Pregnancy and birth can add to trauma if you are the survivor of sexual violence, writes Anna Nham, but understanding what is happening and why may help
As I waited for the surgery that would officially finish my first pregnancy after a missed miscarriage, my body wouldn’t stop shaking. The anaesthetist waited for a minute for the fentanyl to kick in and stop it, but it didn’t. “This has never happened before,” he said.
What he didn’t understand was that it wasn’t fear in my mind of what was to come that was causing the shaking, but fear in my body, remembering old fear, old trauma. Administering a drug to calm my mind wasn’t going to stop that. As the shaking continued he had to pin my arm down onto the bed so that he could get the anaesthetic in. As he did that my brain shattered, flooded by memories of being pinned down by a man in a very different situation.
The next thing I remember is waking up from the anaesthetic, my pregnancy over, a bloody towel between my legs, and a blank in my memory. It all felt too familiar. A steadily rising panic attack sent my oxygen levels bonkers and all the machines started beeping. A nurse rushed to my side. After flapping around with the machines and the oxygen mask for a while she looked at me. “Do you get panic attacks?” she asked. All I could do was roll over and whisper, “It’s in the notes.”
What was in the notes was the fact that I have PTSD as a result of being raped as a young woman and a subsequent long-drawn-out police investigation and court case. It took a long time even for me just to be able to share that fact, but over the years I have found a way. I had told a few people at the hospital this information and it was written in my notes. I had hoped it might help them know what to do in situations like this. Yet here I was, panicking, with no one around who even understood why, let alone how to help.
Fast-forward almost exactly a year to the day, and I am once again being wheeled into an operating theatre, this time for a c-section to deliver my 34-week breech baby son.
Once again my body is shaking. Even in the throes of full-blown labour my mind is not there in the room, but somewhere in the past. This time, however, something is different. This time I have a midwife I know with me. A midwife who understands what my brain does and why. A midwife who has been there before when it happens and knows how to help. She holds my hand and tells me that it will be OK, that I am safe. She tries to keep my mind in one piece in the labour room as we prepare. She calls for a surgical team with no men, and gets it.
When my baby is born my mind is hanging on by a thread. Months later I will remember very little and find that hard, but I will always know that when my baby is born my midwife is there with me. When my brain finally lets go and shatters as the surgical team are closing up, she sends them all away so it is just me and her in the operating theatre, and gently coaxes my mind back into the room. She is with me in recovery, and when yet again the machines cannot cope with my panic attack, she switches them off and turns to me and helps me calm and ground. Half an hour later, when she hands me my son, she does not assume my response. She waits and lets me lead. She knows it may be hard.
She does not take away the PTSD, the pain, but she helps me get through it. She does not make it worse; she does not add trauma on trauma.
Over and over, through two pregnancies, one miscarriage, one birth, and the first 6 months of my son’s life, as a survivor of sexual violence I have been faced with situations, procedures and services meant to help that have triggered old trauma.
Through it all I felt so alone, but in the age of #metoo we know how many people have been through what I have. And yet there is so little out there to help. In my experience, maternity services and care throughout pregnancy and beyond are not equipped to support survivors of sexual violence. In an age where the UK government has made maternal health a priority, still no one is joining the dots.
But there are things that can help, and there are people out there who understand. It is thanks to them that I am here, sitting with my 6-month-old son, writing this. Thanks to them that I HAVE survived. Again.
follows are five things that might be hard for a survivor of sexual violence
when pregnant, miscarrying, giving birth, or raising a newborn, and five things
that might help. It’s not all-encompassing and it only speaks to my experience
as a middle-class, white cis woman, who is a fluent English speaker with secure
immigration status, living in a country with a national health service. But I
offer it as one more piece of a puzzle that is still missing so many pieces. I
hope it helps someone, somewhere.
that might be difficult for a survivor
1. Body stuff. Pregnancy, miscarriage and birth are perhaps some of the most physical things you will ever put your body through. For me that led to all sorts of difficult feelings about my body as the site of a trauma I had not healed from. When I miscarried I blamed my body, just as I had done in the past, for something that was not my fault. Feeling I had lost control of my body both in pregnancy and birth pushed my brain to the very edge. Often I would disconnect from my body in response to that. In later pregnancy this meant I would be unaware of my baby’s movements, which is hard when they are used to track the baby’s health. Even post birth, breastfeeding my son raised all sorts of challenge related to my body and other people’s access to and control of it.
2. ALL the triggers. Many of the things that happen during your medical care for pregnancy, miscarriage and birth are possible triggers if you are a survivor of sexual violence. Internal scans and examinations, people touching your body, possible surgery, general anaesthetics, birth, vaginal or otherwise. It’s hard, so hard. And if one of your responses to this is, like me, to dissociate, then it’s going to get even harder. Having your brain shatter and no awareness of what is going on is horrible at the best of times. When your brain does it during appointments it makes things really difficult; when it does it during your child’s birth it’s devastating.
3. People not reading notes. This is my biggest frustration and the thing that often led to so many awful situations that could have been avoided. Over and over people wouldn’t read the notes and therefore would do things that sent my body or brain into a spiral, and then would have no idea what was going on. For example, when I was admitted for surgery for my missed miscarriage, the next person I saw after I had told the nurse my history was another nurse who inserted tablets behind my cervix, by hand, without explaining what she was doing or asking for my consent. I understand completely that time is tight in the NHS and notes are long, but something needs to change. The immense effort it takes for someone to disclose to a stranger needs to somehow lead to an impact worth that effort.
4. Services meant to help. For me the experience of our justice system was just as traumatic as my actual rape. This led to all sorts of things to do with service providers and the way they treat me being really difficult for me to cope with. It was actually this, rather than the triggers from the rape itself, that was often the most challenging thing for me when it came to my maternity care. Even the idea of a midwife appointment or hospital visit could send me into shutdown. When we discovered at a scan that our first baby didn’t have a heartbeat, on top of the trauma of the miscarriage itself the room we were made to wait in sent my mind to memories of police interview rooms. A year later, because our son was born prematurely, we spent some time in the neonatal unit. Even here I struggled to believe that these people were on my side. This made engaging very hard for me, and also challenged the people I encountered who were trying to help.
5. The sex of the baby. “It’s a boy.” Three words I dreaded. I knew I needed to find out the sex of my baby as soon as I could, because I didn’t want the birth clouded by my fear of having a boy. Having the time to adapt to this reality while still pregnant definitely helped me, so when I saw him for the first time I was able to see beyond his sex to the baby I wanted so much. Though I now love him more than I ever thought was possible, the sex of my child continues to challenge me in new ways every day.
Things that might help:
1. Understanding yourself and understanding trauma. It has taken years, but I’ve developed a pretty good understanding of how my trauma affects me. Even with this I’m still massively impacted by my PTSD. Sometimes all the self-awareness in the world doesn’t make a difficult situation better. (In fact, sometimes it can make it a whole load worse: knowing the problem and still not being able to fix it is a place I really struggle to be in.) But in general, understanding what is happening to me and why has helped me survive. When my partner and I decided to try and have children I thought some things might be a challenge, but I didn’t expect everything to rear its head in such a massive way. But when it did I at least understood what was going on.
2. People knowing what you have been through. Sexual violence is hard to talk about and so often a secret that we keep to ourselves. But until all services are run in a way that’s good for survivors as a base level – which they should be; someone having to ask consent before they touch you, or wait for permission before entering your room shouldn’t be a special provision but instead a basic right for all – if people don’t know, they don’t help and in fact they can often make things worse. When I am thinking about sharing, it helps me to remember that people do not need to know the whole story or all the details to be able to help. Working out what I feel comfortable to share with different types of people has been an important step for me. This extends to both staff and services but also to partners and friends. If they know some of what I have been through, they can support me in the way I need.
3. Slings. Slings have been my lifesaver. After the detachment I felt at my son’s birth, the closeness helped me bond with him in a very easy and natural way. We feel like one unit, and this helps me work through the fact of his sex. I find wrapping him with both stretchy wraps and woven wraps really therapeutic, creating a space where we can just be together and close without needing to try too hard. Slings also have helped with crying: if he is upset, the sling almost always calms him down. This is essential for my PTSD brain, which is always on hyper-alert. Finally, if my brain does shatter and dissociate I feel much safer when my son is in the sling, knowing he is safe and held by more than just my body. The wrap protects him both physically and mentally from what is happening. If he is in the wrap he does not know that Mummy cannot respond right now: he just feels me there with him. I fear that as he grows and I can wrap him less he will begin to notice these times when Mummy is ‘gone’. But for now, the sling protects him from that a lot of the time.
For the services:
4. Continuity of care. This is the single most important thing that enabled me to survive this experience. By week 24 of my second pregnancy I had never seen the same midwife twice. At my 20-week scan we walked into the scan room to a male sonographer, even though my notes said I was not supposed to see male staff, and I broke down. I went to my GP, whom I trusted and who knew my history, and I told her I couldn’t go to any more appointments. I was at rock bottom. Luckily it turned out I live in a city that had an incredible 1:1 midwifery team, and being under their care changed everything. Getting to know them allowed me to begin to trust them, something I find incredibly difficult to do. Knowing they knew me, knew my history and most importantly knew how to help me made all the difference. There I met all three midwives, and one of them was always on call, so knowing that one of them would be there at the birth helped me prepare and start to believe it could be OK. Knowing I could call them at any time if I had a problem and that I wouldn’t have to explain myself to a midwife I had just met allowed me to begin to engage with the services and with the care I and my baby needed. Post birth I have also had continuity of care from a health visitor who received a handover from the midwives. She has visited us regularly, again doing things to build my trust slowly rather than assuming it is just there.
5. Trauma-aware staff. The first time my brain shattered in an appointment and the 1:1 midwife knew what to do to help, my world changed. In fact the team knew even more than I did what would help me, and for that I will forever be grateful. They understood trauma and what it does to the brain, and this led their responses and care for me. They knew that my trust was something they needed to earn, not something I could just give because of their job. Without all that, things would have been so different. In the age of #metoo I feel that a basic understanding of trauma and how to support people who have been through trauma would go a long way in maternity services and general health services alike.
I hope that by offering these things I have learnt from my own experience I will be helping someone else to be spared some of the pain I went through. Survivors of sexual violence are everywhere, whether you know it or not. In the age of #metoo our maternity services should reflect this. However, all too often it’s going the other way. In the six months since I gave birth, the 1:1 midwifery team in my area has been cut, leaving me full of dread about what I will do if I want another child. Other continuity midwifery services up and down the country have also been cut or are at risk. Mothering through #metoo has been and continues every day to be one of the biggest challenges of my life, but I now know that I can survive. If you are going through it now, please know that with the right help you can too.
Anna Nham is a writer figuring out how to mother as a survivor of sexual assault.
My Body Back runs maternity clinics for survivors of sexual violence – www.mybodybackproject.com
Illustrations by Veronica Petrie http://www.studiovink.co.uk