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

Notes from Penny Simkin's Video

I just finished watching a video of Penny Simkin's 2/95 presentation on "When Survivors Give Birth" which is now a book co-authored with Phyllis Klaus and am psyched to share some very good tips with y'all.

I thought these were some great tips for any doula to better serve a client (or answer for yourself why you reacted this way) who is a survivor of abuse.

Signs she was abused:

• fears vaginal exams (tries to avoid them altogether)
• fears blood draws
• fears ultrasounds w/vaginal probe
• hates breast exams (feels voyeuristic, etc.)
• extremely modest of her body
• presents frequent medical complaints; chronic vaginismus with no apparent underlying disease
• general angry/abrasive personality
• fears labor & birth - truly believes she may die
• demands c-sec to not violate her vagina or to maintain her control over her body (deciding when and how the baby comes)
• wants immediate epidural upon arrival at hospital
• fears loss of control, is a control freak
• very unyielding in her birth plan/very long birth plan or is very passive, low self-esteem, feelings of worthlessness, has "given up"
• labor progression stops for no apparent medical reason - woman's mind-body connection is not allowing herself to feel out of control in 2nd stage (doulas - you can start up a stalled labor by getting her to talk about her "issues" if she is willing and able - for some women this is not an appropriate time to broach such subjects, but for others, this does the trick! Ina May Gaskin has a great example of this)
• demands pain meds. then screams and resists when they are given
• she brings many people with her (including a doula) to be her "protectors" against the "strangers" (doctors/nurses)
• is angry/distrustful of medical staff for no apparent reason - may chose homebirth for this reason
• higher risk of pregnancy induced hypertension - is hypervigilant
• higher rates of eating disorders
• substance abuse
• mental disorders: depression, anxiety/panic attacks, nightmares, fear of invasive medical procedures (phobic), other phobias, dissociative disorders, blacking out, PTSD, multiple personality disorders, obsessive/compulsive disorders, psychosis, psychosomatic illnesses etc. dysfunctional relationships
• dates/marries much older man (fitting with profile of her perpetrator)
• rejects changes in her body during pregnancy and postpartum; may not allow themselves to breastfeed
• repeated miscarriages
• frequent preterm labor
• desire for abortion
• strained relationship with partner
• fetus seen as a parasite/invader sucking away her energy
• strong gender preference for baby: wants male - so a daughter wont go through
• what she did or wants girl because she hates males now
• strong gender preference for care provider (wanting a woman)
• fear of not being a good mother
• morbid fear of childbirth pain
• bad reactions to strangers (hosp staff) coming into her room
• feelings of mutilation by episiotomies or tears
• a lot of vomiting with labor
• dysfunctional/non-productive labor
• fighting against staff during labor
• strong abandonment issues - not allowing husband to leave - needs to be "protected" from the strangers
• ambivalence towards anesthesia (compliant/passive, given-up, defeated)
• labor may produce for the 1st time in her life body memories of abuse that she has repressed
• repressed memories may occur
1. when she first enters a monogamous relationship
2. when their own child/grandchild is the age when her abuse happened
3. when perpetrator dies (now she's "free")
4. when she feels vulnerable/loss of power (i.e., labor)
• wants to wear full make-up, hair-style, not get all sweaty - trying to maintain control over her body

Some suggestions to doulas from Penny's talk:

• Remember that an angry/hostile client has very good reason that she's become this way. Realize that even though she may be directing her anger at you, that it is not about you, and to be a successful doula for her you must deflect that anger and realize it comes from her life experiences.
• You don't have to approach her about possible abuse issues, many will deny it or not see it as abuse. Just offer a simple sentence of support that you are available if there is anything she wants to talk about.
• Be aware that commonly used words and phrases by doulas during labor may be triggers of her abuse, such as "Surrender" (to the contractions) or "Yield" or "relax and it won't hurt so much" or "sweet talk" that her perpetrator may have used.
• She may have been raped from behind, so administering an epidural or anyone behind where she cannot see is very threatening/traumatic.

• Is there anything about the development of your sexuality that you'd like to discuss?
• Have you ever been in an abusive relationship, including now?
• Have you ever had sexual activities against your will? (some women will answer yes to this, even if they don't consider it rape)

Listening to your clients: Find out where the client is and take her to where she wants to go.

Teach clients "I messages" to effectively communicate with the staff her wishes, needs, fears, issues, etc. (also great for everyday communication!). This opens up effective problem solving for them with their caregivers instead of getting off to a wrong start.