Julia is the co-author with Mickey Sperlich of Survivor Moms—Women’s Stories of Birthing, Mothering and Healing after Sexual Abuse from Motherbaby Press.

WHY I WROTE THIS BOOK: When I was a new labor and delivery nurse, I observed women in distress during internal examinations and in labor. It seemed to me that they were having the kinds of reactions to the intrusive, sometimes painful touch that someone who had been raped might have. Nobody I worked with seemed comfortable discussing these women’s apparent struggles. I supposed that made sense because talking about rape is hard.

Since I was not finding knowledgeable colleagues to inform me about what I was seeing and what I could do to help these laboring patients, I decided to read up on rape survivors. I read everything I could in the nursing literature written by Sexual Assault Nurse Examiners (SANEs) who are the forensic nurses who provide post-assault care and collect evidence. I read about what they called Rape Trauma Syndrome. The research on Rape Trauma Syndrome showed that many rape victims recovered within a few months of the assault. But, by implication, many also did not recover. I wondered what happened to them.

I next learned that rape is a significant cause of Posttraumatic Stress Disorder (PTSD) among women, along with other gender- and sexually-based forms of violence, such as intimate partner violence and childhood sexual abuse. PTSD affects both men and women and can occur in the aftermath of many types of traumatic experiences, from accidents to combat to torture. But it affects women at twice the rate of men. It also is chronic in about half of women who develop the disorder. A hallmark of PTSD is feeling like the trauma is happening all over again when something reminds or "triggers" the trauma survivor. I vaguely remembered learning about PTSD in my psych/mental health coursework. But nowhere had I learned that it had relevance for reproductive health nursing. It seemed to me that what I was seeing with patients could be posttraumatic stress reactions to aspects of labor or gynecologic examinations that reminded them of past sexual trauma.

Eventually I found a few articles in journals for birth professionals that discussed case histories or discussed literature from the fields of psychology and social work that made linkages between childhood sexual abuse history and women’s stressful reactions during labor. At that time none explicitly named the reaction as PTSD. Along the way I also found some professional role models who helped me develop ideas about how to respond therapeutically. But we were adapting these responses out of basic nursing skills informed by more sophisticated psychotherapy concepts. At the time, there were no research articles describing how PTSD might affect women as they went through pregnancy, birth, breastfeeding, and adapting to mothering. There was no evidence-base to guide gynecologic or maternity care practice.

While I was in my master’s degree program to become a midwife, I realized that I enjoyed conducting research very much and that I had a strong desire to fill in some of the gaps on this topic with research findings. I decided to shift my career from practicing midwifery to being an "academic midwife." I wanted to study PTSD-affected women’s experiences of childbearing and learn if they had worse outcomes than women who were not affected by this disorder. So I completed a doctoral degree in Women’s Health and a postdoctoral fellowship in outcomes research.

Just as I was finishing my schooling and starting my academic career, Mickey Sperlich asked me to work with her on this book. Eight years later, we are still collaborating, and I am constantly sustained, enriched, and blessed by her friendship.

It is my hope that the data and analyses I contribute in the field of women’s health are informative to women and their maternity care providers. I hope, eventually, they lead to changes that improve both the personal experience and the outcomes of childbearing for survivor moms. Meanwhile, it has been my privilege to have the task of bringing to the Survivor Moms book what research information there is from the fields of psychology, social work, psychiatry, obstetrics, midwifery, and nursing that can guide clinicians now and let each survivor mom know that she—for sure—is not the only one.