Patricia Miller was having contractions every two and a half minutes. Today, Miller is a director of adoption services and a volunteer board moderator at Pandora's Aquarium, a forum for survivors of sexual assault. Back then, she was a 25-year-old abuse survivor, expecting her first child. Labor wasn't progressing, so Miller was sent to radiology to determine what was wrong. The technician told her doctor that labor must not be very advanced — after all, Miller hadn't made a sound. What he didn't know was that Miller had learned to keep quiet during her abusive childhood.
"It was very dismissive," Miller tells Romper. "Why was he making those assumptions? Ask me. Talk to me like I'm a real person."
The x-ray showed multiple untreated breaks in Miller's pelvis, and the doctor whirled on her. She couldn't have a vaginal birth with injuries like those. Why hadn't she said anything?
"How would I have known to say, I was tortured and never saw a doctor? He never asked about any of my crap. How would I have known?" Miller wonders.
They began prepping for a c-section. The anesthesiologist tied her arms down without asking her permission. Memories of the abuse flooded in.
If doctors had asked about her history, how she responds to pain, and how she preferred to be treated and touched, things might've gone differently.
When the epidural didn't take, Miller was paralyzed but awake throughout surgery.
Treated dismissively, triggered by bonds, and suffering excruciating pain, Miller found herself reliving her trauma, and "it was horrifying."
Miller now brings a one-page summary of her abuse history to every doctor’s visit. The sheet explains that she must be treated with compassion and respect for her body’s boundaries. But isn't that how she should have been treated to begin with?
Practicing Trauma-Informed Care
Miller's first child was born in 1982, but the birth world largely continues to ignore the impact of past trauma. Providers don’t ask about abuse, and patients don’t always feel comfortable sharing. Even when they do, most doctors and midwives have little to offer them. It all adds up to culture of silence and shame.
Yet it’s easy to imagine a better birth experience for Miller. If doctors had asked about her history, how she responds to pain, and how she preferred to be treated and touched, things might've gone differently.
In fact, this more compassionate treatment has a name — “trauma-informed care.” In other words, health care performed with the awareness that any woman may have suffered sexual assault in her lifetime.
For Cat Fribley, director of the Resource Sharing Project, trauma-informed care means openly discussing the possibility that pregnancy will be triggering, and always seeking affirmative consent before performing any procedures (such as vaginal exams or being tied down). Trauma-informed care also means giving birthing women as much control over their environment as possible. For instance, a nurse might ask if she prefers lights on or off in the delivery room, because dim lights and whispers remind some survivors of the night of their abuse.
“Feeling in control of your own body and the care you’re receiving is never going to be anything but welcome to every person, whether they’re a survivor or not,” Fribley says.
While every survivor experiences childbearing differently, many feel a sense of powerlessness and vulnerability, starting in pregnancy. Strangers view expecting bodies as public property, touch without asking, and trespass in other ways — such as scolding women for food choices in restaurants. For survivors, losing boundaries is a potential trigger.
Language is often another trigger for women with a history of abuse. During childbirth, doctors may say infantilizing and paternalistic things. “'Oh, you’re being such a good girl,' or 'hang in there.' They think they’re being super supportive,” Fribley explains.
Applying trauma-informed care to everyone makes perfect sense on three levels. First, as Fribley notes, one in six women suffer sexual abuse at some time — a significant number. Second (and this feels silly to say but also necessary to write) all women deserve to be treated with respect. Third, while many providers are happy to adjust their behavior for women with abuse history, not every survivor feels comfortable disclosing — or even remembers — her assault. And in our culture, generally speaking, nobody asks.
The Body Remembers
“From pre-pregnancy to being a grandmother, women told us that trauma can have an effect,” Dr. Julia Seng of the University of Michigan tells Romper. Seng and her team found that survivors of childhood maltreatment in particular are at much greater risk of experiencing post-traumatic stress disorder (PTSD) during pregnancy.
Why? Possibly because pregnancy is a highly psychological and sexual situation, and when childhood abuse survivors begin families of their own, they're naturally reminded of the past.
Today, Dr. Seng and her long-term collaborator Dr. Mickey Sperlich are in the process of testing one of the first pregnancy-specific interventions for trauma survivors to be used in hospitals and clinics — systems that touch millions of pregnant women’s lives each year. The program is called The Survivor Moms' Companion, and it's specifically geared towards women suffering symptoms of PTSD. But it’s 2017, and her groundbreaking book Survivor Moms came out decades ago. Why haven't there been more large-scale interventions like this one?
“We ask ourselves that every single day,” she says, and refers to an idea from trauma and recovery expert Judith Herman. “Clearly, childhood maltreatment is not taboo, because it happens way too often. What’s really taboo is talking about it," Seng says.
A Culture of Silence
Sarah Beaulieu, founder of The Uncomfortable Conversation, strongly believes the world is a better place when discussions of sexual violence aren't taboo.
As a survivor herself, Beaulieu was shocked to find that even after years of therapy, she was “grossly unprepared” to give birth. Despite the fact that she disclosed her trauma, her midwives never addressed it, and neither did anyone else.
“My birthing class didn’t say, 'if you’re a survivor of sexual violence here are some things you might want to think about. Here’s how that might affect your birth plan, your breastfeeding plan' … These were not things stated to me in any clear way,” she tells Romper. Beaulieu speaks vociferously, and you can't blame her. Because of a traumatic birth, she’s been in “a PTSD state” for the last six years.
I woke up to lights on, five people in my room, and two of them with their hands in my body.
During early labor, Beaulieu fell asleep in her hospital bed. While she slept, her son's heart rate accelerated.
“I woke up to lights on, five people in my room, and two of them with their hands in my body,” she says. “From the perspective of somebody who was sexually abused as a child, at night, this was not the most pleasant experience.”
Beaulieu's son was born 15 minutes later, by c-section. The birth triggered “body memories,” and Beaulieu’s first years of motherhood were marked by hyper-vigilance and high anxiety — symptoms of PTSD. She says she wishes she'd been better prepared.
“You walk into the midwife’s office and they have like 47 different pamphlets on the wall. Why not have one on sexual violence and birth? You’re going to ask me if I don’t feel safe at home, but not if I feel safe in your office? That’s ridiculous to me,” she says.
Surviving A Second Time
What about women who don’t remember their abuse? Survivors of childhood maltreatment may repress memories, making it even less likely that they'll disclose. That can be dangerous under a system in which doctors assume patients don't need special care unless they tell them so directly.
When Kristen Hovet, now a science journalist, became pregnant in 2001 at just 20-years old, her body remembered what her mind didn’t. The sensations of pregnancy stirred up nightmares and flashbacks of childhood events she was only just beginning to remember. She recalls feeling alienated from her own body, “numb much of the time.” Only in retrospect does she realize that she should have brought her symptoms to a doctor.
People are not comfortable with pain, especially a mother’s pain and anguish. We want childbirth to be nice, clean, and natural, with an inspiring story at the end.
"For me, the abuse was so long ago that there were memory issues," Hovet explains. "It was very much my body remembering first. Then it sort of trickled up to my brain, slowly, over time. I think that can make it more difficult, that lack of understanding of what’s going on in your body. It can make it more challenging."
If a doctor had raised the possibility that pregnancy could trigger old traumas, she says, she might have understood what was happening sooner, and might not have ignored her symptoms for so long. After she gave birth, the nightmares and flashbacks became more frequent. Eventually, she sought therapy to understand what was happening in her mind, and practiced yoga to better understand and inhabit her body.
During pregnancy, Hovet felt pressured by family to have a natural birth, and the way nurses and doctors spoke to her during prenatal care made her feel “like an object, a container.”
Hovet received an epidural only very late in labor — and it didn’t take. She remembers watching nurses track her blood around the room. She recalls the cold feeling of forceps, which punctured her son’s eye. Her son nearly died that day. But when she tried to tell her story, people around her responded by minimizing it, insisting her traumatic birth was past and asking about plans for more children.
“People are not comfortable with pain, especially a mother’s pain and anguish,” Hovet explains. “We want childbirth to be nice, clean, and natural, with an inspiring story at the end.”
For survivors, that narrative is cruelly restrictive. Hovet’s traumatic birth, compounded by the trauma of her abuse, led to a diagnosis of “complex PTSD” that she wrestles with to this day. She’s now 37 years old.
“Only in the past few years have I truly learned to inhabit my body,” she says.
The Mind-Body Connection
“There’s a switch in everyone’s brain that sends you into fight-or-flight mode,” explains family therapist Crystal Clancy. “For people with PTSD, it’s like that switch is always on.” Clancy is the co-executive director of Pregnancy & Postpartum Support Minnesota, the state chapter of Postpartum Support International.
One way survivors cope with extreme stress is by escaping from their bodies, or dissociating. “Some people describe losing time. Others have a kind of out-of-body experience,” Clancy tells Romper. She explains that from a mental health perspective, it’s very important to prepare women for the possibility that their bodies might respond this way, and that it's not their fault.
Any survivor — even one with years of therapy behind her — can feel distress during pregnancy and birth.
Clancy sees a common thread among survivor mothers. They tell themselves they ought to be happy, that they’re supposed to feel the elation depicted in magazines and Facebook feeds. When your lived experience of childbearing is traumatic, these expectations are salt in the wound that can lead to greater feelings of shame.
Any survivor — even one with years of therapy behind her — can feel distress during pregnancy and birth, but that doesn’t mean they haven’t worked hard enough to heal. “I know so many moms who say they didn’t realize they had these risk factors," says Clancy. "They wish they'd known."
Roads To Healing
For survivors, birth can also be a turning point. A chance, potentially, to reclaim control over their bodies.
Katie Wise is a yoga teacher and bhakti musician, but before that, she was a doula. She's also a survivor. Today, Wise believes she entered the birth world in pursuit of her own healing.
“I wanted to see 150 women give birth before I did,” she says. “Like, what does it mean to let this part of your body transform from something that was a place of wounding to this center-of-attention event?”
Wise describes her birth as traumatic, triumphant, and ultimately, a rewriting of her body's story. “When a woman feels violated, one end result is feeling much smaller. Having a powerful birth experience, it was like expanding into my full power … I just felt like I was a superhero. I felt like I could destroy any of my perpetrators in a single blow.”
I just felt like I was a superhero. I felt like I could destroy any of my perpetrators in a single blow.
As an advocate, Wise believes childbearing women need more agency in the healthcare system. If she doesn’t want a vaginal exam, she doesn’t have to get one. If breastfeeding is a trigger, she shouldn’t be pressured to nurse. If an intervention is absolutely necessary — a uterine massage for a woman who’s hemorrhaging, for instance —treatment should be carefully narrated and performed with consent. When she’s treated like an object, an indifferent body, or an emergency, a survivor is left vulnerable to reliving emotions associated with her abuse.
"Treat me like a real person," Miller said, back in 1982. Advocates of trauma-informed care are asking for the exact same thing today.
For the women I spoke to, advocacy and motherhood were aspects of recovery. When Miller held her first child, she says, she finally understood what love was. After years of stifling her emotions in order to survive, they began to switch back on, one by one, like lights.
Miller found healing by loving her children as she wasn't loved.
She says, "By playing with them, and taking them camping, and having cookouts in the backyard. By going swimming with them and taking them to the library every single week — by teaching them to read, and playing cards and Scrabble and every other stupid card game known to man. Doing all of those things over the years was hugely healing."
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