Sexual Abuse Survivor Considerations in Childbirth and the Connection to Maternal Mortality

Written by: Jess Kimball

There is an important link between sexual trauma and maternal mortality that needs to be recognized in order for parents to prepare to give birth and for providers to deliver quality, informed care. Understanding the link between these two areas expands the work done by reproductive justice advocates and creates a necessary bridge between them and sexual abuse survivor advocates.

Bridging the work that these two groups are doing could meet a major need for birthing individuals. Many people who are currently pregnant are victims of sexual abuse. This number will continue to rise as more states pass laws banning abortion or limiting access to abortion care. The steps to creating this bridge include network and outreach between organizations, but also an increased understanding of the needs of pregnant survivors, by both groups.

The correlation between groups impacted by maternal mortality and groups impacted by sexual violence should be looked at more closely. Indigenous people are the most likely to experience sexual violence and the rate of maternal mortality for Indigenous birthing people is actively rising. Sexual violence and post-traumatic stress disorder increase the risk of suicide. Intimate partner violence is linked to mental health-related maternal mortality. With 20% of maternal mortality postpartum being from suicide, it is important to explore how experiences pre-pregnancy may impact the mental health of the birthing individual because pregnancy, birth, and postpartum are all times when past traumas can be triggered. Survivors may struggle to trust their provider which can reduce the likelihood that they will disclose problems that arise in pregnancy and postpartum. The Maternal Health Blueprint explores the link between maternal mortality and adverse birth and postpartum outcomes. It takes a look at how pain being ignored or lack of disclosure about pain due to not trusting a provider impacts the U.S. maternal mortality rate.

Statistics around birthing individuals and sexual violence experiences are not very well known. Reports have very different findings. The World Health Organization estimates that one in four birthing people has experienced a form of sexual violence. One report found that 20% of pregnant women assessed reported some form of sexual abuse in their lifetime. A study by Black Women’s Blueprint found that 70% of girls experience sexual abuse before the age of 18. The Washington State Department of Health (2010) reports that 10% of women reported physical, psychological, or sexual abuse by an intimate partner around the time of pregnancy, and nearly 22% of teens (ages 15-19) report experiencing physical, psychological, or sexual abuse around the time of pregnancy.

Labor and delivery can cause distress for sexual assault survivors due to pain in intimate parts of the body, lack of privacy, frequent exams, and loud voices in the room. Survivors can benefit from working with trauma-informed providers as well as a doula who can advocate for a calm, low-stimulation birthing environment.

Birth is not the only area where triggers can come up for parents. Breastfeeding can be especially hard depending on the type of trauma the parent experienced. Working with a trauma-informed lactation consultant can be beneficial. They can recommend different positions to try or even provide recommendations around other ways of supplying the baby with breastmilk, such as pumping.

For many women, the triggering factors in medical settings even come up during basic reproductive health appointments. There are providers that exist who are willing to let the patient insert the speculum themselves or even do their group B swab during pregnancy themselves. Finding a trauma-informed provider is incredibly important. Sometimes the best option can be a midwife who is able to do exams in the client’s home and is more open to patient-led exams. Midwives and doulas have a model of care that is centered around client autonomy, empowerment, personal strength, and informed consent or refusal. This framework can be incredibly beneficial to survivors.

There are many resources that providers can begin engaging with in order to adopt a similar framework to support their clients. If you are looking for resources on supporting survivors through pregnancy, birth, postpartum, or even basic reproductive care we recommend When Survivors Give Birth by Penny Simkin, trainings offered by the Black Women’s Blueprint, connecting with sexual abuse advocacy organizations in your own community, and attending a trauma-informed reproductive care training. Emily Likins-Ehlers is a survivor who partnered with The Educated Birth to discuss methods for supporting survivors in labor. Her piece can be read here. Kings College London has a free course focused on supporting birthing individuals who have experienced childhood sexual assault that can be found here. Additionally, the Washington Coalition of Sexual Assault Programs has a great resource found here.

At Global Foundation for Girls (GFG), we are active thought partners, serving global communities of birthing persons in order to advance and support the advocacy movement. We lead webinars and trainings for providers including doulas, social workers, childbirth educators, and more! To learn more about our upcoming trainings click here!

Jess Kimball, AS, CLC, CD, PCD, PMH-C

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