dear blog readers,
for the first time in the history of this blog, we have invited a guest blogger to comment. we were asked by a reader to offer specific suggestions that might be helpful for survivors of sexual assault/abuse who want to become more comfortable with medical exams, specifically with an abortion. i asked a colleague with more experience than i to write the response. she agreed to do so, but asked that i post a reminder to readers who themselves might be survivors. she asked that i mention that her response contains language about assault/abuse and that readers should view it only when it feels safe to do so. we hope that what you read here is helpful and we welcome all comments.
First of all, thank you so much for sharing your story. There are so many survivors of trauma and assault out there who will recognize themselves in your words. Please give yourself credit for having the courage to speak about this experience and to ask for help. Recognize that this is a sign that you are in a place of healing. It's not surprising to me that this pregnancy has brought up feelings from your previous experiences. Pregnancy--sometimes even more than other significant life changes—can stir stuff up. It's a bigger decision than which job to take, where to move, where to go to college. The decision about whether or not to welcome a pregnancy into your body or start a family can lead you to reflect on your sexuality, your family history and your relationships. It's very common for survivors, even those who have done lots of good work in counseling or therapy, to experience a surge of strong feelings when faced with a decision about motherhood. An unplanned pregnancy can make you feel that your body has done something outside of your control. For survivors of abuse or assault, this can be very distressing. Now that you've made the decision to end your pregnancy, it sounds like there is some preparation you'll need to do to work through these fears in order to have an experience that feels at best, empowering, or at the least, one that does not feel like a further violation.
EXPLORE HOW FAR YOU'VE COME
For many of us who are survivors
of trauma, abuse or assault, recovery is a process. We have periods
when we feel very 'over it' and then periods that feel more 'in it.'
Be gentle with yourself as you work through this and understand that
unexpected or huge life events—like an unexpected pregnancy--can sometimes
make us think or feel more about our past experiences than we
are used to. This doesn't feel pleasant for most survivors, but it doesn't
mean that all the progress and recovery that you've experienced thus
far has failed or was somehow fake. Take a moment to reflect on how
your life has changed since you began your healing. Try coming up with
a list of things that are different in your life now. Make this list
as long and comprehensive as you can. It could include things
like “I am not being abused today,” “I have fewer nightmares than
I did five years ago,” or “when I am intimate with my partner, I
think about my abuser less than I used to.” Give yourself lots of
credit for the work you've done and honor how far you have come.
EXPLORE WHAT IT IS ABOUT THIS THAT IS TRIGGERING
Some of the fears that come up for trauma survivors can be adapted to until you feel prepared to work through them. (A dark bedroom is scary to you, so you plug in a nightlight until you are ready to try sleeping without it.) Other times fears or triggering situations come up that interfere with daily life or must be confronted in order for necessary things to happen. In your case, there is a medical procedure that you are trying to find a way to get through in the most tolerable, safest way possible. One way to do this is to explore exactly what it is about this experience that is scary for you. It sounds like you've already started to interrogate your fears to explore this. Ask yourself exactly what is scary about the procedure. You've already mention that the IV was particularly distressing and that the doctor “between your legs” when you weren't aware or awake triggered fears for you.
Once you've named these fears specifically, explore how the abortion is different than the situation it's reminding you of—how is this different than when you were abused or assaulted? One answer might be that you were an child were abused and had to rely on the adults around you to keep you safe. Now you are an adult, capable of making your own mature decisions and better able to attend to your own mental and physical safety. Another answer might be that when you were assaulted, the perpetrator willfully ignored your consent. A physician is prohibited from performing a medical procedure without your full, informed consent. (You were allowed to leave the hospital when you decided that you did not consent to the IV, on the day you described. YOU were the one in control.) A third answer might be that your abuse/assault was intended to violently harm your body or make you feel powerless. A safe, legal, normal abortion with a skilled practitioner is not intended to make you feel powerless or to harm your body.
WHAT CAN YOU DO TO GET THROUGH
Once you've identified the things that are distressing for you, ask yourself, what can I do about this? If it is being sedated with IV medication that makes you feel this way, perhaps it is an option not to have IV sedation and just use a local anesthetic. Similarly, if the thought of being awake for the procedure was the thing that you found triggering, perhaps IV sedation would be one answer to help you make it through the procedure without feeling out of control.
If it is not an option to be
awake for the procedure, ask yourself how the abortion could be made
more tolerable for you. What would it be like for you to experience
safety, rather than fear, when sedated or during a gyne exam? What strategies
would you need to have in place?
Look to similar medical procedures to call upon your own natural coping
techniques. Have you had vaginal exams since your assaults? What do
you find makes them the most comfortable and tolerable for you? Have
you ever been under IV sedation before? What did you find comforting
or distressing about this experience? Come up with your own list of
things that might make the abortion more tolerable for you and then
share these with the staff at the clinic or hospital you are planning
on going to. Be frank and brave and share your story with them. Give
them a window into your experience and explain the reasons behind your
fears. Help them see the procedure from your perspective. Ask them if
they have any strategies that they think could help you. Finally,
if you feel that it is absolutely impossible that you'll receive sensitive
care at the hospital you were initially intending to go to, perhaps
you could look for another facility or clinic that has practitioners
who are more mindful of the needs of abuse/assault survivors. It may
be worth the extra time, research or expense if this can be a safe,
healing experience, rather than a traumatic one.
Plan ahead of time for how
you will care for yourself after the abortion, both physically and emotionally.
Call on your most supportive, trusted confidants and ask them to spend
some time just listening as you reflect on your story. You may find
that it's helpful to meet with a counselor a few times or enter back
into a therapeutic relationship to process what's happened. This abortion
can be an opportunity to experience something that has traditionally
very scary or triggering (being under sedation, having a vaginal exam)
in a different way. Perhaps this can be an opportunity to gain greater
self-knowledge and new strategies for dealing with your fears.
Even if, with all your preparation,
the day of your abortion does not go completely smoothly--if someone
is insensitive or you do wind up feeling triggered or fearful--be proud
of yourself for doing everything you possibly could do to take care
of your whole self. Plan a way to honor the hard work you have done.
Getting over phobias is difficult work and don't be harsh with yourself
if your fear doesn't vanish immediately. Honor how brave you have been.
Finally, thank you so much for your words. Telling your story on this website is a gift to other assault survivors who have struggled with these fears. It's my hope that they will gain hope and insight from your story and from our dialog. Your words are also a gift to the doctors, nurses and counselors who read this blog. For practitioners, they offer a window into the abortion experience that they may not have considered before and can help sensitize them to the needs of survivors. I hope you find this post useful and wish you strength, health, peace and hope in these next weeks.