How Recognizing and Healing Trauma Helps Clients

Editor’s note: This article first appeared in Midwifery Today, Issue 130, Summer 2019.
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Often birthworkers have little problem recognizing the signs of overt trauma in their clients. Most are familiar with the (now-accepted) fact that those who have experienced assault are more likely to have myriad discomforts with pregnancy, birth, and breastfeeding. Many birthworkers understand how traumatized parents may struggle to connect with their child, experience higher levels of postpartum depression (PPD), and stop breastfeeding sooner than those who feel connected and competent as a parent. More difficult to recognize in our daily practice is the interaction between our own trauma, the family’s trauma, and the ripple effect both our trauma and its healing have on the families we serve.

Many have been taught that to be a good care provider, they have to protect themselves by staying disconnected. This assumption sets up the paradigm that we should not connect because it is not professional and we will get hurt—when the reality is that we have to connect to heal and only healthy connections facilitate healing. It can be a vicious cycle, because unless you have the tools to heal trauma, opening yourself up to more trauma is not healthy.

Often birthworkers became birthworkers because of their trauma. You will recognize this if you have met a birthworker who is immersed in the job because “I cannot let what happened to me happen to anyone else” or expresses the feeling that “if I rest and don’t take every single client, people will suffer.”

Some birthworker trauma manifests itself as burnout, some as a savior complex, some as limitations placed on the families to be served. All of these manifestations have the same cause: unhealed trauma makes us angry, overwhelmed, and feeling helpless/hopeless. We have to work to be aware of the reasons for our driving passion and actively heal any trauma. If we will only support families in the hospital, only at home, or only if they make the “right” choices that align with our values and avoid our triggers, we can be sure we are working from a place where our traumas and triggers are in charge. This extends beyond the dynamic between us and the families we serve and causes myriad issues within the midwifery community. Attacking one another is something a traumatized pack of animals does if it does not learn other ways to interact.

The great news is that healing creates more healing, and there are ways to heal.

Many of the people I have worked with over the years tell me the same thing: their pain or trauma was minimized by the person or people they tried to tell. What they often don’t say outright (but is painfully obvious once you know what to listen for) is that they have been conditioned not to complain, to focus on the positive, and to suck it up and be thankful it wasn’t worse. I call this at leasting, because we say “at least you have a healthy baby,” “at least you got the homebirth you wanted,” or “at least you are young and can try again”… often followed up with “not everyone has that.”

The primary reason we encourage people to focus on the positive is that we are uncomfortable with their trauma, which highlights something unhealed in our own life. These are often called triggers.

I hear the same themes repeated by those who are experiencing unhealed trauma:

  • They don’t believe their pain or trauma is “bad enough” to tell others about.
  • They know others who have had it worse, so they don’t want to be seen as whiney.
  • They worry that it is keeping them from connecting with their child/partner.
  • They fear mentioning their concerns—worried that they will be seen as a “bad parent” or as “ungrateful” for what they have.
  • They feel distance growing between themselves and their partner because they do not feel heard or supported. Some of them have even been told they are being dramatic or unappreciative and too often they have heard the monster of all dismissive phrases—the “at least” phrase.

Quite often several other themes emerge within the context of supporting birthing families. You can truly know that you are making a difference in the lives of these families when you learn to help them feel supported. People have told me how deeply their trauma affected them:

  • I switched doctors after my last birth; I didn’t even go in for follow-up appointments. I did not want to see him ever again and the thought of going to that office again gave me nightmares. I am fine with the new doctor; I am going to a different hospital, too.
  • It never occurred to me to file a complaint because so many people I talked to had it worse than I did.
  • I don’t even like to touch myself “down there” when I go to the bathroom and a year after my child’s birth I still don’t like my husband to touch me down there with his hands.
  • I was told so often that I “failed to progress” that I worried from day one about whether my instincts are any good. I had thoughts like, “What if I don’t have good intuition and catch some danger sign before it is too late and my baby is harmed because I am afraid to go to the doctor’s office?”
  • I had a birth mantra: “She believed she could, so she did” and now I feel like it should have been “She believed she could, but nobody else did, and she was lied to, and in the end she gave up, feeling utterly destroyed.”
  • How can I be a good example of a strong woman to my daughter  when her very entrance into the world began with me not being able to do what I believed I could?
  • It was years before I told anyone how traumatized I felt by what others called a “great birth.” Only when I realized how much it felt like the secrecy and shame surrounding my rape 10 years earlier was I able to talk about it without feeling overwhelming guilt for not having done better.

It is important to realize that the language people use if they are feeling traumatized may not mention trauma at all. Their trauma may present as overwhelm or a sense of not being a good enough parent or a hyper-vigilant parent. They may say they are having:

  • problems sleeping when the baby sleeps, or sleeping too much
  • feelings of numbness or disconnection from the baby
  • scary or negative thoughts about the baby
  • worries that they might hurt the baby
  • worries or fears that something bad might happen
  • guilt or shame about their job as a parent
  • sadness
  • more tiredness than usual or less energy during the day
  • upset or annoyed feelings about little things
  • trouble thinking, concentrating, or making decisions
  • no appetite or eating too much
  • worries that they might hurt themselves or feeling like they want to die
  • trouble enjoying things that used to be fun
  • no one to talk to
  • feelings that they just can’t make it through the day
  • feelings of worthlessness or hopelessness
  • continual headaches, backaches, or stomachaches

It can be very helpful to recognize when someone is culturally expected to hide their trauma, if they are minimizing or “at leasting” themselves, as well as concrete ways to help and be a positive influence in their journey to becoming a stronger parent.

How can you, as a non-therapist supporter of people in this vulnerable position, help?

First, recognize and understand that “trauma is in the eye of the traumatized.” You cannot decide whether another person is traumatized; only that person can. It does not matter if others saw the birth as “routine”; the mother may have felt marginalized, ignored, or secondary to the child—which is not the healthiest place from which to start a parenting journey.

Familiarize yourself with some of the symptoms she may not realize are related to birth trauma and help her understand that she is not abnormal, alone, or “going to ruin her baby” by admitting that she feels traumatized. You are in the position of a loving support person to help her feel stronger and more capable. A strong, capable person is a strong, capable parent and raises strong, capable children.

Ask parents if they think everything went well or if they felt frightened or ignored at any time during their birth. Remind them that they deserve to have their experiences heard and that their experiences are valid. If they feel there was trauma, there was trauma and they deserve support to work through it. Only if you are a trusted provider who has connected with your clients will your referrals to additional mental health resources be well received.

When I share this information with caregivers who have been using the “at least” or “count your blessings” responses, they can feel a bit lost about where to go from there. First, if nothing else, when your mind goes blank, there is a phrase you can use:

“That is perfectly normal after all you have been through.”

I don’t care how crazy the symptoms, whether you have seen them before or not, or whether you think it is in their head or they are being dramatic. At first, just practice saying it. You don’t even have to believe it yet. The truth is, everyone does the best they can with the resources, information, supports, and energy they have in the moment. My RISE UP method of postpartum stress relief addresses this in depth. This method has all of the critical pieces someone needs to make a decision. It is an exercise I teach that supports compassionate healing and connection. I have seen so much benefit from application of this one concept that I am sharing the short version of it here:

It is important to be compassionate with and forgive ourselves for not having everything we needed to do something different in a situation that we look back on with dismay. If only we had … done something else. I call this our “shoulda-woulda-coulda” regrets. We do not know what our client’s past traumas look like; we barely recognize our own! If we could have done better, we would have—and that is true for everyone who comes to us with trauma.

What is happening to anyone during pregnancy and birth is not a singular event. This deep creation mode calls on every level of our being, and when we are in that super-creator mode both trauma and healing can be amplified. That means we have work to do in order to be present in that space. As birthworkers, we are affected by how expansively creative our clients are when we connect in healthy ways. We must be able to mentor compassion and healing without using words. We do that by being as accepting and compassionate with them as we are with ourselves.

Besides the phrase “that is perfectly normal after all you have been through” (which can be rephrased in many ways), what else can you say? The best approach for knowing what else to say is to listen in a compassionate way. Learn more about active listening and start practicing that while also actively working on having compassion for yourself and healing your own trauma. When you are more compassionate toward yourself you will automatically have more compassion for others.

When asked to name the most important skill for midwifery, I always say trauma healing. A person with no trauma around birth can be an amazing attendant, while one with all of the book knowledge plus trauma around birth can be a detriment rather than an asset. Everyone in birthwork needs to prioritize the tools to heal trauma—for ourselves and our families—and to reverse the patterns of trauma within the midwifery community that are destroying choices for all families. In creating a paradigm in which all families are supported, there are times when anyone being honest with themselves will personally feel uncomfortable and may feel triggered. That’s okay when you see triggers as an opportunity for healing.

Triggers can be our best tool for healing. They are a sign that there is a loaded charge, ready to explode. Only a weapon that’s loaded can be affected by a trigger. Trauma tells us the trigger is the problem, rather than considering the huge amounts of explosives behind the trigger. Healing trauma heals the explosives, and the trigger is no longer dangerous.

Ideally we unpack our own explosives, serving and supporting those who are unpacking their own, thus rendering the triggers ineffective. We can do that by allowing others to have every right to autonomy and decision-making we have—even when it makes us feel triggered. Especially when it makes us feel triggered. Healing our triggers creates healers.

What does this look like in community? What does it say about my compassion and support of families if I advocate that only certain people (who agree with me, specifically) have access to midwives? That those who choose differently care less about their families than I do? The extrapolation of that is very dangerous indeed. It is a huge problem which is caused by a lack of trust and perpetuated by those who are traumatized. When I heal my trauma around people who choose differently than I have been taught, I can allow the space for them to do so without thinking that they are wrong or should be punished.

Let’s explore how triggers and trauma conspire to harm our relationships with ourselves, our families, and the families we serve, and what we can do about it.

Here is a personal example of how concretely unhealed traumas can affect our relationships with the families we serve: My doctor insisted that my first child’s placenta be manually removed after 40 minutes—which led to cord traction, spraying blood, injections, retained placenta, and D&C. Up until this time limit was reached I had experienced no problems. Perhaps  hospital policy was to blame in this situation. Yet, as a midwifery student at the time I had learned that a week earlier a woman had died in their care at the 40-minute mark, because of an amniotic fluid embolism. When I knew more of the story it became obvious that the treatment I received was a direct result of the trauma from the prior week. Not surprising. There are many reasons why this is a problem, on top of the fact that my process was rushed because of the trauma from the prior week. How many of us think it is a healthy paradigm when no time is left for healing? Should that OB have been expected to be back on duty and were the support and healing tools available to address the very real trauma caused when someone in their care had died?

It is the same with what I have heard called “secondary trauma”; it is not secondary to a person who is traumatized. Even if that person only watched or participated in an event that traumatized another person, that does not mean it was not traumatic for the viewer. The fact that it is a trigger for a past trauma does not make it less real. Trauma that occurs and is then perpetuated is too rarely addressed.

When serving someone with last week’s trauma in mind, it is important to know whether you are taking valuable information from that experience to treat the current client with better information or just treating the current client based on the past trauma. Each client deserves a caregiver’s full attention; treating a current client based on another person’s event means not being fully there for that client.

Often parents worry that they will be forever disconnected from their child after a medicated or traumatic birth. It is very important for us not to see them as forever damaged, lest we reinforce the hopeless feelings they may share with us. By healing from these deep wounds, we set an example for ourselves and are able to mentor those who feel they will never recover.

Find ways to recognize and heal your trauma, attend workshops to heal it, take classes, and learn coping mechanisms as though the families you serve depend on it. They do, as do you.

Trauma reminds us to keep our distance. Healing that trauma allows us to connect, which accelerates healing. Healing people heal people.

About Author: Lori Barklage

Lori Barklage is the owner and director of Ancient Art of Midwifery Institute. She is a passionate advocate for choices in birth. She also founded Birthing Peace Within, where she helps families heal their traumatic births to better nurture future generations.

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