In this powerful and personal article Dr Kathryn Gutteridge, Independent Consultant Midwife, explains the importance of addressing the impacts of Child Sexual abuse in maternity care. She points to a forthcoming book to help practitioners.
Trigger Warning: this article contains information that may be cause distress.
I have worked for many years in raising awareness around a common problem in society, not just in our westernised culture which exists globally. This is more common that any other medical problem in maternity and it may shock you to know it is even more common than diabetes, hypertension and other everyday pregnancy issues. It is Child Sexual Abuse and world organisations estimate that 1 in 4 women have a history of unwanted sexual attention and abuse and it may be more than this as disclosure rates are difficult to access.
I first wrote about this subject in 2001. I had just completed my Master of Science in Counselling and Psychotherapy and had interwoven maternity and pregnancy care throughout my models of in-depth counselling. The article was called ‘Failing women – The impact of sexual abuse on childbirth (2001). The article was read by many midwives and I soon started to receive messages from those midwives who themselves were survivors of sexual abuse. The way I wrote this article was different from much of the routine publications in maternity as I structured it around me. It was my journey of being a survivor of incest and child sexual abuse, it was my observation of what I felt during my own pregnancy and birth and it was my reflections of becoming a mother and all the frailties that I had. I set up a virtual support and education platform called SANCTUM Midwives and this is still important today.
Professor Mavis Kirkham read the article and got in touch with me and invited me to present my work at an event she was hosting. Of course, I was pleased but I would be declaring my past, my journey and baring my soul to the world, how would that feel? Well, I did it and the rest is history as they say. I have presented my work around the UK, in universities and Royal Colleges. I have worked with organisations like NICE, Royal College of Medicine, NSPPC, NHS Scotland and many more. I have especially enjoyed working with CISTer’S, a charitable organisation that supports women who have been affected by this issue and still maintain a close relationship with Gillian Finch, the founder. I am also pleased to be working with Professor Elsa Montgomery who achieved her PhD investigating the experiences of survivors of child sexual abuse. Elsa has produced positive interest in her work and has closely respected the experiences of survivors by involving them at all times and has produced tools that are available on the The Survivors Trust website.
Still, midwifery and obstetrics are virtually blind to the commonality of survivors of sexual abuse in their education programme, their clinical practice and especially in the conversations and discussions they have with women. I believe this is amoral, it is harmful and, as a service to women, will potentially retraumatise women survivors.
Just for context I think it would be useful to look at material that I collated to compare frequency and commonality of CSA and that of other known risk factors during pregnancy and childbirth. Evidence suggests 1:3 women are survivors of unwanted sexual attention, 1:4 have experienced unwanted penetrative sexual contact. Therefore, in the childbearing population, we can assume from evidence it is likely to be 1:3-4 of all pregnancies. However, when we look at other risk factors we screen and provide education for maternity clinicians, it is stark by comparison.
- GDM = 3.5% of all pregnancies
- Mild PET = 6% of all pregnancies
- CS = 22-25% of all pregnancies
- Puerperal psychosis =1-2 per 1000
Therefore, the work of Elsa and others who have committed to educate and provide support for this deficit is vitally important. I can also tell you that, although I am no longer working clinically, I still provide support and guidance to midwives, obstetricians and women who contact me for help.
I am really pleased to tell you that my work and personal story around child sexual abuse and maternity care is reaching a new zenith. Although I have published my work and continued interest in maternity care for survivors of child sexual abuse, I have always believed that a book about my experiences and what I have learnt might be of use to women, their families and services alike. So, when I retired from clinical practice and during the pandemic I started to write. I say write but I had kept so much material over the years that I started to sort out what I could use for this project. I had the go ahead and a contract from Pinter and Martin Publishers, which was great news.
Like many survivors there is a cost to disclosure, the vulnerability and flashbacks of my past were a constant presence to my wellbeing. Some days were impossible for writing and I had to accept that I might not be able to complete this work in the timescale I had anticipated. In the midst of this was my ever present grief at having lost my sister, who was also a survivor of incest, and my only child, who died 10 years ago at the age of 33 years. There is no doubt that my sister died as a result of her abuse but that will be a story for the future; I will commit to honouring her life and story in time.
I know that this subject matter causes clinicians to feel unnerved and vulnerable and for many of them it will evoke their own experiences and memories that have been buried. However, as professional organisations, we must be better educated. The recent Birth Trauma Inquiry, led by MP Theo Clarke and Rosie Duffield, showed that maternity services were ill equipped and dismissive of women’s and their families’ emotional wellbeing and psychological health; something I have been saying for more than 35 years. It has taken the experiences of two brave women in our parliament to recount the bleakness of what exists in our maternity services. Of course, there are individuals who work tirelessly to give continuous personalised care and there are many midwives especially who are up against the system and still they care about how women feel. I do not know how many women with birth trauma have had unwanted sexual experiences in their past but research tells me that they are many.
My final thoughts to you are these: If you do not know how you feel about caring for women who are survivors have a think about what you might feel like if you were so scared of being touched you would rather endure the birth alone in your bedroom; if you had palpitations every time you saw the news and yet another scare of small children being abused made your heart pound out of your chest because that could be you; and finally, if you had the good fortune to know that the woman you have just met disclosed her past abuse to you and she had trusted you enough to speak about it, how would you respond.
We are brave women, we survivors, we are living our lives the best way we can. We want you to care for us and not leave us with more emotional pain to process. My book is due for publication this year through Pinter and Martin Publishers.
References
APPG on Birth Trauma (2024) ‘Listen to Mums: Ending the Postcode Lottery on Perinatal Care. A report by The All-Party Parliamentary Group on Birth Trauma
https://www.theo-clarke.org.uk/sites/www.theo-clarke.org.uk/files/2024-05/Birth%20Trauma%20Inquiry%20Report%20for%20Publication_May13_2024.pdf
Gutteridge, K E A (2001) Failing women: the impact of child sexual abuse on childbirth. British Journal of Midwifery, (9) 5, 311-315.
https://www.researchgate.net/publication/261157836_Failing_Women
June 2024