Tuesday, May 23, 2006

Sexual assault and homebirth advocacy

I am repeatedly struck by the high level of self-reported childhood sexual abuse and rape in homebirth advocates. I just put in the words "rape survivor homebirth" into Google and found 15 separate instance of phrases like "since I am a survivor of rape, I wanted a homebirth" or "as a survivor of rape I knew that the way my OB treated me what just like rape". On this message board, on NHS Blog Doctor, and on personal blogs I have come across additional stories of childhood sexual abuse and rape among homebirth advocates.

Are there any figures on the numbers of homebirth advocates who have been sexually assaulted? I have cared for thousands of women over many years, and seen much more sexual abuse than I ever knew existed, and yet I have never come across such a high incidence of previous sexual assault in any other group before.

I wonder about the significance of this. Are women attracted to homebirth advocacy because of past sexual abuse? I have already suggested that women who claim to have PTSD after childbirth probably have PTSD from previous abuse, not from the birth experience. The extraordinary level of previous sexual abuse among homebirth advocates seems to confirm this. Frankly, I am startled by this connection. I had never considered homebirth advocacy as in any way related to a history of assault.

7 Old Comments:

"The extraordinary level of previous sexual abuse among homebirth advocates seems to confirm this." This is totally conjecture, as far as we both know right now. Only studies can prove that. You wrote a whole post based on this "fact", justifying it with a google search and some other observations you have made.

Besides that huge flaw, let's assume that women with past sexual abuse are more attracted to homebirth and midwives. I think a logical reason would be that they find the more personal, intimate care more comforting and less scary.

By Anonymous Anonymous, at 9:44 PM  

You said...
"I have already suggested that women who claim to have PTSD after childbirth probably have PTSD from previous abuse, not from the birth experience."


Wow. I wonder what is wrong with me then... must be that I'm just insane or something. I guess I can only "claim" to have ptsd. I am now thrilled to understand why it is that all 14 physicians I have called in the last two months have not bothered to call back or take me for an appointment. Ptsd doesn't exist to those of us who have had a "traumatic birth"... but have not been sexually abused. Shucks. Why didn't someone explain that to me a while back? I wouldn't be wasting all this time and energy trying to get help! Oh and I had a homebirth, isn't that a kicker? A point for the evils of homebirth, seeing as we are keeping score huh?!

By Anonymous Anonymous, at 10:01 PM  

" let's assume that women with past sexual abuse are more attracted to homebirth and midwives. I think a logical reason would be that they find the more personal, intimate care more comforting and less scary."

Yes, that does seem likely.

By Blogger Amy Tuteur, MD, at 10:01 PM  

Yes, I can agree with this but have no studies. What are the % considered to have been sexually assaulted in their life- 1/4-1/3 of everyone---
I was raped and had PTSD after my first hospital birth- and I could not have even made a statement to the doctor beforehand about being raped because I did not know that there would be any connection, nor could I have talked about having been raped, at that time.
But I would also say that many behaviors of the physician - unequal relationship, exertion of power-by controlling movement, going to the bathroom, eating, assistants who also treat them with deference and lack of power themselves, willing to carry out their orders even if they disagree- people willing to hold you down- yell at you in your face- stick their hands into you vagina without even much warning frequently roughly and no communication with you, even if you ask them not to or even if you are screaming no- they are condescending and tell you to shut up and do this for the baby-- wearing masks... so dissociation can get you through - but then what? how much do you want to step back into the world? Have you heard woman say- I am so sorry I didn't do it right.
Yes I have many many clients who are survivors of a kind-- and even some who are survivors of their previous births-- a deaf couple having their last baby at home-- made a first appointment statement -#1 first of all do not hit my wife on her face or forehead! if she is in the middle of a contraction speak to me and I will relay the information when she is done working hard
#2 we will hire our own interpreter- the interpreters who were at the births in the hospital were mostly men- and they interpreted everything that was being said in the room - even housekeeping talking amongst themselves about their own business-
#3 relating to #2 no extra people in the room that don't have to do with the birth and could they please not talk about their own lives -
#4 during the birth please do not yell- we can see the expressions and can read lips too but it is very disturbing to be yelled at when she is working so hard-
many many clients come from having had horrible hospital experiences and we can hardly believe some of the things that have happened to women-- fathers who are so afraid of births that they may want to be out in another room with birth comes because they have seen that there is really no role for them and that they are often pushed aside-
death stories or near death stories where the doctor is yelling at everyone or nurses are snippy and refusing to believe-- parents xyz is happening-
in any case my guess is over 1/2 of our clients have had some form of abuse or are currently being abused.

By Anonymous Anonymous, at 11:15 PM  

from a PTSD web site-- do a search AMY
"PTSD is different from most mental-health diagnoses because it is tied to a to particular life experience. A traumatic experience typically involves the potential for death or serious injury resulting in intense fear, helplessness, or horror."

I think that birth itself is a serious enough event to lend to PTSD- and I wonder how often postpartum depressions is related to PTSD.

By Anonymous Anonymous, at 12:58 AM  

I am not suprised, actually.

One aspect of molestation can be that the authority that should have been a safety net for the girl or woman was not and in fact may have exacerbated the problem. So when a woman is faced with the experience of birth, which is admittedly difficult even under the very best of circumstances and certainly frightening for the first time mother, and which is so closely connected to her sexual aspects, she has a distrust of any authority that would preside over the birth.

This anger could also be projected onto the entire culture of hospital care for births. It probably has a significant impact on the culture of homebirth advocacy, even when the person advocating has not been sexually assulted.

I think, then, that it might be useful to ask screening questions when beginning prenatal care. A woman who has experienced molestation may have sensitivities during the birth experience. It may take extra care to establish a stronger bond of trust with her care provider. The establishment of trust and sensitivity would carry a higher priority than under normal circumstances.

But still, some situations become chaotic and when an emergency is happening the doctor's priorities become saving the life of the baby and mother. There isn't time in some cases to calmly explain what is going on and why such interventions are needed. What should probably happen in those circumstances is a 'debriefing'. The doctor or care provider who performed the procedure, even, should counsel with the mother about what happened. An apology may or may not be appropriate, but an expression regret and sympathy for the events that occured certainly would be. This should happen as soon as possible afterwards, and should be reiterated at subsequent post partum visits. That would be good practice no matter the background of the mother. I suspect some good doctors already do this kind of thing.

By Anonymous Amka, at 3:06 AM  

"I have already suggested that women who claim to have PTSD after childbirth probably have PTSD from previous abuse, not from the birth experience."

I have PTSD only from treatment during childbirth that caused me to experience a sexual assault, not from a previous bad experience. There should be an acknowledgement that there is at times no bogeyman -- whether it's most of the time or only rarely is not important to the individual practitioner and patient involved when a woman ends up experiencing birthrape. What damage is done when the practitioner blames a bogeyman that isn't there? The bogeyman assumption allows practitioners to duck out of responsibility for things like physically restraining a woman and then penetrating her over and over when she has cried out, get your fingers out of my vagina. If there has been bad treatment, it should be rehabilitated so it is not repeated. A woman deserves humanized, respectful treatment whenever possible, EVEN IF she was not previously sexually assualted. EVEN IF she was. What is important is a sensitive look at provider behavior. If the provider has been as respectful and humane as possible, then whether there was a bogeyman or not is irrelevant too. This is a brief treatment of a serious issue. Please consider that in your critique. It's a very serious and difficult issue on both sides. MM

By Anonymous Anonymous, at 12:48 PM