Transcript for
Trauma-informed perinatal care for people who have experienced sexual trauma
Vicki Mansfield (00:00): It’s a three-way dialogue in some ways. You’re allying and understanding and empathising with parents, in this instance, probably particularly mum. But you’re also holding within that dialogue conversation, what’s the baby experiencing and supporting mum to notice what’s happening for baby and to notice how pressures might be impacting on her ability to parent or mother in the way that she wants.
Narrator (00:28): Welcome to the Emerging Minds podcast.
Chris Dolman (00:33): Hello, everyone. My name is Chris Dolman and welcome to this Emerging Minds podcast. Today, I’m speaking with Vicki Mansfield, a social worker. And we’ll be speaking about one aspect of Vicki’s practice experience, and that is working with mothers who’ve experienced sexual trauma, who’ve been subjected to child sexual abuse or sexual assault, and we’ll be talking about their experiences of pregnancy and childbirth and some helpful ways of responding to women when working with them. So please be aware of your own emotional safety as you listen to this podcast.
(01:01): We’d like to acknowledge the many skills that practitioners have developed to take care of their own emotional wellbeing when working with children and families, as well as acknowledge their relationships with family and friends and colleagues and supervisors that really help sustain practitioners in this work. However, if at any point you find you are struggling, or if you need to seek other help, please call lifeline on 13 11 14, Beyond Blue on 1300 224 636, or SANE Australia on 1800 187 263.
(01:33): Vicki, thanks so much for joining us today. It’s lovely to be speaking with you about this important topic.
Vicki Mansfield (01:37): Thanks, Chris. Lovely to be here.
Chris Dolman (01:40): Thank you, yeah. I was wondering if you could begin just by saying something a bit about when we think about our work with mothers who have experienced sexual trauma, what are some of the challenges that you’ve heard from them that they do face during this pregnancy and birth and postnatal period?
Vicki Mansfield (01:55): I think for women who have experienced sexual trauma, then birth and pregnancy can bring that back to the forefront, even if they have had support previously around that. And for a couple of reasons, one is that becoming pregnant does involve a lot of bodily changes and certainly birth is a very physical aspect. So sometimes that can be a retriggering experience, but also I think because when you become pregnant, you start to think about parenting and you start to think about the experience of having a baby. And so that’s often a time where women will start to reflect on their own experiences. And so if they’ve had experiences that have been traumatic in their childhood, then that can come to the forefront in those reflections and can raise some concerns or distress sometimes.
Chris Dolman (02:49): When you say concerns, raise concerns about the safety of children, for example, that sort of thing?
Vicki Mansfield (02:55): It can be a mixture of keeping children safe, but also concern around their own wellbeing. And depends on where they are in their journey of healing, being able to feel well in themselves sometimes in terms of being able to parent in a way they want to parent.
Chris Dolman (03:16): Okay. So the concerns relate both to concerns about children’s safety perhaps, as well as how they can go about parenting their children.
Vicki Mansfield (03:25): And I think it also comes to the forefront, particularly after birth, that anxiety can increase or the fear of concern about their child’s wellbeing and their safety can present in a heightened vigilance. And so maybe not at first that they’re kind of making the connection that it’s linked to trauma. So yeah, it can be present sometimes and mums thinking that they’re just struggling or not really kind of making the connections. So it can be really overwhelming that distress and concern because they think something’s wrong with them as a mum or something’s wrong. They just can’t sleep or they’re feeling really wound up and not certain how to navigate it.
Chris Dolman (04:08): Right. And so actually, perhaps being interested in the link between those current experiences and the history of trauma and abuse in their life can be helpful and can relieve them of something. Do you think?
Vicki Mansfield (04:20): Yes. And so antenatally, often, it will be women seek support with sometimes directly, saying that this is of concern. And then that work is certainly around supporting them to make sense of how they’re feeling to explore and be curious about how they’re feeling about becoming a mum and also to work proactively with them to be able to manage their wellbeing. So looking at a multidisciplinary perspective and supporting them to develop a birth plan that can really attend to some of the fears and concerns that they may have, or that we may unpack as we work together. So initially, it’s certainly holding a safe space for them so that they’re not alone, that this is not something that they have to hold or have shame about because they think that can be really prominent sometimes.
Chris Dolman (05:17): What do you think we are risking by not attending to some of these things then?
Vicki Mansfield (05:21): I think what we risk and what happens if we aren’t able to support antenatally, is that in birth, women’s trauma will be retriggered. If the team’s not aware of that, then the interventions, any physical interventions can be really retriggering or even the birth process even of itself, even with the best of care can be retriggering, because the body’s sort of feeling out of control like the experience of trauma. And so if that occurs in birth, that means someone can disassociate in birth and also extreme panic and overwhelm. And so that can really influence their experience of birth and really influence their experience postnatally of connecting with their baby and enjoying that experience. So supporting them to have a plan that allows them to have some control and choice and for their health team to know what that is, can reduce the possibility or reduce the probability of re-traumatising.
Chris Dolman (06:26): So when working with a woman during pregnancy and as a worker, it becomes apparent that she has experienced sexual abuse or sexual assault. What is it that’s important in terms of how we are to go about supporting her during this time?
Vicki Mansfield (06:43): First of all, I think it’s really just giving them the space and the validation of how much courage it takes to make that disclosure. For some women, it’s the first time they’ve disclosed and that’s really significant. And so holding a safe space for them in that, and really then supporting to explore in that safe, sort of therapeutic space what’s that’s meaning for them in their current day to day life and experience of the pregnancy. If they require significant work support around their trauma, you might be getting them that particularly, but from my role, it was often around supporting them in that perinatal period. And so really focusing on how it might be impacting them day to day, because sometimes it is impacting them day to day and also impacting how they’re feeling about going into birth and giving them choices.
(07:40): For some women, their partners aren’t unaware of their history. And so step by step sort of talking through supporting that process. And if a partner, if they’re feeling that they want to share that, or how we can use a partner as a support in birth. And again, giving them choices around consent to share it with their health professionals and to be clear about reducing the number of interventions, limiting the number of people in a room and the permissions. I guess, spelling it out for the health practitioners. All of that in conversation antenatally gives the woman more control and choice and feels that there’s power, that there’s agency in that.
Chris Dolman (08:26): Thank you for that. So really a couple of things you’ve said there that stand out to me is really acknowledging, honouring the disclosure itself and what that might have taken for her to say that, and even why that might be important for her to be speaking about that. But then also getting, what you’ve been talking about, is getting clear understanding about what this might mean in terms of what she’s concerned about for the upcoming birth, and I guess even postnatal as well.
Vicki Mansfield (08:48): Postnatally, yeah. And I think also honouring how much courage it takes to make that disclosure, but often that’s motivated by, I want to be the best mum I can be, and I’m really fearful about things that might be occurring. And so really honouring that, that’s a protective stance and honouring that already they’re thinking about how they want to be as a mum.
Chris Dolman (09:14): Yeah, so the disclosure in fact is protective stance that they’re taking.
Vicki Mansfield (09:18): Yeah.
Chris Dolman (09:20): And then when we think a bit about the postnatal period, then as well and practitioner’s familiar because the woman has spoken about it, her own experiences of abuse and what this might have been concerned about during this period. Again, what is important from the practitioner’s perspective in terms of how they respond to that and work with that?
Vicki Mansfield (09:41): It means that postnatally, when it gets much busier with a brand new baby. So that’s a big transition for all parents. So having already established a relationship, it means that you have a better understanding of what supports might be needed and that you may proactively have started to consider some of those supports. But I think often postnatally, giving mother experience of being able to debrief about birth, so how it went and how she experienced that, giving them an opportunity to talk through that, make meaning of that. But also looking for the strengths that they’ve drawn on in that time. Because everybody experience some strength in birth. It doesn’t happen without strength and courage.
(10:29): And so postnatally then also, exploring with her how she’s feeling now in that space. Because I think sometimes if birth has been retriggering, you can still sometimes be experiencing high levels of distress or anxiety or sometimes intrusive thoughts around fear or safety. And so supporting the mother and her partner, I guess, to help reduce that distress. And if you’ve worked antenatally, you can draw on the resources that they already have. So draw on how they’ve managed in the past so that they are able to be present and able to experience that early days. And lots of reassurance about this is for all new parents, an experience that is new and that you’re learning on the run. And so reassuring and helping guide through some of the worries they might have.
Chris Dolman (11:30): And what if one of those worries is in relation to their relationship, their connection to the infant, and that they’re seeing that perhaps less than hopeful connection as a result perhaps of the abuse that they’ve experienced then. What ideas and practises support you to be responding in those circumstances?
Vicki Mansfield (11:51): Yeah. It’s then becomes around, you’re being both an ally to the parent, but you’re also becoming an advocate for the baby. So it’s supporting if there is concerns. Sometimes women definitely are fearful of that experience of, and will I be able to, or feel ambivalent or numbed? So you might feel numb because of the shutdown response of trauma. And so it’s really a step by step, very at their pace process of being able to validate that, but also in being able to acknowledge what the needs are of the baby, because it is very hands on and it is demanding in the beginnings in the first three to six months. And so also bringing in other supports, if needed, if mum is struggling. If there’s a partner or extended family, having those supports in place to help out. Having a plan to support them around their sleep deprivation, the practicalities.
(12:54): So yeah, really ensuring that they don’t feel alone in it and really reassuring that it’s not always instantaneous, that bond and connection. That, that really is a getting to know you process. And where there are things that are causing distress for them, slowly guiding some of those interactions and connections and noticing with them and just noticing the basics and helping. Sometimes babies are really grounding because they really do bring you back to the present moment, but reassuring and taking it step by step for them and really reassuring that they’re not failing. Because I think often women will feel like they’re failing or feel guilty or feel that they’re not good enough. And so being curious and noticing the exceptions to that story that might be playing quite loudly for them.
Chris Dolman (13:45): A couple of times, Vicki, you’ve mentioned about the partners of the women that we’re referring to.
Vicki Mansfield (13:51): Yeah.
Chris Dolman (13:51): I was just wondering about working with them as well and what are some important messages or ways of working with them that can best support the wellbeing of the infant and of course, the woman herself.
Vicki Mansfield (14:01): If mum’s consenting, we can meet partner antenatally because they think that is important to have those conversations. If mum’s consenting, we can have transparent conversations then. And we can really, in that birth plan, talk very much with, one, with dad’s understanding that process. And so providing some psychoeducation to them about what might occur or might not occur. Dads often, sometimes in birth feel quite helpless because you’re seeing someone in physical pain, someone you care for or partners and they want to be able to make it better, but can feel quite overwhelmed as well.
(14:44): So I think antenatally and in birth, doing some preparation around what to expect. Or if mum’s aware of what happens for her when she becomes distressed and overwhelmed, we’re providing support to the partner around him being able to again, have agency and look out for that and thinking about how he can support in that process. And also then postnatally, we’re certainly supporting them both about how to, I often say be the good tag team, but also acknowledging that that is a big transition for partners as well and providing that support or linking them to supports if necessary.
Chris Dolman (15:31): When you say linking them to supports if necessary, what would alert you to be really encouraging of that seeking additional support?
Vicki Mansfield (15:39): For a partner?
Chris Dolman (15:41): For a partner and for the woman themselves. When do you recommend that?
Vicki Mansfield (15:46): I always think earlier is better. There’s a lot of pressures around what we expect it to be, and there’s a lot of societal pressures about how to be as a mum. So lots of people will often struggle for a long time and they can often struggle and feel shame about reaching out and saying actually that this is, you know, “I’m scared or I’m ambivalent.” Or often people will come and say, “I’m feeling like I’m going crazy.” And so really encouraging parents to seek support from their GP if it’s in the postnatal period. Child and family nurses, excellent support because they have a really great appreciation. And even on the ward, maternity and midwives, really they can appreciate these struggles. And so getting that support early, I think is really significant in terms of how you experience those early months, where it’s pretty hectic for everybody.
Chris Dolman (16:45): You said before about women in the early stages of pregnancy, and again, you talk about women who’ve been subjected to sexual abuse or sexual assault, might feel as though that those experiences are somehow implicated and how they’re going in their parenting. That they’re kind of making sense of perhaps not feeling such a good parent because of those experiences. I guess I’m just wondering about some of the myths that might be capturing of mothers at these times and how to respond to those.
Vicki Mansfield (17:16): There are lots of myths about motherhood, I think. And I think one is that we will instantaneously know what to do and feel instantaneous attachment and bond, and really that places a lot of pressure on women. One of the other pressures that I think women often will experience is, particularly if you have experienced sexual trauma, is around breastfeeding as well. So for some women that can be triggering experience. And so that can compound this sense of there’s a lot of benefits from breastfeeding, but it can feel like a pressure. And so you can feel like a failure if you don’t breastfeed and you can get pressure from the system and from health professionals sometimes questioning.
(18:01): And so that can be really challenging for a woman to be trying to juggle with both of those pressures. So wanting to maybe breastfeed, but also feeling challenged around that. And I think also that increasingly in our society, we have an expectation that you have the baby, you go home and you’ve got just maybe a partner or sometimes you might be on your own and that you can make it all work. Whereas really there’s a lot of supports needed in those early times.
Chris Dolman (18:35): And so in relation to those myths, those understandings, how do you respond to those, or how do you even know that women might be being influenced by those for a start, but then how do you respond to those?
Vicki Mansfield (18:48): I think in terms of responding to them, I will often name some of them. So I will be fairly direct and name them as the myths of motherhood. But also I think if you are listening and validating and empathising with a woman and exploring her experiences, and if you start to unpack what sort of expectations they have of themselves, then you can make links to some of the social pressures. And I think those social pressures are more influential than ever in some ways, in terms of social media. I’ve heard it described as sort of a curated life. And so there’s a lot of images that we get exposed to and narratives that we get exposed to about how you should be as a mum. And the shoulds are one of the ones that I look out for.
(19:37): So you’ll hear in language, “I should do this, I should do that.” And so that’s always an invitation to explore because where there’s a should, there’s usually an expectation. And so examining, what is that expectation? Is it linked to a myth of motherhood or is it linked to expectations that someone else is placing or internal expectations that… Yeah, so unpacking the shoulds.
(20:00): Often clients will go away, on the lookout for the shoulds. And so they will notice, they’ll come back the next week and go, “Oh my God, I didn’t realise how many shoulds I have. I should do this. I should do that.” And lots of them around, “I should be this type of mother. I should be that type of mother.” And so it’s starting to build an awareness of some of the expectations and pressures they might be feeling in their own self talk and teasing out what might be a better fit for them in terms of their own values of parenting. And that takes time.
Chris Dolman (20:31): Earlier, you used the metaphor of ally and advocate. Would these conversations be part of that ally position with the mother and their partner as well?
Vicki Mansfield (20:42): Absolutely, yeah. And I think it’s understanding, you’re holding both parties. It’s a three-way dialogue in some ways. You’re allying and understanding and empathising with parents, in this instance, probably particularly mum. But you’re also holding within that dialogue conversation, what’s the baby experiencing and supporting mum to notice what’s happening for baby and to notice how pressures might be impacting on her ability to parent or mother in the way that she wants.
Chris Dolman (21:11): So that was what you mean by using that advocate metaphor in relation to the infant as well? Like inviting the mum and supporting her to be noticing something about the infant’s wellbeing and their relationship?
Vicki Mansfield (21:24): Yeah, absolutely. So to be an advocate where we’re holding the space for mum to be able for her to hold space for baby and empathise with baby. So it’s very hard to be empathic and connected with someone if we’re not well within ourselves.
(21:43): The image of a Babushka doll is a good one. If you can think of practitioner holding a mother, holding father, holding partners, and then holding baby, and there might be family linked in there as well. So it’s holding and bringing to life sometimes some of the wonderings about child and baby and infant. Because yeah, that is a learning, that’s a new role. So yeah, we can be an advocate in that way of drawing attention to and being curious with parents about that.
Chris Dolman (22:20): Vicki, I guess for some practitioners, these areas of conversation with women, with mothers, with would-be mothers can be quite challenging. What is it that’s really important to hold onto as we enter these conversations with women?
Vicki Mansfield (22:33): Yeah. I think it’s really important to bring compassion to the conversation, to acknowledge the courage it takes for women, and to validate that and be really empathic about… Sometimes certainly when we’re busy, in busy antenatal clinics, or in busy universal home visits, we can be doing screening questions and sometimes it can be one, it can be a difficult question to ask sometimes. It can be challenging for the practitioner, but also we are sort of doing it in a perfunctory way. And I think it’s really important that we bring compassion and empathy and honour how sensitive this is. That shame can be really silencing. And so for women to have the courage to speak up, then it’s really important that we bring compassion and that we give them choices. And so if a woman chooses to get support, that’s her choice. If a woman chooses to say no, that’s her choice. Because when people experience abuse, choice is taken away. And so it’s really important for practitioners to honour a woman’s choice and also then to offer supports if she is wanting support. And so, yeah, listening compassionately and offering options if appropriate.
Chris Dolman (23:59): Vicki, thanks so much for the conversation today, for sharing your practise insights and reflections. It’s been really valuable. So thank you so much.
Vicki Mansfield (24:07): Thanks, Chris. I’m glad we’ve been able to talk about such an important area.
Narrator (24:12): Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian government Department of Health under the National Support for Child and Youth Mental Health Program.