Impact of #domesticviolence or sexual assault on #pregnancy

Refreshing as it is (well, kind of) to hear domestic violence and sexual assault talked about more frequently in the media today, there is an aspect of that violence that is long-lasting and sadly, seldom mentioned. That is how the violence of an assault can impact a woman during pregnancy.

Pregnant survivors of violence have more challenges during their childbearing years than non-survivors do. Those challenges not only depend on the kind of abuse that the woman suffered but also when the abuse happened. Let's look at two examples of how this might look-

  • An adult survivor of childhood sexual abuse becomes pregnant and decides to keep the baby. She learns the baby is a boy. She starts finds herself repulsed by the baby. She cannot stop thinking about how she has been abused by men and begins fixating on how this future man might end up hurting her too. Although she originally wanted the baby, the idea of something growing inside her is beyond horrifying. She is ashamed to tell anyone of these feelings but starts (often unconsciously) to make decisions that reflect that disengagement like skipping her prenatal appointments and not talking about the pregnancy with anyone.
  • A domestic violence survivor who was abused by much older men including her father is untrusting of anyone and has difficulty maintaining relationships. She becomes pregnant and finds herself at a ob/gyn practice where there are older male doctors. At her appointments, she is unable to advocate for herself and ask questions when it comes to routine care. Or perhaps the exact opposite: she is very high maintenance, demanding with a highly detailed birth plan, only to turn around and at the next appointment announce that she wants to schedule a csection. 

A background of abuse has a huge impact on how a pregnant survivor thinks about herself and how she sees/thinks about others. This is not something that can be disregarded, either by the pregnant survivor or practitioners, friends, or family who interact with her. 

One of the issues that I work on with Trauma Counseling survivor clients is identifying the core issue for their visit and developing supportive tools to help them as they move through their pregnancy with confidence. We also work together to talk about what she might expect as her pregnancy continues. An adult rape survivor, for example, might call not because she's having fear around a vaginal delivery, although she really wants to "go natural". 

Emotional and physical changes as well as socioeconomic issues can complicate how any pregnant woman copes on a regular basis. But all of those are compounded and amplified in scale for the pregnant survivor who is already less emotionally equipped to deal with her changing identity. 

This is the first in a series that will look at how abuse impacts a woman in her childbearing years. 

Thank you for reading.

 

{new #OutsideTheMomBox post} Impact of maternal #childhood #sexualabuse on #babies

Childhood sexual assault (CSA) survivors have a different set of challenges than new moms who aren't survivors. [For perspective, about 1 in 7 girls will be sexually abused before her 18th birthday.] These challenges can manifest themselves in different, often unexpected ways, not just in mom, but also in baby. As the first in a new series here dedicated to raising awareness about the realities that survivors face as pregnant women and new moms, I'm going to highlight three ways that a history of CSA in mom can impact a newborn's health and well being:

  1. From the strange new feeling of your milk letting down to the realization that your breasts really aren't your own anymore, breastfeeding can be a very triggering act for a survivor. Add in factors like an infant's roving hand, pain of any sort, feedings at all hours and you can start to see why some survivors don't breastfeed. For survivor moms, it's usually less of a "choice" and instead often related to not being able to tolerate breastfeeding or the fact that it just doesn't work for them. And yet, we all know that breastfeeding is ideal for baby. Studies that confirm this are numerous; check out the first paragraph here for details. 
  2.  Failure to thrive (FTT) is a state of undernutrition due to inadequate caloric intake, inadequate caloric absorption, or excessive caloric expenditure. There are two types of FTT: non-organic (a non-medical reason the infant isn't thriving) and organic (a medical reason that the baby isn't thriving). With both types, the bottom line is that baby isn't getting fed enough. There are many reasons why FTT can occur: lack of success breastfeeding, emotional overwhelm in mom, misunderstanding or a lack of understanding about basic infant needs in mom/parents, lack of attachment to baby by mom, etc. Each of these above reasons can be by-products of mom's past history of abuse. Dr. Kathleen Kendall-Tackett, IBCLC talks a bit about this here.
  3. Not all women bond immediately with their baby.  For survivors, however, that bonding may take even longer, even if the baby is "just" a normal, dependent infant. If the baby is special needs, is "difficult" or has other challenges (colic, etc.) then bonding may be even harder. "Mere" insistent neediness of a baby may stir up past feelings of vulnerability and powerless that mom associates with the perpetrator of her abuse. It's normal: the perpetrator took what he wanted from the survivor and when a new baby enters the survivor's world, dependent and unable to feed or care for herself, the survivor's body is once again at the whim of someone else. This lack of bonding can become problematic though if FTT (see #2) develops and/or if mom begins to have ideas of harming her baby.

What does all of this mean? Well, simply due to their past abuse, survivors carry with them challenges that can complicate their ability to provide the best care for their baby. Add in factors like poverty, a lack of education, an absent or abusive partner, and you have a survivor mom who may barely be hanging on. This is something that should concern all of us. But here's what we can do:

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  • Keep in mind the challenges of survivors that we discussed above when you hear the ever-present "breast is best" motto. Click here for a bit more on this issue. Not being able to breastfeed a child can be devastating for a new mom's fragile mental health but what is often more detrimental to mom and baby is the societal guilt that moms are made to feel by not doing the "best" they can for their child i.e. breastfeeding.
  • Provide support. Support is continually named over and over one of the best resources that you can give a new mom. Good, informed support helps new moms feel less alone, more normal and more accepted. Not to mention provide them with trusted resources that they trust when they need more help or advice. All of this is why I offer free groups. What can you do? Attend a group, help make a group happen for those who need it, or volunteer in a way that feels right to you.
  • Rise above the "mommy wars". It can be so hard to sit back and mind your own business. That's true for me too! But we really must. When we accept that we can't ever know someone's whole story and therefore have no place to judge them, then we are removing ourselves from the insidious "us vs. them" battle. It's a battle that neither side will win, even if we "lean in" so let's just opt out of it altogether.

Starting this fall, I'll offer my first virtual program: a childbirth education class specifically for survivors. Open to any survivor, living anywhere, we will meet weekly over a conference call line for seven weeks. First names only. If you'd like more details, head over here to give me a call or message me. Thanks for reading.

Why We Need to Stop Saying "Breast is Best"

This post is adapted from one I wrote in June 2013.

Everywhere we turn, there is an abundance of information about the value of breastfeeding.  Breastfeeding saves lives and moneypromotes good brain development and even helps mitigate the affects of tragedy or disaster, to name a few recently cited reasons why new moms should breastfeed. The assumption is since breastfeeding is best for baby, it should be The Choice for every new mom. That’s not the case, however, as this post will discuss. I love that breastfeeding is such a popular topic (I wish another public health issue- intimate partner violence – received as much attention and support!) but saying “breast is best” ignores and marginalizes the experiences of mothers who cannot breastfeed. 

Research tells us that there are no end to the benefits a baby receives when she is breastfed but what we don’t hear discussed as often, and which should be given at least as much attention, are the challenges that new moms face in breastfeeding. New moms encounter two kinds of challenges as they tackle breastfeeding for the first time: “general” ones (making sure baby has a good latch; dealing with an over-supply/under supply of milk; how to express efficiently, etc.) and “individualized” ones that are more complex and less talked about (the privilege of breastfeeding; negotiating the task of breastfeeding when you work outside of home; emotional and physical triggers involved with breastfeeding). Often the “general” challenges, while they can be emotional, are a result of a physical issue and can be an easier fix, with informed hands-on help.  Hands-on help can come from a number of resources including the family’s post-partum doula, a CLC/CLEC or IBCLC, a pediatrician, or any number of internet resources (such as this great video on maximizing production). For my purposes in this post, I’m going to leave “general” challenges aside and concentrate on the “individualized” challenges behind why saying “breast is best” is problematic. The focus will be on the US as that is my experience.

As a new or expecting mom, the assumption is that you will do what is best for your baby and choose to breastfeed. For many moms that means making the commitment to breastfeed during their maternity leave, if they meet certain criteria. Some moms also choose to breastfeed for six months, i.e. until baby is ready for solids (although the age indicator is arbitrary and one should go by baby’s signs of readiness instead.). Other moms have the goal of one year. One year is the time recommended by the AAP although the WHO recommends two years. Obviously behind any good intention lay many complicated issues, an important one of which is privilege.

Being in a position to exclusively breastfeed your child for any amount of time is a place of privilege. Note: for my purposes here I am defining “exclusively breastfeeding” as feeding baby only breastmilk, either pumped milk or milk directly from mom. Exclusively breastfeeding often takes substantial early effort to ensure success and while it becomes more effortless, maintaining an exclusively breastfed baby takes a considerable amount of time on the part of the mother.  Let’s look at both of those parts a little more closely:

  • Breastfeeding may be the “most natural thing in the world” but it’s not easy.  Getting it right (pain-free for you and meeting the needs of baby) is learned.  Remember the “general” challenges (good latch, etc.) that I discussed above?  They may be “general” but these are often reasons why moms decide not to breastfeed.

  • Time. Newborn babies should be fed 10-12 timeswithin a 24 hour period.  And even after the first two weeks, baby still needs to eat 8-12 times within 24 hours.  Even now at 13 months, Elisabeth nurses generally every 3-5 hours, although not as often overnight. That’s a lot of time that mom spends feeding a baby!

Given these two factors of time and effort, obviously then there will be some women do not have the luxury of choosing breastfeeding. Which new moms then will be disproportionately challenged more than other moms? Answer: poor women for three main reasons-

  • Poor women are more likely to be employed part-time at low wage jobs (fast food staff, gas station attendants, etc.) which do not really support a breastfeeding mom, either because their maternity leave was short or non-existent or that the infrastructure of the job is such that 20-30 minute breaks to pump milk isn’t possible* even if employers are required by law to support a breastfeeding mom;

  • These moms are also less likely to get the support that they need to fix those early “general” challenges because of: costs associated with that help; logistics involved with getting the help (transportation, finding the help, etc.); a lack of knowledge that such help exists and which laws and resources protect their rights as a mom;

  • Finally, poor women are also more likely to have more than one child that they care for, either full or part time.

Poor women, then, are hit with a triple whammy of obstacles that often exist even before their baby is even born.  And these are the obvious obstacles.  Perhaps you can think of other obstacles such as culture and family history, an unsupportive or even abusive partner, an unhealthy body image and/or a history that includes mental health issues.

Consider the life story of a newly separated woman, Maria, for example. Maria breastfeeding is not a choice because:

  • Circumstances: Maria’s baby was born early, started on formula at the hospital and the lactation consultant at the hospital didn’t visit Maria until the 2nd day of their stay;

  • Resources: Maria works 45 minutes from her home and she doesn’t have the time to pump as often as she’d need to or the extra money for a pump and its accessories;

  • Family: Maria’s sister watches the baby while she’s at work, raised her children on formula and thinks formula feeding is easier.

Breastfeeding, then, is clearly a privilege that not every woman has.  And this is the first of three reasons why I believe we need to stop saying “breast is best”.  When we make this assumption, we ignore the life story of the mother and in doing so marginalize and isolate her at a time when she is most vulnerable. This belief is the core reason why I started Outside The Mom Box: all too often our society disregards the needs of the mother as soon as she birthes her baby. Moms’ lives counts too…just as much as baby’s.

Until we have sufficient social systems (from milk sharing programs to lactation rooms in places of work) in place to fully support moms who want to breastfeed but cannot for whatever reason, then we have no right telling women that “breast is best”…and thus shaming moms who don’t, by “choice” or otherwise, breastfeed their baby.  Doing so is like telling a domestic violence survivor that she should leave her abusive partner but not provide her with the resources she needs: transportation, a place to go, food to eat or money for her cell phone.

Who am I then, and indeed, who is society, to tell Maria and others that “breast is best”?

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Why Everyone Should Read the Dylan Farrow Letter

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And it's not because "...imagine if she were your sister or daughter."  No, everyone should read Ms. Farrow's letter because women are the key to our future.  In many ways, of course, but what I'm referring to here is the most basic biological one: we are the ones who bear children.  

If we know that 1 in 4 girls* will be sexually abused by their 18th birthday, we can be confident in saying that childhood sexual abuse is an epidemic.  It's certainly a trauma that will affect that girl for the rest of her life and it can, affect her own children, if she has any**. And what if she opts not to have children because of her past abuse?***  Whether she worries she might become an abuser herself, she doesn't trust her body, anticipated challenges during pregnancy, childbirth & postpartum, or anything else, doesn't really matter.  Everyone should read Dylan Farrow's letter because every woman deserves to have the choice of whether or not to have children AND have that choice be uninfluenced by doubts, fears or worries about themselves and their ability to have a child. When those choices are taken away, either because of abuse or politics, we venture into a slippery slope that starts to sound a bit too close to Big Brother's voice for most of us.

*1 in 6 boys.

** CSA survivors often struggle with infertility issues.

***While I haven't found any solid evidence to support my theory that CSA survivors may decide not to have children simply because they were abused themselves, it seems like this would ring quite true for some. 

Agree? Disagree? Leave a comment below.  

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