4 Myths Destructive to Pregnant Survivors of Abuse

For many years, through my work with A Safe Passage, I’ve been training care providers (doulas, midwives, physicians, social workers) to create safer spaces to elicit and respond to disclosures of abuse. Over that period of time, I’ve come across many myths in the minds of participants. Myths about who experiences abuse, who perpetrates abuse, how people respond to being victimized; myths about the causes of abuse, the impacts of abuse, the role of care providers in responding to disclosures of abuse; and on and on…

These myths are powerful. They perpetuate dominant ideas about abuse and how the person being victimized ought to respond. They become particularly powerful when combined with cultural notions of what it means to be a “good” pregnant person. These myths permeate our culture, and inform how we, as care providers, work with pregnant people in general, but are uniquely destructive to pregnant survivors of abuse.

4 myths I would like to challenge:

Myth #1: Not my clients

Reality: If you’re working with pregnant people, you’re working with survivors

Breaking through the myth that survivors of abuse are “not my clients” has been a pervasive and ongoing conversation I’ve had with members of various birth communities. This myth extends from many prevailing stereotypes, among them who experiences abuse, how people who experience abuse would appear/present, what kinds of service providers a pregnant person being abused would (or would not) access, and who perpetrates violence. In reality, pregnant people from all walks of life are abused, even murdered, by their partners at an alarming rate, during a period of time when they are more likely than at any other point in their life to be in routine contact with a care provider.

Furthermore, 1 in 3 women globally “will experience physical and/or sexual violence by a partner or sexual violence by a non-partner in their lifetime.” This means that even when a pregnant woman is in a non-abusive relationship at the time she comes to you for care, she may have already experienced violence in her life in a way that affects her experience of both her pregnancy and the care you provide.

This prevalence of violence is no less significant than the rate of caesarean interventions (1 in 3 births), yet you’d never know it from the disproportionate amount of time care-providers spend discussing ways to lower the rate of unnecessary medical interventions, compared to how little time is spent exploring ways to address and respond to any abuse a client may be experiencing during their pregnancy, or the impact of any abuse they may have suffered prior to it.

Myth #2: It is not in my scope of practice to elicit or respond to disclosures of abuse

Reality: Given the prevalence of violence in the lives of pregnant people, it is every care provider’s responsibility to be trauma informed in their approach.

While not all care providers are expected or equipped to systematically screen for violence in the lives of their clients or elicit disclosures of abuse, we can all become trauma informed so that we can all know how to respond effectively. Trauma informed care is a framework underpinned by theories of social justice and harm reduction, and is a strengths-based approach to the whole person. Such an approach is deeply rooted in understanding how trauma impacts, shapes, and distorts people’s experiences of themselves and the world around them. The focus is on the physical, psychological, spiritual, and emotional safety of survivors and care providers, as they work together to re-establish the survivor’s sense of predictability, control, and self-efficacy.

Myth #3: People who smoke tobacco, drink alcohol or use illicit drugs while pregnant are selfish and uncaring

Myth #3Reality: For survivors, these habits are coping strategies for managing very complex triggers associated with abuse

Research has confirmed that drinking alcohol and using illicit drugs in pregnancy is almost always a coping strategy that existed prior to conception and is extending into pregnancy. Substance use in pregnancy is highly correlated with physical abuse, sexual violence, low social support, adverse childhood experiences (ACEs), active and ongoing mental health issues, and partners’ efforts to sabotage pregnant people’s efforts not to use these substances during pregnancy. For survivors of abuse, becoming pregnant can be a powerful trigger, escalating alcohol consumption. Rather than framing pregnant peoples’ substance use as merely selfish and uncaring, it is more appropriate to understand it as a strategy to self-manage trauma. This is often within relationships where their efforts are undermined, and in a context where accessing services could bring about a host of (re)traumatizing events, e.g. involvement of child protection, police services. Fear of being shamed or threatened by “professionals” remains a significant barrier to accessing routine health care in pregnancy. It’s also responsible for a survivor’s tendency not to disclose substance use to their health care provider.

We all play an important role in establishing safer spaces, safer services, and safer communities for pregnant people to open up about these deeply stigmatized behaviours. It begins with valuing the inherent worth of the person who is pregnant, valuing their health and humanity, and advocating across sectors regarding the role that substance use plays in the lives of pregnant survivors. It is also impossible to adequately address substance use in pregnancy without recognizing that pregnant people who are racialized and living in poverty are targeted for their substance use at rates far greater than white people, while drug treatment and health care is grievously inadequate.

Myth #4: If they just knew better, they’d do better

Reality: Information alone is not enough.

In the course of my career, this is perhaps one of the most damaging myths I’ve seen perpetuated by care providers. The over-reliance on “information,” the belief that the only obstacle to people making “better” choices for themselves and their families is a lack of information, shapes how we organize our time with clients, how we provide information to them, and why we provide the type of information we do (e.g. the seduction of induction). We live in an information paradigm, wherein we strongly embrace the idea that if people just knew better, via the best available evidence, they would do better.

While knowledge is power, as the saying goes, knowledge about options is often not what (or not only what) the person, family or community needs in order to access the resources necessary to support healthier outcomes. Providing evidence-informed options is important, but so too is the removal of social, economic, and cultural constraints that afford some people the opportunity to access appropriate resources in a timely manner, while others are excluded, judged, villainized, or even criminalized when asking for help. Pregnant survivors of abuse are bombarded with messages about how they could be doing pregnancy better to optimize fetal outcomes, and yet what are we doing to create environments that are truly non-judgmental, safe, and supportive for persons who are pregnant?

There is, of course, much more to be said about each of these myths, and other myths to challenge as well. I’ll be covering more myths in other blog posts and in much more detail in my upcoming book. In the meantime, let’s each do our part to dispel the myths destructive to pregnant survivors of abuse.
jodi

 

 


Selected References

Coles, J. & Anderson, A. (2015). Breastfeeding duration after childhood sexual abuse: An Australian cohort study. Journal of Human Lactation, 1-8.

Copper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homeless service settings. The Open Health Services and Policy Journal, 3, 80-100

Fonti, S., Davis, D., Ferguson, S. (2016). The attitudes of healthcare professionals towards women using illicit substances in pregnancy: A cross-sectional study. Women and Birth. Retrieved from: http://www.womenandbirth.org/article/S1871-5192%2816%2900004-4/fulltext

Frankenberger D, Clements-Nolle K, Yang W. (2015). The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Women’s Health Issues, 25(6), 688-695.

Good Mojab, C. (2015). Pandora’s Box Is Already Open: Answering the Ongoing Call to Dismantle Institutional Oppression in the Field of Breastfeeding Journal of Human Lactation, 1-3. doi:10.1177/0890334414554261

Obedin-Maliver, J. & Makadon, H.J. (2015). Transgender men and pregnancy. Obstretric Medicine, 1-5.

WHO, Intimate Partner Violence During Pregnancy, Retrieved from: http://www.who.int/reproductivehealth/publications/violence/rhr_11_35/en/

Prentice, J., Lu, M., Lange, L., & Halfon, N. (2002). The association between reported childhood sexual abuse and breastfeeding initiation. Journal of Human Lactation, 18(3), 219-226. doi:10.1177/08903344020180030

van Boekel LC, Brouwers EP, van Weeghel J, Garretsen HF.(2013). Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: Systematic review. Drug Alcohol Dependency, 131(1–2), 23–35.

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