ORI GIN AL PA PER

Sexual Trauma and Pregnancy: A QualitativeExploration of Women’s Dual Life Experience

Kami L. Schwerdtfeger Æ Karen S. Wampler

Published online: 22 January 2009� Springer Science+Business Media, LLC 2009

Abstract Using a qualitative methodology, we investigated the possible connection

between pregnant females’ past sexual trauma experiences and current experiences of

pregnancy. Semi-structured interviews were conducted during the third trimester of

pregnancy with ten expectant mothers with self-reported histories of sexual trauma. Par-

ticipants were asked to describe their past sexual trauma experience, current maternity

experience, and any relationship or connection between these life experiences. Four

dominant categories emerged: (1) Negative consequences of sexual trauma, (2) Becoming

a survivor, (3) Pregnancy: A new beginning beyond sexual trauma, and (4) the Integration

of sexual trauma and motherhood. In addition, subsequent themes and sub-themes that

emerged as a part of these categories are reported and discussed. Participants’ descriptions

offer clinical insight into both the maladaptive and adaptive dynamics that bi-directionally

interplay between women’s dual life experiences of sexual trauma and pregnancy.

Keywords Sexual trauma � Pregnancy � Posttraumatic growth and resilience �Women’s mental health

Introduction

When trauma impacts the lives of women it is often connected to elements of gender. As a

central part of women’s reproductive lifecycle, the pregnancy experience marks a unique

life phase that is intimately connected to women’s mental health and general wellness.

Trauma represents a specific life event that has been targeted within previous studies as

a specific risk factor likely to have a negative impact on women’s reproductive health

K. L. Schwerdtfeger (&)Human Development and Family Science, Oklahoma State University,233 HES, Stillwater, OK 74078, USAe-mail: kami.schwerdtfeger@okstate.edu

K. S. WamplerFamily and Child Ecology, Michigan State University, 7 Human Ecology,East Lansing, MI 48824, USA

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Contemp Fam Ther (2009) 31:100–122DOI 10.1007/s10591-009-9083-9

(Beck 2001; Ross et al. 2004). Research has revealed both negative physical and psy-

chological reproductive outcomes associated with women’s previous trauma exposure.

The association between trauma exposure and women’s reproductive lifecycle may be

particularly relevant during the pregnancy period for sexual trauma survivors. In recent

clinical and research literature a question has been raised regarding whether women with

sexual trauma histories confront unique issues during the pregnancy period that may

impact their mental and/or physical health (Robertson et al. 2004). Additionally, although

current thought in the field seems to suggest that trauma likely places women at higher risk

of developing various mental health symptoms during the prenatal period and/or after the

birth of their baby, little attention has been given to the possible role that pregnancy may

play in coping and healing from previous sexual trauma experiences. The current study

focused specifically on examining the dual impact of sexual trauma and pregnancy in the

lives of pregnant female sexual trauma survivors. A qualitative approach was used in an

attempt to understand the lived experiences of expectant mothers with past sexual trauma

histories.

Sexual Trauma

Sexual traumas, including sexual molestation, incest, sexual assault, rape, and sexual

harassment, comprise a group of traumas that are uniquely associated with gender and are

most commonly experienced by women (Kessler et al. 1995). Although estimates of the

occurrence of sexual traumas vary, studies suggest that lifetime estimates among women

range from 7 to 17% for sexual assault and from 3 to 15% for rape (Acierno, Kilpatrick and

Resnick 1999). Estimates for rates of child sexual abuse are the highest of the sexual

traumas reported, with up to 40% of women reporting this experience (Lev-Wiesel and

Daphna-Tekoa 2007).

Sexual trauma occurs within the context of an interpersonal relationship and often

involves deliberate threat or injury, which distinguishes it from traumas that are non-

personal in nature (i.e., natural disasters, accidents). Interpersonal traumas are more likely

than other types of traumas to result in severe psychological symptoms (Breslau et al.

1998; Green 1998; Schwerdtfeger and Nelson Goff 2007). Studies have found sexual

traumatization to be associated with multiple psychological problems, including post-

traumatic stress disorder (PTSD), general anxiety disorders, depression, and personality

disorders (Tyler 2002).

Sexual Trauma and Pregnancy

Sexual traumas represent a specific category of interpersonal traumatization that may have

a unique impact on pregnancy and pregnancy outcomes. As noted, sexual victimization has

been associated with negative psychological, emotional, and behavioral outcomes. Preg-

nant women who have been sexually abused have been shown to manifest more PTSD

symptoms than pregnant women who experienced other types of trauma or who had not

experienced trauma (Lev-Wiesel and Daphna-Tekoa 2007). Seng et al. (2004) found that

while PTSD symptoms and features have an impact on both pregnancy and labor and

delivery experiences, they also noted that participants represented a wide range of variance

in the extent to which PTSD symptoms and features presented during the pregnancy

period. Although some women in the study found it difficult to tolerate the bodily

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sensations associated with pregnancy, other women described the same bodily changes and

sensations as rewarding. Similarly, from a biological perspective, studies suggest that

elevations in hormone levels during pregnancy may diminish the expression of selected

symptoms of PTSD. For example, Smith et al. (2006) found that pregnant women who had

experienced a trauma reported significantly less re-experiencing of symptoms associated

with PTSD when compared to nonpregnant women with a trauma history. They suggest

that these findings may possibly be associated with the hormones progesterone and glu-

cocorticoids, which have been associated with blunted memory and diminished anxiety and

are found at heightened levels during pregnancy.

Current research findings have led some to identify the period just before and after birth,

known as the perinatal period, as a particularly vulnerable time in a woman’s life during

which psychological problems may arise (Eberhard et al. 2002; Ross et al. 2004). Recog-

nizing the widespread impact trauma may have on survivors, it is not surprising that trauma

exposure and PTSD symptoms have been identified as a specific risk factor for negative

psychological and physical outcomes among expectant mothers (Robertson et al. 2004). The

experience of stress or trauma prior to pregnancy may impact a woman’s transition to the

maternal role by compromising a woman’s abilities to successfully accomplish the devel-

opmental tasks suggested by Rubin (1975) and Mercer (1986, 2004). With much of the

research on pregnancy exploring such negative experiences or outcomes as perinatal mood

disorders, a focus on pathology and negativity seems to neglect the range of experiences

possible, including posttraumatic growth that women may evidence during pregnancy.

Posttraumatic Growth

Despite the strong focus on PTSD within trauma research, positive adaptation and changes

following trauma also have been noted (Linley and Joseph 2004). The terms ‘‘stress-related

growth’’ (Park et al. 1996), ‘‘thriving’’ (O’Leary and Ickovics 1995), ‘‘adversarial growth’’

(Linley and Joseph 2004), and ‘‘posttraumatic growth’’ (Tedeschi and Calhoun 1996) have

all been used to describe the phenomenon of individuals overcoming trauma with

improved psychological, cognitive, and emotional functioning (Tedeschi and Calhoun

1996). More specifically, positive changes associated with posttraumatic growth include

improved relationships, a greater appreciation for life, a greater sense of personal strength,

and spiritual development (Tedeschi and Calhoun 1996). Such positive changes following

trauma have been documented in case studies, conceptual writings, and a growing body of

research, suggesting that in addition to negative changes, positive adaptations also may

follow exposure to various traumas (Linley and Joseph 2004). Among other traumatic

events, research studies have documented posttraumatic growth following such sexual

traumas as rape (Burt and Katz 1987), incest (Draucker 1992), sexual assault in adulthood

(Frazier et al. 2001), and sexual abuse during childhood (McMillen et al. 1995).

Posttraumatic growth frequently has been seen as the antithesis of PTSD, suggesting

that higher levels of posttraumatic growth would be associated with lower levels of PTSD.

However, as indicated in the recent reviews by Linley and Joseph (2004) and Tedeschi and

Calhoun (2004), inconsistent associations between distress and growth have been found.

Although a longitudinal study of 171 adult female sexual assault survivors (Frazier et al.

2001) found a negative relationship, with higher levels of growth associated with lower

levels of distress, other studies have found no reliable relationship between the two trauma

responses (Cordova et al. 2001; Powell et al. 2003). These findings offer support for

Tedeschi and Calhoun’s (1995) model of posttraumatic growth, which conceptualizes

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distress and growth as separate dimensions that can coexist in individual trauma survivors.

The experience of growth does not necessarily put an end to distress following a traumatic

event, and the experience of distress does not necessarily prevent growth (Calhoun and

Tedeschi 1998; Tedeschi and Calhoun 2004). In fact, Tedeschi and Calhoun (2004) suggest

that distress may in fact promote the continuation of the cognitive processes associated

with growth. Indeed, research on posttraumatic growth has significant implications for

clinical practice by guiding the development of interventions that focus on promoting

adaptive coping, resiliency, and growth following trauma.

Aim of Present Study

A review of the research offers support for the idea that past sexual trauma can play a

significant role in expectant mothers’ maternity experiences and pregnancy outcomes.

Although research provides support that sexual trauma may serve as a negative risk factor

for perinatal mood disorders and negative pregnancy outcomes, few studies have examined

how past sexual trauma may impact an expectant mother’s experience and view of the

maternity period in a manner that leaves room for positive outcomes. While researchers

have begun to examine the possible impact of trauma on pregnancy, studies have failed

notably in exploring the impact pregnancy may have on a woman’s adaptation to or

experience of past trauma. Although this conceptualization of the bi-directional relation-

ship between sexual trauma and pregnancy makes sense, few studies exist that support the

rationale that pregnancy can function as a time of healing following a traumatic experi-

ence. There is a need for research that allows participants dealing with the complex

interactions of a sexual trauma and pregnancy to share their stories, thus providing a

foundation for an inductive theory that can inform and direct future research. The findings

of this study provide information contributing to a broader understanding of the maternity

experience through the lens of sexual trauma.

The purpose of the current study was to explore and understand the lived experience of

pregnant women who have self-reported histories of sexual trauma. The focus was on

understanding the possible bi-directional relationship between sexual trauma exposure and

subsequent pregnancy experiences by making space for both positive and negative ele-

ments and stories to emerge. Using a descriptive phenomenological approach, we sought to

provide essential information that can contribute to the broader understanding of the

maternity experience through the lens of sexual trauma.

Methods

Qualitative Methodology

In designing and conducting the current study, a primary concern was the safety of par-

ticipants. Given the sensitive nature of trauma-focused research, which often involves

asking participants about difficult or traumatic experiences, and the focus on a special

population considered vulnerable, the issue of participant risk and safety was of critical

importance (see Schwerdtfeger and Nelson Goff 2008). A two-phase research procedure

approved by the University Institutional Review Board was employed in an effort to

identify possible participants in a manner that maximized autonomy and freedom to

decline participation.

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Initially, a broad demographic questionnaire (involving the collection of data from 109

pregnant females) was used to recruit potential participants and provide an overview of the

past trauma and current pregnancy experiences of expectant mothers. In addition to basic

demographic data, the questionnaire also included the Traumatic events questionnaire

(TEQ; Vrana and Lauterbach 1994). The TEQ assesses experiences with nine specific

types of traumatic events (i.e., accidents, natural disasters, crime, child abuse, rape, adult

abusive experiences, witnessing the death/mutilation of someone, being in a dangerous/life

threatening situation, receiving news of the unexpected or sudden death of a loved one)

reported in the DSM-III-R (American Psychiatric Association [APA] 1987) and the

empirical literature as having the potential to elicit post-traumatic stress symptoms. In

addition, two residual categories are included, allowing respondents to report any other

traumatic event not listed and other events that they considered to have been traumatic. For

the purpose of the current study, the demographic questionnaire was used as a springboard

for recruitment of pregnant females who indicated a specific sexual trauma history and a

willingness to be contacted to participate in a qualitative interview.

Potential participants were contacted by telephone and an additional screening was

performed to assess whether the individual met the selection criteria. Recruited participants

were reminded that the study included a number of questions about their past life expe-

riences, and that the qualitative interviews were specifically focused on previous sexually

traumatic events. General information about confidentiality and participants’ rights to

refuse participation or stop the study procedures at any time were discussed and recruited

participants were encouaraged to ask any questions they might have prior to scheduling the

study interview. Interviews with participants were then scheduled at mutually agreed upon

times and locations.

After reviewing and completing the informed consent form, participants completed,

one-on-one, semi-structured, open-ended individual interviews in which participants’

experience of sexual trauma and pregnancy were assessed. Interviews ranged from 60 to

90 min in length and all were conducted and analyzed by the first author. Each interview

began with a ‘‘life-line exercise’’ adapted from a therapeutic technique outlined in KID-

NET (see Schauer et al. 2003 for a complete description of the lifeline technique), a child-

friendly exposure treatment for children and adolescents with PTSD that also can be used

with adults. For the current study, the lifeline exercise was adapted and utilized in an effort

to quickly assess each participant’s personal trauma history. Participants were invited to

share as much or as little as they felt comfortable about each event marked. It should be

noted that while no participants expressed or illustrated overwhelming emotions or dis-

tress, each participant was monitored for distress or discomfort throughout the interview,

and several procedures were outlined as additional assurances of participant safety and

protection prior to the initiation of the study.

Following the completion of the lifeline, the open-ended interview continued with 23

questions and focused on the participant’s experience of pregnancy, (e.g., How did you feel

when you found out you were pregnant? How has your pregnancy most affected you

personally? Do you know the gender of the baby? Do you feel you would be experiencing

the pregnancy differently if the baby was of the opposite gender? What impact, if any, has

your pregnancy had on you as a woman?); the participant’s sexual trauma experience (e.g.,

How has that experience most affected you personally? Describe how the experience had

the most negative effect on you. Describe any positive outcomes or anything positive that

you gained from that experience. What impact has your sexual trauma had on you as a

woman?); the possible connections between current pregnancy and past sexual trauma

(e.g., Tell me about the issues related to your [sexual trauma] that have come up in your

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pregnancy, if any. Has the [sexual trauma] had any negative effect on your pregnancy

experience? Have there been any positive effects that the [sexual trauma] has had on your

pregnancy experience? If you would not have experienced the [sexual trauma], how do you

think your pregnancy experience would be different now? Has your pregnancy impacted

your past sexual trauma experience?); and the participant’s definition and process of

becoming a ‘‘mother’’ (e.g., What does the word/term mother mean to you? What does

mother mean to you? Do you feel like or consider yourself a mother? If so, when and what

was the first experience of feeling like a mother? If not, do you think you will begin

experiencing yourself as a mother?)

Following the interview, participants were orally debriefed. Specific attention was given

to clearly explaining the nature of the research and ascertaining the participant’s reaction to

the process. All participants indicated normal mood and distress levels, and the session was

ended once the participant had been provided with a copy of the informed consent form, an

informative handout outlining common symptoms related to trauma experiences, contact

information for local mental health service providers, and verification that they had been

presented with and had read a formal debriefing statement.

Participants

In order to provide an intensive study of key informants, the researcher attempted to obtain

a small sample of approximately 12 pregnant females with a self-reported history of sexual

trauma. Participants were from a volunteer sample of 109 females who completed the

initial demographic questionnaire. To meet criteria for participation in the initial demo-

graphic questionnaire women had to be 18 years of age or older, currently in the first,

second, or third trimester of pregnancy, under the prenatal care of a physician, and not

currently experiencing a high risk pregnancy. From the women who completed the

questionnaire, 40 (36.7%) indicated willingness to participate in a follow-up interview and

provided contact information.

Of the 40 women who indicated willingness, 16 (14.7%) also met criteria for partici-

pation by reporting a previous sexual interpersonal trauma experience on the TEQ (Vrana

and Lauterbach 1994), which was completed as part of the initial demographic question-

naire. Due to unsuccessful attempts to contact 3 women, interviews were scheduled with

the remaining 13 women who agreed to participate. Of the 13 women, two participants did

not show up at the scheduled time and place for the interview, and were unable to be

contacted. One other participant who scheduled an initial interview was unable to complete

the interview due to physical complications resulting in a high-risk pregnancy and thus

excluding her from the sample. Of the 10 participants, 4 were originally recruited through

hospital childbirthing classes, 4 through nonprofit pregnancy center parenting/prenatal

classes, and 2 through the community health center.

Participants ranged from 18 to 34 weeks in their pregnancies (7 third trimester, 3 second

trimester). Half of the participants (n = 5) reported that the current pregnancy was their

first pregnancy; however, only two participants had previous full term pregnancy and

delivery experiences. Six participants reported that the current pregnancy was unplanned;

four reported that the current pregnancy was planned.

Of the 10 participants (9 Caucasian, 1 Mexican American), ranging in age from 18 to

34 years, 5 were married or in a committed relationship, 2 were dating, 2 were single, and

1 was currently separated. The 10 participants had diverse educational backgrounds,

including some high school (n = 1), a high school degree (n = 5), some college (n = 1),

and graduate degrees (n = 3). Total annual gross family income for participants ranged

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from ‘‘below $9,999’’ to ‘‘$100,000 and above,’’ with half of the participants (n = 5)

reporting a gross annual family income below $29,999. Half were employed full time or

part time.

The report of trauma history on the TEQ indicated that individual participants had

experienced a range from one to nine specific trauma events. In describing the specific

interpersonal sexual trauma experience, seven participants reported experiencing child-

hood sexual abuse and three reported adult sexual victimization. In addition to a sexual

trauma history, three participants also reported childhood physical abuse and two partic-

ipants reported adult domestic violence. Participants also reported noninterpersonal trauma

experiences, which included receiving news of the unexpected death of someone close to

them (n = 4), being in or witnessing a serious accident (n = 4), being in serious danger of

losing one’s life or being seriously injured (n = 4), witnessing the serious injury, muti-

lation or violent death of someone (n = 4), and experiencing a natural disaster (n = 3). In

addition, four participants reported having experienced a traumatic event that was not

listed on the TEQ (i.e., previous perinatal loss, finding a young boy who hung himself, and

nonviolent sexual assault). None of the participants reported that they were currently

seeking mental health services.

Qualitative Data Analysis

A phenomenological perspective was utilized in this study in that the goal was to under-

stand the lived experience of pregnant females with a sexual trauma history. Employing a

‘‘zig-zag pattern’’ of data analysis, the recording of each interview was listened to and the

transcript read prior to the subsequent interview (Creswell 1998). The continual data

analysis process allowed the dominant themes within each individual participant’s inter-

view to shape and guide subsequent interviews with other participants. Analysis of

interview transcripts was conducted using the phenomenological analysis procedures

outlined by Colaizzi (1978).

Issues of Trustworthiness

An important issue addressed within the current study pertained to issues of the trust-

worthiness of the qualitative phenomenological inquiry. Comparable to the issues of

reliability and validity within quantitative research methods, trustworthiness refers to

whether or not the findings are ‘‘worth paying attention to’’ (Lincoln and Guba 1985, p.

29). In planning the current study, several procedures were included to increase the

trustworthiness of the findings. In keeping with the traditions of phenomenological studies,

the first author engaged in an initial step of bracketing prior to beginning data collection

and analysis. Bracketing, which involves a thorough examination of the researcher’s

thoughts and experiences about the phenomenon being studied, is often utilized by phe-

nomenological researchers in order to avoid possible contamination of the findings due to

the researcher’s bias. As part of bracketing, the basis for the study was fully explained,

reflections and presumptions about the phenomenon based on the researcher’s personal

experiences were identified, and a review of relevant literature on sexual trauma and the

pregnancy experience were recorded prior to conducting the research interviews. The

bracketing procedures increased the credibility of the current study by minimizing bias

within the processes of data collection and analysis.

Credibility refers to the believability or ‘‘truth’’ of the findings (Lincoln and Guba

1985). In the current study, the issue of credibility was addressed by employing a member

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checking procedure of checking information and interpretations with respondents. Both

within data and across data member checks were performed. Participants were contacted to

verify their transcripts and the study’s findings, and were given the opportunity to provide

feedback on the findings. All feedback received from participants served to support the

current findings and final thematic structure.

Transferability is similar to the concept of external validity within quantitative research

and refers to the use of thick description of the time and context in which findings emerged

so that the reader can adequately judge the ability to apply the findings to similar popu-

lations and contexts (Lincoln and Guba 1985). When possible, a thick and detailed

description of each thematic category has been provided, using participants’ own words to

describe the emerging categories, themes, and sub-themes.

The concepts of dependability and confirmability refer to the criteria that the findings

are reasonable and are based upon sound methodology (Lincoln and Guba 1985). An

additional feature of analysis for the study was the first author’s self-reflexive journaling

throughout the study. Directly following each interview, post interview notes, which

contained any initial impressions regarding potential questions, emerging themes, or

possible biases, were completed. Notes taken during and after each interview were filed as

part of the data for each participant and were included in the development of categories.

Also included within the journal were personal thoughts, feelings, and insights during the

data collection and analysis process and any methodological decisions.

Throughout the data collection, analysis and writing, frequent meetings were held with

the internal auditor in order to check perceptions. Including an internal auditor in the data

analysis process is a common method of validating the themes that emerge and ensuring

that the personal experience, hypotheses, and other biases of the researcher are bracketed

successfully (Strauss and Corbin 1998). An external inquiry audit also was performed by

an experienced qualitative researcher. The external auditor was asked to review the tran-

scripts, interview summaries, post interview notes, and other project materials related to

the research to ensure that a logical path was followed in the data analysis. Feedback from

the internal and external auditors was noted and integrated into the final analysis.

Findings

Presented below are the four dominant categories and subsequent themes that emerged

from the ten participant interviews. Although each description focuses on some of the

information indicating each participant’s uniqueness, emphasis is on the shared com-

monalities. The primary categories and themes are presented in a way that illustrates both

the adaptive and maladaptive experiences that emerged from the participants’ descriptions

of the dual life experience of sexual trauma and pregnancy. It should be noted that because

all participants experienced the sexually traumatic event prior to the current pregnancy, the

themes are presented in a manner that illustrates the timing, as well as the bi-directional

relationship described by the participants.

Negative Consequences of Sexual Trauma

All ten participants recounted experiencing negative consequences or effects of their

sexual trauma experience. Based on their reports of the most negative impact of sexual

trauma, five main sub-themes emerged: ongoing reminders, changed social relationships,

altered sex and sexuality, loss of self regard, and overwhelming emotions.

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Ongoing Reminders

All ten participants discussed the past sexual trauma as an experience they will always think

about and that will always impact their lives. Some participants shared metaphors to describe

the negative, long-term lingering aspect of their past trauma, referring to their sexual trauma

experience as ‘‘a black cloud,’’ ‘‘pure darkness,’’ and a ‘‘lifelong scar.’’ Participants

described their sexual trauma experiences as ‘‘something that’s never going to go away.’’

One participant who had been raped 2 years before the interview reported feeling as though

she will never be able to separate herself from her sexual trauma experience. She states,

It just feels like something you can’t wash away. I feel like no matter what I do, I’ll

never be able to forget it. No matter what I do, I’ll never be clean of it. So it’s not

necessarily a physical thing, but it’s metaphorical. I just feel gross.

In describing the ongoing reminders, seven participants specifically recounted experi-

encing intrusive flashbacks, memories, or thoughts of their past sexual trauma experience.

They reflected on specific negative ways they are reminded of the past trauma. Participants

recounted flashback experiences triggered by familiar places, smells, sounds, and people.

One participant, who was gang raped, recounts,

…there’s times when I’m alone somewhere, like this summer when we were hiking in

the mountains sometimes, you get flashes; it’s kind of like having war flashbacks or

something. You’re just kind of like ‘‘wow,’’ and you have to sit down and think, ‘‘it

happened, but you’re past it now. You’re doing better. You’re living your life.’’ You

don’t let it take over you. That’s kind of the worst part, just like little things that remind

you…’Cause I’ll be somewhere and it’s the same forestry smell and it brings it back.

Changed Social Relationships

In response to their sexual trauma experience participants also described various ways their

relationships were negatively impacted. All ten participants reported initially withdrawing

from relationships with partners, family members, or friends following the sexual trauma.

Participants described that generally feeling ‘‘more leery of people’’ led to them pulling

away from others. Seven participants recounted that changes in social interactions resulted

from a general loss of a sense of safety within relationships. Participants described that

following their sexual trauma, it was very hard to trust others. One participant reported,

‘‘I was scared of other people…many people thought I was shy, but it really was not that I

was shy; I just did not trust anyone, and I really did not want to talk to anyone.’’

Altered Sex and Sexuality

Eight participants also reflected on the specific effects of sexual trauma on sex and sex-

uality. Participants provided several examples to illustrate the effect of sexual trauma on

their sense of sexuality, reporting on the negative issues, messages, and habits they

associated with their sexual trauma experiences. Participants described that changes in the

meaning of sex and sexuality resulted in unhealthy behaviors and attitudes toward sex,

leading to two extremes: repulsion and promiscuity. One participant described her personal

process related to sex:

At first, I didn’t want anyone to touch me at all…Then once I started having sex,

I started feeling like I needed sex to feel accepted. Then still even though I was doing

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it to make me feel like that man wanted me, it made me feel like he didn’t at the

same time, but I would keep on. Then it just got to where I didn’t want it anymore.

I went through both phases of it, I guess.

Another participant shared how her sexual trauma background has impacted her sense

of sexuality:

I don’t feel sexual. I’m just not good at that at all; I’ve just never been able to. It’s

just really hard. I know that’s not a normal feeling, especially to have as great a

husband as I have, but I, it’s like, it’s horrible…I’ve never had that and I imagine that

it’s from my experiences.

In contrast, one other participant shared her own experience with sex and messages

regarding sexuality that followed her own sexual assault, stating: ‘‘It had an effect on my

sense of sexuality, I guess, because I think it gave me the sense that sexuality is something

that you use, that other people want and that you can get things with it.’’

Loss of Self Regard

Participants discussed the impact of their previous sexual trauma on their perceptions of

and feelings toward themselves. Nine participants described difficulties accepting them-

selves and struggles with identity associated with feeling worthless or dirty. Several

participants referred to feeling like trash. Participants also described a sense of experi-

encing oneself as weak or weaker and struggling with not being able to take care of or

protect themselves. One participant reflected on her feelings of worthlessness associated

with her childhood sexual abuse:

Sometimes when you think about it, it just makes you feel like trash, just like you’re

worthless. That’s how I guess I always thought about it. It’s like I was worth nothing.

I was completely worthless that these people, my family, my cousins, my brothers,

people that were supposed to be so close and were supposed to care so much about

me could just use me and abuse me like that. It made me feel like I was nothing.

Overwhelming Emotions

All ten participants described significant negative emotional responses to their sexual

trauma. While some emotions were specifically directed at themselves, others were broader

experiences and expressions. Participants reported feeling sadness, guilt, anger, loneliness,

and stress. In referring to her childhood sexual trauma, one participant shared, ‘‘the

emotions are still so strong when I think about it, and the hurt, and the anger.’’ Another

participant elaborated on how her emotions have changed over the course of time fol-

lowing her sexual assault, ‘‘…still, I have a lot of the same feelings. Although, I would say

there’s more sadness and anger than there is guilt, in the beginning it was just guilt. That

was just it. Now it’s, it’s more sadness and anger.’’

Becoming a Survivor

Despite reporting negative consequences and effects, all ten participants recounted a

personal process by which they were able to move forward from their sexual trauma

experiences. Based on their reports of the positive effects that the sexual trauma had, four

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sub-themes emerged: gaining a new perspective on life, finding an inner strength, using asupport system, and letting it out.

Gaining a New Perspective

Eight participants described how their previous sexual trauma experiences led to positive

change in their personal perspective. Some participants shared that as a result of their

sexual trauma experience they gained a new perspectives on life and a greater under-

standing of the world around them. One participant reflected, ‘‘it’s given me a lot of

perspective, a lot of understanding. In that way it’s good we all have life experiences that

help us see and understand.’’ Another participant stated:

You can understand how other people feel who are out there…you don’t even have

to talk about it…I’m pretty open minded. It makes it easier to let go and help others

change, understand it and deal with it.

Another participant reported:

…it does have a positive impact, because I had to stop and look at myself and be like,

that’s not what I want to have to deal with every day. So, it made me stop and think

about what I was doing with my life, and it made me change it.

Finding an Inner Strength

All ten participants shared that because of their sexual trauma, they began to see and

experience themselves as stronger beings. One participant shared: ‘‘I think it made me

stronger…’cause if I can get through that, I can get through anything, honestly.’’ Another

woman recounted how her newfound strength brought positive meaning to her previous

rape experience: ‘‘It’s made me stronger as a person, so I think that was the reason (it

happened). Just to prove to myself that I’m a strong person. If I can make it through that, I

can make it through anything.’’

Although participants reported that the past sexual trauma experience will always be a

negative element or part of their life, they all described striving not to let it overtake them.

All participants expressed a desire or motivation not to be defined by their previous sexual

trauma, but rather to find ways to ‘‘take control’’ of their own lives. One participant

reflected:

You don’t let it take over you…It changed me, but I didn’t let it overtake me. I’ve

moved on…I’m not Ella, the girl who was raped up there. That’s not who I am. I’m

Ella1 who likes to go have fun and do my thing…So, it kind of doesn’t really define

me as a person but just things in my life I have to deal with.

Using a Support System

Although a variety of important relationships were described, including those with

grandparents, aunts, mothers, friends, and partners, all ten participants reflected on the

significant role these relationships played in effectively coping with their sexually trau-

matic experiences. Five participants discussed how their relationship with their partner and

father of their unborn child has played a particularly significant role in their ability to grow

1 A pseudonym chosen by the participant has been used to protect the identity of the participant.

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beyond their past sexual trauma. These participants described the positive impact of their

partner’s acceptance of them and their past experiences. One participant reflected, ‘‘my

boyfriend actually accepted me for who I was, after he knew everything I went through.

That was probably the most positive thing that happened.’’

Letting it Out

Participants also specifically described the importance of talking about, telling, writing and

sharing their thoughts and stories in effectively coping with their sexual traumas. Two

participants specifically described the positive coping method of pouring out their thoughts

by writing poems and stories. Whether with mothers, partners, or therapists, participants

shared the positive, healing effects of talking about or sharing their thoughts and experi-

ences with others. One woman described her own positive experience:

I guess not keeping it bottled up inside of me probably made, played a major part in

my life because I felt that whenever I did keep it bottled up, I felt like I’d went

through a lot; and now that I’ve talked, I’m more open about talking about it, I feel it

has changed my personality a lot. And, then like, I don’t feel that pressure there

anymore as much as I did before when I didn’t say anything…I kept it bottled up for

a long time. I felt when I kept it bottled up; I was a totally different person; that just

wasn’t me. And I started talking about it more and more, and I feel that I’m finding

myself now, that I’m not what I, like how I was before.

Pregnancy: A New Beginning Beyond Sexual Trauma

Initially, all ten participants described that their previous sexual trauma had little to no

negative impact on their current pregnancy. In addition to the natural separation between

life experiences described in the previous theme, the participants also described a process

by which the current pregnancy served as a positive coping resource in regard to their

previous sexual trauma experiences. Four sub-themes emerged: distinctly different expe-riences, a new beginning, a new relationship, and a new found hope.

Distinctly Different Experiences

During the course of the interview, participants were asked to discuss any connection or

relationship they identified between their past sexual trauma experience and their current

pregnancy. All ten participants described experiencing little to no negative effect of the

past sexual trauma experience on their current pregnancy. Instead they reported a distinct

difference between the life experiences, separated by both time and meaning.

Seven participants described how time serves as a natural element of separation between

the life experiences of sexual trauma and pregnancy, inherently protecting the maternity

experience from the negative effects of their sexual trauma history. One participant, a child

abuse survivor, responded, ‘‘Yeah, that’s two different things. That’s my past, this is my

future. No, I don’t let my sexual trauma get in between me and my pregnancy.’’ Another

participant described how she has ‘‘compartmentalized’’ a sexual assault by a male peer

and her current pregnancy as distinct life experiences:

I don’t know if it’s sort of, I think of maybe this kind of being compartmentalized in

some way… when I said to you on the phone, ‘‘Are you sure you really want me in

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[the current study]?’’ Because I mean I really don’t think about it as a sexual trauma.

At that time in my life, it was very traumatic…And so it really does feel like

something that happened, and then there’s been the rest of my life … it’s not

something I really ever think about.

A New Beginning

All ten participants described a process by which pregnancy represented a new life, a new

beginning or new direction, which further separated participants from their past sexual

trauma. One participant described:

I think about [the sexual trauma], but it’s not my everyday thing. I kind of look at the

pregnancy and her coming as a totally new beginning. I’m still the same person and I

still wanna do as much of the same things that I can. But it’s a new direction that I’m

going on. So, it’s kind of like, ‘‘that happened, but I can’t let it have an effect on

what’s going to happen.’’ So, I have to adjust myself to it. It’s not related to my past,

it’s something new…going another way.

Another participant described her current pregnancy as a natural beginning:

…I’ve separated the whole, those two things. Maybe like a start of a new life, a new

beginning. It’s not like I’m just shutting the door, but I feel like I’ve worked through

it a lot. I feel like I’m ready to move on. It’s a natural beginning.

A New Relationship

Participants also described how the current pregnancy serves to validate and change their

current partner relationship. Six participants specifically reported a sense of pride in the

ability and opportunity to carry their partner’s child. One woman, a childhood sexual abuse

survivor, shared:

…I’m happy to have this child, and I’m proud that out of anybody that [my partner]

could’ve picked, it’s me, because he’s great. That’s what I tell him all the time, ‘You

could’ve had anyone, anyone in the world.’ He said, ‘But I didn’t want anyone. I just

wanted you.’ He said, ‘I just want you, and I want you forever.’ He says, ‘You’re all

I ever want.’… It makes me proud to have his baby.

One participant described how her previous experience of sexual assault as an adult

increased the positive meaning of her current pregnancy and her current partner relationship:

It made it a really big deal when we got pregnant…it’s kind of like this pregnancy

represents me and him in the most obvious way, and I think was a big deal because

I felt that we had gone through all the issues that [the sexual trauma] raised with us

and marriage…

Another participant elaborated on the importance of carrying her husbands’ child:

I don’t know that [the sexual trauma] had really an impact on the current pregnancy-

except that it’s kind of made me realize that I’ve taken more pride than I thought

I would in it. I hear a lot of women say, ‘‘Oh, I’m carrying my husband’s child.’’ And

I didn’t think that I would feel that much pride from that, but I do and maybe even

more so because of [the sexual trauma]…I don’t know that it would be a different

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experience, but I might not appreciate as much or get as much satisfaction out of

carrying my husband’s child.

Similarly, another woman reflected on how the current pregnancy represents over-

coming her past sexual trauma and validates her relationship with her husband:

I think it’s sort of a victory. Just in the fact that becoming pregnant was a chance for me

to say, ‘I can do this, I can get over you people and, you’re not going to rule my life, and

I can have a relationship with my husband and you don’t have to be on the bedpost.

The strong theme of the partner relationship as a positive factor during the pregnancy

was further illustrated in the narratives of the three participants who were experiencing

their current pregnancy without a partner. Due to various circumstances, those participants

were dealing with being alone during their pregnancy. All three mentioned difficulties

involved with not having a partner as they discussed their current pregnancy experiences.

One participant, whose partner ‘‘just up and left’’ a little over a week before the interview,

shared, ‘‘It’s me by myself, instead of with the both of us.’’ She elaborated, ‘‘It’s stressful,

cuz I’m gonna have to do it all by myself.’’ Another participant reflected on the stress

associated with the father of her unborn child serving in the military overseas, ‘‘…so it’s

gonna pretty much, still gonna be a single mom. He’ll be in her life but not like full time,

all the time. So, it’s gonna be kind of difficult…’’.

While another participant, whose husband was also currently deployed by the military

to Iraq, shared:

I’m really scared not to have my husband here when I go into labor. That’s my

biggest fear. I know I’ll have my mom and I know I’ll have my dad, but it’s not the

same. That’s my biggest fear, is not having my husband here and him missing out on

that. I’m partially worried because what if something happens to me, you know…my

husband is like the only one who’s been there, and he understands me the most. Like

he knows when I’m in pain, I get mad. And he’s very supportive. So, I don’t know,

but when you think about going into labor, you think about your husband being there

to coach you through and not your mom. So I think that’s, I don’t know whether I

don’t know why, but I really worry about that. I really wish he was there.

A New Found Hope

In contrast to participants’ description of their past sexual trauma experiences, they also

described that their experiences of pregnancy brought new, more hopeful perspectives on

their life and the world around them. One participant articulated:

[The current pregnancy] made my feelings open up more. Just the way I look at

things, it’s made me look at life different, because everything was so dark to me

before. Now that it’s all settled in, it’s going to be, he’s going to be there, and

everything’s going to be okay. It’s made me look, and there’s some light there…It

makes it feel like everything might be okay.

Another participant described how pregnancy validated her ability to move on from her

past sexual assault:

I guess the pregnancy almost kind of validates that we can come out of something

like this and be able to enjoy the joys of pregnancy…And now it’s kind of like, it’s

there, but there’s a lot of good going on now and that’s more important.

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Another woman shared how her current pregnancy has restored her faith:

…my dream has come true. And this is the only thing I ever wanted, was to be a

mom. It has changed my whole outlook on life. I know that good things can hap-

pen…I feel like everything happens for a reason. I got raped for a reason, and now

I’m pregnant for a reason. So it just kind of restores your faith. It just makes me more

grateful to be able to have a baby.

Integration of Sexual Trauma and Motherhood

Participants discussed ways that they anticipated their sexual trauma experience would

impact their role as a mother. Participants described three subthemes focused on how they

will be more protective of their own children, the role of gender in the way they approach

the role of mother, and hopes for child in the future.

More Protective

Seven participants described how their previous sexual trauma experiences would make

them more protective and more aware of their own children. One participant shared how

she will have to protect her unborn daughter from the ‘‘black cloud’’ of sexual trauma that

she experienced in early childhood:

[The sexual trauma] just makes it hard, cuz, I do know how mean the world can be.

How mean and cruel it can be. And, at the same time, how beautiful it can be. And,

it’s just gonna make it hard. I call it a black cloud. And it lingers over me quite a

bit…I’m gonna have to protect her from it.

Another participant expressed:

I think I will be more protective over who my kids are around and all that. And

I hope it don’t affect my kids. I hope it don’t make a major complication between me

and my kids, but when he or she gets older and realizes that it’s been better for her

and that mom has been through it and that mom is just trying to do what she can to

keep you from going through it, then I think we’ll be fine.

Gender

In discussing how their previous sexual trauma would likely impact their role as a mother,

all ten participants described anticipating a difference in the mother role based on the

gender of the unborn child. One participant, who was currently pregnant with a boy,

reported that her sexual trauma experience was not impacting her current pregnancy

because of the gender of the child. In responding to being asked if she experienced any

connection with her current pregnancy, she shared:

Not really so much as I think if it was a girl…I guess I know bad things happen to

boys, too, but I guess I feel like they’re stronger. They’re really not, I guess, when

they’re kids, but so I don’t think it really affects me as much as if I was pregnant with

a girl.

Another participant elaborated, explaining the experience of finding out that she was

having a girl:

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I worried a lot. I’ve always been so anti-abortion, but when I found out it was going

to be a girl, I wanted to give her away or just not have her. I was so scared I wouldn’t

be able to protect her and that something would happen to her. It made it hard. It

made it hard a lot, because I thought about [the sexual trauma] a lot when I was

pregnant.

While another participant responded:

I think about it because if it is a girl, I’ll probably be a lot more protective of her; and

I would probably watch everything…you just don’t ever know whenever there’s a

chance for something to happen. I’ll probably be a lot more protective of my

daughter as to who’s around her or my son even, as to who’s around them.

A participant, currently pregnant with a girl, described the connection between her own

sexual trauma history and the role of gender in her current pregnancy:

I think I wanted it to be a boy so I didn’t have to deal with these girl things. I think it

was just kind of like, to have a girl is terrifying. To have to go through all girl – just

development and all these things that I’m still not comfortable with, talking to her

about sex and, ‘‘here’s your first bra.’’ I think that’s just really scary. It’s probably the

best thing in the world for me…but, there’s a lot that girls go through.

Hopes for Child

As mothers, each of the ten participants discussed hopes that their own children will never

experience the negative impact and effects of sexual trauma. As one participant reflected:

I just want to be there so much more for my kids, because I don’t want [a sexual

trauma] to happen to them, because it hurts so bad, and it makes things so much

harder in your life…I know a lot of people it has happened to and it’s just a big

difference.

Another participant expressed, ‘‘I hope and pray things don’t happen to her the way that

they did [for me] so that she will have a good life.’’ In a similar vein, one woman stated,

‘‘there’s still times I think about [the gang rape]. Especially right now with the preg-

nancy—really it’s just I don’t want it to happen to her. I want her to go live life and not be

afraid.’’

Discussion

Participants’ discussions of their previous sexual trauma experiences suggest that the

specific events have a long-term and lasting impact for women despite the age, ongoing

nature, or situational context of the sexual trauma itself. Reflecting the defining nature of

trauma, participants expressed the common sense of vulnerability and loss of safety

experienced as a direct result of the sexually traumatic event and described shifts in both

worldview and abilities to adapt (Janoff-Bulman 1992). Participants described the negative

impact of intrusive memories, flashbacks, heightened awareness and caution, and attempts

to escape or avoid situations, emotions, or individuals; these are all common posttraumatic

symptoms discussed within the literature and fitting within the symptom categories (e.g.,

reexperiencing, avoidance, and hyperarousal) for Posttraumatic stress disorder (APA

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2000). These findings serve to confirm the previous findings of Seng et al. (2004), in which

fifteen pregnant women with previous childhood sexual abuse experiences reported core

symptoms of PTSD, including avoidance, hyperarousal, numbing, and intrusive

reexperiencing.

Despite the negative impact reported, all participants also identified and described

positive adaptation and changes following trauma similar to those noted in the literature

(Linley and Joseph 2004). Participants reported that positive self-change and self-definition

resulted from their sexual trauma experiences. These descriptions of positive changes in

perception of self, approach to interpersonal relationships, and overall philosophy of life

offer support for the emergent phenomenon of posttraumatic growth (Tedeschi and Cal-

houn 1996; Tedeschi et al. 1998). Additionally, these dual themes of both negative and

positive effects of sexual trauma further support Tedeschi and Calhoun’s (1995) model of

posttraumatic growth by suggesting that distress and growth are separate dimensions that

can coexist in individual trauma survivors. According to participants’ descriptions, the

experience of distress does not necessarily prevent growth, and conversely, the experience

of growth does not necessarily put an end to distress following a traumatic event (Calhoun

and Tedeschi 1998; Tedeschi and Calhoun 2004).

All participants reflected on specific resources and methods they utilized to progress to a

healthy and effective process of coping with the negative effects of their sexual trauma

experiences. Participants described how relationships with others (i.e., grandparents,

mothers, friends, partners), talking about their trauma experience, and maintaining a

positive mindset assisted their process of posttrauma recovery. Each of these processes

may be associated with the cognitive processing and restructuring method, referred to by

Tedeschi and Calhoun (2004) as recurrent rumination. According to Tedeschi and Calhoun,

in an attempt to reduce distress trauma survivors may engage in an ongoing process of

analyzing the past trauma experience as part of a search for meaning. Through their

relationships with others and talking or writing about the previous sexual trauma, the

current participants seemed to describe a process by which they were able to maintain a

positive mindset that incorporated the trauma experience in a manner that was more

resistant to negative effects.

Most notable within the findings of the current study was the bi-directional relationship

that participants described between the experiences of sexual trauma and the maternity

experience. In addition to relating that these two life experiences were distinctly separated

by time and the nature of the event, participants described a process by which the sexual

trauma increased the positive value and meaning of the current maternity experience, while

the maternity experience decreased the negative value and meaning of the previous sexual

trauma. In discussing the lack of a negative linear connection or relationship between the

previous sexual trauma and the current maternity experience, participants also offered a

narrative description of a positive bi-directional relationship.

In relation to the dual positive impact, participants expressed that the pregnancy rep-

resented a victory over the previous sexual trauma by providing a new and more positive

worldview, enhancing their partner relationship, and offering a new beginning or direction

for their life. These salient themes seem parallel to the specific domains (e.g., identification

of new possibilities for one’s life, more intimate and meaningful relationships with others,

a general sense of increased personal strength, positive spiritual change, increased

appreciation of life) used to define the concept of positive posttraumatic growth (Tedeschi

and Calhoun 1996; Tedeschi et al. 1998). These themes suggest that the maternity expe-

rience and pregnancy, as a unique and significant life experience, may function as a

catalyst for posttraumatic growth and healing in some expectant mothers who have had

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previous sexual trauma experiences. Based on participants’ reports, the experience and

processes linked to pregnancy and becoming a mother seem to naturally initiate the

cognitive processing and restructuring that Tedeschi and Calhoun (2004) associate with

posttraumatic growth. Therefore, the conclusion that past sexual trauma experiences serve

solely as a risk factor that inhibits a woman’s ability to successfully maneuver the

maternity experience (thereby compromising her functioning as an effective mother)

appears to be limited. While previous studies have documented the negative outcomes and

impact of sexual trauma on women’s experiences of pregnancy, the reflections of partic-

ipants in the current study offer a more hopeful and positive perspective.

In discussing the potential connection between their sexual trauma and maternity

experiences, participants did acknowledge and describe a direct linear relationship between

their past sexual trauma and their anticipated or current mother role. As a response to their

own sexual trauma, they described an aspiration to increase their caution with and

awareness of their own children. In expressing this concern, participants were particularly

focused on the need to provide more protection for daughters, thus highlighting the role

gender is likely to play in the future parent-child relationship. Ultimately, participants

expressed a hope that their own children would not have to go through a similar experi-

ence. These themes draw attention to the impact parental trauma likely has on the parent-

child relationship.

While participants expressed their increased caution and awareness generally as a

positive attribute, it is possible that their own past may result in overprotection and

excessive control practiced within the parenting role. Studies in the area of attachment

have found that mothers who indicated a lack of resolution of childhood trauma were at

risk for establishing disorganized attachment relationships with their infants, which is

linked to conduct disorders, oppositional defiant disorder, and coercive behaviors in older

children (Lyons-Ruth and Block 1996). The women in the current sample exhibited many

indicators of resolution of the trauma (willingness to talk about it, making meaning of it,

helping others) and, therefore, the negative impact on the parent-child relationship may be

minimized. These complex and long lasting effects emphasize the importance of advancing

the understanding of how trauma impacts family members across generations.

Limitations

This study provides important information about the impact of trauma on expectant

mothers’ maternity experiences. The study is unique in its focus on pregnant females, a

type of sample that has not been widely used in trauma-focused research. However, a

number of limitations are worthy of discussion. It is important to consider these limitations

when interpreting and applying the results.

All participants were initially recruited from private and public medical clinics and

hospitals in one county in west Texas. Therefore, the sample was non-random and based

only on pregnant females who were obtaining prenatal medical care and who agreed to

participate. As well, none of the participants reported that they were currently seeking

mental health services of any kind or indicated that they were currently taking any psy-

chotropic medications. The findings thus may be unique to this specific sample of

seemingly resilient, self-selected women who were willing to participate because they had

overcome the negative consequences of their sexual trauma histories. Gaining information

from a more diverse sample may lead to further understanding of how previous trauma

impacts expectant mothers from a variety of backgrounds, including possible demographic

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characteristics, such as geographic location, academic achievement, partner relationship

status, prenatal health care, race, and ethnicity.

Initially the purpose of this study was to gain a better understanding of the possible

impact of sexual trauma on expectant mothers’ experience during pregnancy, as well as the

possible impact of the pregnancy experience on women’s adaptation to sexual trauma

experiences. While a portion of this goal has been achieved, it is important to understand

the context in which these findings should be interpreted. When discussing sexual trauma

experiences, theoretically, at least six different categories of sexual trauma could exist.

This is dependent on when the sexual trauma was experienced (childhood vs. adulthood),

the age of the perpetrator (peer vs. adult), and the chronic nature of the trauma (single vs.

multiple event).

During the process of interviewing the ten women, we noted that the women seemed to

fall into different categories based on the nature and onset of their previous sexual trauma

experience. A majority of the women reported sexual trauma experiences that began in

childhood. In the current study, only one participant reported experiencing a single sexual

trauma in adulthood. Of the nine participants reporting childhood sexual traumas, six

reported adult perpetrators (5 reported multiple events, 1 reported a single event) and three

reported peer perpetrators (1 reported a single event, 2 reported multiple events). Recog-

nizing that each participant’s experience was distinct and unique, the findings must be

interpreted in this context. The unique individual characteristics and sexual trauma

experiences of the participants provide important information through which to interpret

these findings.

Similarly, while ten in-depth, face-to-face interviews were conducted, the qualitative

findings are limited to this specific group of ten women who experienced various sexually

traumatic experiences prior to their current pregnancy. While all shared the common

experiences of sexual trauma and pregnancy, other contextual differences make it difficult

to definitively interpret the relationship and connection between these two specific life

experiences. For example, the time line of the sexual trauma, relationship to the perpe-

trator, and current partner relationship status differed among participants. As well, the

participants differed in their experiences of previous perinatal loss, infertility, and previous

pregnancies. Therefore, the findings of this study need to be interpreted with the unique

contextual demographic elements, as well as specific trauma and pregnancy elements in

mind.

Research Implications

This study employed a fairly homogeneous sample limited by race/ethnicity and geo-

graphic region. Although the diversity within educational attainment and socioeconomic

status is a strength of the study, future research should focus on reaching a more socio-

cultural and geographically diverse population. By gaining similar information from a

more diverse sample, further understanding as to how trauma impacts expectant mothers

from a variety of backgrounds may be attained.

Although it was the goal of the current study to explore a specific sub-group of inter-

personal trauma, namely sexual trauma, it would be beneficial for future research to further

narrow the focus to an even more specific group of sexual traumas. The specific themes

associated with sex and sexuality that emerged from the qualitative findings further

highlight the unique effects of trauma that is sexual in nature. Recognizing the possible

confounding effect of other nonsexual traumas on the findings, a study that focuses on

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women who experienced only a sexual trauma is an important initial step in clarifying the

unique relationship between sexual traumas and pregnancy. Furthermore, since the current

study included both childhood and adulthood sexual traumas, it is necessary for future

studies to explore how the impact of trauma in childhood differs from that experienced in

adulthood. Future research could focus on the unique impact of even more specific types of

sexual interpersonal traumatic events, specifically gaining more understanding of how age,

multiple versus single events, relationship to the perpetrator, and time line impact

expectant mothers’ experiences during pregnancy.

Future research also might focus on how expectant mothers are impacted by traumas

that occur during the pregnancy to understand the difference between past traumatic events

and more recent trauma experiences. In the current study, all sexual trauma experiences

reported by participants occurred prior to the current pregnancy. Two participants revealed

that although they did not identify a strong or direct relationship between their previous

sexual trauma and their current maternity experience, they hypothesized that if the sexual

trauma had occurred during the current pregnancy, or resulted in the current pregnancy,

there would be a much stronger connection between the two life events. Research

examining the specific impact of trauma experiences during pregnancy would help in

developing an understanding of the role timing plays in the relationship between sexual

trauma experiences and pregnancy.

Finally, this research demonstrates the need to continue examining, in more detail, the

process associated with posttraumatic growth and resilience. The current findings suggest

that future research continue to explore the role that pregnancy and the maternity expe-

rience plays in expectant mothers’ positive growth, resiliency, and healing associated with

past sexual trauma experiences. Also suggested is a need to go beyond the description of

the experience. Implementing a study that assesses and reflects the observed attachment

behaviors, posttraumatic growth, and trauma symptoms of expectant mothers during the

postnatal period in a manner that allows for comparisons of traumatized and nontrauma-

tized women may allow for the bidirectional impact between sexual trauma and pregnancy

to be better understood.

Clinical Implications

The major clinical implications of the current study seem to be related to the importance of

adapting a more holistic approach to prenatal care that recognizes the key role of psy-

chological elements of women’s health during pregnancy. As highlighted by participants in

the current study, openly discussing the previous sexual trauma can function as an

important process in limiting the possible negative effects. Healthcare workers may pro-

vide more effective medical care by conducting routine trauma history and PTSD symptom

screenings to identify mothers with a sexual trauma history. In addition, the findings of the

current study suggests that training health care workers and childbirth educators to facil-

itate effective and comfortable conversations focused on emotional and psychological

preparation during pregnancy may be important interventive and preventive measures for

expectant mothers who report a previous trauma experience (specifically sexual interper-

sonal traumas). As well, it may be important and beneficial to directly address trauma and

PTSD, depression, and other mental health related issues in prenatal education classes.

Clinicians also should acknowledge the important role the partner relationship seems to

play for women as a resource in coping with previous sexual trauma experiences. Par-

ticipants currently in a partner relationship described how a strong partner relationship can

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potentially serve as a primary element of positive change and growth following a previous

sexual trauma. Based on these experiences, clinicians may want to give special attention to

patterns and themes within the partner relationship when working with sexual trauma

survivors. Furthermore, they may want to assist clients by enhancing communication skills

within the partner relationship. Clinicians also may find it beneficial to provide psycho-

education on trauma in order to increase both clients’ and partners’ awareness regarding

any potential triggers that might generate physical or emotional reactions. Overall, clini-

cians should give specific attention to minimizing the impact of past trauma on the current

partner relationship.

By seeking more training in trauma-related issues and symptoms, as well as the issues

of pregnancy, clinicians may increase their competency in working with this specialized

population. As research continues to highlight the psychological, social, and emotional

factors affecting pregnancy outcomes, the growing need for a more holistic approach to

prenatal care will be recognized. In order to increase accessibility to this population, it is

likely that therapists may find themselves working in less traditional settings, such as

prenatal medical clinics. It is important that clinicians prepare themselves to assist women

in effectively preparing physically, psychologically, and emotionally for the role of

motherhood.

Conclusion

Exploring the maternity experience of expectant mothers with a self-reported sexual

trauma history seems an important way to reach a better understanding of the broad

consequences of sexual trauma. The current study provided an exploratory and in-depth

look at the impact sexual trauma can have on expectant mothers’ perceptions, processes,

and experiences during pregnancy. Findings suggest that although sexual trauma does have

a long-term influence and impact, based on the individual experiences of ten women, the

maternity experience can be a period of enjoyment and positive self-change. Although

further research in this area is needed to replicate, confirm, and expand the current findings,

this study has important implications for researchers and clinicians interested in better

understanding both the individual and the systemic impact of sexual trauma across gen-

erations. In order to prevent the possible negative effects of sexual trauma on women’s

reproductive and mental health, greater attention needs to be paid to pregnancy and the

maternity experience as a critical phase for possible healing, growth, and adaptation for

women who have experienced a previous sexual trauma.

Acknowledgments The authors would like to acknowledge Dr. Tom Kimball, who served as an internalauditor, Dr. Laura Bryan, who served as an external auditor for qualitative data collection and analysiswithin the original study, and Dr. Amanda Harrist whose suggestions and comments on initial drafts of thisarticle were greatly appreciated. This research was funded in part by the Graduate School Summer Dis-sertation Research Award, Texas Tech University.

References

Acierno, R., Kilpatrick, D. G., & Resnick, H. S. (1999). Posttraumatic stress disorder: Prevalence, riskfactors, and comorbidity relative to criminal victimization. In P. A. Saigh & J. D. Bremner (Eds.),Posttraumatic stress disorder: A comprehensive approach to research and treatment (pp. 44–68).New York: Allyn & Bacon.

120 Contemp Fam Ther (2009) 31:100–122

123

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd edn.,revised). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn.,text revision). Washington, DC: American Psychiatric Association.

Beck, C. T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50, 275–285.Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, C. G., & Andreski, P. (1998). Trauma and

posttraumatic stress disorder in the community: The 1996 Detroit area survey of trauma. Archives ofGeneral Psychiatry, 55, 626–632.

Burt, M. R., & Katz, B. L. (1987). Dimensions of recovery from rape: Focus on growth outcomes. Journal ofInterpersonal Violence, 2, 57–81.

Calhoun, L. G., & Tedeschi, R. G. (1998). Posttraumatic growth: Future directions. In R. G. Tedeschi, C. L.Park, & L. G. Calhoun (Eds.), Posttraumatic growth: Positive changes in the aftermath of crisis (pp.215–238). Mahwah, N.J: Lawrence Erlbaum Associates Publishers.

Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R. S. Valle & M. King(Eds.), Existential phenomenological alternatives for psychology (pp. 48–71). New York: OxfordUniversity Press.

Cordova, M. J., Cunningham, L. L. C., Carlson, C. R., & Andrykowski, M. A. (2001). Posttraumatic growthfollowing breast cancer: A controlled comparison study. Health Psychology, 20, 176–185.

Creswell, J. W. (1998). Qualitative inquiry and research design: Choosing among five traditions. ThousandOaks, CA: Sage.

Draucker, C. B. (1992). Counseling survivors of childhood sexual abuse. London: Sage.Eberhard-Gran, M., Eskild, A., Tambs, K., Samuelsen, S. O., & Opjordsmoen, S. (2002). Depression in

postpartum and non-postpartum women: Prevalence and risk factors. Acta Psychiatrica Scandinavica,106, 426–433.

Frazier, P., Conlon, A., & Glaser, T. (2001). Positive and negative life changes following sexual assault.Journal of Consulting and Clinical Psychology, 69, 1048–1055.

Green, B. L. (1998). Psychological responses to disasters: Conceptualization and identification of high-risksurvivors. Psychiatry and Clinical Neurosciences, 52, 567–573.

Janoff-Bulman, R. (1992). Shattered assumptions. New York: The Free Press.Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder

in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060.Lev-Wiesel, R., & Daphna-Tekoa, S. (2007). Prenatal posttraumatic stress symptomatology in pregnant

survivors of childhood sexual abuse: A brief report. Journal of Loss and Trauma, 12, 145–153.Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Newbury Park: Sage.Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A review. Journal of

Traumatic Stress, 17, 11–21.Lyons-Ruth, K., & Block, D. (1996). The disturbed caregiving system: Relations among childhood

trauma, maternal caregiving, and infant affect and attachment. Infant Mental Health Journal, 17,257–275.

McMillen, C., Zuravin, S., & Rideout, G. (1995). Perceived benefits from child sexual abuse. Journal ofConsulting and Clinical Psychology, 63, 1037–1043.

Mercer, R. T. (1986). Transition to the maternal role. In R. Mercer (Ed.), First-time mother: Experiencesfrom teens to forties (pp. 1–30). New York: Springer.

Mercer, R. T. (2004). Becoming a mother versus maternal role attainment. Journal of Nursing Scholarship,36, 226–232.

O’Leary, V., & Ickovics, J. R. (1995). Resilience and thriving in response to challenge: An opportunity for aparadigm shift in women’s health. Women’s Health: Research on Gender, Behavior, and Policy, 1,121–142.

Park, C. L., Cohen, L. H., & Murch, R. (1996). Assessment and prediction of stress related growth. Journalof Personality, 64, 71–105.

Powell, S., Rosner, R., Butollo, W., Tedeschi, R. G., & Calhoun, L. G. (2003). Posttraumatic growth afterwar: A study with former refugees and displaced people in Sarajevo. Journal of Clinical Psychology,59, 71–83.

Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartumdepression: A synthesis of recent literature. General Hospital Psychiatry, 26, 289–295.

Ross, L. E., Sellers, E. M., Gilbert Evans, S. E., & Romach, M. K. (2004). Mood changes during pregnancyand the postpartum period: Development of a biopsychosocial model. Acta Psychiatrica Scandinavica,109, 457–466.

Rubin, R. (1975). Maternal tasks in pregnancy. Maternal Child Nursing Journal, 4, 143–153.

Contemp Fam Ther (2009) 31:100–122 121

123

Schauer, M., Neuner, F., Schauer, E., & Elbert, T. (2003). Training manual for narrative exposure therapy(NET)—A short term intervention for the treatment of traumatic stress disorders in children & adults.Cupramontana, Italy: Vivo.

Schwerdtfeger, K. L., & Nelson Goff, B. S. (2007). The intergenerational transmission of trauma: Exploringmother-fetus prenatal attachment. Journal of Traumatic Stress, 20, 39–51.

Schwerdtfeger, K. L., & Nelson Goff, B. S. (2008). The effects of trauma-focused research on pregnantfemale participants. Journal of Empirical Research on Human Research Ethics, 3(1), 59–67.

Seng, J. S., Low, L. K., Sparbel, K. J. H., & Killion, C. (2004). Abuse-related post-traumatic stress duringthe childbearing year. Issues and Innovations in Nursing Practice, 46, 604–613.

Smith, M. V., Rosenheck, R. A., Cavaleri, M. A., Howell, H. B., Poschman, K., & Yonkers, K. A. (2006).Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics.Psychiatric Services, 55, 407–414.

Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developinggrounded theory (2nd ed.). Thousand Oaks, CA: Sage.

Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath ofsuffering. Thousand Oaks, CA: Sage.

Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positivelegacy of trauma. Journal of Traumatic Stress, 9, 455–471.

Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empiricalevidence. Psychological Inquiry, 15, 1–18.

Tedeschi, R. G., Park, C. L., & Calhoun, L. G. (1998). Posttraumatic growth: Conceptual Issues. In R. G.Tedeschi & L. G. Calhoun (Eds.), Posttraumatic Growth: Positive Changes in the Aftermath of Crisis(pp. 1–22). Mahwah, NJ: Lawrence Earlbaum Associates.

Tyler, K. A. (2002). Social and emotional outcomes of childhood sexual abuse: A review of recent research.Aggression Violent Behavior, 7, 567.

Vrana, S., & Lauterbach, D. (1994). Prevalence of traumatic events and post-traumatic psychologicalsymptoms in a nonclinical sample of college students. Journal of Traumatic Stress, 7, 289–302.

122 Contemp Fam Ther (2009) 31:100–122

123