Jennifer Byrnes, LPC, PMH-C: The Impact of Sexual Assault and Abuse on Pregnancy and Postpartum

Transcript

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Hello, today I have with me Jennifer Burns, lpc, pmhc and EMDR certified therapist.

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Jennifer is a therapist specializing in perinatal mental health and trauma.

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She is the mother of two boys and she is here today to talk about the impact of sexual abuse and assault on pregnancy and postpartum experiences.

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Jennifer, welcome and thank you for joining me, hi.

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Kelly, thank you so much.

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I really appreciate you bringing me back on the show to talk about something that's really important and unfortunately affects way too many people out there.

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So, as part of this, I just kind of want to put out there a little bit of a trigger warning that this podcast does contain detailed information about sexual abuse and assault, and so to please listen with care and to let people know that if you or someone you know has been sexually assaulted or abused, there'll be resources provided at the end of the podcast and in the show notes.

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You're not alone and there is help available.

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So, like Kelly said, I am an LPC, I specialize in perinatal health and I'm EMDR certified, and even though I currently work in the field of perinatal mental health, my education and experience previously was actually in the field of forensic psychology.

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So I have done a lot of work on both sides of sexual abuse and assault, so with perpetrators and also with those who have been victimized.

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So I think this is a topic that is incredibly important and, again, unfortunately, way too prevalent.

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I want to mention that this is an overview of a really complicated issue and there's many pieces of this that we likely won't be able to cover just today, but hopefully this discussion can provide some validation, information and encouragement for those women for whom pregnancy after sexual assault is a reality.

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For the purposes of this podcast, I'm going to talk about voluntary pregnancy for individuals who've had a sexual assault or abuse history and have conceived with a partner who has not been sexually abusive toward them.

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Realize that's a mouthful.

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I won't be discussing pregnancy as a result of a sexual assault or pregnancy in the context of ongoing sexually abusive relationship.

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So that's a really important topic, but it does warrant its own discussion because there's additional physical and psychological complications.

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There is certainly some overlap, but I just want to be very clear that you know this is specific to a voluntary pregnancy in the context of a non-abusive relationship and I'm going to do my best to kind of give you sort of the framework in which I'm going to be talking about this.

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So to outline what we're talking about when we say sexual assault, for the purposes of this discussion it's going to refer to any instance of non-consensual touching over, under clothing, any digital penetration, sexual intercourse, including oral, vaginal or anal sex.

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This includes instances of sexual assault or abuse when a person is unable to fully and enthusiastically consent to, voluntary or involuntary, drug or alcohol intoxication, intellectual or physical disability, age, coercion or power differential.

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This also includes instances of sexual abuse and assault where initial consent was given but then revoked, verbally or non-verbally, and the sexual behavior continued following this revocation of consent.

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It's super important to affirm that sexual assault can be perpetrated within the context of romantic relationships, as this has historically been overlooked or dismissed.

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So those, those matter as well.

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So, as you can see, consent is a complicated, wide-ranging concept, and if I didn't cover a specific scenario, it doesn't mean it doesn't count.

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It really comes down to how someone perceives a sexual interaction as violating or traumatic.

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So I realized that was a huge amount of information that I just gave, but I want to just be very clear and as inclusive as as I possibly can be, because one person's experience may seem like not such a big deal to somebody else, but it's a very big deal to that person, and so the implications of what happens as a result of that, you know.

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That also matters and can be considerable.

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Now statistics according to the CDC, one in four women will be sexually assaulted in their lifetime, and this means that a staggeringly high number of women who become pregnant are also carrying this experience through what we really hope would be a happy and exciting time for them.

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So it's just this kind of cloud that's potentially, you know, overshadowing something that you know they were hopefully looking forward to.

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So what we know about trauma itself is that it's stored within the body and that, given, pregnancy, along with labor and delivery, breastfeeding, et cetera, are among the most physically intense experiences a person can have.

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It stands to reason that it could potentially trigger a myriad of physical and emotional trauma responses.

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So, even if an assault occurred decades in the past, these things can still be brought to the forefront when someone becomes pregnant, and it often really catches people off guard, because that is just not the framework through which they're often viewing this new experience, particularly if it's one that they were really looking forward to and really hopeful about.

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They can just be sort of gobsmacked by all of the unanticipated responses and sensations that they're having.

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It can trigger long suppressed feelings and body sensations around one's body changes, and it's interesting that this impact can begin even prior to conception, even when individuals are making decisions about one whether or not to have children at all.

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That can for sure be an impact.

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But also, how do you even undertake that process.

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There are times when individuals choose to forego traditional means of conception, aka sexual intercourse with a partner and lieu of medical interventions like IUI and IVF, because the act of sex, even with the express purpose of conceiving a baby, is just too overwhelming and physically and emotionally triggering.

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Another byproduct of this is that survivors may be more likely to seek only minimal prenatal care or forego prenatal treatment altogether, which can have very detrimental effects on mother and child, which unfortunately can significantly increase infant morbidity.

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So even before conception, there's already some problematic consequences to coming into this with that history.

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For individuals to become pregnant, or even just through the IUI and IVF process, your body is on full display and it's frequently touched internally and externally, which can absolutely bring up previous memories of abuse.

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Anyone who's ever experienced a transvaginal ultrasound can attest to how invasive that process can be, which can be complicated by the often very happy and excited feelings that come with senior baby for the first time.

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There's a lot of different emotions juxtaposed against one another through this process and that is just one of them.

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So even the gynecological chair exam table in general creates a sense of vulnerability and exposure for individuals, regardless of sexual abuse or assault history.

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I mean you're laying there, often at least partially uncovered, and your legs are often open.

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That's a very vulnerable position to be in.

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So for some people that can be very overwhelming and intolerable.

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So for people in general, that's very vulnerable, and this is really compounded for those individuals that have this assault history as well.

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The changes to your body, including significant breast changes in development, changes happening in your pelvic area, a lot of discomfort right Baby kicking you in the cervix all kinds of stuff like that continue to increase feelings of vulnerability and exposure.

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And just the idea of growing something in your body, regardless of how much a child might be wanted, it can create feelings of alienation and distress.

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I think most people who have grown a baby internally have had a moment of feeling like there's an alien growing inside of them, and so to have that experience, but compounded by feeling like this sort of internal violation, that can be very unsettling and distressing as well.

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It can bring up feelings of loss of control over your body.

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We know that people who've been assaulted or abused there's a very big lack of control there, and so to be put in a position where you're incredibly vulnerable again, where all of these things are happening to your body that you have no control over.

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You don't know how they're going to necessarily impact your play out.

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That is also incredibly overwhelming and distressing for a lot of people.

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It may make people feel really dirty and bring up a lot of feelings of shame, so again really complicating and contaminating a period of time during which women want to feel joyful and excited most of the time.

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One of the things I would have mentioned is that it's been noted that survivors of childhood sexual abuse also report more physical ailments, specifically gynecological issues.

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Some of the things that come up include things like chronic pelvic pain, dyspharonia, which is pain in the pelvis before, during or after intercourse.

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Vaginismus, which is the involuntary contraction of muscles around the opening of the vagina.

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Non-specific vaginitis, which is inflammation of the vagina that can result in discharge, itching and pain, and so those are the gynecological things that can sometimes come up, but there's also increased reports of things like digestive problems, fibromyalgia and sleep disorders.

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This is a non-exhaustive list, but there's some of the more common physical complaints and Kelly, I'm sure, can speak in better detail to some of these other things that I mentioned before.

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You know.

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Interestingly, though, a lot of times we don't hear about that.

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So patients may not disclose and, like you said, that they may not even be prepared for that to be an issue.

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So a lot of times we just kind of have to observe and then, without re-traumatizing, somebody asking if they have any history, because it's not something that people want to talk about when they're about to deliver.

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Yeah, that's a really really good point.

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It's not something that people really talk about enough and, you know, obviously one of the most common interventions that's recommended are things like pelvic floor therapy, which is a fabulous intervention and one that also can be invasive as well.

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Triggering, yeah, but we're kind of walking through a minefield of potential triggers as we navigate pregnancy and postpartum with people who have this kind of history.

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So something else that I just want to mention people cope with trauma in many different ways and one of the challenges for women who have maybe used alcohol or other substances to cope with the trauma they experience this may continue to happen during pregnancy.

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There's all of these things that are coming up for them that feel very out of control, and if that was something that was effective for them in the past and kind of keeping them separate from those feelings, it's unlikely to change necessarily during pregnancy.

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So we know that that can cause health problems for both mother and baby.

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Again, really really important to provide services to women who are struggling so that they can find support and develop other effective coping mechanisms during and beyond their pregnancy.

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If there's anything moms and parents know, it's that being apparently stressful in general.

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Those are some of the things to consider during preconception, being pregnant.

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Librarian delivery has its own specific set of challenges for survivors of sexual abuse and assault because it is incredibly physically demanding, vulnerable and painful.

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In most cases One of the most common things that happened with people who have this history they may dissociate themselves from their body during labor and delivery.

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Again, that's a coping mechanism, potentially, that they've used in the past.

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That has been very effective.

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Generally speaking, human beings like to avoid pain whenever possible.

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If that works, that's going to be the thing that is our go-to, but unfortunately it can hinder and extend the labor process at times.

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We do need to be present in our bodies so that we're able to sort of feel the things that are happening, whether they're pleasant or not, and so for those individuals who experience a high degree of dissociation, it's really important to have someone that they trust with them during this process to help gently ground them back in their body, and to also have someone to provide support and advocacy.

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That's a big challenge just in general, and even more important for someone who may have some additional triggers that the medical team may or may not be aware of.

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So that person could be a partner, a spouse.

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It could also be a doula, another support person or a family member Doesn't really matter who, as long as that person is someone that the mom trusts.

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Something that's very useful in terms of preparation are things like meditation and grounding techniques.

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What are those things that we can do to help us more easily stay in our body to cope with the distress of the process and also the pain itself.

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This can help reduce dissociation a lot.

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There was a 2016 study that indicated that women with a history of childhood sexual abuse reported vastly higher levels of negative labor and delivery experiences compared to a control group.

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This is not surprising given everything that we've just kind of talked about as far as feeling potentially violated during this process.

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So we obviously want to do everything we can to mitigate further trauma, improve the likelihood of a positive labor and delivery experience.

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That's outside of just having a healthy baby.

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Having a healthy baby is the goal, but it is not enough.

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We have to really make sure that we do what we can to really make sure that mom is OK, and some of the ways that this can be helped is by having doctors and nurses' medical personnel be as transparent as possible regarding any medical intervention and ask for consent throughout the process.

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One of the most common situations in general that leads to an experience of traumatic birth is feeling like there's no ability to say no or not enough information to give consent, or it's just happening to you.

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There, of course, are life-threatening situations in which interventions have to be acted on immediately, but it's really, really important for there to be follow-up and debriefing from the medical team to avoid further traumatization.

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I mean, I can say this in relation to my own traumatic birth.

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I had none of that initially, and it helped my healing tremendously to have someone Kelly in particular really talk me through what happened, and so I think that is an incredibly important piece of this, particularly if there are things that have to happen that there's just not enough time to provide all of that information that we want to make sure that we give, and a big part of this, too, is making the woman a part of the decision-making team, like before, during and after labor and delivery.

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We all know that birth plans are subject to change, often subject to change, but really, if a mom is coming in and saying I absolutely do not want to have a vaginal delivery, that may or may not be possible, but the conversation about it is really important because that mom is.

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If she's so adamant, there's a reason there and we need to know what that is.

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So having those conversations, really being a part of the decision-making team, answering the questions that someone might have, really does go a long way in terms of instilling trust in your medical team and hopefully facilitating positive labor and delivery experience.

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And for everyone out there who is pregnant and preparing to deliver, one of the greatest things that you can do to empower yourself to have a more positive labor and delivery is to be your own advocate.

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Familiarizing yourself with your rights as a patient, knowing about things like being able to refuse cervical checks, things like that, feeling like you can ask the questions that you have in the back of your mind.

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This can help really bring a greater sense of control and autonomy over your body and, at the end of the day, when we have someone who's coming in with that type of sexual violation, that matters a lot.

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So, moving on to postpartum, again, postpartum recovery is a very physical process which often has a lot of pain in the pelvic or genital area, which can continue to bring ongoing physiological distress.

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I mean and this is assuming that everything went well with labor and delivery right there's still stuff that you're healing from physically, sensations that are very uncomfortable during the postpartum healing process.

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Breastfeeding is another area of potential concern as, again, this might be a part of the body that holds traumatic memories and sensations.

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It may feel intolerable for women to breastfeed due to the physical sensations that are triggered, or it can result in ongoing dissociation while breastfeeding Just because it's too hard to be in their body.

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Some mothers who might want to breastfeed their child may choose to bottle feed in order to avoid the feelings.

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So, whether or not a mom wants to bottle feed or whether they want to try breastfeeding, this history of trauma can rob someone of a choice that they want to make.

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It's a catch-22 of you can either suffer while you breastfeed or you forego an experience that you might really have wanted to try.

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So it's really important to give the mom support.

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However, she feels most comfortable feeding her baby, and if a mom would like to attempt breastfeeding, nurses, lactation consultants, can ask how the mother would like to be coached.

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So, whether it be hands-on, whether it be hands-off to give again some greater sense of control, to hopefully avoid any further triggers to her body, increasing opportunities for consent all of these things.

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Other considerations psychologically include the higher likelihood of PTSD, higher rates of postpartum depression and anxiety from untreated trauma and, unfortunately, revictimization.

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If an individual isn't given adequate support throughout the pregnancy, labor, delivery and postpartum healing.

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This can complicate and make bonding and attachment with the baby more challenging, which can lead to subsequent grief and loss around a pregnancy and postpartum experience that someone might have envisioned.

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So there's a real ripple effect there that is worth discussing.

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We all have some idea about how we want those things to go.

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Most of us don't get things exactly the way that we want them to, but again, the goal is how do we help somebody get through such an intense experience as whole and healthy mentally and physically as possible?

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So, given the prevalence of sexual assault and abuse in our society, it's really important that survivors seek treatment and be offered resources to help them process through this trauma.

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It's likely to reduce the many physical and psychological impacts of not only the sexual abuse and assault itself, but any additional trauma or distress that comes up during this perinatal time period.

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Body therapy work can reduce symptoms of somatic distress, which is body level distress, if it can be tolerated.

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Some people with this history can handle it and they find it very soothing.

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Other people they're not in a place where that is something that feels okay, but things like massage, yoga, breath work can all be very healing and helpful for individuals throughout the pregnancy, labor and delivery and postpartum time.

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There are trauma-informed yoga classes or yogis out there, and so if that's a way in which you're hoping to kind of work through some of the trauma you've had, I would strongly suggest trying to find someone who has gone through that type of training.

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I actually have a certification myself in trauma-informed yoga, so having kind of been a witness to and participant in some of that, I can say that what I've seen is that it is a little bit different.

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There is a lot more emphasis again on consent, on not touching, on asking and checking in, which I think is really important.

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There are trauma-specific therapy interventions like EMDR, which stands for eye movement, desensitization and reprocessing.

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Again, emdr is not the only way to process through trauma, but it is the one that I practice and so am most familiar with, and EMDR can be very healing and it is considered safe during pregnancy at any stage.

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I do want to mention that in the past there has been some controversy regarding whether or not it is safe to use during pregnancy.

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However, the most recent research does point to it being safe at any particular stage.

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I would suggest seeking out an EMDR-trained perinatal therapist if that is something that you are interested in doing, just because they have a lot more training around things like birth trauma and how to work with people coming in with this experience to help them have a healthier pregnancy.

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Postpartum delivery.

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The short-term increase in distress during the EMDR process in order to reduce the overall distress and increase feelings of safety is minimal compared to the daily high levels of distress that might be being managed throughout a pregnancy, which impacts mom and baby.

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So that's where the controversies lied previously.

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Participating in EMDR can be a very physical process, and so there had been concern previously that gosh, if we're introducing all of these stress hormones during EMDR while someone's pregnant, that would have a negative impact on the baby.

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But what we really know now is that it is such a short-term thing compared to this chronic high level of stress and distress that someone's carrying, and truly it is in a lot of ways, safer.

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So if somebody has questions about that, there are resources available to learn a little bit more about it.

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We do know that untreated mental illness and high levels of stress during pregnancy does have a negative impact on fetal development.

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That is something that we know, that has been well-documented.

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One of the nice things about EMDR is that it can be a shorter process than many other types of talk therapy, particularly if there's one discrete trauma.

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While everyone processes trauma differently and comes in with their own history, there can be a significant reduction in distress and even the development of just calming resources that can be developed over a few or even just one session.

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So that's something that might be worth exploring if that's something you are interested in.

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So, as far as resources for you or someone who's affected by sexual abuse or assault, here are a couple of suggestions.

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It's not exhaustive, but there are a few places you can get started, and one of them is the National Sexual Assault Hotline, which is 1-800-656-4673.

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Rain, which is the Rape, abuse and Incest National Network, at wwwrainorg.

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The National Sexual Violence Resource Center at wwwnsvrcorg.

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And the Mdria website, which is where you can go to search for an EMDR therapist if you so choose, and that website is wwwemdriaorg.

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Thank you so much, jen.

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That was very informative.

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I think a lot of providers don't consider the effect of sexual assault on breastfeeding and you had also mentioned that people don't consider the effect of sexual assault, a history of sexual assault, on the whole experience, but specifically for breastfeeding.

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I find that, especially for moms that have issues with a latch, it is much easier to just latch the baby, help them, latch the baby like physically and show them how it's supposed to look and feel.

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So I'm just thinking for providers that do use the hands-on approach.

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I think it is important to reiterate the consent to touch.

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But also it may require a little bit extra expertise, for instance, making sure that a lactation consultant is in there working with them a little bit extra in the hospital.

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But also if you're a survivor of sexual assault and you feel like breastfeeding is challenging because of that, I want to encourage people who are pregnant to seek a lactation consultant that they trust before delivery so that you have that resource after delivery.

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If that is how you plan to feed your baby, it's perfectly fine to choose to bottle feed your baby.

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But if it's your wish to breastfeed your baby and have that experience, everybody needs support during that I don't think a lot of people realize or set themselves up for that.

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I know I was guilty of that even as a nurse and second-time mom.

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I did not set myself up for much support, so I just want to encourage that because that's going to be an additional challenge.

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I think, something that I didn't say explicitly but I think is really important.

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The hope is that you would have providers that you trust enough to share this with, but the reality is that that is not going to be the case a lot of the time, or even if some information is shared, you may not have anywhere close to the information that you might want in order to provide even more trauma-informed care.

00:28:09.137 --> 00:28:26.374
So I think it's probably good practice just to go into these interactions with the assumption that someone somewhere has probably been touched in a way that was violating to them, and we want to just mitigate that start to finish.

00:28:26.374 --> 00:28:34.549
If anyone doesn't, we don't want to be the person that potentially gives them that experience, however well-meaning.

00:28:35.244 --> 00:28:43.595
So, a lot of the times we're just not going to know, so we sort of have to lead with the assumption that this may be a part of their history.

00:28:44.277 --> 00:28:48.275
Yeah, the other thing is that you brought up is the options for delivery.

00:28:48.275 --> 00:28:53.576
So I don't meet with the patient usually as a labor and delivery nurse before delivery.

00:28:53.576 --> 00:29:01.696
If I'm in a different setting I might, but often it's not something that I'm discussing with the patient because that's just not my role.

00:29:01.696 --> 00:29:14.694
The patient sometimes will disclose the sexual assault history and sometimes there is a plan for delivery made that takes that into consideration.

00:29:14.694 --> 00:29:21.907
So a couple of options are you mentioned to the right to refuse cervical checks In that situation.

00:29:21.907 --> 00:29:44.057
Some of the options that we've presented patients, especially if there's a planned vaginal delivery, would be either an epidural from the beginning so that there's no sensation of cervical checks, or sometimes, when we had nitrous oxide available at one of the hospitals that I worked at, that would be an option, or some of the IV medications.

00:29:44.057 --> 00:29:46.051
Those were all options that were presented.

00:29:46.051 --> 00:29:52.367
But if those options did not make the patient feel comfortable enough, oftentimes a C-section was recommended.

00:29:53.144 --> 00:30:05.756
And that's not because we're trying to say you can't refuse cervical checks, it's because it's somewhat difficult to know, especially depending on the nature of the delivery.

00:30:05.756 --> 00:30:09.696
So for instance, if it's an induction, we need to kind of know what's going on.

00:30:09.696 --> 00:30:12.138
If someone comes in in labor it's completely different.

00:30:12.138 --> 00:30:29.115
But because if your labor is ongoing and continuous and everything is safe and there are no safety risks or health risks, then you can kind of get away with not doing cervical checks, because then you can gauge how the pregnant person is reacting and how the baby's reacting and figure out how labor is progressing.

00:30:29.115 --> 00:30:33.718
But if it's something where we have to start the labor, it's really really hard to do without a cervical check.

00:30:33.718 --> 00:30:40.759
And so I've seen in the past just a recommendation for a C-section if none of those other options is available.

00:30:40.759 --> 00:30:53.498
And it's just something for listeners to consider, because if this is something that is going to be just too much, it's okay to talk to your provider about that and come up with an alternative plan for delivery.

00:30:53.890 --> 00:31:24.695
Yeah, I really appreciate, kelly, you mentioning some of the different options, because I think, again, what so much of this boils down to is communicating and being able to consent If you know that you don't want a C-section, unless it is an absolute requirement, and in order to have that vaginal delivery that you were hoping for, you might need to have that checked to be a part of the discussion about, like, well, how often might that need to be?

00:31:25.951 --> 00:31:51.999
And you know, okay, I think I can do that and this is how I would be the most comfortable doing that but I think oftentimes what happens it happens to the best of us, right Like what is so routine to us as providers is not a routine for people who are coming in, and I think there's just not as much awareness or knowledge of what a patient's rights might be or what options are available to them.

00:31:51.999 --> 00:32:00.576
So I appreciate you bringing that up because, again, so it's not always about whether or not you have the cervical check or you don't.

00:32:00.576 --> 00:32:06.238
It's about having the empowerment to be a part of that decision-making.

00:32:06.329 --> 00:32:16.837
Because I know that, you know I'm sure you've heard plenty of stories of people who felt like it was forced upon them and so that in and of itself can be traumatic.

00:32:16.837 --> 00:32:36.395
So the more conversation, and again I can see the point that, like emergencies are emergencies, but you know, I think also it's true in the vast majority of cases Most of these things are not emergencies and I know it may take a little bit more time but it may make things a little bit easier on everybody moving forward.

00:32:36.978 --> 00:33:06.440
Yeah, the other thing I wanted to bring up is, even if you want a vaginal delivery and you're doing all the things to achieve that, and for instance, just for an example, if you get an epidural to be able to tolerate the vaginal exams or whatever procedures have to be in place in order to achieve that vaginal delivery and it's still too much for you, you can always request to not deliver vaginally.

00:33:07.210 --> 00:33:36.515
Just because you've walked in with a plan does not mean that that plan is set in stone, even if it was your plan when nobody's playing a set in stone, there's always new information that we're considering, and that's why, when I talk about a birth plan, I try I'm trying to move away from that verbiage, because, in my opinion, there's really no such thing as a birth plan, because you're always changing the plan, there's always new information and you have to respond to that information, and so if the new information is, this still is not tolerable for me, even though I no longer have feeling in that part of my body.

00:33:36.515 --> 00:33:38.537
Let's explore some other options.

00:33:38.537 --> 00:33:40.115
You can do that.

00:33:40.115 --> 00:33:42.136
Essentially, you can tap at any time.

00:33:42.136 --> 00:33:50.415
The only thing is that your baby has to come out somehow, and so you get to choose the mode of delivery that is safest for you and your baby.

00:33:50.636 --> 00:34:08.099
Yeah, I think you may find also the flip side of that, where medical interventions can also make people feel like they're out of control, right when that they don't have the ability to control what they're feeling or experiencing.

00:34:08.099 --> 00:34:19.858
And so there may be some patients that come in that are very adamant that they don't want any external intervention because they want to be in control of every single part of what they can be.

00:34:19.858 --> 00:34:29.960
So the idea of not having any sensation may feel more intolerable than taking that potential physical sensation away.

00:34:29.960 --> 00:34:41.840
So everyone's experience is so different that making them a part of that conversation start to finish is probably the best possible intervention.

00:34:42.369 --> 00:34:54.536
Yeah, and for providers I mean I'm just thinking of someone that we do have patience, regardless of whether or not they've disclosed sexual trauma that once the epidural has occurred, their leg whoa, I can't move my legs.

00:34:54.536 --> 00:34:56.135
This is not good.

00:34:56.135 --> 00:35:02.195
Most of the time we can work through that, but if that isn't something that can be worked through, you can turn off the epidural.

00:35:02.195 --> 00:35:13.856
So I just want parents to feel like they can speak up and ask for alternatives and you can explain what's coming up for you and then ask for what the alternatives are.

00:35:13.856 --> 00:35:28.378
Ask for advice, because there's always another option, I feel like for the most part, unless there's so many complications that we ultimately land on one safe option, most of the time there is flexibility.

00:35:28.710 --> 00:35:45.500
Yeah, and when that happens, the damage control, the mitigation comes afterward where you go, have those conversations, you acknowledge that that was something that they did not maybe get as much information about or didn't have the level of consent that they wanted to have.

00:35:45.500 --> 00:35:59.097
I know that piece can sometimes really go missing, and a little bit of validation that that was a situation that they didn't have the level of control that they were hoping for can go a long way.

00:35:59.097 --> 00:36:00.099
Yeah, absolutely.

00:36:00.369 --> 00:36:02.958
I like that you were talking about preparing beforehand.

00:36:02.958 --> 00:36:47.300
I think that, other than the debrief, because we've already potentially experienced the trauma if we've had the debrief, the preparation beforehand I think is essential because if you have some sort of idea of what's possibly coming and what you want and you've worked through the feelings that you might have around some of those things and you've asked all your questions, I think it's less likely and I don't know the statistics I was actually looking that up today and I need to kind of explore that a little bit more but the statistics of I know that it is said or it is theorized and discussed that if you have worked through that and prepared mentally for those things, that the incidence of trauma is significantly less.

00:36:47.300 --> 00:36:56.195
Several studies I was looking at that, I again don't remember the numbers even go as far as saying you can decrease the incidence of post-traumatic stress disorder.

00:36:56.195 --> 00:37:02.697
So I just can't stress enough the importance of preparation for the birthing process for parents.

00:37:02.697 --> 00:37:06.298
I think there are a lot of resources for preparation.

00:37:06.298 --> 00:37:08.034
Some are better than others.

00:37:08.550 --> 00:37:15.396
A lot of parents want the quick one day class and then what I hear afterwards was there wasn't enough information.

00:37:15.396 --> 00:37:23.556
It was all condensed into a six hour period, but when you sign up for that you're like, oh my gosh, six hours, are you kidding me?

00:37:23.556 --> 00:37:28.809
So I think people would do better to look at this as I mean.

00:37:28.809 --> 00:37:37.961
It's not just birth, it's the marathon, it's the pregnancy, it's the birth, it's the parenthood, it's all this whole new thing that you are preparing for me.

00:37:37.961 --> 00:37:41.427
You don't just jump into a new career after six hour class.

00:37:41.427 --> 00:37:45.543
Most of the time you know your, your new career is gonna be parenthooding.

00:37:45.543 --> 00:37:51.320
Getting into that process is gonna take some preparation, even the birthing process.

00:37:51.320 --> 00:38:07.108
So I just want encourage parents to spend a little bit more time understanding what's gonna happen, no matter what kind of birth you're having with your having home birth, the hospital, birth, first center no matter what you're doing, understand what the options are and why and what might be coming up for you with all of those options.

00:38:07.456 --> 00:38:11.684
Absolutely, and I really to piggyback off of that a little bit.

00:38:11.923 --> 00:38:36.369
In the beginning of the podcast I mentioned that A lot of times people can be really caught off guard by a lot of this stuff coming up and I would say that sometimes they're not even really aware of why they might be Having certain intrusive thoughts or why they might be having a really strong negative emotional reaction to something.

00:38:37.056 --> 00:38:47.708
And I would really encourage anyone who might be having things that just you feel really out of sorts and you're not really sure why you're having some of the experiences.

00:38:47.708 --> 00:38:51.277
Are the symptoms you're having like that's a good time to intervene.

00:38:51.277 --> 00:38:58.295
Then you don't have to necessarily know the explanation at that time, what's going on.

00:38:58.295 --> 00:39:10.811
The fact that you're already starting to struggle is enough and important enough to get you in to get some help, even if someone never necessarily makes the connection that it was related to an abuse or an assault that happened in their history.

00:39:10.811 --> 00:39:22.590
We all deserve to have support and resources available to us to reduce the amount of distress that we're having, to improve the sleep to the extent possible, because no one's sleeping really well during pregnancy.

00:39:22.994 --> 00:39:36.170
And so I would just say regardless of the reason, let your obino, reach out for help from a therapist, a perinatal therapist, any therapist to begin with, just to see if you can't get ahead of some of that stuff.

00:39:36.554 --> 00:39:49.791
Yeah, I think more and more I see when patients come in anxiety and depression as listed in their past medical history and to some extent I think that's because people are just being more honest about it.

00:39:49.791 --> 00:40:08.224
But it is so normalized from our end at this point that whatever stigma you might have in your head about talking to your obi about that, I just want to validate the presence of anxiety, depression In society because I don't think that there, from our end, is any stigma.

00:40:08.224 --> 00:40:10.409
It's just, it is what it is.

00:40:10.409 --> 00:40:15.702
It's just something that we see and we say, okay, yeah, don't we all and we move on.

00:40:15.702 --> 00:40:40.237
It's not to minimize it either, but I just want people to feel comfortable Expressing those feelings of anxiety if they're coming up and know that it is something that you can speak about and share about without feeling the judgment or the stigma, because there's help out there and there's no reason to fear when you, when you want to come forward and say that that's what you're experiencing yeah, absolutely.

00:40:40.559 --> 00:40:50.974
It's highly treatable and highly treatable in pregnancy, highly treatable in your postpartum experience and especially even just around P.

00:40:50.974 --> 00:40:55.599
Mad or perinatal mood and anxiety disorders, is an umbrella term.

00:40:55.599 --> 00:41:02.786
One in five people right have some form of perinatal mood disorder anxiety.

00:41:02.786 --> 00:41:05.769
One in seven have postpartum depression.

00:41:05.769 --> 00:41:26.759
These are common occurrences, even as we really wish that they weren't, so hopefully people are continuing to talk about them and hopefully the messages are getting out to parents to be that these are things that we don't need to brush off.

00:41:26.759 --> 00:41:35.617
These are things that are unfortunately common experiences, but fortunately common in the sense that You'll be able to find a provider.

00:41:35.617 --> 00:41:39.224
Hopefully that can help you navigate that, because it is highly treatable.

00:41:39.224 --> 00:41:42.155
You don't have to suffer yeah, well done.

00:41:42.195 --> 00:41:44.940
is there anything else that you wanted to talk about that we haven't brought up?

00:41:45.221 --> 00:41:46.664
I mean I think I hit the high points.

00:41:46.664 --> 00:42:05.179
Like I said, you know, this is a really Complex issue that's hard to cover in just one, and I realize that there are specific scenarios, as I kind of mentioned in the beginning, that sort of warrant their own Podcast or their own form of treatment, just because they're even more complex.

00:42:05.179 --> 00:42:15.371
But hopefully there has been some helpful information and validation today and hopefully starting this conversation or continuing it a little more.

00:42:15.894 --> 00:42:17.898
Well, jennifer, thank you so much for joining me.

00:42:17.898 --> 00:42:25.809
As always, I learned a lot, and those resources that Jennifer mentioned will be in the show notes for you to look up.

00:42:26.175 --> 00:42:26.818
Thank you, kelly.

00:42:26.818 --> 00:42:28.103
I appreciate you bringing me back.

00:42:28.103 --> 00:42:29.141
Thank you.

Jennifer Byrnes, LPC, PMH-C: The Impact of Sexual Assault and Abuse on Pregnancy and Postpartum

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