12/20/2025
I discovered this book not in a bookstore, but clutched in the steady hands of a seasoned midwife after I, as a new doula, witnessed a client dissociate completely during a routine cervical check. The woman’s body was present in the bed, but her eyes had retreated to a place I could not reach. The midwife whispered the title to me, and I understood it was a key to a locked room I had just glimpsed. Penny Simkin and Phyllis Klaus have written what is arguably the most essential, compassionate, and clinically vital text for anyone supporting a childbearing person with a history of sexual abuse or trauma. This is not a self-help book for survivors themselves (though many find it profoundly validating), but rather an indispensable manual for the caregivers—midwives, doulas, obstetricians, nurses, therapists, and partners—who walk alongside them. It illuminates the invisible battlefield where past violation and the profound, physical vulnerability of pregnancy, birth, and postpartum converge.
The authors, a pioneering physical therapist and a renowned psychotherapist, merge decades of frontline experience with deep empathy and unflinching clarity. They explain, without jargon, how the very processes of conception, prenatal care, labor, and breastfeeding can act as powerful triggers, awakening somatic memories and psychological defenses. The book provides concrete, practical tools for creating safety: how to phrase questions about abuse history, how to tailor physical exams, how to maintain a survivor’s sense of control and dignity during procedures, and how to recognize signs of trauma activation (like dissociation, extreme panic, or sudden withdrawal). Reading this book fundamentally changed my practice. It taught me that “informed consent” for a survivor is not a legal formality but a continuous, sacred dialogue. It shifted my goal from just a “healthy baby” to a psychologically intact mother. This book gave me the language and the protocols to help transform a potentially re-traumatizing medical event into an opportunity for profound healing and reclamation of bodily autonomy.
Ten Foundational Principles for Trauma-Informed Maternity Care
1. Childbirth is a Neurological Minefield for Survivors
The sensations of labor (pressure, pe*******on, loss of control) and common procedures (vaginal exams, being strapped to monitors, bright lights) can mirror the physiology and helplessness of abuse, triggering a primal trauma response that has nothing to do with logical thought.
2. The Body Remembers What the Mind Forgets
Trauma is stored somatically. A survivor may not consciously recall abuse, but her body may react violently to stirrups, specific touch, or certain positions. Caregivers must learn to read the body’s language of distress—the flinch, the freeze, the sudden rigidity—as clearly as a fetal heart monitor.
3. “Control” is the Antidote to “Helplessness”
The core therapeutic intervention is to restore the survivor’s sense of agency. This means offering real choices at every step (“Would you like to insert the speculum yourself?”), explaining procedures before and during the act, and honoring a “no” or “stop” instantly and without question.
4. The Caregiver’s Presence is Part of the Treatment
Consistency, predictability, and non-judgmental presence from a trusted caregiver can provide a “corrective emotional experience.” Being seen, believed, and protected in this vulnerable state can actively challenge a survivor’s internalized belief that the world is unsafe and that she is powerless.
5. Dissociation is a Common Survival Tactic, Not Non-Compliance
A survivor “checking out” during care is not being uncooperative; she is deploying a brilliant, ancient psychological defense to survive an unbearable situation. Recognizing dissociation and gently helping her re-ground (e.g., through eye contact, calling her name, offering a cold cloth) is a critical skill.
6. Prenatal Care is the Foundation for a Safer Birth
Building trust and creating a detailed, individualized birth plan with the survivor—addressing potential triggers and specifying preferences for every stage—is preventative medicine. This collaborative planning process itself can be empowering.
7. Language is a Scalpel or a Balm
Every word matters. Replacing institutional language (“We’re going to do your exam now”) with empowering, collaborative language (“I’d like to check how your baby is descending, with your permission. Would now be a good time?”) can make the difference between re-traumatization and feeling respected.
8. Partners Need Guidance, Not Just Information
Partners often feel helpless and confused by reactions they don’t understand. The book provides crucial guidance for partners on how to be an anchor—how to advocate, how to recognize distress signals, and how to provide physical and emotional support without unintentionally triggering.
9. Healing is Possible Through the Birth Process
While fraught with triggers, birth also presents a unique opportunity for healing. A positive, empowering birth experience where a survivor feels safe, in control, and supported can be a powerful act of reclaiming her body and rewriting a narrative of violation into one of strength and sovereignty.
10. This Knowledge is a Standard of Care, Not a Specialty
Given the staggering prevalence of sexual abuse, the authors argue that trauma-informed care should not be a niche skill but a fundamental competency for every maternity care provider. Assuming every patient could be a survivor creates a baseline of respect, consent, and safety that benefits all.
When Survivors Give Birth is a landmark, life-changing, and morally necessary book. It is clinical wisdom infused with profound humanity. Penny Simkin and Phyllis Klaus have provided the missing curriculum for compassionate maternity care. This book is required reading for anyone who touches the life of a childbearing person. It equips caregivers to do no further harm and, with immense skill and heart, to actively participate in the profound healing that is possible when birth is handled with true, trauma-informed grace. It is quite simply one of the most important books ever written in the field of maternal health.
BOOK: https://amzn.to/4pC9kK0
