The Legacy of Sexual Abuse

One in every three or four women have a history of childhood sexual abuse, and during pregnancy, many of them struggle with anger, shame and other powerful emotions.

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When Anna (not her real name), a 36-year-old product designer, was expecting her first child, her doctor asked her if she planned to breastfeed. Anna said no, and her doctor asked why. Immediately Anna felt lightheaded, and her heart began to race. "I knew that due to extreme sexual abuse from ages 6 to 8 by my father that included sucking on my nipples, I would not be able to breastfeed," Anna says. "But it's tough to talk about--I feel kind of like I am doing something wrong."

Anna is not alone. One in every three or four women have a history of childhood sexual abuse, and during pregnancy, many of them struggle with anger, shame and other powerful emotions, according to Penny Simkin, a doula, childbirth educator and co-author of When Survivors Give Birth (Classic Day Publishing, 2004). Vaginal and breast exams and other routine health checks can trigger panic and fear.

"Powerlessness, invasion of body boundaries, exposure of sexual body parts and lying down while others are standing may all remind a woman of the abuse," Simkin explains. Simkin says Anna's reaction is not unusual for sexual abuse survivors. "Giving the baby access to their breasts, especially if they were a major target of the abuse, may trigger resentment, guilt and memories of childhood when they could not say no," Simkin adds.

Anna's feelings were compounded by well-meaning friends and acquaintances who harassed her when she told them she did not intend to breastfeed. "I had to live with the guilt of being sexually abused compounded by the guilt of not being able to be the best mother possible because of the belief that breast is best," Anna says.

When Anna told her doctor about her history, the doctor responded in a compassionate way and suggested a support group. Anna was too embarrassed to attend, "but it was reassuring to know I was not the only person who would not be able to breastfeed," she says.

Nothing can erase sexual abuse, but Simkin advises taking steps to protect yourself from reliving abuse-related feelings during pregnancy: • Discuss your abuse history with your caregiver if you feel comfortable doing so. • If you would rather not go into detail, try to communicate your needs without revealing what is behind them. For example, if vaginal exams are stressful, ask that your doctor or midwife perform as few as possible and as gently as possible. "A sensitive caregiver can respond to a woman's needs without needing an explanation," Simkin says. • Consider choosing an empathetic doula or midwife, who can offer compassionate support.

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