retraumatisation and revictimising or 'abusive' interactions with caregivers.
Finding a psychotherapist/counsellor or similar with knowledge and understanding of abuse issues and their impact on maternity can be helpful , even recommended, in order for her to work through any issues which may arise during and after her pregnancy and birth.
Preparing for childbirth with a positive birth preparation programme (such as HypnoBirthing®) which emphasises empowerment and control for the birthing mother can offer an opportunity for healing - both in her relationship to her body, her partner and her relationship to authority- as well as avoiding a potentially traumatic birth experience (NB: the HypnoBirthing programme is not an alternative to personal therapy specifically for abuse issues and maternity or abuse-related anxiety connected to birthing. Most abuse survivors will therefore need personal therapeutic support in addition to the programme.)
Reading "When Survivors Give Birth" will give her an understanding of what she may be experiencing and information about accessing the resources needed to empower her.
Most importantly, whilst pregnancy and birthing is a challenge for a survivor it is also an opportunity for empowerment and profound healing with the potential for the survivor to reclaim a positive connection and relationship with her fertility, her sexuality and her body.

For more information on childhood sexual abuse and how to create a positive birth experience Contact Denise at Persephone Hypnobirthing.

Physiological effects of abuse and trauma

The long-term effects of trauma and abuse can lead to alterations in nervous system functioning. The loss of feelings of safety and experiences of betrayal and danger lead to a 'hyper-sensitivity' in the 'fight, flight or freeze' mechanism whereby the body becomes over-sensitive and either remains constantly on a low level of alert and/or reacts to innocuous situations or events by triggering a fear response. Simply put, this is thought to be due to overwhelming traumatic experiences causing the hypothalamus - the part of the brain that regulates hormones including the release of stress hormones - to become dysregulated.

Simply explained, a dysregulated hypothalamus (or HPA axis) becomes unable to distinguish between 'real' threats to survival and indiscriminately fires a fear response for all sorts of non life-threatening situations. However as innocuous situations often contain associations to the traumatic event these also trigger a fear response: the traumatised brain perceives these situations AS real survival threats based on traumatic memory.

It is also believed that the alteration in the hypothalamus leads to an abnormal cortisol functioning: where cortisol ( a stress hormone) gets 'switched off' in a normally functioning fight-or flight mechanism this does not happen in post-traumatic stress therefore cortisol is constantly being released triggering continual feelings of fear, anxiety, panic etc.

The state of high - or even low- alert in an abuse or trauma survivor affects both the nervous, the endocrine and the immune systems with the woman living in a constant state of fear. The body is normally programmed to run mainly on the parasympathetic system ( rather like a car engine on 'idle') with an occasional firing up of the sympathetic system (the fight-or flight mechanism). This is the autonomic nervous system (ANS) which maintains a balance between the parasympathetic and sympathetic systems. These systems switch between each other depending on our state of alert. The triggering of the sympathetic system might therefore be likened to slamming the foot on the accelerator when the engine is on idle.

An abuse/trauma survivor's body tends to be largely running on the sympathetic system and is therefore like a car engine constantly 'revving'. This leads to shut down of non-essential organs, not required for survival - which include the uterus - and depletes the body of energy required for healthy functioning. This leads to stress, anxiety, exhaustion, depression, sub-optimal health and can also affect fertility. The hypothalamus which regulates the release of stress hormones also regulates the hormones used in reproduction. It makes sense that a woman who does 'feel safe' is also instinctively not likely to feel safe enough to conceive. This may lead to a diagnosis of 'unexplained fertility'.

Once dysregulation of the normal balance between the parasympathetic and sympathetic nervous systems has occurred only regular relaxation will lead to normal regulation. Hypnotherapy and the teaching of self-hypnosis during hypnotherapy treatment can provide the necessary relaxation for rebalance the systems.

Hypnotherapy and Psychotherapy can reduce stress, eliminate fear, regulate the nervous, hormonal and endocrine systems and help heal unresolved abuse issues. This can lead to enhanced fertility, increased chance of conception and to a much more positive birth experience for the survivor.

Back to Survivors and Childbearing

Back to Fertility

Problems with links? Try this link: http://www.radmid.demon.co.uk/articles.htm and click on the links of the following articles:

Issue 90: A journey from abuse to motherhood

Issue 92: Childhood sexual abuse and potential impact on maternity

Interview about childhood sexual abuse and motherhood with Penny Simkin and Phyllis Klaus (authors of When Survivors Give Birth)

Impact of childhood sexual abuse

ORDER "When Survivors Give Birth": from Penny Simkin.
If you have difficulty accessing this link try clicking on Penny Simkin's home page and click on the link button 'When survivors give birth'.

More helpful books on abuse:

Trauma and Recovery : a groundbreaking book on sexual abuse and society's response to trauma by a world-respected expert on childhood sexual abuse Herman J.L. (2000) Pandora, London

The Courage to Heal: 'THE' book on healing from childhood sexual abuse Ellen Bass & Laura Davis (1988) Random house, London

Home Booking Contact Links

Denise Marleyn DHP(NC) MRNHP HBCE Tel: 01525 850334 E-mail: contact@myhypnobirthing.co.uk

HypnoBirthing® is a registered trademark of the HypnoBirthing Institute