The journey to heal after sexual violence is a non-linear process and survivors may navigate an ever-evolving relationship with their trauma history for years, decades, and sometimes, throughout their whole lifespan. One of the realms which can be challenging for survivors is that of intimacy and embodiment and often times, survivors find themselves re-learning repeatedly how to safely explore the landscape of sensuality, sexuality and relationships. For many trauma survivors, managing intense sensation, whether pleasurable or painful, whether purposeful or simply necessary, can sound the internal alarms of panic that recall their experience of trauma. There is a loss of control in that space – whether emotional, physical or spiritual – that regardless of our best preparations and the most loving intentions of those we are with, can feel both terrifying and deeply confusing. Therefore, it is not such a leap to imagine that for some survivors; pregnancy, delivering a child and becoming an essential caregiver in the life of a newborn would come with unique concerns and fears and may require adaptations to enhance the survivor’s sense of safety.

What resources currently exist that bridge the gap and make the essential connections between sexual trauma, birth and parenting? How do we support survivors of sexual violence whose experience of pregnancy may be loaded with anxiety about what may surface in the process of delivering her child? What wounds may be potentially re-opened for survivors (as well as those who haven’t experienced sexual trauma) and how can we best arrange for their support as birth attendants, physicians and partners? What tools and techniques are available to people who’ve survived sexual violence and sexual trauma in preparing – physically, mentally and spiritually – for labor and birth?

As the experience of pregnancy, labor, birth and parenthood can in and of itself be destabilizing to a person’s identity, their connection to their body and sexuality, it seems clear that additional support for a survivor traveling this path would be useful. Since birth is an inherently unpredictable event (despite our endless attempts to control it) and requires a trusting of both the Universe and the Self unlike any other, it offers incredible teachings related to self-connection, presence, embodiment, relationships, and the practice of letting-go – all of which can serve not only the laboring parent, but everyone around them who participates in this awesome journey into the mystery of life itself.

In this 3 part series, “Cycles of Healing through the Lens of Pregnancy, Childbirth and Parenting” we explore a variety of themes related to creating a trauma-informed birthing experience, survivor/person-centered pregnancy, the physiology of trauma and labor, the transition into parenthood, and much more. We begin the conversation with Kimberly Johnson, one of The Breathe Network’s practitioners who is a yoga instructor, Rolfer, Somatic Experiencing practitioner, doula, and an educator on pregnancy, birth and postpartum recovery. Kimberly offers multiple trainings a year across the country for bodyworkers, yoga teachers, birth support professionals and pregnant women on the powerful work of preparing, exploring, healing and thriving along the heroic journey of parenthood. For more information and to reach Kimberly directly, you can visit her practitioner page.

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The Breathe Network: Can you share with me how you became interested in working with women (and couples) during and after pregnancy?

Kimberly Johnson: I have always been fascinated by birth. But it was the birth of my own daughter, which was such an unexpected descent and an awakening that led me to work with women, and couples in the motherhood transition. Like so many women, I had endlessly prepared for the childbirth experience, but had no idea how the process of transformation would continue way beyond the birth itself. For me, my experience of adjusting to motherhood, the process of re-assembling myself, and living into a new wholeness inspired me to support women and families through the transition.

TBN: What kinds of roles have you served in connected to your work with women during their journey of pregnancy, birthing and post-partum care and what does that look like?

KJ: I work as a birth doula. I also help pregnant and postpartum women stay comfortable and mobile with yoga and Structural Integration. I help women with pelvic floor health – including incontinence, prolapse, pain during sex and other discomfort with internal pelvic floor work. I help women navigate birth injury and birth trauma with Somatic Experiencing and bodywork. I have recently been studying Birth Story Medicine with Pam England.

TBN: In your experience, how common is it that people who are survivors of sexual violence experience some sort of trigger or emotionally charged experience during pregnancy, labor or afterwards? 

KJ: In my experience, sexual abuse survivors often experience difficulty in medical procedures and during the birth experience. Sometimes the abuse comes up in more overt ways – women don’t want to have cervical checks, or to be touched in certain ways. But a history of abuse can also come up in things like late stage birth (going past 42 weeks), in difficulty dilating, in pushing – in ways that somatically echo an abuse experience. It could also be more subtle like a hesitancy to question authority or the opposite – what may appear to be a disproportional defiance against authority. Sometimes women who have experienced abuse make specific birth choices as self-care in order to ensure a less triggering environment. A history of abuse can also weigh heavily in a woman’s choice on where she wants to birth.

TBN: What do you do in your role to support women through that journey so that is one of empowerment that minimizes re-traumatization – to the extent that is within your capacity?

KJ: First, it is important to meet women where they are in their healing journey. Some women may not even be aware that they have been abused, but their actions seem to suggest it. Other women may be quite far along in their healing journey. And of course, each woman’s story and path is unique. Most women are unprepared for labor.

As our culture gets more and more technologically oriented and has less and less opportunities for intergenerational interactions, women seem less prepared for birth. Most of us are less connected to nature and its rhythms, and it is hard for us to truly “unplug”, relax and settle. Birth requires an ability to ride the waves of an oscillating nervous system. When a contraction comes, there is a rise in sympathetic arousal, and on the downside of the contraction, the parasympathetic system needs to be online. There is an activation and deactivation (an upswing and a downswing). Just because someone is functional does not mean that their nervous system is healthy and regulated. I believe that this is one of the reasons why birth is harder than ever for women. For a woman who has experienced sexual abuse or trauma, the nervous system regulation could potentially be even more imbalanced.

To minimize re-traumatization (and also to have an enjoyable birth), it is important for women to feel agency in their birth choices. Identifying ahead of time possible triggers, whether they be power dynamics, physical positions or environmental alarms, is important. So the first step is to make choices for a safe and nurturing environment. Often times, there is a lot of indecision and it can take time to parse out what the most supportive environment will be. Birth itself is unpredictable, but minimizing the unpredictable is useful. In my opinion, a doula is imperative. Having a person who is there only to attend to the woman’s emotional, physical and spiritual needs is key in a woman not re-experiencing unnecessary or additional trauma.

TBN: Are there techniques, intake questions, or ways in which you work with women that you’ve developed after years of supporting them in this capacity? Perhaps a way they can intentionally prepare for the possibility of the trauma story surfacing?

KJ: I believe that internal pelvic floor work is highly effective in potentially unwinding and encountering trauma before arriving at the birth gate. Birth is such an inherently intense experience, where women are at the life/death/life door, that if it is possible to meet and encounter some of the sensations and images beforehand, it is desirable. Birth works best when women are able to enter an erotic trance. Many survivors have difficultly in relinquishing control enough to enter an erotic trance or have dissociative strategies in place. The sexual arena is a potent space for practice. A woman can be led through this practice with a Sexological Bodyworker or a holistic pelvic floor health care specialist. Preferably women would do this work in preparation for becoming pregnant. The internal work is not generally recommended while a woman is pregnant, but I believe tools like the Epi-No are effective for psychological and physical preparation.

TBN: Would you say there is a way in which we could make pregnancy and birthing, as well as recovery after birth, more “trauma-sensitive”? What do you think that would look like?

This is a big question. In some ways the way that we are living- less contact with other human beings and with nature, placing a much higher demand of stress regulation on the nervous system, makes birth inherently more difficult than it has ever been. As birth educators, we have to straddle the line of giving women (and families) enough information. We want to take care not to reduce birth to be simple a mechanical and medical event and leave sufficient space to welcome each person’s internal process and questioning. There is not a lot of great childbirth education out there. Many methods are staunchly anti-interventionist so women set themselves up with strong expectations and ideals and feel like failures if their birth does not go as their class suggested it could. Other methods, in teaching pain coping strategies, are actually teaching women to check out. The approach that to me puts the pieces together- gives partners enough information and guidance towards the important internal questions for each person – is Birthing from Within from Pam England. She is a midwife who planned a homebirth for herself several decades ago and ended up with a Cesarean that was devastating to her and made her question everything she thought she knew about birth and how she was preparing women.

During pregnancy, it is important to identify specific triggers and fears with the pregnant mama. (this is true for all women, but especially so with survivors) That way, as a support, I can be especially mindful of preventing those situations or facilitating when they do happen.

Most births happen in hospitals, and for some, a hospital itself is a triggering environment. The low temperatures, often being connected to monitors, frequently being restricted to freely move, wearing institutional clothing, and changes of staff can all be overwhelming to someone who is in a hormonally charged state. So to make a birth “trauma-sensitive,” looks a lot like how I would help any woman prepare for the most successful birth possible. A woman should feel like the protagonist of her birth experience. That means that she needs to know what is going on and feel like she has a choice, outside of a genuine emergency. Because OBGYNs are present for so little of the birth experience, and you never know which nurse you will get, I recommend having a doula. A doula will go to the home of the laboring woman, and together with the couple will help to determine when it is time to go to the hospital so that hospital interventions are minimized. It is also extremely useful to have some continuity between home and hospital and a doula can help make that bridge. The birthing environment itself is more “trauma-sensitive” and conducive to physiological birth with low lights, warm temperatures, the ability to wear one’s own clothes, and choose one’s own physical positions. That way re-traumatization is less likely to occur, as is creating new trauma.

In the event that trauma occurs, women need the support of trained birth story listeners and somatic therapists. Often their partners and their babies also need support.

TBN: What would you recommend to those in the roles of pregnancy and birth support (such as RNs, obstetricians, birthing center staff, doulas, midwives, etc.) to create a more “trauma-informed” environment for the mother?

KJ: This is a complex question because many of these people are dealing with their own trauma. It is important that birth workers have support in processing their own trauma. The often superhuman demands both in time and volume that many RNs, OBs, CNMs and other staff operate within contribute to their relative ability to be present with women in trauma. All of these birth professionals would do well to understand the physiology of trauma- fight, flight, freeze and collapse. They should understand that it is best not to do any procedure, unless absolutely necessary, while a woman is activated and in sympathetic arousal. And they need to know why. They need to understand the function of these adaptive responses – that a woman is not being “difficult” – she is responding to a real or perceived threat. In order to do this, women’s personal experiences have to be a part of a key to best serving her, rather than an impediment to moving her along through the cogs of the system. I believe many, or even most, of these professionals have the best of intentions in terms of supporting women, but the cogs of the hospital wheels do not always turn at that speed. There are a lot of pressures on the birth professionals. Of course, there are some hospitals nation-wide that follow more of a woman-centered midwifery model.

TBN: What would you suggest for a newly pregnant woman who is a sexual violence survivor and has anxiety about the process of pregnancy, birth and future parenting? 

It depends where the woman is along her healing path and also what kind of abuse she suffered (ritual abuse, incest, stranger rape, acquaintance rape) Each woman will have her own journey. I think it is important not to create a sense of impending doom. Birth is unpredictable and the loss of control that facilitates the process of birth is uncomfortable for most women, not just survivors. It is up to the woman to decide who to disclose to, but it seems important to have a trusted birth companion other that the partner who is clued in to her experience and her fears. Many women experienced a loss of control of their physical autonomy and severe breaches in trust, so it is important that a woman be supported in both making choices about her own body, as well as establishing connections that she can trust.

TBN: Do you think that the birth experience and/or parenting have the capacity to be part of the healing journey for a survivor? 

This experience of creating, birthing and becoming a mother has powerful transformative possibilities for all women, survivors included. Women have the possibility to reclaim a sense of the awe and the power of creating and get closer to the natural intelligence of their body. Some women may feel estranged from their body as it goes through these unfamiliar processes that they can’t control. These women, who may not “like” pregnancy, need extra support and also not be made to feel the pressure that you have be “in love” with every part of the process. The glorification of motherhood can make women who experience the normal everyday flux of emotions and a grieving process of the earlier stages of life feel “wrong” or “bad.” It’s normal that it is not all rosy.

Women who were exposed to abuse early on may experience fear for their baby or their young child. As we parent our children, we re-live ourselves at the ages they are passing through. It is as if we are parenting a 2 year old at the same time as we re-parent our inner two year old. Knowing that, women can get professional support if they notice that their anxiety, dread, or protective instincts seem to be disproportionate to the situation at hand.

We have mostly talked about women who identify as survivors when they embark on the motherhood journey. However some women have experienced abuse and don’t know it – it hasn’t surfaced into their consciousness yet. Birth can awaken these experiences, as can early motherhood. As we take full responsibility for the safety and health of another being, feelings surface about the kind of safety and health we were provided. Many women find themselves catapulted back into work on their primary relationships at that time.

All of these experiences are opportunity for repair. We have the chance to give ourselves what we were not given. We can ask for support where we couldn’t before. We can use our voice, speak up, and make choices for the kind of care that we want. We can surround ourselves with the kind of environment that makes us feel more secure and more at ease. And as we navigate these choices, we have a chance to repair and reprogram ourselves. During intensity, we can maintain our personal sovereignty. Of course, everything is not always perfect and does not always go as planned. Our chosen doula can get sick or be out of town. Our hospital can be full and we have to birth in another. Our homebirth could require a transfer. We may birth so quickly we don’t have time for the epidural we planned for. And yet, in all of these unexpected turns of events, we can connect to the resources of body scanning, communicating, and relying on both internal and external resources that have been developed as part of the birth preparation (or earlier in life).

TBN: I am truly in awe of you and your in-depth experience working with the body, mind and spirit through a range of complementary healing arts, supporting women through birth and beyond, leading teacher trainings and restorative retreats, traveling the globe – and you are also a Mom! Can you tell us how all of your training and lived experiences come together in your work and your vision – not just with survivors, but also with all women who are navigating pregnancy and motherhood? 

My personal mission is in spreading awareness of the continuing transition of the post-partum period. After the feared and revered birth experience, women are often totally un-prepared for the adjustment that is a part of recovering from birth, adjusting to a new normal, and walking the path of becoming a mother. While there is rising awareness about post-partum depression, there is an absence of realistic information about the realities of new motherhood and new parenthood. While I don’t want to scare women, I do want them to arrive at this juncture understanding what a profound transition it is to become a mother on every level – physical, emotional, psychological, spiritual, relational and sexual. In some ways, it is impossible to understand until you pass through it yourself. However, we need to sit in circle with other women and tell the truth about all the major passages, from menarche to menopause, including the post-partum period that we pass through in our lifetimes. During especially the first 40 days after childbirth, a woman’s health, on all levels, is especially vulnerable. Her energy body and physical body are receptive to both healing and to dis-ease. Society encourages women to “get their bodies back.” Women are lauded for getting back into shape and into their life (the life they had before) as quickly as possible. All of the emphasis is on resisting, ignoring or completely overriding the inevitable changes of living into a new life stage. We won’t be the same woman we were plus a baby. We won’t be the same relationship we were, plus a baby. We are new. Our partnerships are new. In the age of “I can have it all,” many women do not understand that it is not only their social life and professional life that will change completely. All aspects of who we are change, and we don’t necessarily know it or feel it at the time, although many women do. Becoming a mother is a rite of passage.

And, on the whole, women feel completely unprepared. Most new moms say, “I had no idea. NOBODY told me.” While I, of course, acknowledge that some amount of post-partum depression is an actual women’s mental health issue, I believe that birth injury, birth trauma, nutritional deficiency, lack of support, and expectations of unrealistic self-sufficiency are all major contributors. If we respected women enough to build in this support to our communities as a rule, instead of an exception, we would see much less post-partum depression. Most women and families need help in crossing this threshold into parenthood. Incontinence, prolapse, loneliness, isolation, pain during sex, difficulty in breastfeeding can all make a person feel depressed and can awaken earlier traumas. But instead of anti-depressants, which are definitely necessary in some cases, women need birth story listeners, somatic therapist, pelvic floor physical therapists, and a cadre of women to attend to all the changes. Of course, it is difficult for most women to ask for help. In the fog of caring for a newborn, it is hard to think rationally and parse apart a problem. Doctors tell women that most symptoms are “normal,” even if they are nowhere near optimal. Caring for the baby supercedes most women’s concern for their own health. Therefore as a community we need to raise awareness of the needs of new mothers and new families.