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Book Review: When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women

by Penny Simkin, PT, and Phyllis Klaus, CSE, MFT
Classic Day Publishing, 2005
Reviewed by Anne Marie Miller
Lilburn GA USA
From: LEAVEN, Vol. 42 No. 4, October-November-December 2006, p.80

When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women justifies its presence in a La Leche League Leader or lactation consultant's library within the first few pages. Although there is no specific data, surveys and studies have led experts to estimate that the incidence of childhood sexual abuse is 25-40 percent of girls and 20-25 percent of boys. In more than 80 percent of the cases, the perpetrator is known to the child. Given these statistics, it is possible that a Leader will find herself helping mothers who have been abused. In many cases the mother will not tell you about the abuse, and may not even realize how her past history of abuse is affecting her current childbearing situation, including nursing her child.

The authors, Penny Simkin, PT, and Phyllis Klaus, CSE, MFT, start by listing the types of sexual abuse (verbal, psychological, and physical), and then give the incidence of abuse. The book covers a wide scope of information. Sexual abuse can have long-lasting implications. The process of pregnancy, birth, and breastfeeding can bring out some new feelings and can create new challenges for childhood sexual abuse survivors. Topics covered for the health care professionals who work with childhood sexual abuse survivors focus on communication, help, and healing. The impact on the survivor can affect her pregnancy, including becoming pregnant, choosing a caregiver, and her possible disclosure of abuse. The survivor can have issues of control and delayed recognition of abuse-related events in childbearing. Special considerations for childbirth and postpartum care, including breastfeeding concerns, are all covered in this book.

The authors have created a very readable discussion of the problem, including case histories (suitably disguised) that give life to the general information they are sharing with the reader. As the title indicates, this book is focused on helping caregivers do their work effectively. Once the problem has been described in the first part of the book, the authors go on to discuss communication and counseling techniques and when each different technique may be useful. They outline self-help methods, examples of birth plans, and charts of "triggers," including how each trigger can be addressed. (A trigger refers to some action or problem that causes distress for the mother as it relates to her abuse history.)

Simkin and Klaus point out "some of the greatest challenges in the postpartum period occur with breastfeeding." The portions of the book that most directly address the concerns of Leaders are in the sections about the postpartum period and breastfeeding. The chapter about maternity paraprofessionals (childbirth educators, doulas, breastfeeding consultants, and massage therapists) would also pertain to LLL Leaders.

Aspects of breastfeeding that can be a problem for childhood sexual abuse survivors are very common experiences for all breastfeeding women: "breast exposure, secretions and dripping, strong sensations from the baby's suckling, fondling, and stroking as well as continuous demands by the baby." The list of potential challenges continues with such things as problems with the mother's partner, comments by others on her breastfeeding, cracked nipples, fatigue, nighttime feedings, a crying baby who creates doubts in the mother about her adequacy, and so on. Many mothers can overcome these problems and take pride in nourishing her baby at the breast. However, for others, breastfeeding stirs so many memories that very creative help is needed to help the mother through these stumbling blocks.

LLL Leaders can often assist these mothers successfully, even without knowing about past histories. All through the book there are discussions of the best way to talk with these mothers. As I read, I realized that much of what was suggested are extensions of what we are already encouraged to do. These mothers need to be allowed to remain in control, to be respected and believed when they list their problems and old history (if they share that), and not to be hurried. Since sexual abuse survivors may be very suspicious of authority figures, it becomes even more important for us to offer support and information, and not to give advice or push our own agenda onto them. The authors state very explicitly that the most helpful consultants "are those who are flexible, creative, patient, sensitive to the mother's concerns, and able to see the whole picture."

Even though my specific focus in reading this book was the breastfeeding information, I found it helpful and informative to read the whole book. Many times something in a non-breastfeeding chapter provided helpful tips on what to do or not do. Suggestions about how to discuss sexual abuse with reference to childbirth and breastfeeding while avoiding both an overly sympathetic and an overly intrusive approach were particularly helpful.

I have had the experience of helping a mother for quite some time before she told me her history of abuse. I realize now that I had clues to this history, but I did not know how to interpret them. I can only be glad that I continued to respect her and support her in her efforts, even when she made choices that I might not have made for my family. Although I can think of many things I might have done better to help a mother in this situation, reading this book has definitely made me feel more confident about my basic reactions to such a situation. I hope you will find it equally useful.

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