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Birth after sexual violence: where’s the support?

Newborn baby right after birth plan skin to skin
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Birth after sexual violence: where’s the support?

Newborn baby right after birth plan skin to skin
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Preparing for birth after sexual trauma can be a really challenging situation. This article is part of a series of 3 articles. This is the first: this article deal with why we need to increase support for survivors of sexual violence, especially around birth. The second is Birth Preparation for Survivors of Sexual Violence, an article which is a detailed set of questions and considerations aimed at helping survivors think about what they need in birth, so they can look at getting the support and care they need. Recognising your needs puts you in a stronger position in terms of being able to advocate to have those needs met. Thirdly, my personal birth stories, available here: My Births: Birth after sexual violence and birth trauma. These I needed to write to be able to extricate them from creating a resource that might help other people.

I set out to create a resource that would help survivors of sexual violence increase their chances of having a positive birth. I wanted to write a positive approach to birth for survivors because any form of support for us as we approach birth is, at best, thin on the ground and mostly non-existent. The more I have researched, and written, the more I feel that widespread changes are needed that will change maternity care more widely, but in the meantime I think there is a strong case for services aimed at supporting survivors of sexual violence in pregnancy, birth and the postnatal period.

Why society needs to talk about this. 

The extent of the issue

A conservative estimate suggests that 1 in 5 women experience sexual violence of some kind, whether abuse, assault or rape, after the age of 16. (That figure is not inclusive of violence towards children.) (Rape Crisis website: statistics). 31% of young women aged 18-24 reported having experienced sexual abuse in childhood (NSPCC, 2011). The scope of sexual violence is huge.

2018-2023 Strategic Direction for Sexual Assault and Abuse Services promises

There are numerous studies showing that around 80% of survivors of sexual violence have at least one mental health condition, and more than half have more than one mental health condition, which can persist for years afterwards (National Institute for Health Research, July 2018). The 2018-2023 Strategic Direction for Sexual Assault and Abuse Services promises “Lifelong care for victims and survivors“, yet it makes no mention of services for pregnancy and birth, nor for supporting women to access cervical smears. The lifelong seamless care that is hailed in this strategic direction still feels like it is some way off.

The impact of mental health conditions on physical health is well documented. However, the focus of the Strategic Direction seems to focus solely on mental health.  This ignores the holistic experience of survivors even when only considering healthcare. It ignores, for example, economic and social factors like difficulties working and remaining in employment or socialising.  These are outside the remit of the NHS, but would certainly be a part of holistic and seamless support services

No antenatal support for survivors of sexual violence

Up to 5% of pregnant people experience Gestational diabetes that requires management during pregnancy. Pre-eclampsia affects up to 6% of pregnancies. Pregnant people are screened for these conditions. Information about symptoms, what to look for, and what the tests involve are provided to pregnant people. Information about foetal screening tests, as well as articles on what to pack in your hospital bag, are also provided. Where is the leaflet about support service for survivors of sexual violence with concerns about pregnancy and birth? Pregnancy and birth are exciting times of massive change, and huge vulnerability. For survivors of sexual violence issues can arise from historical traumas that have seemed dormant for years. 

This needs to be on more people’s radars. Midwives need training on dealing sensitively with disclosures, offering space for people to be open about their experiences. They also need to know where to signpost people who do disclose sexual violence, so that if they wish to seek support they can do so. These things are very difficult to do in time pressured appointments, especially when you may not see the same midwife twice throughout your pregnancy.

Support without delays

Support needs to be readily available, there’s a crucial time window to support pregnant women. Pregnancies do not have a pause button whilst referrals are processed. So many instances of sexual violence go unreported, and many survivors do not seek help at the time.  This makes it especially important to make help as accessible and available as possible so that once help is sought it is readily available. At present even access to Perinatal Mental Health Teams is a postcode lottery. Services tailored to supporting survivors of sexual violence seem like a pipe dream. 

Birth: a huge life event 

Birth trauma and birth preparation

A traumatic birth affects more than just the perception of the birth. It can affect the way people view their body,  bond with their child, and their likelihood of experiencing postnatal mental health issues. This is becoming increasingly recognised by independent support services. Change to health services, however, seem slower. Preparation is key to a positive birth.

Many survivors of sexual violence have concerns about birth. Many survivors would benefit from private, and less time pressured support to prepare for birth. Routine NHS antenatal courses aren’t the appropriate setting.  They have no time for discussing complex concerns or issues, and the stigma surrounding sexual violence makes such concerns difficult to raise.

Birth, trauma and care during birth

Birth can reawaken pre-existing trauma. This is especially common when the birthing person does not feel respected, cared for or in control of decisions. Survivors of sexual violence may be triggered if giving birth feels like a procedure that is performed upon them. Medical professionals often assume consent to routine procedures, such as internal examinations.  Health care professionals often state their offers of care as plans. They assume consent. This makes it hard to decline. Rather than offering something pregnant people can accept or decline, the offer makes it necessary to dispute a plan on order to decline.

In all care consent must be paramount. The information must be available in order to make informed decisions. We need to improve antenatal education about the choices birthing people may face during birth. Considering preferences in advance offers time to think through options, free from the time pressure and the distractions of labour. This “planning” is an excellent tool for making strong decisions.  Planning and educating oneself often go hand in hand. Understanding the context of choices that may arise during birth supports flexibility within one’s preferences. It means that whatever twists and turns a labour takes, the labouring person is better able to make empowered and informed decisions.

Healthy Mum, healthy baby?

Person-centred care

Even the most complex and intervention filled birth can be positive. Actually positive, not simply justified by the outcome. The factor that tends to affect this is how the care team interact with the birthing person. Are they communicating with the birthing person? Do they take time to talk them through their options? Or, do they respond to “issues” within the care team and present the next step as already decided? When care providers consult, inform and respect birthing people, their birth experiences tend to be positive.  This is the case even where the birth, from an external perspective, looks traumatic.

“Healthy Mum, healthy baby” is a phrase often used to dismiss many birth experiences. There is often a feeling that the end justifies the means in birth. There is no problem in wishing for a healthy mum and baby, however, there are two issues with this being the only goal.

Mental health is health

Additionally, mental health rarely seems to factor into the ‘healthy Mum’ equation. Are birthing people left terrified of childbirth? Are they anxious? Do they end up with postnatal depression? Or have flashbacks to their birth? Are they frightened around medical professionals?  These issues have lifelong effects that rarely factor into ‘healthy mum, healthy baby’ summaries. Survivors of sexual violence  are already more likely to experience mental health issues; compounding these issues through a negative birth experience can have a huge impact. 

Improved care for all birthing people

The good news is that the best way to improve maternity care for survivors of sexual violence is largely the same as the best way to improve it for all birthing people. Provide person-centred care, ideally with continuity of care throughout the pregnancy, birth and postnatal period. The bad news is that such improvement seems a long way off with the current budget constraints around all aspects of health care.

In the meantime survivors of sexual violence, a significant proportion of birthing people, have no support for their specific concerns.  Signposting to specific support services is non existent. Even whether there is a local perinatal mental health team is a postcode lottery.  Such teams can deal sensitively with the concerns that preparing for birth may bring for survivors of sexual violence. Positive birth experiences actually have the potential to increase mental wellbeing, facilitate better bonding with babies, and even support a healed self-perception of their body amongst survivors of sexual abuse. 

A positive birth 

Despite the preexisting trauma of sexual violence a positive birth is possible. For some birth can be a fantastically healing experience. Birth can demonstrate the power of one’s body to do and create something beautiful. An empowered outlook on birth helps. An empowered outlook is more likely when supported by a team of Health Care Professionals and birth partners who have faith in and respect for the pregnant person, their body, and their choices. However, for some, birth can be a time of reliving trauma. It can be an experience of pain and fear that brings otherwise buried experiences to the surface. This can combine the critical experience of meeting one’s baby, with past trauma.  

I do not suggest that there is an ideal or perfect birth that all people should aim towards. Everyone is different and all births are different. Perfection is not achievable. There is no single ideal birth. Positivity, actual positivity, not passivity and grudging acceptance, however, is achievable. With support a positive birth is possible regardless of medical history, mental health and experiences of sexual violence. A medical system that treats people as individuals, with respect, and responds to their individual needs could make a huge difference to everyone’s births.

Further resources

If this article has raised any issues for you, or you are looking for support in preparing for birth, then you may find this sister article
Birth Preparation for Survivors of Sexual Violence helpful.

Rape Crisis: England and Wales are a good place to start if you are looking for easily accessible support, and are able to signpost you to specific services in your local area.

The Positive Birth Movement is a fantastic place to start if you are looking for general information and support in working towards or promoting positive birth.

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