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Conscious Empowered Birth
book review

When Survivors Give Birth by Penny Simkin
Reviewed by Cristin Tighe

 

This book is an ultra-valuable resource and the beginning of building great awareness about the reality and negative impacts of sexual abuse, as well as the powerful healing that can happen to women through pregnancy, labor and birth.  The key issues are important to understand: (1) past history of sexual abuse has real implications through the whole timeline of pregnancy, labor, birth and after (p. xv); (2) any of the pieces of this timeline may be when the trauma of past abuse can recur (p. xvi); and (3) if recognition and awareness is used to support and empower women through these times, they can be an uplifting, freeing and very healing for women (p. xvii).  The explicit, detailed definition of abuse (p. 4), and descriptions of forgetting (or disassociation (p. 9)), as well as recall of past incidence is important to understand (p. 12-13), as are the different levels where the impacts can emerge [sexual behaviors, physical and “somatic manifestations, psychosocial disturbances, and mental health disturbances] (p. 22). Another key point is that, before the time of this book, sexual abuse was not really part of the conversation in either cultural or medical settings and still is becoming more understood and discussed.

One of the books strengths is that it has specific information about working through these issues and supporting women in birth/labor (chapter 4) and the postpartum time (chapter 5).  For birth and labor, understanding triggers and issues of control are key (p. 79-82), and after the birth, post traumatic stress disorder (PTSD) and watching for postpartum mood disorders is most important.  The book also does an excellent job of sharing varied women’s stories to give an idea of the scope of abuse impact, ways to shift and transform them, and women’s power.  It is wonderful that these are interspersed throughout, to give the more theoretical writing a personal perspective. 

I feel the book has two limitations: (1) focusing on the role of the care giver/taking a cautious approach regarding actually saying that the medical model typically invalidates women’s needs in the case of past abuse; and (2) its focus on how the caregiver can support women (versus how they can empower themselves).  First, although chapter 6 on “The Relationship Between the Woman and Her Doctor or Midwife” is excellent, it could say more about the value of the midwifery model (e.g., care from another woman, time for someone to feel safe and have their wishes heard over time, a relationship with depth and consistent care, someone who really knows and honors the women and her hopes and needs.)  The midwifery model can give women what Sue Blume writes in the introduction is so significant – their own sense of value and deserved boundaries (p. xxii).

The second limitation (empowering the caregiver) is, in a way, understandable. This is where the valid and real experience of Penny Simkin and her colleagues occurred, that which helped them start to understand these issues and how to support women. Focusing from the caregiver is useful, like communication issues (chapter 11) the value of birth plans (p. 172, 367), how to do pelvic exams with care (chapter 12), and nursing plans (chapter 13).  You can see though that some chapters start to aim more at the women themselves. For example, there is valuable information about choosing a caregiver, disclosure and delayed recognition of abuse (chapter 3) as well as information on self-help (chapter 9), counseling (chapter 10), the role of psychotherapy (chapter 11) and informed consent (chapter 14).  It would be wonderful to see a second edition of this aimed at the women themselves, because really they must be the ones to choose to take the path of awareness and healing; their care providers just assist (and the doctors in a minor way compared to midwives).

The book discusses the history of recognition of abuse, specifically by Freud – how his 1896 published paper linked hysteria to early childhood abuse (p. 9) but then in 1897 he denied his findings: “…if his patient’s stories were true, and his theories correct, he would be forced to conclude that what he called ‘perverted acts against children’ were endemic… among respectable bourgeois families where he had established his practice.  The idea was simply unacceptable.” (p. 9-10)  Since then, the evolution of understanding these issues has been slow, and this book takes a major leap forward in revealing so much about the awful impacts of abuse and also the power of conscious care and potential healing.  On the other hand, looking back at this book with historical perspective, someone may say that the authors were like Freud; not wanting to lose respect within the medical establishment (where doulas and midwives must work today), the book could not really be completely truthful. It needs to be said - the medical model (as well as legal systems, patriarchal cultures and religions in many places) extremely limit the recognition of the reality of abuse (may even allow trauma to persist), does not build the awareness of medical providers (especially general practitioners and gynecologists facing pressure to save time and liability), and thus limits care, support and healing that could be so transformational on many levels for women, doctors, society and through time.
 



 

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