Dear Sister (AK Press, 2014) goes beyond traditional books on healing that use “experts” to explain the experience of sexual abuse survivors and speaks directly to, and for, other survivors. Author and editor Lisa Factora-Borchers has compiled a multi-generational, multi-ethnic collection of letters and essays that create a moving journey through the hearts and minds of over fifty survivors. The following excerpt from “From Trauma to Strength” shares a lesson in childbearing.
Cradling a strangely endearing plush toy pelvis in her hands, the childbirth instructor had just asked our group, “What do you expect of your labor?” I hadn’t thought as far ahead as labor. This was my first pregnancy and I was keenly sensitive to every minute change occurring in and on my body. I was all consumed with the actual pregnancy. I was exhausted. And mildly nauseous, and a little hungry—yet always having the presence of some indigestion. I had a wintertime heat rash in New York and another weird rash on my eyelids, which my hip co-workers had mistaken for me trying out some retro new-wave trend with pink shadow. Being fashionable wasn’t a pressing issue for me in those harried months; "pregnant” was all I felt and thought about.
While some of the couples in the class had a great deal to say, all I could hear in my head was “I expect to live.” Finally, when my turn came, that is what I said. I expect to live. After a prolonged pause of silence in which I was intensely stared at by a room full of strangers, the instructor asked me to elaborate. I begrudgingly explained that “with all the medical technology and stuff, I expect to live.” My husband has my unconditionally loyal love for even less eloquently grunting out in his turn, “Well, uh, yeah. That.” I was surprised that no one else seemed to be remotely freaked out by labor like I was. The couples all shared shiny-happy feelings of what they were expecting: to have their partners support and coach them through the delivery, to use breathing and meditation techniques instead of pain relievers—to have fabulous and empowering birth experiences.
I didn’t expect to puke. I started puking with the first notable signs of labor—which were simply stronger, more painful contractions than the little ones I had been having for days—and I continued vomiting for hours. My water broke, or “partially broke,” but when and how much I wasn’t sure because I was puking when it happened. I had been told to try and eat before coming in for delivery, so my husband dutifully and excitedly brought home a complete shawarma and falafel mezze from our favorite kosher spot on Coney Island Avenue. I savored it, helping my husband to devour every bit, as the midwives had advised me to “eat like an athlete” since I was preparing myself to go into hard labor. Before the empty wrappings were gathered up I resumed puking. I puked in the car and at the intake and for hours in the delivery room. My midwife, who had been giving me ice and sips of cool water, finally went against the implicit instructions on my birth plan and offered me something for the nausea—but I would have to be hooked up to an IV to get it. Panic vaguely pulsed through my tired and weakened body. Surely I had expected this to be hard, but the vomiting was rendering me nearly incapacitated. I was worried that I wasn’t able to think clearly. The offer for sweet relief had to reweighed against my being on an IV; that would be the first intervention chipping away at my autonomy. My movements would become limited, a snowball effect of interventions could occur in which I would become simply a body without say, made pliable and easy for a medical team to “work on.” I wanted to remain in control of what was put in my body, and I wanted to do the labor myself rather than have it done to me.
Where I had once found comfort in the idea of being saved from the pains and uncertainty of labor with the use of medical technology and a thoroughly trained staff, by the time I went in to delivery I understood that medicine would not magically save me. After the birthing classes, I started to accept that the pregnancy would end and that I would have to do the actual labor process. In a last ditch attempt to opt out of labor, I casually mentioned to my husband that maybe I could just have a C-section. He was shocked by this suggestion and reassured me, “It would be better to just have the baby natural, like everyone else, than to be cut into for no reason.” I hadn’t admitted to him or anyone else that I was completely freaked out by the idea of being in labor; on the surface I didn't even understand that I was unusually frightened. I didn’t know where to begin addressing my anxiety, but finally I realized that I had to stop thinking only about the fascinating phenomenon of “pregnancy” and began voraciously reading everything available to me about labor.
I learned that birth was a process that unfolded, and that, when attempting to control the process through unnecessary medical means, both physical and emotional damage could likely occur to the mother and the child. I heard about making a birth plan ahead of time as I would be, well, distracted during the labor process. Care providers could refer to the plan rather than disturb me or force me to make a decision hastily. So I did that and I wrote in it that I didn’t want to be given any drugs and not to even offer me any, in case I should buckle. Perhaps I would have reconsidered my rigid stance had I known that anti-nausea meds may be needed, but in my self-led crash course on What to Expect in Labor, I hadn’t read about puking.
It wasn’t until I was ready to have my second baby that I had learned from Mama Google how vomiting in labor is thought to have a correlation with sex abuse survivors. For that first birth, I was in the dark about how labor can affect sexual abuse survivors; I wasn’t able to connect my freaked-outness about labor and my personal history. I had not yet gone through any therapy or healing process. But today, a dozen years and a few more babies later, I can tell you what was freaking me out about anticipating labor: I knew there was going to be a lot of pain and that it would be centered around my vagina. I knew that there was a looming date fast approaching, at which time things were going to happen to my body that I felt I had no control over. I was particularly worried about the ambiguous “pushing thing” that was about to happen, and I foresaw it in my mind as a scene with a room full of blue and white coat-wearing people screaming at me to “Push! Push! Push!” How was it that they would know when I should push but that I might not? How could I prevent not pushing wrongfully and receiving the kind of horrid lacerations and tears I had heard some women describe? Understandably, all that could be enough to cause panic in someone who has survived sexual assault or abuse. I wasn’t cognizant that this is what I needed to read about: how sexual abuse can affect a woman in pregnancy, in labor, and post-partum. That was information I could have used.
While I have had six babies over the last fourteen years, I have been given innumerable handouts warning me about the dangers correlated with pregnancy, everything from coffee to cat poop. I’ve been given practical information about how to prepare my perineal tissue, vaginal muscles, and even my nipples. But I have never been given a handout that told me, “If you are a sex abuse survivor, it is likely that your prior experience may affect you during labor.” I remember being given Xerox copies of stuff that really didn’t interest or concern me, and being told, “Oh, you can just pass it on to a pregnant friend.” As obnoxious as I think that is, I also think that maybe some of that stuff was important for me to read, and my midwives were optimistic that I might get to it later. As I am the “one” in one out of four pregnant women who have experienced sexual trauma, I’m disappointed that none of my care providers saw the importance of addressing my demographic.
Of the six midwifery practices that I used during my pregnancies, I know that if not all, at least some of them did query me about my medical, sexual, and psychological history, for their records. When they asked, I lied. Well, thank you, stranger, but no, I am not ready to talk to you about the most painful period of my life, which up to now I have only discussed lightly with a very few of my most trusted friends. But if you have a handout that you could slip into my little welcome package or perhaps some titles in your suggested reading material, I may just go ahead and take care of myself.
Between my first and second baby, I went into therapy seeking some help to heal myself, likely for the sake of my child. During that time, in midwife and medical journals and on message boards, I read first-person survivor narratives about sex abuse and how it can affect laboring. Later on, as a thirty-nine year-old woman having her sixth baby, I still felt out of touch with my body and had difficulties discerning hunger, tiredness, or illness. I realized that looking at detailed medical images of the birth process helped me to understand what was happening in my body during labor much more than the common practice of being told how I would feel. My confidence in myself and the process grew tremendously over time as I increased my own knowledge base about pregnancy and especially about labor. Still, that first labor ended much differently than I ever could have imagined.
I had pulled the IV into the bathroom of the labor room and there I hid away from nurses, my husband, my mother, and anyone else passing through the room during the final portion of my labor. My midwife assured me that some women are more comfortable delivering on the toilet and that she could help me do that. That didn't appeal to me; I just wanted to hide away and not be touched or talked to while my baby slowly made his way down my birth canal. I was massaging my own perineum, as I had read this could be comforting (which I found was true), when I felt something firm and very different. His head! Years later I would learn that this was called “crowning,” but right then I knew—it was time to push.
With a few good pushes (based on my own timing, not the nurse’s or midwife’s) he slipped out of my body, and I immediately thought, “That was great!” Amazingly, I likened it to another puke-inducing activity: “That was like a roller coaster,” I blubbered to no one in particular. “I want to do it again!”
I have survived six fabulous births and two miscarriages.
Excerpted from Dear Sister: Letters from Survivors of Sexual Violence edited by Lisa Factora-Borchers. Available from AK Press February 2014.