The childbearing experiences of survivors of childhood sexual abuse

This project was initiated by Maggie Smith, whose interest in the topic arose as a result of her experiences as a practising midwife. It seeks to gain understanding into the problems and difficulties encountered by childbearing women who have a history of childhood sexual abuse (CSA). It consists of twenty in-depth interviews with mothers with such a history, half of whom were also midwives at the time of their interview. Recruitment was in two phases: the first consisted of women who were contacted via survivors' support groups; the second, of midwives recruited via the letters pages in midwifery journals.

The exact extent of childhood sexual abuse is unknown, but some authorities suggest that as many as half of all women will experience some kind of sexual abuse in their lives (Kelly 1988). The shame and secrecy which surrounds CSA means that, inevitably, it is under-reported and consequently many maternity workers will inadvertently come into contact with survivors during their working lives. The aim of this study was to gain an insight into the lived experiences of survivors of sexual abuse during pregnancy, birth and early parenting, in order to inform those working in the maternity services, to enable them to provide appropriate, research-based care for these women.

The project was undertaken from a feminist standpoint in that it was conducted through the promotion of a non-hierarchical reciprocal relationship between the respondents and myself. Data was analysed using grounded theory techniques coupled with the voice-centred relational approach propounded by Mauthner and Doucet (1998).

The findings suggest that there are direct parallels between the dehumanising effects of sexual abuse and the experience of giving birth within a medically dominated organisation driven by its own needs for efficiency, calculability and predictability. The interviewees appeared to have realistic expectations of the physical sensations of labour but were unprepared for uncaring and impersonal encounters with maternity staff. Re-traumatisation was more often than not associated with a routine-focussed approach by caregivers and failures in communication resulting in the women experiencing powerlessness, betrayal and humiliation. Good relationships with carers, in which the women perceived themselves to be valued and respected as individuals appeared to have a protective effect.

The data also suggests that there is no 'standard' approach to providing care for survivors of CSA, but that it is incumbent on practitioners to collaborate with each individual in order to discover how best to care for her.