In the wake of the birth of my second child, I feel compelled to write about my experience in real-time, which is something I don’t typically do.  Birth is raw and messy, and my feelings about it are still raw and messy, made more so by the hormones and sleep deprivation that accompany new mama life. During this pregnancy, I read as much as I could about the intersection of sexual trauma and birth trauma, and didn’t find much available. This is why I’m sharing my story now before hindsight softens its edges.

The birth of my first child was extremely traumatic. You can read the whole story here, but basically, he was born by a terrifying emergency c-section. I had dozed off to sleep during early labor, and was awakened by a team of doctors and nurses because his heart rate had dropped. In the span of 15 minutes, he was born, healthy, but I was completely traumatized. In that short window of time, several strangers had put their hands on me and in me, my body had been sliced open, and I was left alone in a recovery room without my husband or baby. The experience left me traumatized for months, and prevented me from really enjoying and being present with my son as a newborn. I felt emotionally shattered, and guilty for not taking comfort in the fact that “the baby came out all right.”

When I found out I was pregnant again, I desperately wanted to have a more positive delivery. I’m a survivor of sexual abuse, and I’ve done a lot of work to process my experiences, my life, and my healing. I’m generally aware of the kinds of things that trigger strong emotions or flashbacks, and, over time, have come to peace with my body and how I feel about it. Even so, pregnancy and birth is a time of utter vulnerability – at least it was for me.  It is simultaneously empowering, confusing, miserable, miraculous, and amazing. I am not naïve enough to think childbirth is something that can be controlled. But I did think that some planning and preparation could set me up for a decent chance of a more present birth experience.

My husband and I processed and healed from our first birth experience. We hired a doula.  We read about traumatic birth experience and how it was informed by my history of sexual violence. We chose a hospital that had a reputation for patient-centered care, a good VBAC rate, and excellent midwifery, OB/GYN, and nursing staff. Therefore, I was taken by surprise when, despite all this preparation and processing, I was still left traumatized, sad, and angry after the birth of my daughter.

The short version of my daughter’s birth story is after a long labor, three hours of pushing, and no food or sleep for nearly 30 hours, my daughter was born by a repeat c-section. Unlike with the birth of my son, the c-section was not an emergency, but it certainly wasn’t elective or planned. The laboring part, supported by a phenomenal team of nurses and midwives, went really well. I felt safe, cared for, and heard. But when we realized that my daughter wasn’t in a position that would allow her to be delivered vaginally, my care transitioned to a medical team for a c-section. While the experience with the medical team was 1/30th of my total labor, their approach made me feel like things were happening to me, rather than being part of a team bringing a baby into the world. The shift in perspective and approach made me feel panicked during the process, and angry and sad afterwards.

Overall, pregnancy, labor, and delivery is unlike any other experience in my body or in my life. The energy I usually have available to manage my anxieties and emotions is being used up in other ways. With an unmedicated birth, energy is focused on managing pain. With pain management, you are less mobile and may be hungry or thirsty. Labor requires facing new sensations that might be scary or uncomfortable. It’s facing an uncontrollable, unknown force that feels like it exists at the intersection of life and death. Many of those sensations are at the “scene of the crime,” which might make them scarier or triggering for survivors.

That being said, some triggers took me by surprise and some things I was certain would trigger me didn’t. Sure, I was able to predict that unannounced vaginal exams might cause me anxiety, and that was something I was able to manage by asking my health care providers to go slow, explain what they were doing, and be as gentle as possible. But the moment that caused a “I think I’m dying” panic attack was having an oxygen mask placed over my nose and mouth in the operating room before a c-section. I couldn’t move or take it off, and people were telling me everything was okay, even though I felt like I couldn’t breathe.

Throughout labor and delivery, being heard was central to me feeling safe and secure during a necessarily chaotic and unpredictable process. In the experience of sexual violence, I lost my voice. During labor and delivery, my voice was taken in different ways. When I expressed a concern that the epidural wouldn’t work since it had already dislodged once, the OB for my daughter’s birth brushed it off. Later, in the operating room, the narcotics they used in fact did not work, and I felt the initial incision. Of all the things that happened during delivery, this is the one that left me feeling the most angry. The doctor didn’t hear my concern, asked me to blindly trust her, and then didn’t even follow up, apologize, or acknowledge how scary that must have been for me. In fact, after the surgery, she said, “See, that wasn’t so bad?” On the other hand, the OB for my son’s delivery took a moment to listen when I asked her if we could wait for the c-section. She explained what was happening in the moment, and reassured me that I would be a good candidate for a vaginal birth in the future. The 15 seconds she took to pause and listen made me feel much better about the overall experience.

During both deliveries, it felt like things were being done to my body without my permission. There is a big difference between asking for consent – and waiting for it to be given – and informing someone a millisecond before doing something. To say, “OK, now we are going to put the catheter in” while you are doing it is very different than asking, “Are you ready for me to put the catheter in?” and waiting until I say yes. Some expediency is required in an emergency, but in most cases, waiting an extra 5 seconds to really get consent is worth it, and will prevent emotional trauma after the birth.

Between my first and second deliveries, I considered the advantages of presence vs. dissociation. For many of us with histories of sexual violence, the ability to dissociate is a double-edged sword. On the one hand, it’s a survival mechanism that allows us get through scary experiences. On the other hand, it can prevent us from being present for experiences we want to immerse ourselves in. I really wanted to be present for the birth of my daughter, since I had dissociated during the birth of my son. At the same time, I felt like there was judgment around choosing pain management, and “real women” were supposed to have “natural” childbirth.

Ultimately, I decided that I wanted to manage for anxiety rather than pain. Most childbirth preparation classes teach you techniques to manage pain through mindfulness, breath, hypnosis, etc. I used the same techniques, but focused on my anxiety level. When it reached a certain level, the pain became a distraction from managing anxiety, and therefore presence. I chose an epidural for my second labor so that I could rest, process what was happening, and speak up. Some women may be able to do this while also managing pain, but that was not possible for me.

My husband and I aren’t planning to have any more kids – and I don’t think I could emotionally handle another labor and delivery either – but if I could give retroactive advice to my pregnant self, this is what it would be:

Know what you are feeling is normal. If you are pregnant and have a history of sexual violence, it’s totally normal to have issues re-surface – even if you have done a ton of healing already. There is no experience quite like pregnancy and childbirth, and it’s natural for it to trigger new feelings or thoughts. None of them are bad. All of them are normal. In the wake of my birth experiences, some of the things that I felt included:

  • Something is wrong with my body. My body has failed me. I felt this way because of the c-section, because of the baby’s position, and because it wasn’t an “easy delivery.”
  • I’m going to die. My baby is going to die. These were mostly moments or flashes of fear or panic, but reflected my response to feeling out of control.
  • This should be the happiest day of my life, but I’m having all these other negative emotions too. This must mean I’m a terrible mother.

There is no right – or natural – way to have a baby. I realize in retrospect that I incorrectly bought into this notion that an unmedicated, vaginal birth is the “best” way to have a baby. While I do think that American culture has over-medicalized labor and delivery, I also really value modern medical interventions. Without medical intervention, I likely would have faced tragic consequences – for myself or for my children. At the same time, I believe that all women should be empowered and informed about the options that are right for them, which is a truly personal decision. We all need to make the decisions about pain management, birth approaches, and health care that balance the physical and emotional needs of the mother and the health and well-being of the child. There is no cookie cutter solution, and there is no need to judge each other’s choices, which sometimes aren’t choices at all.

Raise the issue of sexual violence with your health care providers.  I told my health care providers about my sexual assault history, which helped me incorporate some things into a birth plan that I might otherwise have left out. They asked about male providers vs. female providers, and spent more time talking me through the types of interventions that might occur so I wouldn’t be taken by surprise. Once the door was open, I felt more comfortable speaking up about things that made me uncomfortable. For example, I asked if it would be possible for me to “know the names of anyone sticking their hands in my vagina.” Keeping things light helps me deal with uncomfortable topics.

Talk to a counselor at a rape crisis center or call a hotline. Even if your assault happened years ago, don’t wait to get support if new triggers or feelings emerge. Healing from sexual violence can take years, and with every new experience you can reach deeper levels of recovery. It’s not a failing to need help or support again.  I met with a social worker at the hospital throughout my pregnancy to help prepare, and she has been a great support after delivery as well.

Learn about other’s experiences. Penny Simkin wrote a terrific book about pregnancy, birth, and sexual abuse. It’s written for health care providers, but worth a read. If there is a resource that was helpful to you, please email me at info@theenlivenproject.com, as we are going to start a listing here as well.

As I started sharing this experience with friends and other moms, I realized how hush-hush we can be about the trauma surrounding birth. And I also realized that as a survivor of sexual violence, there were a whole set of issues that were very likely to emerge, but not likely to be addressed or discussed by my healthcare team, even if enlightened and experiences professionals. Sharing my story is just the beginning of a larger conversation we are starting through The Enliven Project. You can find more details on The Double Silence Series here.

20140210-081337.jpg