Dr Elsa Montgomery is the Head of the Department of Midwifery at King’s College, London. I met her recently and she told me about her research into the experience of childbirth for women who had been sexually abused in childhood.
I was impressed by the way Elsa has used her findings to create an accessible and innovative way to enable silent voices to be heard, and shared widely. When I saw the animation - Elizabeth's story (see below), I felt uncomfortable, just as I had done in the 1970s, when I was first exposed to a scene like this in real time. I remember the horror that I felt as a young woman, seeing another so vulnerable and helpless. I also remember looking round the room and seeing no emotion in my colleagues' faces, just composed stares, intent on the job in hand. I had to try hard to get used to it. Conditioning. Becoming de-sensitised. It is, after all, part of our education.
Or is it?
On the 1st October 2015 Sheena posted a blog entitled ‘Silenced and shamed – speak and reclaim – the journey of a midwife’. In it the author told of how her journey into midwifery triggered memories of her childhood sexual abuse.
Silence was a key theme in my research into the maternity care experiences of women who were sexually abused in childhood and many of my findings were reflected in the experiences the midwife shared. Since I completed my study I have worked on ‘Voicing the Silence’ in order to raise awareness of this hidden issue through the powerful words of the women who spoke to me and who deserve to be heard. This blog explores the experiences of one of those women.
This week has seen the publication of two important reports: the MBRRACE-UK Maternal Report 2015 and the Annual Report of the Chief Medical Officer, 2014 which focuses on women’s health. Both include case studies of women who experienced abuse in childhood. However, despite the magnitude of the problem – approximately 20% of women have experienced some form of childhood sexual abuse – it remains a hidden issue and those affected are frequently silent due to fear, shame and guilt. These women are encountered in the everyday situations of midwifery practice and many of those situations will be reminiscent of their abuse – even if the care they receive is sensitive (Montgomery et al 2015). Lack of disclosure means that their trauma is likely to go unrecognised.
Like nearly a quarter of the women who died between six weeks and one year after pregnancy, Elizabeth (a pseudonym chosen by the woman) experienced significant mental health problems in pregnancy and even made an attempt on her life:
'I just felt overwhelmed with everything and I just thought I would be better off dead, I’d be – this baby would be better off without a mother like me and I would be better off dead.'
None of those caring for Elizabeth in her first pregnancy knew of her history of childhood sexual abuse. Not even the Perinatal Mental Health team to whom she was referred by her GP after she tried to take her life:
'I suppose then people caught glimpses of how bad things were but - I couldn’t, I still really couldn’t tell anybody. I couldn’t, I couldn’t tell anybody about the abuse – and that was really where it all stemmed from'.
Before she became pregnant, Elizabeth had believed that she had left her childhood history in the past, yet, like many other survivors, she discovered that childhood sexual abuse casts a long shadow (Children’s Commissioner 2015).
CLICK ON THIS link to read more about the animation below created by a film production company, JMotion, as a result of a Collaborative Innovation Award from King’s Cultural Institute. It is hard-hitting and portrays Elizabeth’s experience in labour with her first child. She had been so bemused by the number of people in the room that she had asked her husband: ‘Are they selling tickets outside?’
This scene is played out in maternity units across the country every day. The word cloud below was created from the evaluations of the first group of students to see the animation.
They found it disturbing because it is so familiar to those who work in high risk maternity settings and they feared they may have been ‘colluders’ in trauma for women. Elizabeth’s experience is an indictment of what can happen in our maternity care system – especially when control is taken from women and they are not heard. Elizabeth’s story has happy ending even though the journey was a difficult one. Like some of the women mentioned in the midwife’s blog, Elizabeth planned a home birth for her second baby. Although that did not work out, the midwife listened and she had the birth she hoped for. Looking back over her experiences, she was able to say:
And that made me feel so much better about myself, um – that my body could be actually used for some good and, and could make this beautiful baby ….
Although continuity of care is likely to make disclosure of sensitive issues easier for women, Elizabeth’s experience shows that it isn’t essential. Dignity, respect and compassion can and should be available to all women.
Children’s Commissioner (2015) Protecting Children from Harm: a critical assessment of child sexual abuse in the family network in England and priorities for action. London:
Davies SC (2015) Annual Report of the Chief Medical Officer, 2104, The health of the 51%: women. London: Department of Health.
Knight M, Tuffnell D, Kenyon S, Shakespeare J, Gray R, Kurinczuk JJ (Eds.) (2015) on behalf of MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Surveillance of maternal deaths in the UK 2011-13 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-13. Oxford: National Perinatal Epidemiology Unit, University of Oxford.
Montgomery, E., Pope, C., Rogers, J. (2015) The re-enactment of childhood sexual abuse in maternity care. BMC Pregnancy and Childbirth 15:194
Further papers from my study:
Montgomery, E., Pope, C., Rogers, J. (2015) A feminist narrative study of the maternity care experiences of women who were sexually abused in childhood. Midwifery, Vol. 31, No. 1 pp 54-60
Montgomery, E. (2013) Feeling safe: a metasynthesis of the maternity care needs of women who were sexually abused in childhood. Birth, Vol. 40, No. 2 pp 88-95
Thank you so much Elsa for sharing your important research in such an accessible and innovative way, to maximise the potential for health care workers to understand the importance of dignity, kindness and respect.
THERE ARE NO EXCUSES
Elsa can be contacted via Email: firstname.lastname@example.org Twitter @elsamwm