Pregnancy and childbirth is a formative
period in a woman's development during which physical, emotional and
psychological growth is accelerated. If all goes well, a competent and
nurturing mother-self evolves from past childhood and adult experiences
and role models, as well as from the experience of bringing forth life-an
experience which can enhance or disturb the woman's image of herself
as a mother and a woman.
My clinical experience, as well as research
done by others, supports the idea that how a woman experiences birth
has long-reaching effects on her sense of self-esteem as a woman and
on her ability to feel confident with her newborn.
Many women who have suffered sexual, emotional
or physical abuse have come to me for childbirth preparation. Some come
for a first labor; others come for a subsequent delivery. Often, a woman's
childbirth stories echo childhood experiences of humiliation, helplessness
and terror. Themes of betrayed trust, unexpressed needs and ineffective
communication are prevalent, resulting in intimidation and helplessness.
A heightened sense of dependency during
pregnancy and labor makes women-and particularly abused women-vulnerable
to reliving old parent-child wounds through their caregivers. The ways
in which they related to parents who did not protect them can be repeated
in one of two distinct responses to their caregivers.
First, a woman may subconsciously idealize
her caregiver and fantasize that she is the "good and loving parent."
Because of her clouded judgment and childhood memories of intimidation,
she may be unable to clearly communicate her concerns and needs so they
can be realistically addressed by her caregivers.
An example of this is a woman who came
to me for healing after her first childbirth. Her father had been absent
from the family and her stepfather had sexually abused her. In order
to protect herself from further emotional and physical pain, she became
"invisible." And because she idealized her obstetrician and
did not voice her needs during her pregnancy and labor, she became "invisible"
to him as well. Her doctor induced her unnecessarily and she had one
intervention after another. She was also upset because her doctor handled
most of her care during labor by phone. She described her labor as "a
She changed obstetricians with her next
baby, but didn't check on his protocol regarding inducement of labor
or presence at birth. She realized that she was setting the stage for
another bad birth experience and decided to come to me for counseling.
I encouraged her to relate to her obstetrician
as an equal and taught her the skills she needed to effectively communicate
with him. She was able to discuss her feelings about the previous birth
and tell him what she needed for this birth.
The second distinct response an abused
woman may show is distrust of her caregiver. This results in antagonistic,
nonproductive relationship patterns between the woman and her caregiver.
Unlike the woman who idealizes her caregiver and sees him or her as
the "good parent," this woman projects a "bad parent"
image onto her caregiver. She is unable to communicate, except from
the standpoint of feeling victimized. She must depend upon someone to
assist at her birth, yet it calls up childhood memories of having to
depend on a parent who didn't protect her and often abused her.
The idea of expressing her needs is frightening,
but she must be encouraged to develop an equal relationship with her
caregiver. Discussions with the woman usually focus on the idea that
the caregiver is "human" and has needs of her own which must
be acknowledged by the woman. Once the abused woman has some understanding
of this, destructive communication patterns gradually end and the caregiver
can encourage a more positive exchange with her client and find out
who she is and what she needs from her prenatal care.
An example of this is a woman who experienced
neglect and sexual abuse in childhood. Feelings of abandonment were
repeated during her firs/childbirth when she was left alone in a delivery
room to deliver a stillbirth. The physician she had been depending upon
was vacationing out of town, and the doctor on call was unresponsive
to the special needs of her situation.
She changed doctors for her second pregnancy,
but when she overheard her obstetrician's secretary talking about an
upcoming vacation, she assumed the worst. In addition, she neither asked
the doctor about her vacation schedule nor explained what had occurred
in her previous childbirth experience.
She was angry but did not feel she could
influence the situation. Instead, she expressed her tension and anger
nonverbally during her prenatal visits and was, in fact, "punishing"
her doctor for all the neglect she had experienced both in her childhood
and in her previous childbirth. This was destroying her ability to form
a trusting relationship with her doctor.
Because of her vulnerability to abuse,
she required counseling to acknowledge that both she and her doctor
had needs, and that perhaps they could find a way to mutually cooperate.
I encouraged her to be open and honest with her doctor. Instead of attacking
her physician, which had been her initial approach, she told her doctor
that she understood her need for a vacation and that though this was
reasonable, she had particular fears due to her previous experience
and needed to talk about how those fears could be laid to rest. To her
surprise, her doctor not only understood that she would need extra care
following the experience of a stillbirth, but told the woman that she
did not have plans to be away and would be willing to be called when
she went into labor, even if she wasn't on call.
For all women, but particularly for women
with abuse in their backgrounds, trust is the key: trust of the person
they are depending upon, and trust in themselves to stay present through
the normal and inevitable pain of the labor process. This is especially
important for women who have experienced pain associated with sexual
humiliation or degradation on physical and/or psychological levels.
Also important for these women is body-centered preparation for childbirth.
In order to experience labor as powerful, regardless of whether it is
a natural birth or a birth where medical intervention is necessary,
a woman needs to feel that she can cope with what is happening. These
feelings can be encouraged simply by respecting her individuality so
she can meet the pain actively, rather than feel victimized by it. In
addition, the healthy pain of labor must be discussed and portrayed
in ways that the body absorbs, not by intellectual understanding alone.
Postpartum follow-up is an important part
of my work with childbearing women. Reviewing the labor and childbirth,
as well as all of the feelings -- both positive and negative -- that
went with it, and sharing that information with another nurturing female
is the first vital step toward healing. Rejoicing with her at the empowering
feelings, sharing her sadness over any disappointments or struggles,
nurturing her as she holds her newborn all of this can go a long way
toward how she sees herself at the threshold to motherhood. An attitude
of respect and caring for her journey honors her as a woman and as a
new mother, and empowers her in her new role and identity.
One last thought I have is this: I hope
we are not "singling out" women who have been abused and labeling
them with a kind of "scarlet letter" indicating the potential
for birth complications. In my experience, singling out has not been
the case. Women who are physically abused have deep scars; however,
every woman in our culture deals with, and has suffered from, some kind
of psychological hurt and shame associated with her sexuality. Childbirth,
by its nature, should be an empowering experience. The fact that it
is not for so many women, whether they give birth vaginally and without
drugs or with medical intervention, is due to our psychological attitudes
toward women in our society. Women should be given support and those
who help, such as midwives, should be commended for doing so.
Peterson, MSSW, LCSW, PhD is a family therapist specializing
in prenatal and family development. She trains professionals in
her prenatal counseling model and is the author of An
Easier Childbirth, Birthing
Normally and her latest book, Making
Healthy Families. Her articles on family relationships
appear in professional journals and she is an oft-quoted expert
in popular magazines such as Woman's Day, Mothering and
Parenting. . She also serves on the advisory board
for Fit Pregnancy Magazine.
Dr. Gayle Peterson has written family columns for ParentsPlace.com, igrandparents.com, the Bay Area's Parents Press newspaper and the Sierra Foothill's Family Post. She has also hosted a live radio show, "Ask Dr. Gayle" on www.ivillage.com, answering questions on family relationships and parenting. Dr. Peterson has appeared on numerous radio and television interviews including Canadian broadcast as a family and communications expert in the twelve part documentary "Baby's Best Chance". She is former clinical director of the Holistic Health Program at John F. Kennedy University in Northern California and adjunct faculty at the California Institute for Integral Studies in San Francisco. A national public speaker on women's issues and family development, Gayle Peterson practices psychotherapy in Oakland, California and Nevada City, California. She also offers an online certification training program in Prenatal Counseling and Birth Hypnosis. Gayle and is a wife, mother of two adult children and a proud grandmother of three lively boys and one sparkling granddaughter.
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