0:29

Hello , today I have with me

0:31

Jennifer Burns , lpc , pmhc

0:34

and EMDR certified

0:37

therapist . Jennifer is a therapist

0:39

specializing in perinatal mental health and trauma

0:41

. She is the mother of two boys

0:44

and she is here today to talk about the impact

0:46

of sexual abuse and assault on pregnancy

0:48

and postpartum experiences . Jennifer

0:51

, welcome and thank you for joining me , hi

0:54

.

0:54

Kelly , thank you so much . I really appreciate

0:56

you bringing me back on the show to talk about something

0:59

that's really important and unfortunately

1:01

affects way too many people

1:03

out there . So , as part of this , I

1:05

just kind of want to put out there a little bit

1:07

of a trigger warning that this podcast

1:10

does contain detailed information

1:12

about sexual abuse and assault , and

1:14

so to please listen with care and to let

1:16

people know that if you or someone

1:18

you know has been sexually assaulted or

1:20

abused , there'll be resources provided at

1:22

the end of the podcast and in the show notes . You're

1:25

not alone and there is help available

1:28

. So , like Kelly said , I

1:30

am an LPC , I

1:33

specialize in perinatal health and

1:35

I'm EMDR certified , and

1:37

even though I currently work

1:39

in the field of perinatal mental health , my

1:41

education and experience

1:43

previously was

1:45

actually in the field of forensic psychology

1:48

. So I have done a lot

1:50

of work on both sides

1:52

of sexual abuse and assault , so

1:54

with perpetrators and

1:56

also with those who have been victimized

1:58

. So I think this is a topic

2:00

that is incredibly important and , again , unfortunately

2:03

, way too prevalent . I want to

2:05

mention that this is an overview

2:08

of a really complicated issue and

2:11

there's many pieces of this that we likely

2:13

won't be able to cover just today

2:15

, but hopefully this discussion can

2:17

provide some validation , information

2:19

and encouragement for those women

2:21

for whom pregnancy after sexual assault

2:23

is a reality . For the

2:26

purposes of this podcast , I'm

2:28

going to talk about voluntary

2:30

pregnancy for individuals

2:32

who've had a sexual assault or abuse

2:34

history and have conceived

2:36

with a partner who has not been sexually

2:38

abusive toward them . Realize that's a

2:40

mouthful . I won't be

2:43

discussing pregnancy as a result

2:45

of a sexual assault or pregnancy

2:47

in the context of ongoing sexually abusive

2:49

relationship . So that's a really

2:52

important topic , but it does warrant its own

2:54

discussion because there's additional physical

2:56

and psychological complications

2:58

. There is certainly some overlap

3:01

, but I just want to be very clear that you

3:03

know this is specific to a voluntary pregnancy

3:05

in the context of a non-abusive

3:08

relationship and I'm going to do my

3:11

best to kind of give you sort

3:13

of the framework in which I'm going to be talking

3:16

about this . So to outline

3:18

what we're talking about when we say sexual

3:20

assault , for the purposes of this discussion

3:23

it's going to refer to any instance

3:25

of non-consensual touching over

3:27

, under clothing , any digital

3:29

penetration , sexual

3:31

intercourse , including oral

3:33

, vaginal or anal sex . This

3:36

includes instances of sexual assault or

3:38

abuse when a person is unable

3:40

to fully and enthusiastically consent

3:42

to , voluntary or involuntary

3:44

, drug or alcohol intoxication , intellectual

3:47

or physical disability , age

3:50

, coercion or power differential . This

3:52

also includes instances of sexual abuse

3:54

and assault where initial consent was

3:56

given but then revoked , verbally

3:59

or non-verbally , and the sexual behavior

4:01

continued following this revocation

4:04

of consent . It's super important

4:06

to affirm that sexual assault can be

4:08

perpetrated within the context of romantic

4:10

relationships , as this has historically

4:13

been overlooked or dismissed . So those , those

4:16

matter as well . So , as you can see , consent

4:18

is a complicated , wide-ranging concept

4:21

, and if I didn't cover a specific

4:23

scenario , it doesn't mean it doesn't count

4:25

. It really comes down to how someone perceives

4:28

a sexual interaction as violating or traumatic

4:30

. So I realized that was a huge

4:33

amount of information that I just gave , but

4:35

I want to just be very clear

4:37

and as inclusive as as I possibly

4:39

can be , because one person's experience

4:41

may seem like not such a big

4:44

deal to somebody else , but it's a very

4:46

big deal to that person , and so

4:48

the implications of what happens as a

4:50

result of that , you know . That also

4:52

matters and can be considerable

4:55

. Now statistics according

4:57

to the CDC , one in four women

5:00

will be sexually assaulted in their lifetime , and

5:02

this means that a staggeringly

5:05

high number of women who become pregnant

5:07

are also carrying this experience

5:09

through what we really hope would be

5:11

a happy and exciting time for them . So

5:14

it's just this kind of cloud that's

5:16

potentially , you know , overshadowing

5:19

something that you know they were

5:21

hopefully looking forward to . So what

5:23

we know about trauma itself is

5:25

that it's stored within the body and

5:28

that , given , pregnancy , along with

5:30

labor and delivery , breastfeeding

5:32

, et cetera , are among

5:35

the most physically intense experiences a person

5:37

can have . It stands to reason

5:39

that it could potentially trigger a myriad

5:41

of physical and emotional trauma responses

5:44

. So , even if an assault

5:46

occurred decades in the past , these things

5:49

can still be brought to the forefront when someone

5:51

becomes pregnant , and it often

5:53

really catches people off guard , because

5:55

that is just not the framework

5:57

through which they're often viewing this

6:00

new experience , particularly if it's

6:02

one that they were really looking forward to and

6:04

really hopeful about . They can just be

6:07

sort of gobsmacked by all of the

6:09

unanticipated responses

6:11

and sensations that they're having . It

6:13

can trigger long suppressed feelings and body

6:15

sensations around one's body changes

6:18

, and it's interesting

6:20

that this impact can begin

6:23

even prior to conception , even

6:26

when individuals are making decisions

6:28

about one whether or not to have children

6:31

at all . That can for sure

6:33

be an impact . But also

6:35

, how do you even undertake that process . There

6:37

are times when individuals choose to forego

6:39

traditional means of conception , aka

6:42

sexual intercourse with a partner and lieu

6:44

of medical interventions like IUI and IVF

6:46

, because the act of

6:48

sex , even with the

6:50

express purpose of conceiving a baby , is

6:53

just too overwhelming and physically

6:55

and emotionally triggering . Another

6:57

byproduct of this is that survivors

7:00

may be more likely to seek

7:02

only minimal prenatal care or

7:05

forego prenatal treatment altogether

7:07

, which can have very detrimental effects

7:10

on mother and child , which unfortunately

7:12

can significantly increase infant

7:14

morbidity . So even

7:17

before conception , there's already

7:19

some problematic consequences

7:22

to coming into this with that history . For

7:25

individuals to become pregnant , or even just

7:27

through the IUI and IVF process , your

7:30

body is on full display and

7:33

it's frequently touched internally

7:35

and externally , which can

7:37

absolutely bring up previous

7:39

memories of abuse . Anyone who's

7:41

ever experienced a transvaginal ultrasound

7:44

can attest to how invasive

7:46

that process can be , which

7:48

can be complicated by the often very

7:50

happy and excited feelings that come with senior

7:53

baby for the first time . There's a lot

7:55

of different emotions

7:58

juxtaposed against one another through this

8:00

process and that is just one

8:02

of them . So even

8:04

the gynecological chair exam

8:06

table in general creates a sense

8:09

of vulnerability and exposure for individuals

8:11

, regardless of sexual abuse or assault history

8:14

. I mean you're laying there , often

8:17

at least partially uncovered , and

8:19

your legs are often open . That's

8:21

a very vulnerable position to be in

8:23

. So for some people that can be very

8:25

overwhelming and intolerable . So

8:28

for people in general , that's very vulnerable

8:31

, and this is really compounded for those

8:33

individuals that have this assault

8:36

history as well . The changes

8:38

to your body , including

8:41

significant breast changes in development

8:43

, changes happening in your pelvic

8:46

area , a lot of discomfort right

8:48

Baby kicking you in the cervix all

8:50

kinds of stuff like that continue

8:52

to increase feelings of vulnerability and

8:54

exposure . And just the idea

8:56

of growing something in your

8:58

body , regardless of how

9:00

much a child might be wanted

9:02

, it can create feelings

9:05

of alienation and distress . I think

9:07

most people who

9:09

have grown a baby internally have had

9:11

a moment of feeling like there's an alien

9:13

growing inside of them , and

9:16

so to have

9:18

that experience , but compounded

9:20

by feeling like this sort of internal violation

9:22

, that can be very unsettling

9:25

and distressing as well . It

9:27

can bring up feelings of loss of control

9:29

over your body . We know that

9:31

people who've been assaulted or abused

9:34

there's a very big lack

9:36

of control there , and so to

9:38

be put in a position where you're incredibly

9:40

vulnerable again , where all

9:42

of these things are happening to your body that

9:45

you have no control over . You don't know how they're going

9:47

to necessarily impact your play out . That

9:50

is also incredibly overwhelming

9:52

and distressing for a lot of people . It

9:55

may make people feel really

9:57

dirty and bring up a lot of feelings of shame

9:59

, so again really complicating

10:01

and contaminating a period

10:03

of time during which women

10:05

want to feel joyful and excited most

10:08

of the time . One of the things I would have mentioned

10:10

is that it's been noted that survivors

10:12

of childhood sexual abuse also

10:15

report more physical ailments

10:17

, specifically gynecological issues

10:19

. Some of the things that come up include

10:22

things like chronic pelvic pain , dyspharonia

10:24

, which is pain

10:27

in the pelvis before , during or

10:29

after intercourse . Vaginismus

10:31

, which is the involuntary contraction

10:34

of muscles around the opening of the

10:36

vagina . Non-specific

10:38

vaginitis , which is inflammation of the

10:40

vagina that can result in discharge , itching

10:42

and pain , and so those are the gynecological

10:45

things that can sometimes come up

10:47

, but there's also increased reports

10:49

of things like digestive problems , fibromyalgia

10:52

and sleep disorders . This

10:55

is a non-exhaustive list , but there's

10:57

some of the more common physical complaints

10:59

and Kelly , I'm sure , can speak in better

11:02

detail to some of these other things that I mentioned

11:04

before .

11:05

You know . Interestingly , though , a lot of

11:07

times we don't hear about that . So

11:09

patients may not disclose and , like

11:11

you said , that they may not even be

11:13

prepared for that to be an issue . So

11:16

a lot of times we just kind of have to observe

11:18

and then , without re-traumatizing

11:20

, somebody asking if they have any history

11:23

, because it's not something that people want

11:25

to talk about when they're about to deliver .

11:27

Yeah , that's a really really good point

11:29

. It's not something that people really talk about

11:31

enough and , you know

11:33

, obviously one of the most common interventions

11:36

that's recommended are things like pelvic floor

11:38

therapy , which is a fabulous

11:41

intervention and one that also can

11:43

be invasive as well . Triggering

11:45

, yeah , but we're kind of walking through a minefield

11:48

of potential triggers as we navigate

11:50

pregnancy and postpartum with people who

11:52

have this kind of history . So

11:55

something else that I just want

11:57

to mention people cope

12:00

with trauma in many different

12:02

ways and one

12:05

of the challenges for women

12:07

who have maybe used alcohol

12:10

or other substances to cope with

12:12

the trauma they experience this

12:14

may continue to happen during pregnancy . There's

12:17

all of these things that are coming up for them that

12:19

feel very out of control , and if that

12:21

was something that was effective

12:23

for them in the past and kind

12:25

of keeping them separate from those feelings

12:27

, it's unlikely to

12:29

change necessarily during pregnancy

12:32

. So we know that that can

12:34

cause health problems for both mother and

12:36

baby . Again , really

12:38

really important to provide services

12:40

to women who are struggling so that they can

12:43

find support and develop other effective

12:45

coping mechanisms during and beyond

12:47

their pregnancy . If there's anything

12:49

moms and parents know , it's

12:52

that being apparently

12:54

stressful in general . Those

12:56

are some of the things to consider during

12:59

preconception , being

13:01

pregnant . Librarian

13:04

delivery has its own

13:06

specific set of challenges for survivors

13:09

of sexual abuse and assault because

13:11

it is incredibly physically demanding

13:13

, vulnerable and painful

13:15

. In most cases One

13:18

of the most common things that

13:20

happened with people who have this history they

13:23

may dissociate themselves from their body during

13:25

labor and delivery . Again , that's a coping

13:27

mechanism , potentially , that they've used in the past

13:29

. That has been very effective . Generally

13:32

speaking , human beings like to

13:34

avoid pain whenever possible . If

13:37

that works , that's going to be the thing

13:39

that is our go-to

13:41

, but unfortunately it

13:43

can hinder and extend the labor process

13:46

at times . We do need to be present

13:48

in our bodies so that we're able to sort of feel

13:50

the things that are happening , whether

13:52

they're pleasant or not , and so

13:54

for those individuals who experience

13:57

a high degree of dissociation

13:59

, it's really important to have

14:01

someone that they trust with them during this

14:03

process to help gently

14:06

ground them back in their body , and to also

14:08

have someone to provide

14:11

support and advocacy . That's

14:13

a big challenge just in general , and even

14:16

more important for someone who may have some additional

14:18

triggers that the medical team may or may not

14:20

be aware of . So that person

14:22

could be a partner , a spouse . It

14:24

could also be a doula , another

14:26

support person or a family member Doesn't

14:29

really matter who , as long as that person is someone

14:31

that the mom trusts

14:33

. Something that's very useful

14:35

in terms of preparation are things

14:37

like meditation and

14:40

grounding techniques . What are those

14:42

things that we can do to help

14:44

us more easily stay in our body to

14:46

cope with the distress of the process

14:49

and also the pain itself . This

14:51

can help reduce dissociation a lot

14:54

. There was a 2016

14:56

study that indicated that

14:58

women with a history of childhood sexual

15:00

abuse reported vastly higher

15:02

levels of negative labor and delivery

15:05

experiences compared to a control

15:07

group . This is not surprising given

15:09

everything that we've just kind of talked about as

15:11

far as feeling potentially violated

15:14

during this process . So we

15:16

obviously want to do everything we can

15:18

to mitigate further trauma , improve

15:20

the likelihood of a positive labor and delivery

15:22

experience . That's outside

15:24

of just having a healthy baby . Having

15:27

a healthy baby is the goal , but

15:29

it is not enough . We

15:32

have to really make sure that we do what

15:34

we can to really make sure that mom

15:36

is OK , and some of the ways that this

15:38

can be helped is

15:40

by having doctors and nurses'

15:43

medical personnel be as transparent

15:45

as possible regarding any medical

15:47

intervention and ask for consent

15:49

throughout the process . One

15:52

of the most common situations in general

15:54

that leads to an experience of traumatic

15:56

birth is feeling like there's

15:58

no ability to say no or

16:00

not enough information to give consent

16:03

, or it's just happening to you

16:05

. There , of course , are life-threatening

16:07

situations in which interventions

16:10

have to be acted on immediately , but

16:13

it's really , really important

16:15

for there to be follow-up

16:17

and debriefing from the medical team

16:19

to avoid further traumatization

16:21

. I mean , I can say this

16:24

in relation to my own traumatic

16:26

birth . I had none of that initially

16:28

, and it helped

16:30

my healing tremendously to

16:33

have someone Kelly

16:35

in particular really

16:37

talk me through what happened

16:39

, and so I think

16:41

that is an incredibly

16:43

important piece of this , particularly

16:46

if there are things that have to happen that

16:48

there's just not enough time to

16:51

provide all of that information that

16:53

we want to make sure that we give , and a big part

16:55

of this , too , is making the woman

16:58

a part of the decision-making team

17:00

, like before , during and after labor and

17:02

delivery . We all know that birth

17:04

plans are subject

17:07

to change , often subject to

17:09

change , but really

17:11

, if a mom is coming in and saying I absolutely

17:14

do not want to have a vaginal delivery

17:16

, that may or may not be possible , but the

17:19

conversation about it is really

17:21

important because that mom is . If she's so adamant

17:23

, there's a reason there and we need to know what that

17:26

is . So having those conversations

17:28

, really being a part of the decision-making

17:30

team , answering the questions that

17:32

someone might have , really does go a

17:34

long way in terms of instilling

17:37

trust in your medical team and hopefully

17:39

facilitating positive labor and delivery experience

17:41

. And for everyone out there

17:43

who is pregnant and preparing

17:45

to deliver , one of

17:47

the greatest things that you can do

17:50

to empower yourself to have

17:52

a more positive labor and delivery is

17:54

to be your own advocate . Familiarizing

17:57

yourself with your rights as a patient

17:59

, knowing about things

18:02

like being able to refuse cervical

18:04

checks , things like that

18:06

, feeling like you can ask the

18:08

questions that you have in the back of your

18:10

mind . This can help really

18:12

bring a greater sense of control and autonomy

18:15

over your body and , at the end of

18:17

the day , when we have someone who's

18:19

coming in with that type of

18:21

sexual violation , that matters

18:23

a lot . So , moving on

18:25

to postpartum , again

18:28

, postpartum recovery is a very physical

18:30

process which often has a lot of

18:32

pain in the pelvic or genital area , which

18:35

can continue to bring ongoing physiological

18:37

distress . I mean and this is assuming that

18:40

everything went well with labor and delivery right there's

18:42

still stuff that you're healing

18:44

from physically , sensations

18:47

that are very uncomfortable during

18:49

the postpartum healing process . Breastfeeding

18:52

is another area of potential concern

18:54

as , again , this might

18:56

be a part of the body that holds traumatic memories

18:59

and sensations . It may feel

19:01

intolerable for women to breastfeed

19:03

due to the physical sensations

19:05

that are triggered , or it

19:07

can result in ongoing dissociation

19:10

while breastfeeding Just because

19:12

it's too hard to be in their body . Some

19:14

mothers who might want to breastfeed

19:17

their child may choose to bottle feed

19:19

in order to avoid the feelings . So

19:22

, whether or not a mom wants

19:24

to bottle feed or whether

19:26

they want to try breastfeeding , this

19:28

history of trauma can

19:31

rob someone of a choice

19:33

that they want to make . It's a catch-22

19:35

of you can either suffer while you

19:38

breastfeed or you

19:40

forego an experience that you might really have

19:42

wanted to try . So it's

19:44

really important to give the mom support

19:47

. However , she feels most comfortable feeding

19:49

her baby , and if a mom

19:51

would like to attempt breastfeeding , nurses

19:54

, lactation consultants , can

19:56

ask how the mother would like to be coached . So

19:59

, whether it be hands-on , whether

20:01

it be hands-off to give again

20:03

some greater sense of control

20:05

, to hopefully avoid any further triggers

20:08

to her body , increasing

20:10

opportunities for consent all

20:12

of these things . Other considerations

20:14

psychologically include

20:17

the higher likelihood of PTSD , higher

20:20

rates of postpartum depression and anxiety

20:22

from untreated trauma and

20:24

, unfortunately , revictimization

20:26

. If an individual isn't given adequate

20:28

support throughout the pregnancy , labor

20:31

, delivery and postpartum healing

20:33

. This can complicate

20:35

and make bonding and attachment

20:37

with the baby more challenging , which

20:39

can lead to subsequent grief and

20:41

loss around a pregnancy

20:43

and postpartum experience that someone

20:46

might have envisioned . So there's a real

20:48

ripple effect there that

20:50

is worth discussing . We all have

20:52

some idea about how we want those things

20:54

to go . Most of us don't get

20:56

things exactly the way that we want them

20:58

to , but again , the goal

21:00

is how do we help

21:03

somebody get through

21:05

such an intense experience

21:07

as whole and healthy

21:10

mentally and physically as possible ? So

21:12

, given the prevalence of sexual assault

21:15

and abuse in our society , it's really

21:17

important that survivors seek treatment

21:19

and be offered resources to help

21:21

them process through this trauma

21:23

. It's likely to reduce the

21:26

many physical and psychological impacts

21:28

of not only the sexual abuse

21:30

and assault itself , but any additional

21:33

trauma or distress that comes up

21:35

during this perinatal time period . Body

21:37

therapy work can reduce

21:39

symptoms of somatic distress

21:41

, which is body level distress , if

21:44

it can be tolerated . Some people

21:46

with this history can

21:48

handle it and they find it very soothing

21:50

. Other people they're not in a place

21:52

where that is something that feels okay

21:55

, but things like massage

21:57

, yoga , breath work can

21:59

all be very healing and helpful for individuals

22:01

throughout the pregnancy , labor and

22:03

delivery and postpartum time . There

22:05

are trauma-informed

22:08

yoga classes or

22:10

yogis out there , and so

22:12

if that's a way in which you're hoping

22:14

to kind of work through some of the

22:16

trauma you've had , I would strongly suggest

22:19

trying to find someone who has

22:21

gone through that type

22:23

of training . I actually have a certification

22:26

myself in trauma-informed yoga

22:28

, so having kind of been a witness

22:30

to and participant in some of that , I

22:32

can say that what I've

22:34

seen is that it is a little bit

22:36

different . There is a lot more emphasis

22:39

again on consent , on not touching

22:41

, on asking and

22:44

checking in , which I think is really important

22:46

. There are trauma-specific

22:49

therapy interventions like EMDR

22:51

, which stands for eye movement , desensitization

22:53

and reprocessing . Again , emdr

22:55

is not the only way to

22:58

process through trauma , but it is the

23:00

one that I practice and so am most familiar with

23:02

, and EMDR can be very healing

23:04

and it is considered safe during

23:06

pregnancy at any stage . I do

23:08

want to mention that in the past

23:11

there has been some controversy

23:14

regarding whether or not it is safe

23:16

to use during pregnancy . However , the

23:18

most recent research does

23:21

point to it being safe at any

23:23

particular stage . I would suggest

23:25

seeking out an EMDR-trained

23:27

perinatal therapist if that is something that

23:29

you are interested in doing , just

23:32

because they have a lot more training

23:34

around things like birth trauma

23:36

and how to work with people coming in

23:38

with this experience to help them have

23:40

a healthier pregnancy . Postpartum delivery

23:42

. The short-term increase

23:44

in distress during the EMDR process

23:47

in order to reduce the

23:49

overall distress and increase

23:52

feelings of safety is minimal

23:54

compared to the daily high levels

23:56

of distress that might be being managed

23:59

throughout a pregnancy , which impacts mom and baby

24:01

. So that's where the controversies lied previously

24:03

. Participating in EMDR

24:06

can be a very physical

24:08

process , and so there had been concern

24:10

previously that gosh , if we're

24:12

introducing all of these stress

24:14

hormones during EMDR while

24:16

someone's pregnant , that would have a negative impact

24:18

on the baby . But what we really know now

24:21

is that it is such a short-term

24:23

thing compared to this chronic

24:25

high level of stress and distress

24:27

that someone's carrying , and truly

24:29

it is in a lot of ways

24:32

, safer . So if

24:34

somebody has questions about that , there

24:36

are resources available to learn a little bit

24:38

more about it . We do know that untreated

24:41

mental illness and high levels of stress

24:43

during pregnancy does have a

24:45

negative impact on fetal development . That

24:47

is something that we know , that has been well-documented

24:49

. One of the nice things about EMDR

24:52

is that it can be a shorter process than

24:54

many other types of talk therapy , particularly

24:57

if there's one discrete trauma . While

24:59

everyone processes trauma differently and

25:01

comes in with their own history , there

25:03

can be a significant reduction in

25:05

distress and even the

25:07

development of just calming resources

25:10

that can be developed over a few or

25:12

even just one session . So that's

25:15

something that might be worth exploring

25:17

if that's something you are

25:19

interested in . So , as far

25:21

as resources for you or someone

25:24

who's affected by

25:26

sexual abuse or assault , here are a couple

25:28

of suggestions . It's not exhaustive

25:31

, but there are a few places you can get started , and

25:33

one of them is the National Sexual

25:36

Assault Hotline , which

25:38

is 1-800-656-4673

25:43

. Rain , which is the

25:45

Rape , abuse and Incest National

25:47

Network , at wwwrainorg

25:50

. The

25:56

National Sexual Violence Resource Center

25:59

at wwwnsvrcorg . And

26:06

the Mdria website

26:09

, which is where you can go to search for an EMDR

26:11

therapist if you so choose , and

26:14

that website is wwwemdriaorg

26:20

.

26:21

Thank you so much , jen . That was very informative

26:24

. I think a lot of providers don't

26:26

consider the effect

26:28

of sexual assault on

26:30

breastfeeding and

26:32

you had also mentioned that people don't

26:35

consider the effect of sexual assault

26:37

, a history of sexual assault , on

26:39

the whole experience , but

26:42

specifically for breastfeeding . I

26:44

find that , especially for moms

26:46

that have issues with a

26:48

latch , it is much

26:50

easier to just

26:53

latch the baby , help them , latch the baby like

26:55

physically and show them how it's supposed to look

26:57

and feel . So I'm

26:59

just thinking for providers

27:01

that do use the hands-on

27:03

approach . I think it is important to reiterate

27:06

the consent to touch . But

27:08

also it may require

27:10

a little bit extra expertise

27:13

, for instance , making

27:15

sure that a lactation consultant

27:18

is in there working with them a little

27:20

bit extra in the hospital . But

27:22

also if you're a survivor of sexual assault

27:24

and you feel like breastfeeding

27:26

is challenging because

27:28

of that , I want to encourage people

27:31

who are pregnant to seek

27:33

a lactation consultant that they trust

27:35

before delivery

27:37

so that you have that

29:23

resource after delivery . If

29:25

that is how you plan to feed your baby , it's

29:27

perfectly fine to choose to bottle

29:30

feed your baby . But if it's your wish

29:32

to breastfeed your baby and have

29:34

that experience , everybody needs support

29:37

during that I don't think a lot of people realize

29:39

or set themselves up for that . I know I was guilty of

29:41

that even as a nurse and

29:43

second-time mom . I did not set

29:46

myself up for much support , so I just

29:48

want to encourage that because that's going to be an additional

29:50

challenge .

29:51

I think , something that I didn't

29:53

say explicitly but

29:56

I think is really important . The hope is

29:58

that you would have providers

30:00

that you trust enough to share this with

30:02

, but the reality is

30:04

that that is not going to be the case a

30:06

lot of the time , or even if

30:08

some information is shared

30:11

, you may not have anywhere close

30:13

to the information

30:15

that you might want

30:18

in order to provide even

30:20

more trauma-informed care . So I think

30:22

it's probably good practice just to

30:24

go into these interactions with

30:27

the assumption that someone

30:29

somewhere has probably been

30:31

touched in a way that was

30:34

violating to them , and

30:36

we want to just mitigate that start to

30:38

finish . If anyone doesn't

30:40

, we don't want to be the person that potentially

30:43

gives them that experience , however

30:46

well-meaning . So , a

30:48

lot of the times we're just not going

30:50

to know , so we sort of have to lead with

30:52

the assumption that this may be

30:54

a part of their history .

30:56

Yeah , the other thing is that you brought up is

30:59

the options for delivery . So

31:01

I don't meet with the patient usually

31:03

as a labor and delivery nurse before

31:05

delivery . If I'm in a different setting

31:07

I might , but often

31:10

it's not something that I'm discussing

31:12

with the patient because that's just not my role

31:14

. The patient sometimes will

31:16

disclose the sexual assault

31:18

history and sometimes

31:21

there is a plan for

31:23

delivery made that takes

31:26

that into consideration . So a couple

31:28

of options are you mentioned to

31:30

the right to refuse cervical checks

31:32

In that situation . Some

31:35

of the options that we've presented patients

31:37

, especially if there's a planned vaginal

31:39

delivery , would be either an

31:42

epidural from the beginning so

31:44

that there's no sensation

31:46

of cervical checks , or sometimes

31:49

, when we had nitrous oxide

31:51

available at one of the hospitals that I worked at

31:53

, that would be an option , or some of the

31:55

IV medications . Those were all options

31:57

that were presented . But if those options

31:59

did not make the patient feel

32:02

comfortable enough , oftentimes a C-section

32:04

was recommended . And that's not

32:06

because we're trying to say you

32:08

can't refuse cervical

32:10

checks , it's because it's

32:13

somewhat difficult to know , especially

32:15

depending on the nature

32:17

of the delivery . So for instance , if it's an induction

32:20

, we need to kind of know what's going

32:22

on . If someone comes in in labor it's completely

32:24

different . But because if

32:26

your labor is ongoing and continuous and

32:28

everything is safe and there are no safety risks

32:30

or health risks , then you can

32:32

kind of get away with not doing cervical

32:35

checks , because then you can gauge how

32:37

the pregnant person is reacting and

32:39

how the baby's reacting and figure out how labor is progressing

32:41

. But if it's something where we have to start

32:43

the labor , it's really really hard to do without a

32:45

cervical check . And so I've seen in

32:47

the past just a recommendation for

32:50

a C-section if none of those other options

32:52

is available . And it's just something for listeners

32:54

to consider , because if this is

32:56

something that is going to be

32:58

just too much , it's okay

33:01

to talk to your provider about that

33:03

and come up with an alternative plan for

33:05

delivery .

33:06

Yeah , I really appreciate , kelly , you

33:08

mentioning some of the

33:10

different options

33:12

, because I think , again , what

33:14

so much of this boils down to is

33:17

communicating and being able

33:19

to consent If you know that you

33:21

don't want a C-section , unless it is an

33:23

absolute requirement , and

33:26

in order to

33:28

have that vaginal delivery that

33:30

you were hoping for , you might need to have

33:32

that checked to be a part

33:34

of the discussion about , like , well , how often might

33:36

that need to be ? And

33:38

you know , okay , I think I can

33:40

do that and this is how I would be the

33:42

most comfortable doing that but I think oftentimes

33:45

what happens it happens to the best

33:47

of us , right Like what is so routine

33:49

to us as providers is not

33:52

a routine for people who are coming in

33:54

, and I think there's just

33:56

not as much awareness or

33:58

knowledge of what a patient's rights

34:00

might be or what options

34:02

are available to them . So

34:04

I appreciate you bringing that

34:07

up because , again , so

34:09

it's not always about whether or not you

34:11

have the cervical check or you don't . It's

34:13

about having the empowerment

34:16

to be a part of that decision-making

34:18

. Because I know that , you know I'm sure you've

34:20

heard plenty of stories of

34:23

people who felt like it was forced

34:25

upon them and so that

34:27

in and of itself can be traumatic . So the

34:29

more conversation , and again I

34:32

can see the point that , like emergencies

34:34

are emergencies , but you know , I

34:36

think also it's true in the vast majority

34:38

of cases Most of these things are not emergencies

34:41

and I know it may take a

34:43

little bit more time but it may

34:45

make things a little bit easier on everybody

34:47

moving forward .

34:49

Yeah , the other thing I wanted to bring

34:51

up is , even if you

34:53

want a vaginal delivery and

34:56

you're doing all the things to achieve

34:58

that , and for instance

35:00

, just for an example , if you get an

35:02

epidural to be able to tolerate the

35:05

vaginal exams or whatever procedures

35:08

have to be in place in order

35:10

to achieve that vaginal delivery

35:12

and it's still too much for

35:14

you , you can always request to

35:17

not deliver vaginally . Just

35:19

because you've walked in with a plan does not mean

35:21

that that plan is set in stone , even if it was your

35:24

plan when nobody's playing a set in stone , there's always

35:26

new information that we're considering , and that's

35:28

why , when I talk about a birth plan , I try

35:30

I'm trying to move away from that verbiage , because

35:32

, in my opinion , there's really no

35:34

such thing as a birth plan , because you're always

35:36

changing the plan , there's always new information

35:39

and you have to respond to that information

35:41

, and so if the new information is , this

35:43

still is not tolerable for me , even

35:46

though I no longer have feeling in that part

35:48

of my body . Let's explore some other

35:50

options . You can do that

35:52

. Essentially , you can tap at any time

35:54

. The only thing is that your baby has to come out somehow

35:56

, and so you get to choose

35:59

the mode of delivery that

36:01

is safest for you and your baby .

36:03

Yeah , I think you may find

36:05

also the flip side of that

36:07

, where medical

36:09

interventions can also make

36:11

people feel like they're out

36:13

of control , right when that they

36:15

don't have the ability to control

36:18

what they're feeling or experiencing . And so

36:20

there may be some patients that

36:23

come in that are very adamant that they don't

36:25

want any external intervention because

36:27

they want to be in control

36:29

of every single part of what they

36:31

can be . So the idea of

36:33

not having any sensation may

36:36

feel more intolerable than

36:38

taking that potential

36:40

physical sensation away . So

36:43

everyone's experience is so different

36:45

that making them a part of

36:47

that conversation start

36:50

to finish is probably the best

36:52

possible intervention

36:54

.

36:54

Yeah , and for providers I mean I'm just thinking

36:56

of someone that we do have patience , regardless

36:59

of whether or not they've disclosed sexual

37:02

trauma that once the epidural has

37:04

occurred , their leg whoa , I

37:06

can't move my legs . This is not

37:08

good . Most of the time we can work through that , but

37:10

if that isn't something that can be worked through

37:12

, you can turn off the epidural . So

37:15

I just want parents to feel like

37:17

they can speak up and ask

37:19

for alternatives and

37:22

you can explain what's coming up for you and

37:24

then ask for what the alternatives are

37:26

. Ask for advice , because

37:28

there's always another option , I

37:31

feel like for the most part , unless there's so

37:33

many complications that we ultimately

37:36

land on one safe option , most

37:39

of the time there is flexibility .

37:41

Yeah , and when that happens , the

37:43

damage control , the mitigation comes

37:45

afterward where you go , have

37:47

those conversations , you acknowledge

37:50

that that was something that they did

37:52

not maybe get as much information about

37:54

or didn't have the level of consent that

37:57

they wanted to have . I know that piece

37:59

can sometimes really go

38:01

missing , and a little

38:03

bit of validation that that

38:06

was a situation that they didn't have

38:08

the level of control that they were hoping for

38:10

can go a long way . Yeah , absolutely

38:12

.

38:12

I like that you were talking about preparing beforehand

38:15

. I think that , other than the debrief

38:17

, because we've already potentially

38:20

experienced the trauma if we've had

38:22

the debrief , the preparation

38:24

beforehand I think is essential

38:26

because if you have

38:29

some sort of idea of what's possibly

38:31

coming and what you want and

38:33

you've worked through the feelings

38:36

that you might have around some of those things and

38:38

you've asked all your questions , I think it's less

38:40

likely and I don't know the statistics I was actually

38:42

looking that up today and I need to kind of explore

38:44

that a little bit more but the statistics of

38:47

I know that it is said

38:49

or it is theorized and discussed

38:51

that if you have worked through that and

38:54

prepared mentally for those things

38:56

, that the incidence of trauma is

38:58

significantly less . Several

39:00

studies I was looking at that , I again

39:02

don't remember the numbers even go as far as saying

39:05

you can decrease the incidence

39:07

of post-traumatic stress disorder . So

39:09

I just can't stress enough the importance of

39:11

preparation for the birthing

39:13

process for parents . I

39:15

think there are a lot of resources

39:18

for preparation . Some are better

39:20

than others . A lot of parents want

39:22

the quick one day class and

39:24

then what I hear afterwards was there wasn't

39:27

enough information . It was all condensed into

39:30

a six hour period , but when

39:32

you sign up for that you're like , oh my gosh , six

39:35

hours , are you kidding me ? So I

39:37

think people would do better to

39:39

look at this as I mean . It's

39:42

not just birth , it's the marathon , it's the pregnancy

39:44

, it's the birth , it's the

39:46

parenthood , it's all this whole new

39:49

thing that you are preparing for me . You don't just jump

39:51

into a new career after six hour

39:53

class . Most of the time you know your

39:56

, your new career is gonna be parenthooding . Getting

39:59

into that process is gonna take

40:01

some preparation , even the birthing process

40:03

. So I just want encourage parents to spend

40:05

a little bit more time understanding

40:07

what's gonna happen , no matter what kind of birth you're having with

40:09

your having home birth , the hospital , birth , first

40:12

center no matter what you're doing , understand

40:15

what the options are and why and what

40:17

might be coming up for you with all of those options

40:19

.

40:19

Absolutely , and I really to

40:22

piggyback off of that a little bit . In

40:24

the beginning of the podcast I mentioned that

40:26

A lot of times people can be really

40:28

caught off guard by a

40:31

lot of this stuff coming up and

40:33

I would say that sometimes

40:35

they're not even really aware of why

40:38

they might be Having

40:40

certain intrusive thoughts or

40:43

why they might be having

40:45

a really strong negative emotional

40:47

reaction to something . And I

40:49

would really encourage anyone

40:52

who might be having things

40:54

that just you feel really

40:56

out of sorts and you're not really sure why you're

40:58

having some of the experiences . Are the symptoms

41:00

you're having like that's a good time

41:03

to intervene . Then you don't have to necessarily

41:05

know the explanation at that

41:07

time , what's

41:10

going on . The fact that you're already starting

41:12

to struggle is enough and important

41:14

enough to get you in to get some help

41:16

, even if someone never necessarily

41:19

makes the connection that it was related to

41:21

an abuse or an assault that happened in their history

41:23

. We all deserve to have

41:25

support and resources available to

41:27

us to reduce the amount of distress

41:29

that we're having , to improve the sleep to

41:31

the extent possible , because no one's sleeping

41:33

really well during pregnancy . And so

41:36

I would just say regardless of the

41:38

reason , let your obino

41:40

, reach out for help from

41:42

a therapist , a perinatal therapist , any

41:44

therapist to begin with , just to see

41:46

if you can't get ahead of some of that stuff .

41:49

Yeah , I think more and more I see

41:51

when patients come in anxiety

41:54

and depression as listed

41:56

in their past medical history and to

41:59

some extent I think that's because people are just being more honest

42:01

about it . But it is

42:03

so normalized from our end at

42:05

this point that whatever stigma

42:08

you might have in your head about

42:10

talking to your obi about that , I just want

42:12

to validate the presence of anxiety

42:14

, depression In society because

42:17

I don't think that there , from our end

42:19

, is any stigma . It's just

42:21

, it is what it is . It's

42:24

just something that we see and we say

42:26

, okay , yeah , don't we all and we move on

42:28

. It's not to minimize it either , but I

42:30

just want people to feel comfortable

42:32

Expressing those

42:34

feelings of anxiety if they're

42:36

coming up and know that

42:38

it is something that you can speak

42:41

about and share about without feeling the judgment

42:43

or the stigma , because there's help

42:45

out there and there's no reason to fear when

42:47

you , when you want to come forward and say that

42:49

that's what you're experiencing yeah

42:51

, absolutely .

42:53

It's highly treatable and highly

42:55

treatable in pregnancy , highly

42:57

treatable in your postpartum experience

43:00

and especially even just around

43:02

P . Mad or perinatal

43:05

mood and anxiety disorders , is an

43:07

umbrella term . One in

43:09

five people right

43:12

have some form of perinatal mood

43:14

disorder anxiety . One in seven

43:16

have postpartum depression . These

43:18

are common occurrences , even

43:21

as we really wish that they weren't , so

43:24

hopefully people are

43:26

continuing to talk about them and

43:28

hopefully the messages

43:30

are getting out to parents

43:33

to be that these are things

43:35

that we don't

43:38

need to brush off . These are things

43:40

that are unfortunately

43:42

common experiences , but fortunately

43:44

common in the sense that You'll

43:46

be able to find a provider . Hopefully that can

43:48

help you navigate that , because it is

43:50

highly treatable . You don't have

43:53

to suffer yeah , well done .

43:54

is there anything else that you wanted to talk about that

43:56

we haven't brought up ?

43:57

I mean I think I hit the high points . Like I said

43:59

, you know , this is a really Complex

44:02

issue that's hard to cover in just one , and

44:05

I realize that there are specific

44:07

scenarios , as I kind of mentioned

44:10

in the beginning , that sort of warrant their own

44:12

Podcast or their own

44:14

form of treatment , just because they're

44:16

even more complex . But hopefully

44:19

there has been some helpful

44:21

information and validation today

44:24

and hopefully starting this conversation

44:26

or continuing it a little more .

44:28

Well , jennifer , thank you so much for joining me

44:30

. As always , I learned a lot

44:32

, and those resources

44:34

that Jennifer mentioned will be in the show notes

44:37

for you to look up .

44:38

Thank you , kelly . I appreciate you bringing me back . Thank

44:41

you .