As a survivor of sexual violence, birth and preparing for birth may be a particularly stressful time for you. It may be that the prospect of birth is something that you struggle with, and whilst many people have concerns about giving birth, these may be of a different nature for you. It is considered acceptable to be worried about birth, anxious about pain, but for some survivors there is a literal dread of birth. This can be a very challenging thing to talk about, which can be a very lonely situation to be in.
Everybody is impacted differently by their experiences, there are no right or wrong ways to feel. I felt a need to write this because when I was planning my births, I needed this article and it didn’t exist. I needed to feel a bit less alone, and I had no idea where to go. Everyone is different and this guide will take you through some of the questions that you may want to ask yourself to help you prepare for your birth and to maximise your chances of feeling comfortable, calm, and of birthing your baby in the way you want. You may have very strong feelings about some of these things and have no issues at all with the idea of others, again that is fine. These are just prompts for themes that have come up for me and people I have listened and spoken to.
“Are You Safe?”
Your midwife is expected to ask questions to ensure that, if you are in a relationship, it is safe, and that you are not experiencing or at risk of domestic violence, sexual violence, or coercive control. Pregnancy is a significant risk factor in the onset of abuse in relationships that may have previously felt very safe.
If you are not currently safe then finding a way to let someone know that there are issues so that they are able to support you, and to keep in touch so that you have a safe way to request help if you need any is ideal. This question should be asked of everybody, and it may be asked again in subsequent appointments, even if you answered that you were safe early on in your care, in case the situation changes.
For this article I largely assume that the rape, sexual assault or abuse is historic, and not something that is ongoing. This is clearly not always the case and this article may still be useful if you are in a currently abusive situation.
What makes you feel safe?
You may find it easier to answer what makes you feel unsafe, but this can help you identify what makes you feel safe. For example, I laboured in a pool almost fully clothed to the end in my second birth. It felt safer than being naked, and the wet clothing put a pressure like a weighted blanket on me which helped me feel contained. I laboured in my home, because I felt safer in an environment where I was literally on my home ground, and the care providers were guests.
Other suggestions – being held by your partner, making eye contact with your partner, having a blanket to wrap around you or a favourite jumper/pyjamas/slippers. If you have objects, positions or situations that help you feel safe, then you can work out how to incorporate and use these.
What can you do to ensure you feel as in control, and empowered, as possible?
Fear of not being in control is one of the most common fears about labour, because nobody can tell you how your labour will progress. However, for survivors of sexual violence, a lack of control, or your power and bodily integrity being taken from you, can make this a particularly emotionally charged issue. You feeling in control can be central to feeling safe in a situation or environment.
Consider what comes to mind immediately when you think of taking control. Consider when you most feel out of control and how you could address that.
There are, generally, two tendencies amongst sexual violence survivors in terms of how they relate to medical practitioners. One group see them as authority figures who they find intimidating, and in the face of which they become either evasive or passive. This means they may avoid contact with medical services until late in pregnancy, miss appointments and they do not tend to ask questions, or engage with what is being asked of them, This group will often “placate” and consent immediately.
The other tendency is to seek to maintain control to a potentially “unrealistic” extent. This may mean creating a detailed birth plan that does not allow for any deviation and may involve feeling as though the medical team is “the enemy”.
Both of these responses are rooted in fear, and usually in parallels between something you don’t necessarily want being done to your body; either consenting to “get it over with” because resistance may have resulted in the situation worsening in the past, or “fighting” to avoid the thing happening.
In my own experience I am very much in the needing to maintain control camp, but I want to reiterate here that neither of these responses is better than the other and neither come from a position of empowerment. It is utterly essential to feel respected in your pregnancy and birth, to feel that your consent is paramount, and that nothing should be done to you that you do not agree to. However, when you fear your care provider, or are instantly antagonistic towards them, it can impede your decision making. Sometimes they may be suggesting something because it is routine and the easiest way for them to ascertain your progress in labour, for example, cervical dilation checks. It is entirely reasonable for you to say, and repeat if necessary, that you do not wish for internal examinations to assess labour progress but would prefer other methods. These could be based on the holistic observance of the mother in labour, or the brown/purple line that often develops in the cleft of the buttocks. (This and other methods of assessing progress are discussed by Birth without Fear in this article) However, there may be situations in which there is a genuine concern for the safety of birthing person, or baby. In these situations being able to listen to what is being suggested and weigh up the risks, ask questions, and work together feeling supported and informed by your care provider is likely to bring better physical outcomes, as well as, potentially, better emotional outcomes. These decisions are then collaborative and based on informed consent.
The purpose of this question is about ensuring that you do not feel out of control, that you feel listened to, and able to engage in decision-making. You need to be able to trust the information given by your care provider and trust them to respect your decisions.
Do you have people you trust to support you and advocate for you in pregnancy and in birth?
Who you choose is totally up to you. You may find that hospitals or midwife led units tend to encourage you to keep birth partners to one or two people, but there may be wriggle room if you feel that having more people is beneficial to you.
Don’t be afraid to ask people that you trust to be there, or to ask those who you don’t feel will support your feelings of safety and power to be absent. People may feel put-out but that is less important than your birthing experience. Possible people that may (or may not) be helpful are a partner, family member, friend, doula, specific midwife or doctor.
Do you feel a doula may help?
Doulas can be wonderful advocates for birthing mothers. As they are, in a sense, professional birth partners, they may be better able to represent your needs and wishes to the care providers and ensure that they are listening to your stated wishes. Births are very powerful events, and ones that we do not routinely encounter in our society. Being in a birth room, even when that is your own bedroom, can feel intimidating. Even the most strident and supportive partner, mother or friend may find themselves being less assertive than they intended to be. Doulas are trained to advocate for you. They are also able to communicate what the care providers are asking or recommending, to help you think through these options, reminding you of your preferences, and help you to make a decision that you are comfortable with, without coercion.
You may feel that having another stranger/person in the birth room is not for you.
Have you considered an independent midwife in order to ensure continuity of care?
Having an independent midwife is likely to offer the best possibility for continuity of care for you. They offer you the same person throughout your pregnancy and birth who can get to know you and follow your preferences. It also means you get control over who is caring for you, and, depending on the choice within your area, can pick someone you trust and feel you are able to work with well.
They do come with a cost, though there are payment plans available, and you can find more information at IMUK.
What generally makes you feel threatened or unsafe?
Consider what things in your life can make you feel this way. This may help you to know what kinds of situations you may want to avoid, and you may already have strategies for lessening the feeling. Examples may include certain noises, certain smells, bright lights, or darkness etc.
What are your known triggers?
A “trigger” is something that you experience now that causes you to become distressed about or relive your trauma. They can trigger panic, freezing, anger, fear, or a dissociative state in which you feel like you are no longer present in your body, that you are an observer of the situation from outside your body. These could be anything you see, hear, read, smell, or feel and will be individual to you and your experience. Commonly known triggers in these situations may include (but are certainly not limited to) the ways people speak to you, ways of being touched, positions such as lying on your back, and people you don’t know entering the space without warning.
If you are aware of these and can list them then you may be able to work out how to minimise their occurrence. If you feel able to discuss these with your midwife than it may help to do so, so that you can discuss strategies that do not set off these triggers, and for contingency plans. For example, stating “no vaginal examinations” or “I do not give permission for anyone to look at my vulva”.
Discussing these with your midwife and other advocates will be important, because they will need to implement alternative plans to their normal procedures. They will also need to agree with you any situations where your preferences may not reasonably be possible, and how you might want to proceed in these cases. These situations may include genuine emergencies or, following the above example, if for instance there has been a tear, how could it be assessed and repaired in a way in which you feel most comfortable and with minimal distress to you.
If you have ever previously managed to do something that involved these triggers, what strategies did you use?
If you have experienced being triggered before, you not only will be aware of your trigger(s) but may have had some experience either managing being triggered in the moment, or in avoiding the trigger altogether. Consider your past experiences and whether skills you have learnt could be transferred to your birth experience.
Agree a Stop Signal
I strongly suggest that you agree a stop signal. Make it something you can do or say, a nonverbal sign may be best (but consider the range of positions you may be in when you need to give the sign), that says STOP. No matter what it is that you want to stop, whether examination, touching you on the shoulder, speaking to you during a contraction, anything. This needs to be known by your partners, ideally, and the birth professionals. This is non-negotiable, not, we will stop as soon as the exam is complete. It means stop now.
About the birth
What are your main concerns about birth?
When considering your birth, there are certainly a lot of choices to be made and preferences to be laid out for others. These can range from where to birth, who is with you, what terminology you would prefer to be used, how you are planning to manage your contractions, who is allowed to touch your baby and when, how you would like the placenta to be born. I could go on for a while. As this isn’t a traditional preparing for birth resource, I am simply going to say that before considering all these details, make a list of your main concerns about the birth.
Once you know what your concerns are, you can ensure that with each decision you make, you are addressing those concerns.
How do I get the best possible outcome for me and my baby’s physical, mental and emotional wellbeing?
The answer is to make considered, informed choices and to work with people who understand your needs and that you trust. You may need to consider what choices you might make if things are not going to plan. If you feel respected, listened to, feel like you are being given the information you need to be able to make decisions, and feel able to trust that if you withdraw consent for something then it will stop, it is often possible to make the best choices, and to be at peace with those decisions. This is not to say that everything will be easy. But making empowered and informed decisions in response to the situation at the time increases your chances of the best outcomes.
What about the details?
For each thing you can choose in birth there is a ton of information to take in. Ensure that you find someone to educate you about birth who knows their stuff but does not have an agenda. Choose someone who really cares about informing your personal choices. If you are able, look at multiple sources of information yourself when you are not sure.
Where can I give birth?
One of the first questions you are often asked in a booking appointment with your community midwife is where you plan to give birth. There are all sorts of aspects to consider when deciding where to give birth, such as the facilities that are available. These can include medical forms of pain relief (gas and air, pethidine, epidural), non-medical forms of management (birthing pool, shower, bath, birth stool, birth ball, rebozo, fabric wrap for supported squatting, music, low/bright lighting), the access to medical support if it were needed, the familiarity of the staff in these locations with your birth preferences and their ability to support you in using your preferred techniques.
What are the choices?
- Hospital Labour Ward
- Hospital Midwife Led Unit
- Midwife Led Unit not on hospital site
- Home birth
- Free-birth – birth outside hospital or midwife led unit, possibly in your home, not attended by any medical professional
Technically an independent midwife could attend you birth in any of these places, but it is up to hospital policies locally and it is important to check that, if you choose an independent midwife, she is able to support you in your preferred birth place.
Where do sexual violence survivors do best?
There is no right answer to this question. For survivors of sexual violence, as discussed above, it is important to consider the following:
- Where do I feel safest?
- Where do I feel most empowered, most in control and most able to represent myself and my needs?
These considerations are important for anyone giving birth. However, for those with residual trauma who are concerned about pregnancy and birth triggering traumatic memories, flashbacks, and dissociative states, considering where you feel best able to stand up for what you want is of the highest importance.
This may be at home, it may be in a midwife led unit where you feel the team share your ethos about birth, it may be that you feel that a hospital is the best fit for you, you may wish to opt for a caesarean section. All of these are valid choices, and as long as you make your choices understanding the implications, then you have the basis for a good decision.
Could I visit?
When deciding about you place of birth it may be possible to visit the labour ward or a local midwife led unit. They may routinely offer an opportunity to tour the facilities, or they may restrict them only to those who have a need to visit the units.
Birth anxiety and mental health concerns are likely to count as valid reasons, but you may need your community midwife, therapist, or perinatal mental health worker to arrange the visit. If you feel that it would be beneficial to you, it is worth requesting to be supported in this request.
Working With Professionals
Do I need to inform them?
You have the choice whether to disclose sexual violence to your midwife and any other care professional you may see during the course of your pregnancy and birth. You do not have to do so. You do not have to give reasons for any of your choices, preferences, or refusals to consent at any point. If you are considered to have mental capacity your decision is final.
The criteria for mental capacity are the abilities to
Understand information given to [you]
Retain that information long enough to be able to make the decision
Weigh up the information available
Communicate [your] decision – this could be by talking, using sign language or even simple muscle movements such as blinking an eye or squeezing a hand”
If you meet these criteria then you are considered to be able to make decisions for yourself, up to, and including decisions that may lead to your death and/or the death of the unborn child. I do not say this to suggest that such choices are advisable, but they are within your power to make. Thus, if you choose not to inform your care team they should abide by your stated wishes, seek informed consent, and not put any pressure on you to change your mind, but provide all of the options, and the information needed for you to decide between these options.
However, in reality, decisions are not always respected. Presumed consent is a much too common attitude that can make it very hard to continually decline to consent, especially as the giving of pertinent information is also controlled by a person who has their own preferences on your decision. This can make it hard to give informed consent, or to withhold consent knowing the real likelihood of the implications involved.
For this reason, it can be helpful to explain the reasons behind your decisions, explain that you are considering additional factors including harm to your mental health. This can help encourage care providers to take more time in presenting the information and the alternatives to you. It can encourage them to ensure that you understand to what you are consenting, and to assure you of your ability to withdraw consent at any time. It may encourage them to consider whether there are any changes they can make to, for example, the position that you might be encouraged to be in for a cervical check to make it less traumatic or triggering for you. There is no guarantee that this will help. Marginalisation of mental health as less significant than physical health does happen in some cases and it can be used to fuel the assumption that you are not rational, and therefore need to be encouraged to conform to what they feel a rational and right-thinking person would agree to.
In the end you simply have to weigh up what feels right to you, for you.
Would it help to have my history recorded in my notes?
You can opt to have your history recorded in your notes, which should mean that anyone dealing with your case will be made aware of your history. This can reduce the number of times you have to disclose your past trauma in person. However, some people may prefer to have more control over who is informed and how they are informed, and if your partner or any other birth partner is not aware of your history, or is the perpetrator of the violence, then it may not be ideal to have this written down.
Do I need to inform them?
Again, this is your choice. You may find that a supportive birth partner or doula who understands your history is better able to advocate for you. They may be better equipped support you in standing up for your choices and help you to withstand pressure to consent to something, or to ensure that a change of mind is not caused by pressure but a genuine willingness. (You are also, of course, allowed to change your mind about any of these preferences and move with the situation that unfolds whilst in labour. This realisation that you are happy to consent to things that you did not expect to be happy with is very different to feeling pressure to do so.) If your birth partner does not understand your choices then they may be less able to support you in them, however, this is not necessarily the case, and you may trust them to advocate for you without understanding your reasoning. You may not see the role of a birth partner to be an advocate for you at all, it may be that you simply want them to be with you during your labour and birth, or that they want to be there. If you have strong feelings about not wanting someone there it is worth remembering that you do not have to have any birth partners at all, and nobody has a right to be at a birth.
Where your current relationship is unsafe it is worth considering whether you can communicate this to your care team. If you wish to you may choose avoid having your partner present, if this does not involve risks to your safety.
Management of labour and birth
What do I need to consider about medical pain relief in relation to my history?
Removing pain can be freeing from distressing physical sensation. Labour often progresses most efficiently when the birthing person is relaxed and not frightened. If this is something that you feel you may be unable to do, and the abdominal and vaginal focus of the sensations can be triggering for survivors, then an epidural could be a strategy to help you to relax. However, it is worth considering the cascade of interventions that can come with an epidural, such as monitoring, reducing your ability to move freely and to select your preferred positions, sometimes catheterization, and potentially cervical checks to ensure that you are progressing as the cues from your response to the sensations of labour are reduced or removed.
Removing feeling can also make you feel less present in your body. For people concerned about dissociation weighing the distress of the pain or sensations against the remoteness that the lack of sensations can cause is important. Catheterisation is often performed as standard when an epidural or spinal block is placed, which is an intimate procedure thatcould be triggering.
The potential for wooziness, can be concerning to those who are concerned about dissociation and staying present and grounded within their body.
Gas and Air
Can make you feel woozy or not entirely able to focus on what is going on. However, effects only last whilst gas is being breathed, so you can choose not to use it again without lasting effects.
Spinal Block (Anaesthetic) – Used in Caesarean Births and Some Instrumental Births
With a spinal block you remain awake, present and aware of the birth. You can plan for a positive and gentle caesarean if wanted. This can include, for example, skin to skin in the delivery room, and birth partners can be present at the birth. There are many examples of positive Caesarean births included here.
With a spinal block you remain aware of the sensations of the surgery, but without pain, and can feel tugging and movement. The lack of full sensation, whilst necessary, can also be something to consider if you have concerns about dissociating. Undergoing major surgery whilst awake can feel like quite a passive activity, and involves actions being performed to your body which may be distressing or triggering.
Whilst a caesarean is a non-vaginal birth, there are still issues, such as placing a catheter, that involve care professionals looking at and touching you around your vulva or vagina.
No awareness of what is happening, avoids being awake feeling what is happening, and being aware of your passivity. However, having a blank in your memory, knowing that things have happened to your body “without you knowing” or being aware of them may be problematic.
Increased medical risks mean that this is not the preferred or recommended option unless in the case of a medical emergency. You are likely to need to explain your reasoning, not necessarily in terms of your past trauma, to get a care team to agree to an elective Caesarean under general anaesthetic, and this is not a decision to be taken lightly. You may find that a perinatal mental health worker, or similar, is willing to support an unusual decision such as this, if they understand and agree about the risks to your mental health.
Whilst a caesarean is a non-vaginal birth, there are still issues, such as placing a catheter, that involve care professionals looking at and touching you around your vulva or vagina.
What do I need to consider about non-medical management in relation to my history?
Hypnobirthing is a technique that uses visualisation and relaxation to manage pain. This can be an effective tool. It is about preparing yourself for the sensations of labour. Understanding the sensations and remaining calm and relaxed, and using breathing exercises to avoid fighting pain can be valuable tools. Fighting pain tends to both create adrenalin which impedes the progression of labour, but also increases the experience of pain. The nature of the visualisations and exercises used varies between “schools” of hypnobirthing. Some can be encouraging you to go to a safe place “in your head”, and imagine yourself there. Others involve, for example, visualizing a flower opening as you focus a long out breath and can be imagined in your current setting. These differences may be helpful to understand if you wish to remain mentally present in the situation, as you may prefer visualizations or techniques that keep you present in the room, rather than encourage you to be mentally absent, or vice versa.
There are many companies offering hypnobirthing, there are books, CDs, online courses, group classes and private or one to one classes available.
A PERSONAL NOTE- I avoided hypnobirthing with my first birth as I was afraid that it would encourage me to visualize myself elsewhere and that this would make dissociation more likely. My birth did not go to plan and I dissociated for long periods, despite not using hypnobirthing. For my second birth I felt like it was worth trying and found the techniques useful to keep me relaxed in both the run up to and during labour. I did use visualisations that involved imagining going to a safe place, and I did not dissociate at any point during the birth. This is anecdotal, but it showed me that I did not necessarily increase my risk of dissociation by encouraging myself to feel, in a sense, not present in my body. The focus is rather on relaxing and allowing your body to birth, without triggering stress responses, not about mental absence and certainly is not intended to be disempowering.
A TENS machine (Transcutaneous Electrical Nerve Stimulation) uses a mild electrical current, felt as tingling, which can reduce the pain signal being transmitted to the spinal cord and brain. It can also give a different sensation to focus on and distract, as well as minimize the experience of pain.
You can maintain control of the machine, the level it is set at, whether it is off or on, or boosted or not, which can give you techniques that you feel in control of.
You are usually expected to provide the TENS machine. Some places hire these out, but you will usually need to buy the adhesive pads that transmit the signal so if you want the option to use this, you will need to decide and buy or hire one in advance.
Water is often used in labour to help you to feel more relaxed both between and during contractions. Water gives your body physical support and can make it easier to move without assistance between and during contractions. It can also provide a physical space that can feel safe. It may be easier to avoid being touched without expecting it if you are in a pool. However, if you do need to get in and out of a pool for monitoring or examinations this can be a bigger disruption.
Upright positions and moving during labour are often associated with an easier descent of the baby into and through the pelvis. Positions that keep the pelvis open, the tail bone out of the way of the baby’s descent and which use gravity to work with the descent of the baby have physiological advantages and may lead to a shorter labour than positions that involve being reclined and which tend to mean that the tail bone is in the way and the baby has to be birthed over the tail bone.
Moving during labour can mean that you are able to use different positions and techniques to find your most comfortable position at the time. It can be empowering to feel free to move, rather than feeling restricted. Many midwives can help you by suggesting positions or movements that you may find help you if you would like them to do this. Being active can reduce any feelings of passivity or of feeling trapped.
In what circumstances do I need vaginal examinations?
Every vaginal examination is a medical procedure and you should expect to be asked and your consent sought. You can opt not to have any vaginal examinations, to have them only if essential because of concerns for your health or that of your baby, you can request that your care team use other methods to check progress, or you may prefer to have regular checks to allow you to know where you are. (Be aware that cervical dilation checks offer only a snapshot of where you are at that time and are not necessarily a reliable indicator of how long your labour will be. Focus on a number which can change rapidly or seem to remain unchanged for a long time can be disheartening, without necessarily indicating any medical issue.)
You may ask to be given notice, say 5 minutes, of any procedure help you to prepare. E.g. we would like to do this in 5 minutes, do you want gas and air, do you want a birth partner to make eye contact and talk to you during, do you want professional performing exam to talk you through what is happening and what it shows.
You can ask for someone confident in checking other signs such as these outlined in Birth Without Fear on Methods of Checking Dilation
As always, remember your stop signal.
What do I need to consider if an induction is being recommended?
It is worth considering what your preference are if an induction, or augmentation of labour, is recommended.
Induction (starting a labour that has not yet begun) or augmentation (attempting to speed up or progress a labour that has already begun) can take many forms, and it is important to know exactly what is being recommended and why, to help you work out what options there are. For example, inductions can be recommended for reduced foetal movement, perceived dropping of growth of the foetus, post-dates or being overdue, Gestational diabetes and concerns of a big baby, pre-eclampsia and many other reasons. Some of these may have immediate medical considerations based on your current condition and what can be known of your baby, and others may be based more on probabilities.
For example, if you appear to be developing pre-eclampsia there may be serious concerns to yours and your baby’s health and safety that come with the pregnancy continuing. You may wish to decline induction knowing the risks, you may wish to opt for an induction, you may wish to request a Caesarean section rather than an induction. However, if the issue is that you are reaching the “deadline” for overdue pregnancies to be induced in your Trust’s area then you may have fewer concerns about declining an induction if there are no specific concerns or signs that indicate specific risks in your case. In any scenario, the choice is yours to make, however it is helpful to be able to weigh up the likelihood of the concerned event happening and the probability of it happening when making decisions. BRAINS is a useful acronym for decision making in these situations.
B – what are the BENEFITS of this course of action?
R – What are the RISKS?
A – Are there any ALTERNATIVES?
I – What does your INTUITION or gut tell you? What are the IMPLICATIONS of following this course of action? Will it make further INTERVENTIONS more likely?
N – What if we do NOTHING and wait for an hour or 2 before doing anything?
Inductions and augmentations can take many forms and can include one or several of
- Stretch and Sweep
- Foley Bulb
- Artificial Rupture of Membranes (breaking your waters)
- A synthetic hormone drip designed to replicate oxytocin
All of these have benefits and risks associated with them and it is worth researching these before you are in labour and asking for these to be explained if you are asked to make a decision.
I highly recommend Sarah Wickham’s books, websites and articles on making decisions about induction and understanding the methods and the statistics regarding induction for various reasons.
It is worth considering the cascade of interventions that can occur when you begin an induction of labour and how agreeing to an induction can affect the way labour progresses. You may need additional support and the examinations, monitoring and checks that may be considered part of the induction are not always made clear at the outset. It is also worth considering the effects of these things, for example the monitoring, regular checks, and increased likelihood of having an epidural may affect how active and mobile you can be in labour, or the birth setting may be unwilling to allow people with induced labours to use birth pools, for example. If you are able to understand the implications you can make a more informed decision and decide how you can accommodate your needs best and make the best choice for you.
You may have stated in a birth plan that at the point of an induction being recommended you prefer a Caesarean delivery. This may mean that your care team are able to offer this for discussion at the time as well.
Antenatal Mental Health Support
In some areas there are perinatal mental health teams who may have experienced therapists who can work with you to help you to minimise any anxiety and address your concerns. They may be able to help you deal with any fears you have approaching the birth of your child. They may be able to help you to talk through and make decisions that are likely to work for you, to add a medical professional’s authority to your requests for how you be treated during your pregnancy and birth, and to be able to back up any unusual requests for your birth, such as, in certain circumstances, opting for a Caesarean birth under General Anaesthetic. They may be able to meet with obstetricians with you, visit labour wards or birthing units and help you to prepare for birth in ways that best promote your mental health. This can be extremely helpful, and it is worth finding out if this service is available in your area and how you can be referred if you think this would be helpful for you.
Postnatal Mental Health Support
During my first pregnancy I was informed that my past trauma put me at increased risk of postnatal mental health issues, particularly postnatal psychosis. Knowing the signs of postnatal mental health issues, being aware of what support is available if I felt that I needed it was useful for me. It may be helpful to find out what services are available for post-natal mental health issues in your area and who to talk to if you have concerns.
Positive Birth and Powerful Birth
There are some incredible movements within midwifery, independent midwifery, amongst doulas and birth supporters, amongst hypnobirthing schools and antenatal education providers and also amongst obstetricians to improve care around and experiences of birth, in part by reducing its overmedicalisation. These movements aim to allow women to birth the way their bodies are designed to do, and in the many ways that feel right, including choosing medical interventions. Interventions are available where there is a need, or a choice, to support and ensure that mother and baby are safe even in emergency situations, and that help is fantastic, when it is needed, but to otherwise allow the body to birth the baby.
There are some incredibly beautiful images and videos of women birthing vaginally and through caesarean births that show the beauty and power and strength of birth, and our bodies, and how any birth can be powerful, and positive. For survivors of sexual violence, like me, who at times feel that their body is a dangerous place to live, for whom it is tainted with trauma that can be reawakened, sometimes unpredictably and violently these images can be particularly powerful.
If you feel able to do so, (and you do not have to feel able to do so, please do not feel that this is a pressure) there are some incredible Instagram accounts to follow that help to normalise birth. These images and videos can create powerful feelings, and it is OK not to want to watch them. It is something that I found very difficult to see at first, they felt almost violent to me, and the more I have watched, the more triumphant expressions I have seen on faces, the more babies I have seen eased gently into the world, or rush out and be gathered into their family’s arms, the more I have come to see this as beautiful and powerful. Seeing these images can help to normalise birth, which is something which most people only encounter personally a few times in their lives. Giving birth is not normal or every-day in our lives. It is not unusual to find it a frightening or nerve-inducing prospect. Framing it positively and powerfully can help us make decisions that are not rooted in fear, can help us feel empowered to make decisions whilst preparing for birth, and feel empowered to change those decisions where we need or want to during the course of a labour and birth.
Birth Without Fear
Empowered Birth Project
Gas and Air- midwife
The Positive Birth Movement
Milli Hill Founder of the Positive Birth Movement and author of the Positive Birth book
Kicki Hansard– doula and director of Birth Bliss Academy
Nicole Monet, birth storyteller
Mumologist perinatal clinical psychologist
Independent Midwife @debsagos
Midwife, author and researcher @drsarawickham
Positive Birth After Caesarean
The VBAC link
Whatever your birth looks like, whether an instrumental delivery, an unmedicated water birth, or an emergency caesarean birth, it is possible for it to be experienced as empowering and positive or as traumatic. This is true for survivors and people who have no experience of sexual violence. Factors involved in your care that make a difference to the perception of birth include how respected you felt, how empowered you felt, how listened to you felt, how consulted you felt, and how in control of the decisions you felt, even if you were not able to control the direction that your labour or birth takes. The idea that having a healthy baby and a healthy mother is the only thing that really matters is dismissive of the experiences and trauma that any life event can bring. It is not only events that leave visible physical injuries that cause us trauma and have long-lasting effects. Particularly for survivors who may feel shame and an inability to talk about previous traumas, the idea that we “should” be grateful for a healthy mum and a healthy baby and “shouldn’t” be upset, angry or traumatized by the events of our birth can compound the feeling of trauma and the shame and stigma that can accompany it.
The Positive Birth Movement and The Positive Birth Book are excellent resources for considering what options are there for you in birth, and what constitutes a positive birth for you. They can help you work out how best to plan for a positive birth in which you feel respected and cared for.
I have found it hard to write a conclusion to this article, because it doesn’t feel very conclusive. There are always elements I have not included. If you feel there are points to consider that I could add, then please get in touch. I am more than happy for this to be a work in progress to create a resource that benefits more people.
I want to reiterate what I have said, the main reason I wrote this, a positive birth is entirely possible for survivors of sexual violence, birth can be incredibly healing and powerful. It can help to positively rewrite the story you tell yourself about your body and your relationship with it. Choice, care and consent are key factors in this scenario and if you feel confident that these aspects are covered, then preparing for birth calmly and with confidence, and perhaps even with excitement, is far easier.
About The Author
I am Jenni, one of the owners of It’s A Sling Thing. I have two babies, and have had two very different births. Both have helped me to learn and have brought me to a place where I am passionate about advocating for people having choices in birth the make them an empowered and empowering experience. This article is written from personal expereince and reasearch and has been read and informed by some fantastic people who have helped me to improve it. Thank you to them.