(Re)activation of survival strategies during pregnancy and childbirth following experiences of childhood sexual abuse

ABSTRACT

Objectives

To explore the pregnancy and childbearing experiences of women-survivors of childhood sexual abuse [CSA]. We aimed to generate a theory explaining those experiences for this population (women), this phenomenon (pregnancy and childbirth), and this context (those who have survived CSA).

Method

Participants (N=6) were recruited to semi-structured interviews about their experiences of CSA and subsequent pregnancy and childbirth. Data saturated early, and were analysed using Grounded Theory (appropriate to cross-disciplinary health research). Coding was inductive and iterative, to ensure rigour and achieve thematic saturation.

Results

Open and focused coding led to the generation of super-categories, which in-turn were collapsed into three distinct, but related themes. These themes were: Chronicity of Childhood (Sexual) Abuse; Pregnancy and Childbirth as Paradoxically (Un)safe Experiences; Enduring Nature of Survival Strategies. The relationship between these themes was explained as the theory of: (Re)activation of Survival Strategies during Pregnancy and Childbirth following Experiences of Childhood Sexual Abuse.

Conclusion

Pregnancy and childbirth can be triggering for women-survivors of CSA. Survival strategies learnt during experiences of CSA can be (re)activated as a way of not only coping, but surviving (the sometimes unconsented) procedures, such as monitoring and physical examinations, as well as the feelings of lack of control and bodily agency.

KEYWORDS:

• Childhood sexual abuse
• women’s mental health
• birth trauma
• bodily agency
• childbirth
• maternity care

Acknowledgments

We would like to thank all the women who took part in this study. Sharing your experiences has not only made this research possible, but has allowed us to call for positive changes in maternity care settings.

Authors’ contributions

CR conceptualised the study with SAS and YR. SAS and CR prepared documents required for ethical approval. CR and SAS recruited participants. CR collected all data and led on data analysis and interpretation with SAS. CR and SAS led on writing of manuscript with contribution from EM and YR. All authors read and approved final draft of manuscript.

Consent to participate

All participants provided fully informed consent before interviews commenced.

Consent for publication

All consenting participants also consented for anonymised data to be used in future publications.

Disclosure statement

Sergio A. Silverio (King’s College London) is supported by the National Institute for Health Research Applied Research Collaboration South London [NIHR ARC South London] at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Declarations

Ethics approval

Ethical approvals were sought and granted by the UCL Research Ethics Committee (project ID: 14915/001).

Availability of data and material

Given the sensitive nature of the data produced by this study, the interview transcripts will not be made publicly accessible.