The Time To Ask About Past Abuse or Assault is Never

Apr 6, 2016 by

TheOne of the most upsetting questions I have read on a doula’s personal history form is some version of this: “Have you ever experienced sexual abuse or assault, either as a child or as an adult?” While I realize the doula is trying to be helpful, the attempt is misguided at best, and can actually create problems and stresses for the client that negatively affect the doula-client relationship. What the doula really wants to know is whether there are ways to help the client more effectively, even if what the client wants may seem odd or unusual. There are better ways to obtain that information that don’t create more problems.

Asking the question automatically puts your client in a bind. They have to choose whether to be honest with you before they are ready to do so, or whether to lie. The issue with most survivors of abuse or assault is that the perpetrator took away their power of choice. Their body was not their own, it was the property of the perpetrator. The victim’s only choice was to submit or possibly face worse harm if they resisted. Part of offering healing is for us to allow self-disclosure if it is desired, and when the client initiates it. When we ask the question, it is to meet our own needs even though it is in the guise of good intentions. If our client does not wish to discuss these acts or even for us to know, their only other option is to lie. This dilemma is distressing for our client, which is not the doula’s intention. So don’t ask.

The truth is, what you really want to know is how you can help them more through their birth or postpartum journey. There are ways to get at that information without knowing exactly why. In fact, knowing details about the story is not necessary to offering effective support. Here’s what you really want to know, and I suggest you say something like this on your last prenatal visit (after establishing rapport):

Sometimes people have had life experiences that left them traumatized and that they had to recover from. Sometimes that involves assault or abuse, or even being in a car accident. There may be things that other people do or say that lead you to being instantly scared or startled or remind you of that original traumatizing experience. I just want you to know that I can help you best when I can help myself and others to avoid those behaviors, and what to do if they happen.

You can also offer examples:

  • Sometimes a person is easily startled and doesn’t want to be touched from behind without being asked first and waiting for a response.
  • Another person didn’t want to be in the bathroom alone with the door closed. The door had to be open or someone needed to be with them.
  • Another didn’t want people talking about her as if she wasn’t there. She insisted that they use her name and not call her ‘dear’ or ‘honey’ or ‘mom’.
  • Another was concerned that breastfeeding would bring up negative associations with a past experience involving their breasts. This person needed assistance in being anchored in the present whenever the baby nursed in those first few weeks.
  • Others don’t care for particular words, such as being told to ‘relax’.  

This is the kind of information we really want to know as birth and postpartum doulas. How those needs came to be is not important. We don’t need to know the story in order to be effective.  

At this point your client may choose to tell you the story. But I think it’s important to repeat that you don’t need to know their story to help them. Disclosure should serve a purpose and you want to make sure they don’t feel uncomfortable later if they tell you now. It could be a good time to get a glass of water or use the restroom to make sure their choice to disclose is one they’ve taken a few moments to consider. It is also okay for the doula to not want to know the story! Doulaing is a relationship and you get to take care of yourself too. Perhaps hearing their abuse or assault story would be triggering or upsetting for you, so its okay to ask that they keep their disclosure general rather than including emotional details.

My second point is that childhood sexual abuse is estimated to affect one out of every four women[1] in the United States, and one out of six men[2]. Sexual assault and rape are also common experiences[3], directly affecting at least twenty percent of the population. So, we’re probably better off as doulas if we assume an assault or abuse history rather than seeing it as exceptional. That doesn’t mean that every person who has been assaulted or abused will be affected by it during labor or their postpartum. In fact, some people are relieved to find that it didn’t have a negative effect in that part of their life.

In my experience there are two behaviors that new doulas are most likely to see and that they can effectively address. The first is disassociation – for some reason, the person in labor or postpartum doesn’t seem to be present anymore. They are not in their body, their present moment consciousness is somewhere else. The person may seem distant and unfocused, or may even be looking out the window or down and to the left (recalling a memory). The empathetic neurons in the doula’s gut are giving the message that the client isn’t with you anymore in the room, they’ve drifted somewhere else.

The other worrisome situation is when the laboring or postpartum person’s behavior seems to be totally out of proportion to what precipitated it. In other words, the way they are acting seems to be more dramatic or over the top and is disconnected from what they are responding to. This overreacting may mean they were reminded of something awful that happened in the past. They are responding to that experience rather that what is currently going on.

In both instances, the most effective actions by the doula are the same. Bring them back to the present moment, to being in the room with you, gently and without exerting your power or voice over theirs. This is usually more effective when the doula is quietly and gently persistent, rather than using a loud voice or giving orders.

  • Use your client’s name, use today’s date – or better yet, ask them what day and year it is.
  • Have them look at you, have your client tell you what is happening today, and where they are.
  • Have them notice objects in the room, prompting them with positive ones (flowers, baby book, etc).
  • If invited, touch them in a preferred way (you’ll know them) in a safe place on their body (this will differ). If you aren’t sure, ask. “May I put my hand on your knee, arm, hand?”
  • Rather than ordering them to do something, invite them. Let the client choose – this is very important. “If you can, let yourself come back to TODAY fully.” “When you are ready, let yourself explore feeling safe here in the room with us, letting your body to birth/breastfeed/nurture your baby.”
  • When it seems that your client is mostly back in the present moment, ask something like, “How can I help you to feel more safe right now? Even if it seems silly, please say it. Your brain sometimes has wisdom that doesn’t make sense at first.”
  • Follow through as best you can, with the extra blanket or the pink flowers from the gift shop or finding the right song on the playlist.

These can seem to be scary situations for newer doulas, but we can use the same skills with our friends and family members who have experienced trauma and are triggered in our presence. Sometimes they aren’t even aware that it happened, and our feedback is what helps them to notice that they aren’t in the present moment anymore. To me, because of the commonality of experience of personal violation, these are life skills we all need to see one another through the journey. It’s not about complicated strategies. It’s about being a safe and trustworthy person and allowing the laboring or postpartum person to have their own experience in a supportive atmosphere.

Some doulas have extensive counseling skills, degrees, or training. They have additional strategies to use than what I’ve mentioned here. The book, When Survivors Give Birth by Phyllis Klaus and Penny Simkin, is an excellent resource. There are also facilitators offering two and three day comprehensive workshops for birth professionals wanting to focus on this issue in their practices.

[1] http://www.oneinfourusa.org/statistics.php

[2] https://1in6.org/the-1-in-6-statistic/

[3] http://centerforfamilyjustice.org/community-education/statistics/

8 Comments

  1. I’ve been really wondering if I should keep that question on my forms. Thank you for adding more information and thought to my search.

  2. Thank you for this thoughtful article. I’ve been considering whether or not to put a question about past abuse on my intake form for my doula clients and after reading this I have a much clearer sense of why that would not be helpful and may in fact cause unintended harm.

    I am also a sex educator and one statement that struck me in your recommendations as possibly harmful is asking the question “May I put my hand on your knee, arm, hand?”. If you are familiar with the work of Betty Martin’s consent language, saying may I put my hands on you implies that the touch is for the person doing the touching, rather than for the client. A better way to say this to the client would be “would you like a hand on your knee, arm, hand?” or “would you like some touch?” This empowers the client to decide for themselves if they want to be touched and is a way to help shift the cultural patterning around enduring unwanted touch.

    • Amy Gilliland

      What a great suggestion for modifying the question. I’m so glad that you wrote about it – that’s so incredibly helpful. Thank you!

  3. Having just written a paper about midwifery services for women who have survived sexual assault, I’m inclined to disagree with this post. I definitely see your point that a doula doesn’t need to know about why a woman may need particular support, but rather just wants to know what support to give and how. But for many women, the childbearing continuum can provide an opportunity for growth and healing from abuse, and during antenatal care may be the first time a healthcare professional has given them the opportunity to disclose. The research I read suggested that survivors are generally supportive of screening programmes (in a safe, confidential environment with suitably trained professionals). Many women expressed relief and gratitude at the opportunity to disclose, and said they had never been asked before. And of course they do have the choice about whether disclosure feels appropriate or too challenging for them.

    Without identifying women who need additional support, they can’t be referred to specialist agencies. In general, midwives were identified as the best healthcare professional to ask about abuse, as they are more likely than others to have a long-term relationship with women, and I would expect a doula to have an even more continuous and trusting relationship. I suppose the difference is in working outside of the healthcare model, so perhaps the opportunities for referral are not the same?

    I also discovered that most birth workers do not recognise dissociation as a valid coping mechanism, that some women can consciously use in times of stress. The automatic response from most professionals is to try to bring women ‘back into the room’, but they aren’t necessarily doing this with any knowledge of potential benefit, rather it just feels like something we ‘should’ do.

    Thanks for the thoughtful post though, it gave me lots to think about!

    • Amy Gilliland

      Hi Maeve – I don’t disagree with what you’ve written, but I would want to make sure that it is understood that doulas are not healthcare professionals. Also, damage can be done when the question is asked cavalierly and without sufficient counseling background and skills to listen to the answer. That responsibility is outside of the doula’s role, UNLESS the doula has additional skills and training in this area, and adequate support in case the doula becomes triggered or upset about the client’s answers.
      In answer to your question, yes, the opportunities for referral are not the same as many doulas work independently, outside healthcare systems.

  4. thank you for an informative post on Doulas support. according to me doulas are most inspiring persons

  5. Not sure about bringing labouring women out of their inner selves, sometimes it is better for them to stay there, as a coping mechanism. With my first child I was forced to lie down on a bed with a ctg in progress and a drip to augment my labour. I curled up into a fetal ball and left the room. I had no pain relief. The very last thing that I needed was someone pulling me back into the room to face that horrid labour. OK so yes I had been sexually abused as a child but that had no place in what was happening to me then. It was a coping mechanism and it worked. 4 hours of not being there later I pushed my beautiful baby out and all was well. Do not think that all abused women carry their abuse around with them, that would really make us victims. http://www.painfreelabour.blogspot.co.uk

    • Amy Gilliland

      Ann, what an excellent point that we need to respond to our client’s needs and do what is best to support them. Knowing who they are and supporting them as individuals is always best – and I’m glad your needs were met by your birth team.

Let me know what you're thinking

%d bloggers like this: