News
By Dr Geraldine Butcher, Consultant Midwife (retired) and Jen Richards, Break the Silence
Pregnancy and birth are significant life events, the cause for much excitement and celebration, and yet for some women they also bring feelings of fear, vulnerability, and uncertainty. These emotions may be especially heightened for survivors of sexual abuse and, for some, the anticipation of pregnancy can be overwhelming.
Risk of re-traumatisation
The intimate nature of maternity care may raise concerns about past experiences being triggered, with the potential for re-traumatisation. This can influence decisions about whether or when to have a baby. In some cases, women have delayed pregnancy while, in others, expectant mothers have found that once their pregnancy is confirmed, the sense of vulnerability they feel is difficult to manage.
Fear can affect how women engage with information and support. Antenatal classes, pregnancy books and TV programmes – often seen as a routine part of pregnancy – may feel inaccessible if there is a risk of increased anxiety or psychological distress. These responses are protective, helping individuals manage their emotional safety in the ways available to them.
Respecting individual choice
Choices around birth may also be shaped by a need to feel safe and in control. Some women may, following discussion and informed choice, feel that a planned caesarean offers a more manageable experience. Others may prefer a home birth, valuing the continuity of one or two carers rather than potentially many unfamiliar people involved in hospital. Individualised birth plans that consider potential triggers and aim to reduce distress for sexual abuse survivors can support a greater sense of confidence and wellbeing.
However, where trauma is not recognised or supported, maternity experiences can be more challenging. Birth itself may be a triggering event for some, and this can contribute to postnatal depression, PTSD, or ongoing anxiety. Feelings of fear may continue after birth, including concerns about their baby’s safety, including fears about possible harm.
Psychological wellbeing
It is therefore essential to recognise both physical and psychological wellbeing within maternity care. Creating opportunities for sensitive and timely conversations can help women feel more supported. Routine enquiry during pregnancy may play a role in this, particularly when it is approached with care and clarity, and when women understand that any disclosure of previous abuse will be met with appropriate support rather than feeling like a tick-box exercise.
Trauma-informed care benefits everyone
Growing awareness of the prevalence and impact of sexual abuse has led to a broader understanding that trauma-informed care can be beneficial for everyone. Approaches that prioritise choice, safety, and trust – while seeking to minimise potential triggers – can help create a more supportive environment for women throughout pregnancy and birth.
In this context, small, thoughtful adaptations in practice can make a meaningful difference, supporting women to feel safer, more informed, and better able to navigate their maternity experience.