Having both a midwife and a doula in a homebirth is nice. My midwife mentor and one of the column writers for Midwifery Today, Marion Toepke McLean, cautioned us early on that when midwives do too much labor support, our judgment of what is going on may be clouded. Sometimes labor is very long but very normal. If you have been providing labor support the whole time, you might have the tendency to transport too soon.

A doula can be very helpful in splitting the load and can also assist the midwife as an extra pair of hands. I would caution doulas against taking over the father’s role as one of labor support, however. He needs to bond to the mom and his baby. We are in and out of clients’ lives and need to leave strong seeds of support planted. We must also be careful not to usurp the mom’s power. This is her birth.


Jan Tritten

Hi! Mickey Sperlich here, sitting in for Jan’s blog one more time. I was sharing with you about the forthcoming book “Survivor Moms: Women’s Stories of Birthing, Mothering and Healing after Sexual Abuse.” In addition to the chapters on “Life before Motherhood”, “Pregnancy”, and “Labor & Birth”, we’ve included chapters on “Postpartum & Breastfeeding”, “Mothering & Attachment”, and “Healing & Survivorship”. Like I mentioned before, what the survivor moms who contributed to this book had to say about their lives as mothers went far beyond the experience of pregnancy and birth. Indeed, as I’m sure many of you have either experienced or shared with your clients, getting the baby born, difficult as that can be sometimes, in the final analysis turns out to be the easy part! Until those babes come out with detailed, easy-to-follow instruction manuals, we are on our own when it comes to figuring out how to parent! For any woman, making the transition to motherhood can be complicated. For moms who are also survivors of sexual abuse, further challenges can present.

Our postpartum and breastfeeding chapter is devoted to helping survivor moms figure out their immediate and practical needs during the postpartum period. These needs include processing their birth, especially if it was experienced as traumatic or triggering, learning the signs and symptoms of postpartum depression, and figuring out how to get the practical, daily help they will need in place and working. We look at what supports are available for women, including peers, community, and therapy, and how a survivor mom can go about figuring out trustworthy individuals with which to share her burdens. The vast majority of the moms who contributed to this book had the desire to breastfeed, yet it was very challenging for many of the moms. We address the specific needs a survivor might have around breastfeeding, and offer expert advice for clinicians who assist moms.

Becoming attached to your child may seem like the most natural thing...unless you have had a disordered attachment yourself, and have had no good role modeling for what healthy relationships look like. In the Mothering & Attachment chapter, moms share their struggles with their relationships with their children, and their fears about keeping them safe from harm. They share the challenges of trying to be a good mother and at the same time create time and reserve energy to care for their own mental health. They worry about becoming abusers themselves (though most do not) and how to go about breaking the cycle of violence that has been passed down to them. And they report joyous moments which make motherhood a significant part of their healing journey.

The last chapter of our book is all about what survivors have to say about their healing journeys in general, and different aspects of survivorship. They talk about their relationships with family and friends, and therapies that have proved to be most helpful to them. They offer advice about what good therapy looks like. We share further advice from respected therapists who work with survivors about what to look for in a therapeutic relationship, and some common issues that arise for survivors who are in therapy. Women tell us about how being a volunteer, or an activist, or a caregiver to other women, is an important part of their healing journey. And above all, the women offer many words of encouragement to their sisters on the journey who are struggling, underscoring one of the most important messages that all survivors need to hear: YOU ARE NOT ALONE. Many others share your struggle. Many women have experienced the most horrible kinds of abuse have become caring and competent mothers who raise their children in loving, safe homes, and do everything they can to end the cycle of violence. With help, everything is possible.

I have been so honored to learn from these women’s stories, and I am so excited to FINALLY get a chance to share their stories with all of you. I hope that you will read this book and learn from these women’s lives. And I hope that you will find healing in your own life. Thank you so much, Jan, and thank you so much, everybody at Midwifery Today and Motherbaby Press, for facilitating this sharing. I look forward to seeing everyone at the Hope & Healing conference in May!
Best wishes,
Mickey Sperlich

I got a shock recently. My midwife friend told me that she explains to women that their doctor or midwife will palpate their belly in their prenatal visits to find the position of the baby, and the women look at her like she was from another planet. She said that she learned that doctors, especially, do not palpate bellies. This might be the sweetest part of prenatal care-communication with these little ones who often move under our hands. I guess losing hands-on care is one more danger of ultrasound. My friend also told me that the more technology and interventions used, the less hands-on care we receive. I hope midwives will never lose palpation skills. They provide beautiful communication with motherbaby.

Love, Jan

Hi! Mickey Sperlich here, sitting in for Jan again. I was telling you the story of how our book Survivor Moms: Women’s Stories of Birthing, Mothering and Healing came to be. As I said, there are 81 women whose stories form the basis for this book. Their stories are varied and rich, and span the time from being a little girl all the way to being a grandmother. There were hundreds of pages of material, and we couldn’t include each word, sadly. But we did our best to include as much of the material as we could. The stories are arranged along a woman’s lifespan as a mother, into chapters entitled “Life before Motherhood," “Pregnancy,” “Labor & Birth,” “Postpartum and Breastfeeding,” “Mothering & Attachment,” and “Healing and Survivorship.”

In each chapter, we have let the narratives lead in terms of what to highlight and discuss. And we have tried to weave in our clinical experience as midwives and to offer short, handy summaries of what the scientific literature has to say about the issues raised, and what resources are available to help women and their care providers. We have tried to do this in a democratic fashion, striving to make this a resource for BOTH women and the providers who care for them.

In the first chapter, women share the stories of what happened to them, and how they went about trying to get help around recovering from the trauma. Some of the women told someone what had happened to them soon after it happened, and were heard, and believed, and got the help they needed. But many women did not tell, or they told and were not heard or believed, or they told and were made to feel shame or blame as a result. It is important for other survivors to know that others share their situations around the difficulty of “telling” and getting help, and very important for midwives and doctors to know of these struggles with disclosure and how the establishment or breaking of trust early on in a girl’s life can influence her relationships later in life. Overall, this chapter shows us that understanding and honoring where we are in the broader context of the life-long journey of recovery is an important step in preparing for motherhood.

Pregnancy is an awesome time in a woman’s life, and for many women it can be quite wonderful. But for some survivors, the bodily experiences of being pregnant can trigger memories of abuse and can complicate things. The second chapter of our book highlights the specific ways that pregnancy can be triggering for survivors, and the many ways in which women sought help to deal with these triggers. Positive changes occurred for many of the women, including feelings of healing, surmounting, being helped and being blessed. Many survivors identified needs for help and assembled a team to help meet these needs: friends, a loving partner, a collaborative midwife or doctor, a therapist, a body-focused professional such as a massage therapist or yoga teacher, a childbirth educator or a doula. Others fell back on creative and sustaining inner resources: journaling, meditating and/or praying, releasing hard emotions with crying, talking to their baby and staying hopeful about being a loving, strong and protective mother.

The third chapter of our book is devoted to labor and birth. Women share about three main issues of care, control and coping: finding the right care for themselves, the importance of being “in control” of those things we CAN control, and figuring out positive coping strategies for dealing with care provider relationships, the experience of labor and birth and potential triggers, and dealing with pain. There are many potential triggers for a survivor when it comes to being in labor and giving birth; some are inherent in the process and some are related to the ways that midwives and doctors care for survivors, and how that care is perceived and experienced. One example is the challenge of undergoing an internal pelvic exam, and strategizing ways in which that can be accomplished with the least amount of discomfort and the highest level of respect. In this chapter, in addition to the narratives, we provide a "best practices" section from the perspective of a midwife, a doctor and a survivor mom. Just as in the pregnancy chapter, while many women report difficult challenges around labor and birth, still others report that giving birth in and of itself is very healing for many survivors, and knowing some best practices for how to facilitate such healing is one basic goal of this whole effort. I am happy to report that while we have been working on our book, another great resource has appeared that offers many specific suggestions for dealing with pregnancy, labor and birth-related triggers for survivor moms, and offers strategies to deal with them: When Survivors Give Birth: Understanding and Healing the Effects of Early Sexual Abuse on Childbearing Women (Classic Day 2004). I’m thrilled to report that the authors of that book, Penny Simkin and Phyllis Klaus, will be speaking, together with my co-author Julia Seng and myself, at the upcoming Midwifery Today conference here in Ann Arbor, May 7-10, entitled "Hope & Healing: Collaborating to bring Midwifery & Mental Health Care to Women who are Survivors of Sexual Abuse." I hope to meet many of you there! You can find out more about the conference at: www.Midwiferytoday.com/conferences/HopeHealing2008/.

Signing off for now, but in my next entry I want to talk about the last three chapters of "Survivor Moms." Until then, thanks for listening,
-Mickey Sperlich

Hi there! Jan asked me to contribute to her blog while she is traveling in South Africa. I am honored that Motherbaby Press is going to soon release our book, “Survivor Moms: Women’s stories of birthing, mothering, and healing after sexual abuse.” It is a collection of narratives of women survivors of sexual abuse, who speak about their mothering journey from the perspective of being a survivor.

My friend and colleague Julia Seng is a nurse-midwife and professor who studies posttraumatic stress and childbearing outcomes, who joined the project to help me contribute a midwifery perspective to the book, and to provide an overview of what we know scientifically about how trauma affects childbearing and mothering. The book is a “long labor” of love, a project I began 12 years ago while practicing in a busy homebirth practice. It grew out of a need for me to educate myself about the needs and challenges facing the clients I served who were survivors of sexual trauma. What I noticed back then was that often when an issue came up around sexual abuse I did not know where to turn to access resources for my clients. While there were good books available for survivors in general, like “The Courage to Heal” (the “bible” for survivors), often pregnancy, birth, and mothering were barely mentioned in these books.

As a midwife, it was intuitive to me that many aspects of reproduction and mothering would be very evocative for women who had survived sexual abuse, but there was not much in the literature to offer to women to help them on their healing journeys. I had come up with ad-hoc ways (as I am sure many of you have) of helping the women in my practice who identified as survivors, or who exhibited signs (in the absence of disclosure) that they were having issues related to sexual trauma. But I wanted to know more. Not all women who have a history of sexual trauma are going to have on-going issues that will be evident to their midwife or doctor, or need addressing. But sooner or later every midwife or doc who is paying attention will encounter a woman who is overtly having a hard time with some aspect of her maternity care, or breastfeeding, or bonding, or mothering, and they will recognize her difficulty as being attributable to issues related to abuse. Knowing this to be true, I wanted to ease the path for both survivors and their care providers by acknowledging these issues and learning first-hand from survivor moms what their needs are, and how to go about helping them to get those needs met.

So, just as I felt “called” to midwifery, I felt “called” to start the “Survivor Moms Speak Out” project. I developed a survey which asked basic questions of mothers who self-identified as survivors of sexual abuse, and circulated them across the country. I then invited the women who responded to the survey to write a narrative account of their journey as a survivor and a mother, and the 81 narratives I collected form the basis for our book. As a midwife, I expected much to be written about pregnancy and birth, and indeed, the women had a lot to say about that. But that was only one aspect of the story. Overall, what women had to say was that being a survivor affects their ENTIRE life, from being a little girl and forming relationships, through pregnancy, birth, postpartum, mothering and all the way to grandmothering. Their stories are rich accounts of the many challenges and triumphs women face as survivors and mothers, across the span of time. In my next entry I will highlight some of the themes they raise in their narratives.

Until then, thanks for listening,
Mickey Sperlich

The other day I took my young friend--whose birth I am helping with--to the birth center where she plans to have her baby. The midwife, while showing her the birth pool, stated that recent research show that women experience 70% less pain while birthing in water. I don't know if there is any way to really know that, but since how we think about birth can be so easily influenced, it might be a good thing to tell women. The battle is in the mind. Ina May tells pregnant women, "Don't listen to bad birth stories." We need our own uplifting sayings to counter what our culture has done to women's minds. Does anyone have especially nice counter birth culture words they use for empowering women?

Methicillin resistant staph aureus (MRSA) is another good reason to have your baby at home. It is rampant in hospitals. Our local newspaper reported recently that 90,000 Americans are sickened by this infection each year and almost 19,000 are killed by it. This is more people than are killed by AIDS in the US each year. Overall approximately 1.7 million Americans get other infections while hospitalized, with almost 100,000 dying. These are staggering statistics. The moral of the story is only go to the hospital if you have to--birth is not in itself a medical event. Complicated birth can be, but it should still be treated like the miracle that it is. Weigh the benefits against the risks and stay home. Hospitals have many more risks than just infection. Motherbaby are accustomed to their own germs within their household. This is just one benefit of homebirth.

Hi, I am trying really hard to understand all of this technology so I can blog with all of my birth friends. This is, of course, all to the point of trying to change birth ways for the better for mothers and babies and to make us better practitioners.