Birth Plans

Abuse Survivors and Birth Planning

The following is an interview with a reader who is a survivor of abuse. She shares her story to help others who may be struggling with similar issues.

When/how did you become aware that your abuse history would affect your birth experiences?

It was during labor, I began feeling increasingly out of control and talked down to like a child, the nurses would perform cervical checks when ever without asking- " I need to check you" and then boom there's someone shoving her hand inside me while I'm having a contraction. I felt so out of control and vulnerable but it wasn't until the doctor decided I needed internal monitors that I really flipped. The sensation of the monitor being inserted sent me into a flashback- I didn't just remember what it felt like or think it felt similar- suddenly I was reliving the rapes- I was there- I was screaming but no one knew why- women scream in labor all the time- I guess my screaming wasn't any different. I snapped out of it but I felt as though I had just been raped all over again- my doctor didn't do anything *wrong* it's just how my long ago pain resurfaced in a very stressful time I suspect that the stress and vulnerability along with feeling restrained and muscle memory of something going too far inside my body is what did me in.

I said nothing to anyone for a very long time- it wasn't until I read Kathleen Kendall-Tackett's book The Hidden Feelings of Motherhood, more specifically the chapter, "the Long Shadow" that I finally didn't feel ashamed of what I had experienced-what I experienced can be a common response to what I had endured years before- before this I had felt tremendously guilty for having such negative feelings over the birth of my first child- how could i possibly associate the most traumatic event in my life with what was supposed to be the most precious gift, the birth of my baby? But once I knew it was ok, I could heal.

What did you most need during that first labor? How could those with you have helped you?

Firstly I needed respect, I needed caregivers who respected me as a person, not talking down to me like a was a helpless child. Who listened to my concerns and respected me as a human being.

I needed my husband to be by my side- he watched tv while I labored- he later told me he didn't know how to help so he just decided to stay out of the way. I felt abandoned by the person I needed and trusted most.

I needed to be more informed about the birth process, knowing what's normal would have made things less scary.

Ideally I would have had less interventions-not sure if my circumstances would have allowed it or not but I know the interventions were a huge contributor to my distress- my water broke, with no significant contractions, I had preeclampsia and my blood pressure was rising so I was put on pitocin which meant an IV, and external monitors and ultimately internal monitors all of which made me feel continuously restrained and to add to it when I laid on my side the baby's heart rate would drop dramatically ( it was thought that the cord was being compressed) so I had to remain on my back making the feeling of restraint even  worse.

Freedom to move would have made a huge difference for me.  I knew I wasn't going to get up and run out of the room in labor but in my mind I needed to know I could if I needed to- instead I felt so helpless and at the mercy of those around me.

I needed to know there was the possibility that old issues could come up, even if it was just to know I wasn't some kind of freak.

What did you do differently to prepare for the next labor?

The very first thing was hire a doula, an excellent, caring doula! She educated us on the natural birthing process. She taught my husband ways to help so he was part of things and not a spectator

I wrote a birth plan making sure those caring for me knew I had a history. I've read that caregivers get irritated with "control freaks" in labor (which is not right since every woman deserves to be respected) but if they have some insight as to why a woman is requesting the things she is they're more likely to be understanding and sensitive to those to needs.  I thought it was important for them to know I NEEDED to not feel restrained, and have some "control" I wasn't being a martyr or trying to tell them how to do their job I just needed this as a survivor. And I needed to feel like I was doing my best to protect my baby as well.

I also read the book When Survivors Give Birth by Penny Simkin  it helped me identify possible triggers and ways to avoid them and reinforce that I'm not a freak that what I experienced is normal for someone who went through such terrible trauma.

What worked and what didn’t work for you in labor the next time?

Our doula was amazing! She was my voice she was my strength! She was sure to ask every nurse that entered my room if they'd read my birth plan, if they hadn't she'd tell them they had to. She was our rock she helped reassure and guide my husband helping him to be involved up to his comfort level and filling in the gaps. She constantly reassured me and keep me in the here and now. As a fellow Christian she even prayed with me. I know that's not everyone's thing but it was what I truly needed and she knew that. 

The next two births ( children 2 and 3), the birth plan really made a huge difference I didn't have to continuously tell people over and over i don't want medication, yes I'm sure i don't want an epidural, no I'm not trying to be a martyr, please ask me before sticking your hand where it doesn't belong...the nursing staff was so gentle and respectful it was terrific.

I did have this grand plan to have relaxing music playing: all three of my subsequent births it never happened for one reason or another-next baby, not wasting my time with tapes or play lists.

My last birth was a little more challenging in that it went so incredibly fast( less than 2 hours total only 53 minutes at the hospital), that the staff didn't read my birth plan before we arrived despite a phone call letting them know we were on our way. We arrived before our doula, got to our room, I lie in the bed and the nurse says 'we need to check you' and begins stripping my clothes off me and checks me, i would have preferred to undress myself or have my husband undress me and certainly a "may i check you? [wait for an answer] You're going to feel some pressure..."  would have been a lot more tolerable but it wasn't anything that put me over the edge- she did some other things that I found difficult  but my husband was by my side reassuring me, our doula had done a wonderful job guiding him with the births of our last two sons that he was able to be there for me, when I needed him most. When my Dr arrived the mood of the room changed, he was gentle and unhurried and respectful- and he ran the show the nurse stepped back a bit-my doula arrived just minutes later and by this time it was almost time to push she and my dr get along wonderfully but she butted heads with the nurse a bit. I actually felt better about this- that's exactly why i needed her, to be my voice my protector and she didn't let me down.

After baby was born and I was assigned a new nurse and the rush was over, she was sure to have my new nurse read my birth plan- yes the birth was over but she felt (rightly so) that it was necessary for anyone who was caring for me, even after the birth, know I needed to be addressed with respect and gentleness and my desires for our baby.  It's kind of sad that one needs to write up a plan asking for a basic respect all women are entitled to but I certainly have noticed the difference between those that have read it and those that haven't.

Did you meet any resistance from midwives/OBs as you shared your story?  How did you handle that resistance?

Yes, unfortunately I did. With my 2nd son I tried to share my birth plan with my OB she didn't want to see it, she said to send it to the hospital and it would be in my file for the big day, I told her there was important information I thought she needed to know. Again, send it to the hospital. I was too afraid to blurt out "Hey you, listen, I'm a rape survivor and I need you to know some things." She had a presence about her that suggested she was right and no one could oppose her. 

At another prenatal appointment we were discussing inducing me and I told her how I just couldn't do pitocin again. She told me I could have an epidural right away and wouldn't feel a thing. I reminded her how I didn't want to have an epidural, I just don't want to feel restrained (we had discussed this part before) and she replied real sarcastically "Oh ya, that's right you're afaaaaid of epidurals" I left almost in tears. Thankfully i went into labor on my own on a day she was not on call and while I had a Dr I never had met before this Dr was completely supportive of my birth plan, as were the nurses we worked with at the hospital.  I switched Dr for the births of my next two children to my family practice Dr who has been the best Dr ever.

Basically when I meet resistance I turn into that helpless child again- why I don't know, This is why I need my doula, she's not afraid of anyone. She's sure to let others know how important certain things are to me and can't be ignored.

You said you thought you had healed before the first birth, what did you do after that first birth to continue the healing process?

At first nothing, I felt totally ashamed of how I reacted to his birth, and to add to it we had a terrible time getting him to latch and nurse. I felt damaged and rejected. And when I would try to get my son to nurse and he'd cry, I felt that maybe I was abusing him. That escalated until I was afraid to change his diaper, to wipe him, to bath him. What if I accidentally abused him? I've tried to explain this to people who've not gone through it and they don't get it but others who've come through childhood abuse have said similar things.

I was afraid to be his mother, he deserved better, I was afraid I was going to accidentally hurt him? I was also afraid to tell anyone what I was feeling-how could I associate something so beautiful as the birth of a child with something as ugly as rape? It wasn't until J was over 9 months old-probably a bit older that-I read The Hidden Feelings of Motherhood by Kathleen Kendall-Tackett ( from my local LLL library). The chapter entitled "The Long Shadow" discusses the impact of childhood abuse on new mothers. She described what I was experiencing! I wasn't a freak! I wasn't a horrible mom!

From there I mentioned it to my nurse practitioner who suggested with future births that it's important to mention my trauma to caregivers so they can be mindful of it...why oh why didn't I know this could have been an issue before at least I wouldn't have spent nearly a year in silence worrying that I was crazy?! From there I sought out online resources, message boards, fellow survivors, and eventually a book called When Survivors Give Birth. Not only did it help me prepare for the next child, it helped reinforce that what's happened is a normal response to trauma.

Having each baby and nursing them, has been very empowering to me. This is God's plan for me and I've embraced it!  I've also found it healing to share with others that they are not alone. Even if I couldn't change the flashbacks etc that occurred if I at least known this was a normal response, I wouldn't have spent so much time feeling so bad and alone.

Was there anything specific about the birth experience that was a trigger to re-experience the trauma?

The placement of the internal monitors put me over the edge...the other events: interventions, lack of support, lack of respect, helped get to the edge but the internal monitor probe is inserted all the way up into the uterus to measure contraction stregnth...the uterus is not meant to be entered...just exited. I'm probably being too graphic but as a small child being raped by an adult man things were pushed well beyond where anything was meant to go also. I think "muscle memory", as i've heard it described, was the ultimate trigger for me

Did you have a system set up to help your labor support know if what you were experiencing were flashbacks during the second birth? What did you plan to do if flashbacks did occur?

We didn't really. I guess before I had the flashbacks I started getting panicky first so the plan was to just help me focus and not to panic and avoid the interventions ...in hindsight we probably should have had more of a plan for if it would happen what to do...

What advice do you give to other women who have experienced abuse?

Find support- a doula is great if you can afford one!!

Choose your caregiver carefully one that who will respect you and your individual needs.

Let your caregivers know you are abuse survivor, even if you don't know if it will trigger something- in my experience caregivers seem to approach me more gently when they know.

Educate yourself AND your partner about the birth process, what a normal birth entails, it helps aleviate fear 

Communicate- i was too afraid to tell others what was going on.

Be kind to yourself! 

Do you feel "healed" now?

I used to think I was healed, I put it out of my mind. I didn't like being a victim, talking about it or dwelling on it. But really I don't know that the wounds really ever heal completely. I've come to an acceptance that this is part of me and I can't change the past only learn from it and move forward.

I am dealing with the original assaults again. It still hurts and I'd be lying if I don't still feel anger for my attacker not only for the original harm he did but for interfering with what should have been a beautiful time in my life, becoming a mom. And maybe it's harder now that I'm a mother, I'm very protective. I'm the mom that stays at a birthday party when all the other parents leave, I'm the mom who doesn't leave her kids with a sitter other than a close friend, and I'm the mom who stays at church in a nearby room when her children are at their youth activities no matter how much I like those who are in charge... I couldn't protect myself as a child but I will do my very best to protect my children. 

I know I'm over protective. The rational side of me tells me the likelihood of the same thing happening to them is probably not as great as I perceive it to be but that's how I cope. I feel terrible for saying this because I know we are to forgive but I HATE that man, not for the pain he's caused but for the continuous fear he's created.

I know I can't take away the pain others have endured but if I can reach out to just one mom and let them know "this is what helped me,  you're not alone and you can do this. You are not damaged you are having a natural reaction to a not so natural trauma and deserve to be respected, you will be a great mom and you deserve to be happy!"