Broken Vases…

Last year I published a blog post about my thoughts on the Rotherham report, I received some very kind feedback but also some heart wrenching disclosures from people about their own experiences. One person telling me that I was the first person she had ever told about what she had endured. That blog post was written in anger and not even proof read, I just knew I needed to get it out of my head via my laptop before I would be afforded the luxury of sleep that night.

One conversation which inspired this follow up blog post was one about the way we health care professionals approach adults who have experienced childhood sexual abuse. I don’t mean how to talk to people about what happened with them in a therapeutic way, this is a specialism to be done by the suitably trained therapists, I am talking about considering it in everything we do on a day to day level.

What I am about to share is anecdotal in basis from conversations I have had with fellow survivors, both friends and strangers, there is no evidence base other than my own and their experiences to back up my words but following this advice can do no harm and may possibly do some good.

Around a year ago I became involved in a project which led to a peer reviewed publication in the British Journal of Midwifery, the article was about blended learning ie using service user experience to provide a real insight into perinatal mental health for student midwives. Another lady and I shared our experience of perinatal mental illness but through sharing this realised that we had both survived sexual abuse in our past. The focus of the time we spent with the student midwives was split between talking about mental illness and also the impact of historical sexual violence has on a woman during pregnancy and childbirth. We realised our response to our past during pregnancy and birth had been so similar and since then I have spoken to several other people who have told me their experiences which were very similar indeed.

So who is this blog aimed at? Nurses, midwives, doctors… anyone really who cares for people. NSPCC statistics show that 1 in 20 children will experience sexual abuse before they are 18, that’s more than one child in every class in every school to put it into context. 1 in 3 of those who experience abuse never tell an adult what has happened to them. All of those children who have been hurt grown up to be adults with a story to tell, a story they may never tell.

Whether you are a midwife performing intimate examinations knowing that you are not causing physical pain because it is a task you carry out daily so are confident to continue or a practice nurse who does smear tests so often and tells each woman ‘it may cause a bit of discomfort but it won’t hurt’ or even a ward nurse who inserts catheters following routine surgery or a mental health nurse restraining someone who is acutely unwell to give medication which you know is what that person needs then please always remember those statistics.

As I shared in my previous post I have healed and made peace with my childhood experiences however every three years when I am called for my cervical smear test, as I was last week, I see my name on the scrolling screen in my GP surgery and my actions become robotic. I am aware how important the screening is so I always attend but I know what to expect. I expect to feel traumatised.

I go behind the curtain and undress from the waist down, lie on the bed with a sheet for ‘dignity’ and close my eyes whilst the nurse carries out her task but the discomfort I feel is magnified because of where it is. My eyes are closed and I am a child again for those few seconds, as I re-dress I vaguely hear her telling me about results in the post in a couple of weeks then I rush out because I feel violated.

When I was expecting our daughter I made so many plans in my head which were never written in my birth plan, I planned for how I would feel if I had a boy, he could grow up to be an abuser, I planned for how the physical process of giving birth may generate flashbacks, I planned for how breastfeeding may feel like I was abusing my child as breasts are often viewed as sexual. I was honest and when asked about a history of abuse I answered honestly during my booking in appointment but this was never communicated to the midwives at the hospital where I was to give birth.

On occasions where I have spoken at conferences with midwives and obstetricians about perinatal mental health I have spoken to so many professionals about why nothing happened with my disclosure and the same themes have recurred; ‘the perpetrator is no longer around so baby is safe’, ‘well she managed to have sex to make the baby…’, and more generally a sense of embarrassment that they may be forced into a conversation which would leave them feeling uncomfortable. How can you perform physical examinations and yet be embarrassed talking about this?

I felt out of control and repeatedly traumatised by events during my pregnancy and childbirth experience even though I had planned in my head how I would cope, I wonder if some validation of how I was feeling may have comforted me.

I wonder also on all the occasions in my adult life when I have needed a procedure which left me feeling so vulnerable did any of those health care professionals pick up on my non verbal cues? Did anyone notice that my body language wasn’t just nervous in a usual way like a needle-phobic having a blood test but maybe saw the terror in my eyes?

One of the conversations I had last year when I published that blog post led to someone saying that they worried they may not feel confident to discuss abuse with their patient. I replied that I don’t think, in the majority of cases that a discussion need even take place, that awareness is often enough. A lovely lady I follow on twitter @ladybird_donna was one of those who contacted me when I tweeted asking for advice on what to put in this post, she said the first thing which came to mind was a smear test and has written a wonderfully insightful blog post which can be found here on this issue. She describes how when a practice nurse asked her why she hadn’t attended for her smear although she felt the nurse was kind she seemingly was completely oblivious to the body language being displayed in front of her which led to Donna having to say out loud that she had been abused which can be a very traumatic thing to do. I also understand what she means when she explains feeling a sense of shock that the nurse didn’t ‘just know’ as sometimes it’s easy to feel so broken that you assume it is evident to everyone. I have described myself on a previous blog post as like a vase which has been broken and glued back together, unless you know it was broken the cracks are very difficult to see but because that vase is on my fire place I see those cracks every time I look at it so assume that others do too.

As @ladybird_donna points out in her blog those who are at greatest risk or cervical cancer and should absolutely not miss when they are called for a smear are those women who first had sex at an early age therefore meaning that adult survivors of childhood abuse should be a priority group for targeting by the Department of Health. They are the very same group of women who find it hardest to attend, who want never to have to endure that test for fear of the flash backs it may generate.

In my role as a Mental Health nurse I am acutely aware that on the occasions I have to use restraint that the act of holding someone may generate memories and flashbacks of abuse they have experienced, I know my colleagues talk of having an appreciation of this too so this isn’t simply a heightened awareness due to my experiences. Talking about trauma is something we do with some regularity in mental health settings so I guess maybe this blog post is more aimed at those who care in a more medical setting, I implore you to consider the impact the tasks required by your role may have.

I was fortunate enough to receive a letter following my smear test telling me all was ok and that I need not attend again for another test for a further three years, I can’t imagine how I would have coped if that was not the case. For me the fear of cancer would likely have been less than the fear of flashbacks to the little girl who was hurt on every examination/treatment.

My husband and I are currently talking about maybe having another baby, which after my history of postnatal mental illness after our first daughter eight years ago is a huge decision but I will try to be more assertive in expressing my concerns if we are blessed with another pregnancy. I will make sure that when I answer ‘that’ question and ‘that’ box is ticked those aspects of my history are acknowledged for what they are and not ignored. If professionals are not willing to consider the response they they maybe ought not to ask the question, my history of abuse is not a box to be ticked for safeguarding purposed but a significant part of my life which ought to be considered in the same way a history of heart disease or diabetes would be explored.

So in conclusion if you are a health care professional, in whatever capacity, then please give consideration to how what you do on a daily basis may impact upon a person who has experienced sexual violence, talk to your teams and make sure your colleagues have an awareness too. In my ideal world the NMC would issue guidance to all clinicians to raise awareness but for now a ripple of people sharing this blog and starting a conversation will do. If 1 in 20 people we cared for had a limb missing or another life long condition then we would all have mandatory awareness training…