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The Impact of Abuse on Childbearing Women


Catcup
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I have received yet another flurry of private messages asking about

The Impact of Abuse on Childbearing Women

Here is a brief overview, which I hope you will find helpful.

Just for the record, this happens to be the area where I was trained personally by Penny Simkin in 1992.

Not all women who have been abused will have any of these symptoms or outcomes, or any of the symptoms previously listed on the Normal Human Reactions to Rape thread. However, the symptoms and outcomes I am listing, are normal human reactions to sexual abuse and have been noted in a significant percentage of that population.

Women who have been abused have a higher incidence of cesarean sections for failure to progress. Many times, there is an adequately wide pelvis through which the head could easily descend, but for no apparent reason, the cervix does not dilate or efface beyond, say for instance, 4 cm. and about 50%. (Attention: That doesn’t mean if a person has been diagnosed with failure to progress that you can say they have been sexually abused. That can happen for other reasons….)

During labor itself, some abused women pass their early and middle stages without incident, but in transition, the loss of emotional control can be severe. Women who have abuse in their background can manifest problems earlier, but can especially have difficulty going through the transitional stage of labor. Transition can be rough on any woman. However those with abuse in their backgrounds may be blindsided by a more intense mixture of emotions and stark terror. This sometimes results in dissociative behaviors.

Tuning in to your body and becoming internally aware of the changes and contractions is the usual way to surf the waves of labor. However, tuning in to their labors and giving in to the pain is often frightening for survivors of sexual assault. The pain associated with crowning can be especially traumatic and confusing. For example, and it helps to remind the patient that the pain is from the baby coming out, and not something going in.

In general, because of their past sexual trauma, these patients have a distinct fear of losing control. They fear loss of control not only of their emotions and their physical bodies, but also over the entire process of pregnancy, labor and birth. They may find the changes in their physical bodies disturbing. They may find the normally intrusive but usually painless medical procedures and exams during prenatal care painful and traumatizing. They may have severe reactions to graphic birthing films and breastfeeding instruction.

Fear of loss of control can be manifested in different ways regarding birth. Many of these women have a distinct need to control every part of their pregnancy experience, outlining elaborate and almost impossible to obtain birth plans, and manifest attempts to control the doctors, midwives, and medical personnel. They can be demanding, unreasonable, and distrustful of the physicians and staff. This usually makes for rough relationships with the staff, unless they have identified her as a survivor of sexual assault.

Once a woman has been identified as a survivor of sexual assault, her behavior begins to make sense to the staff, and it makes sense to give this person the power she needs over the experience. At this point if the personnel allow her all the control over her experience they can reasonably and safely give her, the birth experience can actually be a healing and victorious experience for this woman, to have her own control over this significant event regarding the parts of her body that were previously so violated. If she is not identified, there is a danger that she will likely be further traumatized by reactions of the alienated staff.

Rather than try to gain control over everything, some survivors of sexual assault go to the other extreme and give up all control over things that are even within their own responsibility to undertake. They may choose an obstetrician who is dominant or domineering, and surrender all decision making, or refuse to make decisions for themselves. That particular behavior is also seen in women who may not have been sexually abused, but have been emotionally or physically abused by a spouse, significant other, or family member.

For those of you who want to read more, there are at least two books I know of right off the top of my head that you might find helpful:

The Courage to Heal by Laura Davis and Ellen Bass

When Rabbit Howls by Chase T. Jove

For my friend Pond, who might want more scientific proof from the appropriate medical research journals, since she/he finds my own credentials are so woefully inadequate, please reference:

“History of physical and sexual abuse in women with chronic pelvic pain” Rapkin A.J., Kames L.D., Darke L.L., et al. Obstetrics and Gynecology 76(1): 92-96, July 90

“Prevalence of sexual abuse, physical abuse, and concurrent traumatic life events in a general medical population.” Greenwood C.L., Tangalos E.G., and Maruta T. Mayo Clinic Procedures 65 (8): 1067-1071, August 90.

“Dissociative symptoms in relation to childhood physical and sexual abuse.” Chu J.A. and Dill D.L. American Journal of Psychiatry 147 (7): 887-892, July 90.

“Medical problems of adults who were sexually abused in childhood.” Arnold R.P., Rogers D., and Cook D.A.G. British Medical Journal 300:705-707, 17 March 90

A note about post traumatic stress disorder—some have asked questions about this. Rape can predispose a person to this disorder. In fact, a person may get through the initial recovery period without incident and go for a decade or more without problem. And then, when they are faced with labor and delivery, or if they are victimized by say, a burglary, or are involved in an automobile accident, this can actually trigger ptsd, and the symptoms seemingly come out of the blue. Yet these effects are directly tied to the sudden violence and intrusion that occurred in the assault.

Edited by Catcup
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Fascinating and very helpful CatCup!!!

Both of my boys were c-section. Aaron was breach and with Jacob, interestingly enough, I never dilated past 4 cm. My sister (who was also sexually abused) likewise could never fully dialate and ultimately had a c-section too.

It helps me make sense of a recental dental appointment gone awry too, perhaps. The dentist was severely lacking in bedside manner and I can't help but wonder if most people wouldn't have either decked her or at the very least gotten up and walked out much sooner than I did, or in some manner or another "fought back" and expressed anger.

I won't go into the long story, but sufficite to say when I finally made my way out of that office I was crying so hard I coudn't drive the car. I had to call Sushi to go get the kids and then I just sat in the car for about 15 - 20 minutes until I had myself under control enough to drive.

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The ptsd expanation really puts some pieces of the puzzle together. Thanks!

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I am sorry Abby.

You brought to mind when I delivered my 1st child. Unbeknownst to me....it was a teaching hospital. I was held down while one intern after another forced themselves inside of me during contractions (horribly painfull and upsetting) .... as the baby was desending...I don`t know how many of them there were...but Mark says at least 4. I was an object for study...for their learning...I had no say so over who was doing what to me...The contractions were less than 45 seconds apart and the babies head was engaged when I arrived....there was a nurse who had a stack of papers at least a couple of inches high that she was trying to read to me and get me to sign during the contractions and with these men taking their turns....

I absolutely freaked OUT not being allowed any say so as to what was happening to me...I had filled out all of my pre admit forms and been through the hosp lamaz ect...did everything I knew to be prepared....

It was terrifying .... my dr arrived very angry, I suppose maybe because he had just left and had a waiting room full of patients...

I don`t know...I only know that he entered the room and snarled at me that I wasn`t behaving, and if I didn`t want to cooperate that I just needed to leave..now mind you the babies head was engaged..I could not walk...I begged mark to carry me out...I pleaded with him crying to take me away....he couldn`t even begin to carry me...we were both stuck in this nightmare.

The Dr. was brutal, now without examining me, or attending to the baby that was coming....he marched over and held me down and inserted an iv with such force that my arm blackened from elbo to wrist over the next week....

The experience was so traumatizing to me...to lose control over what happened to me...to have all of these people using me as an object to further their education...to have this man that I looked to for the health and well being of myself anmnd my unborn child to snarl at me and insist that I was not cooperating when I was doing my very best to coomply.....it wasn`t like they asked...or even were doing it to help take care of me...I was just an interesting case study.

No this isn`t rape...but something was broken that day... it is as close as I can come to understanding what a rape victim goes through....

I just know that after that...I had 6 more children...but was terrified beyond words to go to the hospital...I had the second one at home with no ones help but marks....I told him that I would rather die at home because the prospect of the hospital was so upsetting...I was too frightened of losing control again....I was too afraid to see a doctor for prenatal for fear that he would know what I was planning...

Over the intervening years, I met some mid wives that assisted with the prenatal care and I even re entered the hosp for a couple of them...but only with the solemn promise that the mid wife and mark would keep all medical staff away from me.

I cannot explain why I am so adamant about staying away from hospitals...I cannot explain the depthe of distrust I have for any physician outside of the two that are personal family friends that care for us gently and kindly...aware of our deep mistrust and need to have absolute say so in our treatments. This mistrust and strong reaction spills over into many other areas.

All I can tell you is that the depths of anxiety that you described abi...I have been there...No I haven`t been raped, so I can only understand a fraction of the intensity that you all describe....and that in and of itself is overwhelming.

The necessity for say so in treatment and control over decisions...and reaction to loss of control is intense. I just understand dimly why a person who had been raped would feel this way.

Edited by rascal
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I think your experience is also very appropriate to this thread, Rascal, and appreciate your sharing it. We think of rape as sexual - though really sex is only the means to the end and not the motive. I think rape can occur in non-sexual forms as well.

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I don't know if that is "rape" but it sure does sound pretty darn close if it isnt. If I were you and planning on having anymore curtain climbers then I think I would pack a gun into the O.R. Just to keep things even. I absolutely hate hospitals myself and I can completely understand the "unexplainable" reason. But that is for another day.

Abi- sweetie I cannot relate. I have five children but they are all adopted. I cannot bear children of my own. But this sounds horrific! And it does help explain why my mother had so much trouble with her children. Her first husband was a real prick!

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All I know is that 6 weeks later when the hospital did it`s courtesy call back and asked me if I was pleased with the treatment recieved....I told them what had happened. I was very carefull in my description of what happened and left some of the worst of it out because I still had to take myself and the baby back to this dr for our 12 week check up (it never occured to me that I didn`t have to go) and was terrified that he would find out that I said something bad.

I got another phone call within 24 hours with an apology and an offer to waive the 500 dollar deductable that we owed after my insurance company paid.

Seems like they must have thought that there was something wrong with the way I was treated and not just an over reaction or non compliance on my part......even when I sugar coated it. :(

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Seems like they must have thought that there was something wrong with the way I was treated and not just an over reaction or non compliance on my part......even when I sugar coated it. :(

Darn straight there was something wrong with it! It was wacked!

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I don't know if that is "rape" but it sure does sound pretty darn close if it isnt. If I were you and planning on having anymore curtain climbers then I think I would pack a gun into the O.R. Just to keep things even. I absolutely hate hospitals myself and I can completely understand the "unexplainable" reason. But that is for another day.

Abi- sweetie I cannot relate. I have five children but they are all adopted. I cannot bear children of my own. But this sounds horrific! And it does help explain why my mother had so much trouble with her children. Her first husband was a real prick!

Curtain Climbers - roflol!!! 5!!! OMG, Eyes, you are a brave and wonderful woman! I have two and the reason I have two is because I do not think I could handle 3 - lol lol!!!

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Curtain Climbers - roflol!!! 5!!! OMG, Eyes, you are a brave and wonderful woman! I have two and the reason I have two is because I do not think I could handle 3 - lol lol!!!

Ditto what Abi said :)

I guess I had no idea why I became so nutty about stuff outside the relm of hospitals and dr.s offices.

When you told about the dentists office Abi, it seemed to make sense that the impact of my treatment by those I trusted could have effects in areas outside of the medical field.

Like I said to cat...it seems like the dots are being connected....once I recognise this stuff...I can get a grip on it.

Thanks guys for helping me to understand.

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great topic, cat

i had a neonatal (?) crisis team involved in my delivery, don't feel like going into the details, but i had fever during delivery, an IV, i never could nurse (my heart's dream), dah dah dah

after, visits from my doctor and other doctors

as well as a letter from the head of a very fine hospital

i wanted to have a second child (not too long after my first, since i was already 38)

but i just couldn't do it, no way, no how

childbirth was one of the worst experiences of my entire life. i was sure i was dying....

--

also, it has taken me YEARS to find a dentist. i finally have one who knows how to treat my panic attacks and fear of dying in his chair

--

oh my

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I hear ya ExC. This particular dentist, instead of explaining what she was going to do and talking me through what she wanted me to do, just jumped right into things and then started yelling at me when I didn't respond the way she wanted me too. Her jumping into it started the panic and her yelling only further increased my panic until I finally just pulled her hand away from my mouth and yelled at her that I couldn't breath.

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God is SO good to me that way as well Ex. Our family doctor is a personal friend and saint...We have the great good fortune to have an orthopedic surgeon as a friend as well.

Whenever we have had officious hosp staff not taking care of us correctly and it has happened...there was a horrendous situation where the nurses had not given my son the medicine he required after surgery...(she had treated him roughly and the iv had come loose leaking his vital meds all over the bed) .and to be able to pick up and dial my ortho`s home number from memory sure dropped some jaws and got some heads rolling.

Same with my dentist...I was terrified...I was sick and shaking crying the first visit...I thought I would vomit...and this big HUGE black man came in...pluncked down beside me and began asking for prayer for a family member....

Not only was the man a devcout and caring christian...I was tickled at what I was sure was an answere to my fervent prayers....that the man presented him as a brother in Christ immediately.....it is difficult to explain...but suffice it to say that he ministered to me more than just in my mouth at that visit.

We thoroughly enjoy our visits...both of us now...my mouth seems secondary in the considerations.

My family physician...lol is a hoot...we talk a few miniutes about medical stuff and spend 15 miniutes talking about horses each others children and spouse...etc :)

Sorry for the tangeant...but in thinking about what ex said.......I was touched with the enormous effort (I believe) of God to place people in my life that can take care of my family without further trauma. That understand my anxiety attacks.

More than once my dr has said.....*no cathy...I don`t think that you will get rabies...or are crazy...or your child has cancer....(pick your ailment)...I can however prescribe something so that you don`t feel so anxious about these things :)

Lol

(((Abi)))

That sounds pretty calloused on that womans part...How DARE she???

Time to find a new dentist....that is one thing I HAVE learned in the last 20 yerars...we DON`T have to put up with mean people.

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how wonderful and miraculous, rascal

ab, years ago i had a dentist yell at me for not relaxing, my jaw locked up, and i couldn't help it. no amount of yelling was going to change that

i pulled everything out of my mouth, threw it on the floor and stormed out, never to return again

ps. tell sushi i went to st. peter's to have my darling baby

--

then, thank you god, i found one that stopped EVERYTHING, sat me up, and like, stroked me and talked to me, once i held my hand up. they understood i thought i was dying of a heart attack

--

catcup, this thread about childbearing can really help a lot of girls.

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Wow, you are brave ex. When I have been in situations like that I have just frozen in terror. I admire folks that don`t take it.

Even now, we have a horrible neighbor who has screamed at my daughter till she cried over something that had nothing to do with her....whom has been in my face over things....I just melt and try to placate.

I make myself ill.

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Aww she is just a bully pure and simple. That was just the most recent example where I allowed someone intimidate me into silence.

I don`t know what it is that shuts me down inside and causes me to accept unfair treatment....shrug

Maybe it is the whole self image thing...willing to accept and believe what others see and attribute to me..the situation.....instead of listening and believing in myslef and perceptions......I dunno too wierd.

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I dunno Rascal. I tend to shut down inside when I am yelled at too. I don't usually just sit there and take it - I usually walk away, but the result is more or less the same. I have on occassion been able to stand up and give it back - but it is very emotionally draining to do so.

I think that is one of the reasons I like the debates on the forums, it allows me to practice for real life. :)

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I am glad this is opening up some dialogue.

Women who have been sexually abused/molested, or even those with near escapes, can find it difficult to deal with medical procedures of any kind, not just gynecological and obstetric. Dental procedures rate high on the list as well. As do run-ins with doctors and caregivers who are authoritarian in their approach.

Authoritarian methods will actually set off the fight/flight response and even full blown panic attacks in the patient. That is what you guys are describing up there in your posts.

This is why those in the medical profession need to be trained to identify behavior that can possibly be linked with such abuse, or have someone in their practice who is trained to spot them.

1. It helps explain the reaction to the physician

2. It demystifies the patient's behavior to the staff, which generates more compassion

3. It increases the likelihood the patient can have a positive experience

4. It decreases the likelihood the patient will be further traumatized

What the doctor can do:

Take the time to establish a good rapport with the patient. Always be gentle. Always carefully explain what you are going to do before you begin. Ask the patient if she is ready to begin. As you are performing the procedure, explain what you are doing and let her know if something will change. If she suddenly wants to stop, STOP and let her gather herself together before you begin again.

Giving the woman as much control as you can reasonably and safely give her in these procedures, especially during birth, can be a very empowering and healing experience, helping the woman regain confidence and some range of comfort with the experience, rather than one that further traumatizes and sets her back.

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Maybe it is the whole self image thing...willing to accept and believe what others see and attribute to me..the situation.....instead of listening and believing in myslef and perceptions......I dunno too wierd.

Ok Rascal love how about this for "attributing and how I see you" You are an amazingly intuitive woman with a heart of gold. You are gentle and caring a woman of incredible strength who isnt afraid to stand up for the weaker folks who would shelter under her formidable wings. And no I aint blowing smoke!

And Abi you are just as gentle and full of understanding. Your heart just pours over onto everyone. Your honesty and straight forward way of thinking has at many times put me in awe of you. Dont you think for one second that you are not capable of staring down Attila the Hun.

Dear Exie, I see in you a profound gentleness and fierce determination mixed with incredible strength of character. I think that you would be the type of person that could bring a room to silence upon entering.

And Cat, wow you just blow me away with your "in your face" confidence and then you have that soft squishy side that makes you loveable.

What can I say ya'll are super! And if you are having trouble facing some stupid bully just let me get my paws on 'em. I'll shake 'em up a bit! That's for certain!

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Thank you for allowing me to participate here...I can`t tell you how much it helps me very much to understand why I am this way. Why the intensity of my anxiety attacks and certain triggers. I was afraid that I was intruding here.

Your explanation catcup is exactly how my physician treats me....and now I understand why I feel that I can trust this man.

Again, I didn`t understand ...I am just glad that I am not alone or completely crazy.

Thank you

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Rascal - that is NOT the way teaching hospitals are supposed to operate! I've never given birth, but my mom's experience with me was similar. She told me about it and said she wouldn't have been surpised if the window washer had dropped by for a look!

I'm NOT defending teaching hospitals in general, but hopefully they are not all like that. We had patients where I last worked who wanted nothing to do with the residents. It was so noted on the chart, and those patients saw the attending physician only.

Also had a funny experience with a little old lady who told a chief resident, an odious and odorous fellow as I recall, that she would rather die than have him do a pelvic on her - and he dictated it into the note!

Three cheers for the little old lady! Stand up for your rights, women!

Of course, she wasn't about to give birth. Those interns, students, residents, and their attending who did that to Rascal should be circumcised with a dully rusty penknife!

WG

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