Someone asked me recently if I was a survivor

Why the answer to unseen trauma is not a better question, but better care.

We had been talking about my work, supporting survivors of sexual trauma through pregnancy and birth. She is someone who has spent years around women at their most vulnerable, so she was listening in that particular way people do when a subject sits close to the bone.

And at the end, she asked, "Are you a survivor?"

It caught me off guard. For a second, I sat with it. Not because the answer was complicated, but because the question itself did something. It turned the lens back on me. It asked me, without warning, to place myself on one side of a line, in front of another person, in a moment I had not chosen.

That single second told me almost everything I needed to know about why this work matters.

One question, and everything it carries

Consider how much was in my favour in that moment. It was a warm conversation between two people. There was no clinical gown, no waiting room, no stranger with a clipboard. Nothing was about to happen to my body. I have spent years building the language for precisely this kind of conversation. And still, the question landed somewhere I was not expecting.

Now imagine the same question asked of a woman mid-appointment. By someone she barely knows. While she is half-undressed, or frightened, or using all her energy to hold herself together. On a day that is already asking so much of her, in a moment she did not choose.

A question is never just a question. It carries a demand, an assumption, a spotlight. And in maternity care, we hand these questions to women at some of the most exposed moments of their lives.

What we ask, and what we miss

Maternity care is, in many ways, admirably thorough. When a woman books in, she is asked about her medical and family history. About previous pregnancies and births. About smoking and alcohol. Her mood is screened with a short set of standard questions. She is asked whether she feels safe at home, because enquiring about domestic abuse is now routine. Where relevant, female genital mutilation is recorded.

All of this is asked of every woman, as a matter of course. It is well intended, and much of it saves lives.

But there is one thing she is almost never asked about, and it may shape her experience of maternity care more than anything else on that list: a history of sexual trauma.

There is no routine enquiry for it. No standard question. In most services, it simply does not come up. We have built careful systems to detect the harm that is happening now, and left almost no room for the harm that quietly shapes how a woman experiences every moment of her care.

Why this is the gap that matters most

Around one in four women has experienced sexual violence. That is not a small group at the margins of a caseload. It is a quarter of the women a midwife meets, and most of them are moving through pregnancy and birth without anyone around them knowing what they carry.

Maternity care, by its very nature, is built around the things that can be hardest for a survivor. Examinations. Exposure. Being touched, often by strangers, often without much warning. The loss of control that comes with labour. Being told to lie still, to open up, to relax. For a woman whose body learned long ago that these things signalled danger, routine care can quietly reactivate the very experience it is meant to be nothing like.

And when her body responds to that, when she freezes, withdraws, refuses, or seems unable to cooperate, staff who do not have the full picture often read it as something else entirely. She becomes the anxious one, the difficult one, the non-compliant one. The care turns into a struggle. She leaves more frightened than she arrived. And nobody in the room understands why.

The tragedy is not only that this happens. It is that it happens invisibly, on both sides.

The temptation to fix it with a form

Once you see the gap, the instinct is obvious. Close it with a question. Add "Have you experienced sexual abuse?" to the booking form, tick the box, move on.

But that is the wrong fix, and it can do real harm.

Asked cold, on a form, by someone she has only just met, that question places the entire weight on the woman in a moment she did not choose. Most survivors will not answer it, and for many reasons. Some have never told anyone, and their silence is the very thing that has kept them safe for years. Some do not trust that it will be handled gently. But one of the quietest and most powerful reasons is this: she does not know what happens next.

If she says yes, then what? Who reads that box? Who does it get passed to? Will she have to explain herself again, to someone new, in a room she has not seen? Will it change how she is treated, how she is looked at, what is written about her? And, most importantly, is there anyone on the other side of that disclosure who is actually trained to catch her, to sit with what she has just shared and guide her through with care? Or has she simply handed over something enormous, only to be met with a silence of a different kind?

For most women, the honest answer is that they cannot be sure anyone is waiting there at all. And a disclosure made into a void is not safety. It is exposure. Faced with that uncertainty, saying nothing can feel like the safer choice, because at least silence is something she still controls.

The absence of disclosure has never meant the absence of impact. A woman does not stop being affected simply because no one has asked, and she does not owe anyone her history in order to be treated with care.

The better way is not a better question

The answer is not a sharper question or a longer form. It is a different kind of care.

It begins by assuming that survivors are already in the room, because they are, and working accordingly. That means responding to distress rather than waiting for words. It means offering control, explanation and choice to every woman as standard, not as a special accommodation reserved for those who happen to have disclosed something. It means recognising that when a woman freezes or pulls away, this may not be difficulty at all. It may be her body remembering.

And when it does come to asking, there is a way to open a door rather than demand that someone walk through it. A way to invite, gently, without asking a woman to name herself before she feels safe. This is a skill, and it can be taught, and it transforms how these conversations go.

When care is safe by default, a survivor does not have to disclose in order to be met with gentleness. The burden lifts off her and settles onto the way we work, which is exactly where it belongs.

You do not ask a woman to prove her pain to deserve safe care.

Where SAFER Birth comes in

This is the heart of what we teach. Our Foundational Training helps maternity teams understand trauma, recognise it in the room, learn how to ask in a way that opens a door rather than closing it, and change the small, everyday things that make care feel safe for survivors, whether or not she ever says a word.

Closing the gap starts with seeing it. And then with asking better.

If you lead or work as a professional with pregnant and birthing women and people, or you work in a maternity team, and this resonates, I would love to bring this training to you.

I write about women here because that is who I most often walk alongside, but this holds for everyone who gives birth. Trans and non-binary parents are survivors too, and they often meet even less safety in the system.