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Mickey Sperlich, well-known midwife and childbirth advocate, speaks about post-traumatic stress disorder (PTSD) in sexual abuse survivors this week. Mickey shares with us her experiences with “survivor moms,” and provides hope that post-traumatic stress can become post-traumatic growth with a safe, healthy, fulfilling birth.

MA: Many women who experience sexual abuse suffer from post-traumatic stress disorder, or PTSD. Can you tell us about your experience with PTSD?

MS: I’m a semi-retired midwife. I had a home birth practice for 20 years, and my interest in working with what I call “survivor moms” really grew out of my practice. So, some very powerful experiences that I had with my clients caused me to realize that survivor moms were bringing particular issues to the whole childbearing process, and needed care and attention that I wasn’t necessarily educated to give them [at the time].

I can give you the example of working with a woman who was pregnant for the fourth time. I’d helped her with three babies prior to that, and they were all boy babies. Everything had been super smooth for her first three pregnancies. This time around, she intuitively sensed that she was carrying a girl. We ended up having an experience late in pregnancy where I was examining her, and she suddenly flashed back to being a little girl. I was no longer her supportive, loved midwife that she knew really well — I was her abusive mother. And, that was a really challenging experience, not only for her obviously, but for me too — to be cast in that role where it certainly wasn’t my intention. Thankfully, I had enough trust established with her that we really worked on this and what had happened. … What she had experienced, that re-experiencing or flashback, that’s one of the hallmark features of post-traumatic stress disorder — which I found out later, in the process of trying to educate myself about this. This happens quite frequently to women, so I just determined — I’m going to find out everything I can.

MA: Speaking of survivor moms, tell us a little bit about your book, “Survivor Moms: Women’s Stories of Birthing, Mothering and Healing After Sexual Abuse.”

MS: I started a survey project around the country where I began asking women, “How do you feel that your history as a survivor of sexual abuse has affected your pregnancy, or your birth, or the post-partum period, or how you feel about yourself as a mother?” I got hundreds of responses, and then I invited those women to write their story in a narrative form, and eventually published a book on that — which is the result of their stories. More than 80 women reported their life story to me within this context. … I was [then] fortunate to hook up with my co-author, Julia Seng, who is a certified nurse midwife, and got her Ph.D. looking at post-traumatic stress disorder and its affects on childbearing outcomes.

For more information on “Survivor Moms,” please visit Midwifery Today.

MA: How would a pregnant woman or her care provider recognize PTSD?

MS: One of the hallmark features would be the re-experiencing … it may be that they feel as if the trauma is happening all over again. A classic example during pregnancy might be if a woman has to have an internal examination for some reason, and in the midst of that, feeling as if she’s triggered back to a rape scenario. And even some of the terminology we use, like telling her to relax and all of that — it seems like a good thing for us to say, unless you consider the [possible] context. When was she told that before? So, some of the language we use can really be triggering. Women, when they’re pregnant, can [also] feel sort of invaded by the baby — out of control. One of the features of having been traumatized, especially sexually traumatized, is feeling like it [the situation] was out of your control. Being pregnant for some women is just a very wonderful, rosy situation, and for other women, they feel like: “Here’s my body — not under my control again.” That would be an example of the re-experiencing.

Then you also have the numbing — that’s another feature. So, feeling like you’re not there, like you’re not connected to what’s going on. Some women might report, “I don’t really feel pregnant,” or just feel really disconnected from their bodies. … Also, just anxiety, fear, anger, irritability — those things come along, as well.

MA: In the wake of PTSD, how can women empower themselves to move forward — specifically during pregnancy and birth?

MS: Something that I’ve found while practicing midwifery is that pregnancy is a wonderfully gestating transformative time — just in its very nature — so it actually is a really good time to work on your psychological issues, and to seek help. Many women reported to me in the narrative project that they saw a great opportunity to stop the cycle of abuse. They were like, “Oh my gosh, I’m going to be a mother. I know that I don’t want to be this kind of a mother — that’s real clear. I know what that looks like, so how can I envision how I do want to be?”

And they’re going to need a lot of support, so reaching out — that’s where maternity care providers can really be helpful, by modeling healthy relationships, listening to women — that’s key, being listened to. When you look at the data about who is resilient or not growing up in an atmosphere of abuse, a little girl or a little boy needs to have one adult in their life who they trust, and who they know really deeply cares about them and wouldn’t harm them. And it doesn’t have to be a parent. It can be a teacher, it could be a friend — it doesn’t matter, but we have to be able to connect in that way. And so, being able to connect in that way is one of the things that allows us to connect with the infant, to be able to attach with the infant.

MA: Is it actually possible to move beyond PTSD?

MS: Absolutely. There’s a lot of talk now about post-traumatic growth. One very cool thing is that many women have reported to me how utterly healing becoming a mother was. Especially for women who had been sexually abused, and that’s how they developed PTSD. To take this space that was formerly violated — a violated space — and to have this beautiful transformation of the baby coming through. Growing a baby, and then birthing that baby, and then having this precious life that you fall in love with — that that in and of itself was transformative, and healing, and fostered their growth — their post-traumatic growth in ways that they had never dreamed possible, actually. And that’s a wonderful opportunity we as midwives have, to foster that, to protect that space for the woman so she can have the kind of pregnancy and birth experience that would allow for something like that.

This interview, originally video-taped for Mindful Mama, was transcribed and re-purposed with permission from Mindful Mama.

Mickey Sperlich, a certified professional midwife with nearly 20 years of experience, helps women on the journey of pregnancy and birth. Mickey is the mother of two grown children, and has been married since 1980. She appreciates being a midwife and mother, and learning so much from the women and families she has served, and also from her own children. Mickey is recently retired from full-time midwifery, but continues to focus on women’s health issues. She currently manages various research projects that look at the effects of post-traumatic stress on childbearing at the University of Michigan’s Institute for Research on Women and Gender. Read more on Mickey’s blog, Survivor Moms Speak Out.

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