The Effects of Sexual Assault on Childbirth
Pregnancy and childbirth are sacred and transformative life events. They are a truly magical part of a woman’s life. These profound moments of life transition can penetrate deeply into the subconscious and cause things to well up out of the deep recesses of the mind. For women who have experienced some form of sexual trauma in their lifetime pregnancy and birth can be very challenging to experience. “Sexual violence against women is a recognized public health problem. Studies suggest that one in five women is exposed to sexual violence during her lifetime, and those exposed are at greater risk of developing health problems, both at the time of violence and later in life.” (3) When a woman goes through an event as traumatic as this it usually results in some form of Post Traumatic Stress Disorder (PTSD), which can affect her entire life. The act of giving birth often can trigger PTSD, causing stress hormones to disrupt birth hormone brain chemistry. This alone can greatly influence the birthing experience and outcome. There is also a physical level of the past trauma, leaving an imprint of muscle memory. This is something most people don’t think to consider in the birthing environment. It is just as powerful as the muscle memory of an athlete’s arm remembering the exact angle to throw a ball to reach the target. This is why it can so greatly affect the act of labor. Studies have shown differences in the rates of types of delivery methods based on when sexual assault takes place in one’s lifetime. This factor, along with the severity of the trauma influences the intensity of the effects on labor later in life. Because various labor triggers can cause many negative possible outcomes it is vital to practice sensitive care techniques when working with women in labor. Since few women disclose whether or not they have experienced sexual assault it should be customary to respect every woman in labor with the same type of gentle compassion. By preparing women during the prenatal period better outcomes can be reached. Providing psychiatric care and sharing types of coping methods can greatly improve their overall brain chemistry leading up to a birth. Educating pregnant women about all of their birthing rights and options can empower them to feel more comfortable and prepared for their birthing experiences. When a woman enters birth confidently without fear there is so much room for healing and transformation. By transforming fear into love a new generation of empowered, compassionate people can emerge into being.
The normal progression of childbirth begins with the fetus’s hypothalamus, (main control center of the autonomic nervous system). It secretes corticotrophin-releasing hormone (CRH), which sets in motion a cascade of hormonal reactions. The CRH is secreted into the pituitary gland, stimulating the gland to secrete adrenocorticotropic hormone (ACTH), which makes the adrenal gland secrete large amounts of the steroid hormone androgen into the fetus’s bloodstream which flows into the placenta. The placenta then converts the androgen into estrogen and is flooded into the mother’s bloodstream. The estrogen overrides the calming effects of the hormone progesterone on the uterus. Estrogen also causes the uterus, membranes, and placenta to produce prostaglandins. These cause the cervix to ripen and the uterus to contract. This hormone also causes the uterine muscles to change, increasing the amount of oxytocin receptors by 100-200%. More receptors causes the uterus to be more sensitive to oxytocin, causing contractions to get closer together. Contractions put pressure on the cervix, causing it to expand. This causes nerve fibers to carry impulses from the cervix to the spinal cord, then to the pituitary gland. It then begins a chain reaction, releasing more oxytocin to create more contractions. (1) This interaction of hormones cannot be disturbed. Labor complications occur when this process is disrupted. This is why labor intervention methods are highly common when doctors try to artificially induce labor. The baby will come when it is ready.
This hormonal chain of events begins in the hypothalamus. This part of the brain is referred to as the hypothalamic-pituitary-adrenal (HPA) axis. “Studies of the HPA axis generally show… elevated corticotrophin-releasing hormone (CRH) in individuals with PTSD compared to controls.” (7) When this hormonal disruption occurs in the brain of a pregnant woman it can negatively influence the initial onset of labor. When there is “chronic overproduction of CRH in the brain [this makes] a woman susceptible to elevated placental CRH gene expression during pregnancy and consequently, increases the risk of preterm birth.” (5) This is because the elevated levels of CRH cause the early release of adrenocorticotropic hormone (ACTH), which then triggers the release of cortisol in the mother’s brain. As mentioned in the previous paragraph, this same hormonal chain of events in normal labor begins in the brain of the fetus when development has come to fruition, stimulating labor in the mother. When this hormonal process begins in the brain of the mother due to a mental disorder this can cause preterm labor. Basically, CRH functions as a placental clock, regulating the length of human gestation. When the maternal brain does the job of the fetus’s brain timing can be off. Sometimes it will begin labor only slightly ahead of schedule, but in some cases it can cause labor to start weeks or months before the fetus is ready. This could lead to many further issues in the fetus. So, this is how PTSD can cause labor issues on a basic hormonal level.
Another way that past sexual abuse can affect childbirth later in life is through muscle memory. This can vary widely in severity. For some women the only time they experience a negative physical effect is in labor. In this instance the woman in labor may simply be unable to dilate and not even know why. A lot of times these women’s muscle memory surfaces as an inability to relax the pelvic floor, thus complicating labor. This can lead to the nee for the use of labor induction drugs like Pitocin. In even more severe cases it can lead to the need for vacuum or forceps extraction, or even a cesarean section. Even still, the situation can be much worse for some women. Just like how on a hormonal level sexual assault can lead to PTSD, it can lead to genital disorders on a physical level. These disorders can include genitopelvic pain conditions (GPPC), vaginismus, dyspareunia, and others. Most of these disorders cannot be explained with medical cause. The most common being “vaginismus, which is a psychological condition causing a spasm or contraction of the muscles around the vagina. This can happen during sexual intercourse, or when inserting a tampon or a pap smear for example.” (10) With all of these genital disorders there is usually pain, especially with intercourse. So imagine a woman with a painful, muscle spasming vagina. This makes for a very painful complicated labor. These women have issues dilating and are also more likely to experience perineal tears. “This may be caused by difficulties in relaxing the pelvic floor to allow for stretching during the second stage of labor.” (9) This “might also make the tissue more fragile” (9) in general. These conditions are thought to be “a kind of dissociative symptom prone to develop in some women with childhood psychogenic trauma.” (8) In these severe cases women have high rates of elective and emergency c-section, and use of vacuum or forceps extraction. This illustrates the importance of relaxation in labor. The woman in labor must surrender to the birthing process on such a profoundly deep level to assist her body in labor. This is extremely difficult for survivors of sexual assault, especially because they usually have a deep seeded need for control in their lives because; they weren’t in control when the initial trauma took place. These tense nerves lead to tense muscles, making childbirth very difficult.
Many studies have been done on different childbirth outcomes of women exposed to sexual assault. These studies show how big of an effect trauma can have. One article compared varying levels of severity of trauma on childbirth outcomes. It compared mild, moderate, and severe sexual assault victims’ birth experiences. This study found that in cases of severe trauma, the rates of elective C-section were much higher compared to less severe trauma and the control group. It also found that in cases of moderate trauma their was higher rates of emergency C-section. Overall, among all sexual assault victims, the study found that there was a higher frequency of induced labor, and a lower rate of episiotomies. (3) This seems to show that in the most severe of traumatic sexual assault, women have such fear of childbirth and such a strong need for control that they simply would rather choose to have a C-section on the date they want. Nothing specific was noted for mild sexual assault, but the overall findings apply. A higher frequency of induced labor was found in all levels of sexual assault victims. This most likely stems from the hormonal disruption of PTSD on the brain, and an inability to relax. This inability to relax stems from tense nerves and possible muscle memory. This could mean labor has begun naturally, but the mother’s fear has caused muscle tension and flooded her brain with adrenaline causing more pain. This could make a mother more likely to get an epidural, which is known to slow labor, which calls for more labor interventions like Pitocin. This is a very common scenario.
Another article compared sexual assault effects on labor based on time since trauma. Victims of childhood sexual assault were compared with victims of adult rape when giving birth. Studies showed that as more time passed childbirth outcomes were better. In cases of adult sexual assault there were higher rates of C-section, operative vaginal delivery, and overall longer labors. The same study also claimed that the victims of childhood sexual assault had labor outcomes similar to that of the control group. (4) This shows how resilient women can be when given time to heal properly, not just on a physical level, but also on an emotional and mental level.
In the third article, a larger variety of labor outcomes were examined. This study done out of Iceland found that in women who experienced some form of sexual assault in their lifetimes, there were higher rates of labor complications. Overall, compared to women with no experience of sexual assault, survivors of sexual assault had increased likelihood to have a prolonged first stage of labor, maternal distress in labor, antepartum bleeding, and emergency instrumental delivery. (6) This all seems to lead back to fear. Fear causes an overload of adrenaline and stress hormones to be released in the brain. This can cause more pain in labor and can disrupt the hormonal process of childbirth. Since the childbirth obviously involves the sexual organs, this can sometimes trigger memories of past abuse, especially when the mother doesn’t truly know or feel comfortable with the birth workers assisting her. For this reason, it is truly vital that all birth workers understand the need to show gentle compassion to all women in labor.
Survivors of sexual assault can sometimes be triggered by things in labor that can cause a re-enactment of their abuse. Triggers can include a wide variety of things most people wouldn’t consider. The more obvious triggers include vaginal exams, pain, and loss of control. Even though this is childbirth, most likely in the hospital setting, the PTSD mind has trouble differentiating the setting of the trigger. “Re-enactment of abuse occurs both as a result of events that involve the crossing of a woman’s body boundaries and more subjective internal factors that relate to her sense of agency.” (2) Many women experience triggers relating to powerlessness and lack of control. Hospital protocol is forcing women to re-experience trauma at a time in their lives that is supposed to be very positive. Something labor and delivery nurses usually wouldn’t consider is how their helping actions can worsen a situation. For example, being held down to receive an epidural has been known to be a trigger, because it causes the victim to be transported back to their abuse where they were restrained in the traumatic setting. Some women experience fear of the dark, or even anxiety upon hearing footsteps coming down the hall. Some women absolutely cannot have their back to a door. These triggers can cause memories to flood back into the mind of the woman in labor. “For some, such experiences during childbirth trigger conscious memories of abuse for the first time.” (2) This causes the woman to mentally leave the present moment and be brought back into the abusive moment. A lack of mental presence during labor can cause a more difficult labor. It is vital that birth workers practice compassionate care with all women, because most survivors of abuse do not disclose this information. It is important that the women are able to get to know their birth workers prior to birth to help them feel more comfortable. It’s also important that women are properly informed of all of their labor options and the pros and cons of them. The more informed she is about the protocol, the less likely to cause triggers. Allowing the woman to be in control of her birth is also very important. For example, if a vaginal exam is truly necessary mention it to her and let her decide when she is ready and which birth worker she feels most comfortable doing it. It is very important that the woman feels heard and respected. “Providing care that leads to healing rather than re-enactment of abuse must be the aspiration of every maternity care professional.” (2) In cases such as this, it is very important to help prepare women for birth during their prenatal period. By empowering women with information they can be much more comfortable when the time comes. Childbirth classes, emotional therapy, and writing a birth plan are all effective tools to help the birthing woman feel less fear of birth. Also things like prenatal yoga, hypnosis, and teaching coping/relaxation techniques can greatly benefit survivors’ childbirth outcomes. Childbirth can lead to growth and healing rather than the re-enactment of abuse with the right kind of care. Women need transformative care during these sensitive times in life.
In conclusion, sexual assault has been shown to negatively affect childbirth outcomes later in life. These traumatic events can cause Post Traumatic Stress Disorder (PTSD) to develop in some women. PTSD can disrupt the normal hormonal brain function in women, which affects labor process. This can lead to preterm labor, which can lead to a cascade of other interventions. Sexual assault can also have lasting effects on a physical level, resulting in muscle memory complications. This can disrupt women’s lives with such disorders as vaginismus, dyspareunia, or genitopelvic pain conditions. These conditions can greatly complicate labor by making it very difficult to relax the pelvic floor to allow for dilation to occur. It has been shown that the severity of trauma and the time passed since the trauma have a real effect on labor outcomes. All of these things can cause women to have emotional triggers that can flood them with fear, disrupting labor. All of these factors can cause women to have prolonged labor, preterm labor, more pain, failure to progress, need for emergency instrumental delivery, along with elective or emergency cesarean sections. These outcomes usually require some variety of labor interventions such as use of Pitocin, prostaglandins, and pain medications among others. This is why it is vitally important for birth workers to practice compassionate care with all women in labor. By shortening the likelihood of aggravating triggers more survivors of sexual abuse can have better childbirth experiences. Assisting women with proper prenatal preparation can greatly assist women in feeling more confident and comfortable in labor. Childbirth is such a sacred and sensitive event in life. It can be a highly empowering and transformative time in a woman’s life. Birth workers need to make it a priority to help this happen, instead of a re-enactment of abuse by activating triggers. All women are goddesses, they need to be reminded of this in order to heal and lead happy, peaceful lives.
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