My goal as author of With Harp & Sword: A Doula’s Guide to Providing Trauma-Informed Birth Support is to provide a resource for doulas, midwives, birth workers, birthing people, survivors and their loved ones to increase awareness around the importance of discussing current or past abuse, violence and trauma, more specifically with domestic violence and sexual assault. In part I explore this issue by sharing about my own personal story of exposure to domestic violence as a child and being raped as an adult. I used my story to illustrate how trauma experiences can live on in the body and mind, even for many months or years after they’ve first occurred and to make tangible connections between relationships that support disclosure and encourage survivors to seek help.
Having worked in the domestic violence field as a victim advocate for over 15 years (locally, statewide and nationally), I’ve come in contact with numerous women who were pregnant and abused or who had recently given birth and were abused. I saw firsthand how difficult it was for these women to tap into their sense of agency after experiencing such intense and repeated physical, emotional, sexual and financial manipulation and abuse. Once I began practicing as a birth doula, I began to see parallels in women’s experiences.
A key discussion in With Harp and Sword is the question of whether or not to ask about a client’s past trauma history. I believe that once a relationship of trust has been established, asking about your client’s experience of trauma is helpful. When I conduct trainings on this topic I ask “What changes?” and “What stays the same?” if we don’t ask. Asking creates space for clients to discuss their fears and concerns. When I ask my clients about their past experiences with trauma or abuse, I’ve learned about one woman’s experience with gang rape in a conflict zone in her home country; another woman’s partner who wished she had aborted the baby, wasn’t sure if he would be involved and who didn’t treat her very well; another woman shared that she had been raped as a young girl, was thinking of becoming pregnant and knew she needed to plan to have doula support; and yet another woman talked about being raped in college but not having thought about it for years.
When we help survivors process their experience with abuse and assault, we help normalize the trauma response—whatever that may be. We can help connect current behavior to past experiences and assist in identifying coping strategies that supports their healing as it begins or continues. My past clients have either expressed appreciation at simply being asked so they can explore the issue for themselves or they’ve been relieved to talk about it and release their fears related to the changes in their body, mind, and emotional state that were associated with their trauma response.
When we don’t ask about trauma history, women may feel silenced by triggers that can arise during labor and not know how to voice their needs. During a workshop, one participant shared that she was a victim of domestic violence when she gave birth to her child. Her husband came to the hospital while she was laboring and began to argue with her. He became louder and started to push and hit her while she was laboring in the bed. When the nurse returned to the room, he abruptly stopped the abuse. The room was tense and it seemed clear there was an altercation happening so the nurse asked him to leave the room for a private procedure but she never asked the woman about what happened or if she was safe or needed different support. The woman in the workshop was unsure of how she would have responded had she been asked but knowing that someone else in a position to help was aware of the abuse may have changed things for her and her baby. She eventually left her abusive husband but it was many years later. Asking about the abuse and making a referral to the hotline (1-800-799-7233/SAFE) or local domestic violence shelter could have made the difference in this woman leaving a violent relationship sooner rather than later.
Not asking can create feelings of being further marginalized and isolated in a person’s experience. Being abused or assaulted, coupled with hostile birth environments where women’s voices and choices are not fully recognized or honored will continue to affect their health and emotional well-being. As birth doulas committed to promoting positive birth experiences for all birthing persons, it behooves us to know the signs of abuse, to offer support and comfort, and to provide referrals for help from well-trained, caring victim advocates.
When I talk about women’s voices and choices not being fully recognized or honored, I’m referring to when my clients advocate for their personal preferences, even prior to labor with a trusted care provider. Let me explain. I like to use the birth plan as both an educational tool for the birthing family and as a communication tool to help them talk through their options and the practices/protocols of their care provider. I encourage them to review the birth plan in detail with their care provider prior to the birth so they know what to expect and in case we need to make any modifications. In the example of women’s voices not being fully honored, I’ve had many clients prefer not to have multiple vaginal exams in the latter stages of pregnancy, for example. In most cases it has become very uncomfortable for them, in others it creates anxiety because they may not be making “progress,” and in some, they just find it unnecessary.
In almost all cases, these women were met with aggressive pushback from their care provider. They would have to advocate for themselves repeatedly during multiple visits to have their wishes heard and respected. Or when they wanted to make a different choice during labor because they were listening to what their bodies needed, again, they were met with resistance. I strongly believe that helping women tap into their agency to be active participants in the decisions related to their labor, childbirth and recovery is vital to improving their individual birth experiences, as well as shifting the culture as a whole to improve maternal health care. When we don’t advocate for change we allow negative birth stories to become ingrained in our culture as normal and “to be expected.”
Writing this guide was my contribution to shifting that culture. I want doulas and other birth workers to be grounded in how to support the needs of survivors that may experience triggers while interacting with their care provider, throughout the physical and emotional changes of pregnancy, or while in labor, birth and the postpartum period. In With Harp and Sword, I discuss specific ways in which doulas or other support persons and loved ones can help pregnant and laboring survivors have a powerful, transformative birth experience. Beautifully illustrated, positive birth affirmations are included throughout the book. I encourage doulas and survivors to use them and put them into practice. Suggestions on how to market trauma-informed services and broach this subject with doula clients are provided, as well as strategies that doulas can start to use immediately if supporting clients with a history of abuse.
Rebecca Dekker of Evidence Based Birth, based in Kentucky says, “Having worked with Kenya Fairley through the Evidence Based Birth® professional membership, I am thrilled that she has published this book on trauma-informed doula support. Given that approximately 6% of pregnant women report experiencing sexual assault or abuse during pregnancy, it is imperative that doulas know how to support survivors during the prenatal, labor, birth, and postpartum period. Kenya’s book provides practical steps for how to do this!”
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About the Author
Kenya M. Fairley identified a gap in doula educational support and decided to take action. Since beginning her practice as a birth doula, and with her history of being a professional advocate for survivors of domestic violence and sexual assault for over 15 years, it became clear very early on that there was a knowledge gap in this area for birth workers that she could have a hand in filling. Thus was born the idea for what eventually became the book, With Harp & Sword: A Doula’s Guide to Providing Trauma-Informed Birth Support. Kenya’s goal is to get this book into the hands of as many doulas and those who serve pregnant women to increase support and trauma-informed care for as many survivors as possible. Her hope is that you find With Harp & Sword to be interesting, informative and valuable to those in our profession. You can read more about the book and purchase your copy at www.kenyathedoula.com/book. Please share the link with a survivor, friend or colleague.