Survivors of Childhood Sexual Abuse and Midwifery Practice
CSA, Birth and Powerlessness
Many midwives will care for women who are survivors of childhood sexual abuse (CSA), whether these women disclose this or not. Pregnant and birthing women commonly experience their bodies becoming 'public property', a variety of sometimes intimate medical procedures, and limited choices on where and how care is provided. For CSA survivors, who have suffered loss of ownership over their bodies as children and may experience recurring feelings of powerlessness and loss of control, these factors can combine with impersonal and medicalised settings and practices to deeply traumatic effect. 'Sexual abuse is all about power, not sex.' - interviewee Many midwives also experience powerlessness and loss of control as professionals as a result of these same settings and practices, and those midwives who are themselves CSA survivors bring a particularly acute awareness of this and of the needs of survivor mothers. This unique study sets out to gain a deeper understanding of the needs of these mothers by exploring them alongside the parallel experiences of survivor midwives. It explores the insights and reflections they together bring to midwifery, and the positive results of more collaborative, personal, communicative and ultimately empowering practices for all involved. 'The significance of this book is far wider than its immediate subject, for it offers us the opportunity to rethink our professional coping strategies. If we seek to make all our professional relationships ones of equality and opportunities for growth, as would benefit someone who has suffered abuse, then we can all grow and flourish.' - from the Foreword by Mavis Kirkham
Table of Contents
Introduction. What is childhood sexual abuse? How the research was conducted: the problems and dilemmas of dealing with such a topic. The interviews. How the interviewees responded. The impact of the research on me. What we already know about the impact of CSA on childbearing. Postnatal issues. The impact of caregivers. A life sentence: the effect of CSA on the interviewees’ daily lives. The uniqueness of trauma resulting from CSA. Vulnerability: the end result. The psychological needs of birthing women, post-traumatic stress disorder and traumatic childbirth. Post-traumatic stress disorder. Re-enactment? The women’s experiences of giving birth. Powerlessness. Betrayal. Humiliation. CSA and midwives: the impact on midwives’ practice. What the midwife-survivors considered to be good practice. The pressure to conform. Coping with the inescapable: survivors’ dissociation, ‘professional dissociation’. ‘Professional dissociation’. What women want from their maternity carers and why the industrial model cannot deliver. The disempowerment of midwives. The separation of midwives and women. The disempowerment of women. Institutionalised childbirth and sexual abuse. Choice and control - the rhetoric. What is the answer? Conclusions drawn from the women’s positive experiences. Home birth — a different world. What can be done?