Survivor Moms
Women’s Stories of Birthing, Mothering
and Healing after Sexual Abuse

WHY I WROTE THIS BOOK: While practicing full-time as a community-based midwife, I had the opportunity to work with many women who were survivors, either of childhood sexual trauma, rape, or both. The experience of being their midwife, and witnessing their challenges and triumphs encouraged me to learn more about the effects of trauma on the body, and on the experience of childbearing specifically.

There were pivotal moments among my interactions with my clients that revealed to me how a history of abuse can impact childbearing and mothering. I will never forget early on in my practice being with a young woman who was fearfully facing her first pelvic exam. It took her an hour to be ready to undergo the exam. I remember the long waiting for her to be ready, with each passing moment feeling another measure of her entrenched terror, and at the same time her courage and determined spirit coming to the fore. I learned a lot from her about the importance of being patient and respectful of a woman's boundaries.

I also remember distinctly another client in advanced labor who, upon becoming fully dilated, expressed fear about pushing her baby out. She stated that she couldn't push her baby out because her baby could also be abused. Try as I did to reassure her that it would be okay, it was her truth of that moment, and she ultimately elected a cesarean section. I was not aware of her history as a survivor of sexual abuse, as this was before we began asking clients about this, and so I had missed the opportunity to work with her on this level before she was at the point of giving birth.

Learning about how memory is submerged and retrieved was facilitated for me by another client, while I was examining her cervix in labor. I was humbled by the face of my client momentarily panicking, believing that I was no longer her trusted midwife but rather the mother who had abused her as a child. She taught me the importance of being "in the moment" with a survivor; of thinking on one's feet about how best to comfort and reassure her that the past is in the past and that we are in the present and that she was in control of her own body. I have witnessed women having a hard time with pelvic exams, birth, and breastfeeding. I have witnessed women "checking-out" when confronted with hard labor or pushing. I have been challenged by the interpersonal dynamics of relationship with some of my survivor clients.

Just as I felt "called" to practice midwifery, I have felt "called" to shed light on issues that survivor moms face during the process of becoming a mother. That calling led me to begin the "Survivor Moms Speak Out" project. I developed a survey which asked basic questions about the ways in which survivors felt that their pregnancies, births, postpartum and mothering had been influenced by their history as survivors. The surveys were distributed at midwifery and birth-related conferences across the country, at doctors' and midwives' offices, and via a contact address on the Web. 1136 surveys were circulated over a two year period, 207 surveys were returned, and from this number 81 women completed a narrative or contributed a poem for the book Survivor Moms: Women's Stories of Birthing, Mothering, and Healing after Sexual Abuse.

During the survey and narrative collection phase of the project, I was very fortunate to meet my friend and collaborator Julia Seng, Ph.D., CNM. We met the day I attended her formal defense of her dissertation study of the correlations between women with a diagnosis of PTSD and pregnancy complications, and she signed on right away as a collaborator to this project. Her scientific expertise, co-authorship and amazing friendship have been essential to the completion of this project.

Having cared for survivors as midwives, we expected the narratives to focus on pregnancy and birth. Indeed, there are many accounts of how pregnancy and birth were affected, but overall the message of these stories is that abuse, and the reactions women have to abuse, affect the whole life of the mother, from thinking about having children all the way to being a grandmother, and that the effects are far-reaching and deeply felt.

The women in these stories are all at different places on their healing journeys. Some of the narrators are just beginning to examine the impacts of abuse on their lives; some are deep in the struggle of recovery. Others have been in recovery for a long while, and feel largely healed from the effects of abuse. They share their experiences across the lifespan; from before motherhood, to pregnancy and birth, postpartum, mothering, and the ongoing journey of healing and surviving.

It was not possible to print each of the narratives in their entirety. Instead, we excerpted the narratives and arranged them into chapters which follow the childbearing process and lifespan of a mother. We have included one or more narratives in its entirety at the start of each chapter, so that the reader can get a sense of the wholeness of the woman's experience and voice, and to allow us to have a 'springboard' for discussing the issues raised within each chapter. We interweave the narratives excerpts with our clinical perspectives as midwives, and contributions from other healthcare professionals. When we knew of scientific data relevant to an aspect of pregnancy, birth, or postpartum that could augment the narratives, we have provided a very brief summary and a reference. By separating out the literature findings and helpful resources alongside the text, we hoped to make such information easy to access for both caregivers seeking to enrich their knowledge of survivor issues and survivors seeking validation of the impact of abuse on women's lives.

If you are a survivor reading this book, we encourage you to check in with yourself on a regular basis, and limit your exposure if you become triggered by any aspect of the stories or text. This is probably not a book to read through in one sitting! If you are a health care provider or support person, you will benefit from hearing first-hand from survivors about the far-reaching impacts of abuse, looking to the state of the science, and reading clinical perspectives.

I am grateful to the women I have cared for as a midwife, and I am grateful to the women who have taken their time to share their story for this book project. These are women daring themselves to open their eyes: to be present to their pain; to admit their own failings but not let these transgressions paralyze their forward motion; to educate themselves; to foster courage to heal and to love; to let that love bring forth children; and to see that those children are raised with THEIR eyes opened and awakened. For when we are awake to our humanity, we are better positioned to protect ourselves and our loved ones. We are better equipped to continue our healing. We are able to look around and see that WE ARE NOT ALONE. We are better able to initiate lasting change, and, ultimately, we open ourselves more to the possibility of love and forgiveness for ourselves and others. I hope you the reader will be as deeply touched and inspired as I have been by their lives. May all of our eyes be opened.

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.