The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Notes from Abuse Workshop with Penny Simkin

I attended a workshop in Atlanta with Penny Simkin this past Saturday, perhaps some other folks who were there can give input to the discussion too. 8.2 CEU's, 8-4pm, well presented, 32pg of h/o:When Survivors Give Birth: Counseling Skills and Strategies to Assist Pregnant Survivors of Childhood Sexual Abuse in Preparing for Birth. Part 1 defined sexual abuse and its impact on childbearing. Part 2 included specific counseling techniques and what to do if clients disclose abuse hx, identifying "triggers" of anxiety during preg/cb. The workshop is based on materials and a book she is writing with Phyllis Klaus. 13p of the book (explaining the counseling process step-by-step, was sold for $5.)

Simkin does counseling with her clients, broken up into several sessions, using a checklist. 3/4 to 1h: discusses present stressors, abuse hx, and an explanation of the counseling method, 30m to explore what make the client feel safe, and how she responds when in fear and pain, 60-90m: identification of client's triggers and their personal meaning (what it is about each trigger that upsets her), 90-120m: brainstorming strategies to either avoid triggers that can be avoided; reduce impact of others or deal with those that are inevitable. There are also homework assignments done between sessions (reading, journal writing, etc). Triggers include such things as changed appearance (make-up, hairstyle, clothing), nakedness/ exposure of sexual parts, body positions(h/k squatting, on back with legs spread), the actual birth, baby bulging the perineum, emerging from body, holding and suckling a baby, hospital environment (smell, machines, sounds uniformed personnel, blood draws, IV, vag exams, AROM, connection to lines from body to machines or containers (EFM cords, IV line, continuous BP cuff, bladder catheter, epidural catheter, O2 mask, bed restriction, epis/tearing, forceps or vacuum extraction, c/s, pp (vag canal inspection, stitches, fundal massage), strangers, behavior of caregiving staff, issues re partner, doula, family, friends (disapproval, abandonment, unreliability, inadequacy, disagreement, trust, dependency), pain with cx, pain-related behavior, panic, loss of control, expressions of pain (facial, vocal, body tension, pain medication "trade-offs": narcotics (groggy, sleepy, less pain, more relaxation), epidural (numb, less participation, inability to do as much, possible inadequate pain relief/less pain, more relaxation), pushing effort, sounds and the pain. By discussing these with the client, they can see what personal meaning the triggers have for them. Together strategies can be set into a birth plan to avoid or cope with the triggers. The caregiver is made aware of the clients needs through development and discussion of the care plan.

Simkin states that research shows abuse survivors are more likely to use "alternative care" in order to reduce stressors. Midwives will have a significantly higher # of the 25-40% of U.S. women who have abuse hx. Caregiver's sexual abuse hx and perceptions can also play into the equation of care. I regret that there was not much time for discussion amongst participants (full schedule)--- maybe some on-line discussion can be had?