How she got through it.

She got through it by fighting.
By screaming she needed to “get the fuck outta here”.
By begging for it all to stop.
She got through it by hissing at those of us trying to help with her eyes wide and wild.
By shoving our hands and our attempted words of comfort away.

By spitting at us.

She got through it by purposely swinging her head around and vomiting all over the front of my shirt.
By screaming that she needed to go for a cigarette.
By relaxing a little only when she was finally, mercifully given an epidural.
Fentanyl infused to help with the violence of laboring.

Labouring withdrawal.

She got through it by screaming her baby out of her vagina.
By turning her head away from her newborn when he was out.
She got through it by finally ripping out frantically tubes and IVs.
By leaving the hospital against medical advice.

She got through it the only way she could.

 © Sarah Chantler Baughman, doula, 2015

Violence is pervasive across the lifespan of women, a global epidemic in fact, with pregnancy being a particularly high risk time for the impacts of historical and/or current & ongoing abuse to manifest.  However, the collective response of the *birthing community has been to remain silent, claiming for the most part, that this topic resides outside of the doula’s scope of practice.

We share the most intimate spaces with women, fostering relationships wherein families’ darkest fears are articulated, and vulnerabilities often exposed with the hope we can assist them to steer clear of birth-related landmines.

And yet, violence and the enduring impacts of trauma in the lives of childbearing women (including perinatal mental health) remains tangential to most major doula training curricula.  This, even though the health related impacts of abuse on pregnant women are well documented, and more common than other preventable health concerns screened routinely for during prenatal care (i.e. gestational diabetes). Globally, violence in the lives of women is more common than any other health issue, and is on par with caesarean birth (1 in 3), but you’d never know it for the time and energy that is spent discussing ways to intervene, and lower the rates of unnecessary medical intervention compared to responding to violence during the childbearing year.

Pregnant women are murdered by their partners at an alarming rate, during a timespan when health care providers are likely involved in their prenatal care. But what are we spending our precious prenatal time with clients talking about? Does the amount of time we allocate to the topic of abuse match the magnitude of the issue?

The impacts of violence on childbearing women, its prevalence, adverse health consequences and intervention possibilities, raises critical questions about the absence of adequate training for birth workers on violence in the lives of childbearing women as part of mainstream doula training curriculum.

The impact of abuse on the transition to mothering is not an “optional”, “special”, or “continuing education” topic.

This gap in training is a gross injustice –  for missing from our knowledge base are not only the impacts of abuse on the lives of women and their children, but a deep and genuine understanding of how women survivors of abuse negotiate the transition to mothering against the odds, and the wide range of “normal” responses to the fantastically unimaginable situations of pain, betrayal and terror our clients have endured.

When this knowledge base is absent we are unable to locate “problematic” behaviour appropriately (as surviving), choices we so judge (if only among our closest colleagues) are not seen within the wider context of women’s lives, and only the options we support as “legitimate” get our full endorsement (yes, our “supporting clients’ choices no matter what as long as they are “informed”” mantra we cling to so dearly is wearing thin these days in many birthing communities). We lose sight of the tremendous resiliency women survivors of abuse demonstrate in the transition to mothering as they navigate the intersections of personal and systemic violence.

Further, when this foundational training on the impact of trauma on the transition to mothering is missing, we aren’t adequately prepared to keep ourselves emotionally and physically safe. Vicarious trauma, also known as compassion fatigue, runs rampant in the birthing community. It’s willful ignorance on behalf of training organizations, which like it or not fosters birth workers to assume positions of authority in the lives of women, yet doesn’t adequately prepare birth workers to screen and respond to violence, to watch for signs of escalation, to remove oneself from potential harm from a client and/or family member, and to develop and enact personal safety plans.

I’ve provided safe space more than once for doulas who have been assaulted by clients at births – who’ve had their hair pulled, been bitten and spit on, name-called.

As a result of the silence, for the most part we are woefully unprepared to extend our understanding of what it means to fully hold authentic spaces for all pregnant, birthing and postpartum women.

We stumble our way through responding to disclosures of abuse.

We turn a blind eye to dynamics between partners that make our stomach knot.

We sit with an elephant in the postpartum room around birth related triggers we witnessed.

We pathologize women’s responses to their birth experiences.

We come to embody this trauma that goes unspoken.

We unknowingly put women at risk.

We collude with the silence.

We burn out.

‘Cuz, it’s not our scope.

*I recognize there is not one homogeneous birth community, and independent doula organizations and birth workers have dedicated tremendous energy and resources to acquiring skills necessary to respond to abuse during the transition to mothering. I am grateful for the support of my colleagues who share space with me, and who inspire me to keep learning and growing. I am especially thankful to Sarah Chantler Baughman who offered me a space to listen and bare witness so openly, to her birth worker journey.

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