Tools for Easing Grief and Birth Trauma
Editor’s note: This article first appeared in Midwifery Today, Issue 130, Summer 2019.
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What do we live for, if not to make to make the world less difficult for each other?
—Mary Ann Evens
During the childbearing year, grief and trauma may visit in every imaginable personal and individual way. Grief will arise for mothers not only due to losses such as miscarriage or stillbirth, but also for mothers grieving the loss of their imagined baby, due to an abnormality or even an unwanted sex. For some mothers, extreme breastfeeding pain, perineal damage, or the conclusion of childbearing may bring on grief that settles on them heavily. Both mothers and fathers/partners may grieve less catastrophic events as well, such as the loss of personal time, changing of their relationship, or another individual experience.
Trauma also may arise in pregnancy and childbirth, even for highly personal and perhaps not obvious reasons. Traumatic stress reactions are normal reactions to abnormal circumstances. As birthworkers, we know the kinds of births that traumatize us: the harrowing ones, the losses and near-losses, or seeing our client treated roughly or insensitively by other care providers. Women can experience their care, pregnancies, or births as traumatic for those reasons, too, although the unique trauma may go much deeper. We had a client share years later that she still felt deeply traumatized from a swift homebirth that we remembered fondly. The transport wasn’t the reason—she had gone for a few hours with the midwife for needed medical attention. It was because she had missed what was for her a highly anticipated event: seeing the siblings awake and meet the new baby.
As birthworkers, such difficult experiences will invariably come our way. We can develop many tools in our helping toolbox to support our clients and ourselves. I find that being familiar with a range of approaches means that there is always something that can be offered, even if we don’t have a bag along or the clients have limited resources. Below are some of the tools I use in my practice to ease suffering, enhance stability, and nurture healing through such challenging times.
Be near me, when my light is low.
—Alfred, Lord Tennyson
While birthworkers generally tend to be sensitive and caring, when things are really rough it can be hard to know what exactly to do. Having emotionally thoughtful support during a traumatic event can lessen, to some degree, the immediate and lasting trauma for that individual. Some ways to provide thoughtful support may include:
- Being present, kindly. Words are not always needed.
- Being a gentle presence, entering her space and field as smoothly and kindly as possible. As during labor, assess the woman’s status or mood, however briefly, before moving in closer or adding your voice.
- Listening, perhaps with a gentle nodding and attentive light focus.
- Not making assumptions about what she “needs.”
- Being sensitive and taking cues from the primary players.
- Not being too sensitive. Don’t take personally another’s extreme feelings, anger, or retreat.
- Noticing that if you also experienced the trauma with your client, or remember previous trauma, you may also have strong feelings. Make sure you do not burden your client with your needs or perspectives; you must not work them out with her.
- Being very aware to not talk too much.
- Getting support to privately process your grief/trauma so you are able to be as cleanly present for others as possible. Social media is not this place.
- Understanding that every aspect of her life may be affected, including bonding with her baby or partner, or breaking her bond with you.
- Being adaptable. The opportunity to be emotionally supportive may come at unexpected times and in unexpected places and ways.
- Making offers that are simple and specific, “May I drop lunch off tomorrow?” instead of “Call if you need anything.”
- Being present in your own body; as Karen Strange teaches, “Is there a floor and are you on it? With awareness, take a deep breath.”
Healing presence is the condition of being consciously and compassionately in the present moment with another or others, believing in and affirming their potential for wholeness, wherever they are in life. As this definition implies, healing presence doesn’t entail much activity. While it can make a major difference in people’s lives as it’s taking place, it may appear that very little is happening.
Movement is a medicine for creating change in a person’s physical, emotional, and mental states.
The body’s sympathetic nervous system (SNS) activates our fight/flight/freeze response to perceived threats, preparing for intense physical activity through dilated pupils and increased sweating, heart rate, and blood pressure. After an animal’s SNS is activated, any adrenaline energy that was not used to escape or fight is routinely released through the animal’s running, rolling, or shaking. After a human being’s SNS is activated, though, energy not used in response tends to be stored in joints and other areas of the body. After a shock, stress, or upset, you need to release the excess energy that your sympathetic nervous system mobilized for handling the stress.
We can start to physically shift this feeling of being “stuck” in the trauma by releasing adrenaline through physical movement. I’ve often used these techniques in the moment, in a hospital bathroom after an event, or even out by the car before I get in to drive back home. Start your self-care with a few minutes of movement before re-entering your home and life, even if later you plan to do more. These simple but highly effective tools can be used anytime and almost anyplace.
- Place your tongue on the roof of your mouth.
Helps to synchronize the brainwaves of the left and right cerebral hemispheres and has a calming effect. Place the tip of your tongue on the roof of your mouth just behind the upper front teeth. Breathe deeply through your nose.
- Clasp your hands in front of you, interlocking your fingers.
This is also said to help with integration of the hemispheres of the brain and promotes calm. The tongue placement above and this handholding work nicely together and can be done in any setting and in front of anyone without drawing attention.
- Yawn and stretch.
Release tension and excess SNS energy mobilized for handling daily stress and strain. Stretch every part of your body. Yawn with your mouth wide open to release jaw tension. Allow yourself to make uninhibited, pleasurable yawning noises. This is helpful multiple times a day, not just upon waking. We used it recently as an ending to a midwife peer review over a difficult case, which let everyone release the energy buildup and brought concluding chuckles.
- The SNS body shake-out:
- Release residual tension and stress from the body-mind system, the way animals do automatically. This is a lot like the old dance, “Hokey Pokey.”
- Start by shaking out your wrists.
- Follow by shaking your wrists and elbows vigorously … include your shoulders.
- Now include your neck in the shakeout, as well as your wrists, elbows, and shoulders.
- Now shake out your chest and hips. Bounce and move your knees. Shake out your ankles. Now shake your whole body.
- Complete the SNS body shakeout by bending over and shaking out your jaw, shoulders, and arms. Slowly straighten from the base of your spine. Take a deep breath and sigh out.
One past client called for support a few days after the family had been in a terrifying rollover car accident, all of them still not sleeping and highly anxious. They found that the SNS shake-out brought immediate relaxation to all three of the adults involved, and the family began sleeping through the night again.
- Jin Shin Jyutsu:
- A centuries-old and disarmingly simple style of acupressure. This practice uses hands as “jumper cables” for dissolving energy blocks and balancing the flow of life energy within us.
- Ring finger hold—For grief, sadness, letting go, lungs, large intestines, and deep skin connective tissue.
This can also be done in the context of a series of finger holds, as each finger has connection to a different organ and mental state. (Guess which finger is the angry liver?) Starting with the little finger, briefly and gently massage up toward the body of the hand, and then hold each finger in turn. Do both hands.
- Pushing on the center of the palm for total harmony.
- Squeezing the web between thumb and index finger helps to ease many headaches; good when the head is hurting after hard crying.
Keep close to Nature’s heart.
An herb is a plant or part of a plant used for its scent, flavor, or therapeutic properties. Herbal medicines are one type of dietary supplement.
- Linden (Tilia spp.): A relaxing nervine, linden helps calm tension and irritability in the nervous system, ease anxiety, relieve muscle cramping, and assist in lowering blood pressure. Rich in mucilage, it helps soothe and protect tissues and ease inflammation. Safe and practical, it’s often the primary ingredient in herbal blends to reduce stress and tension in pregnant mothers.
- Oatstraw (Avena sativa): An excellent herb for helping the body cope with stress and ease depression. High in the minerals magnesium and silica, both of which are needed for the utilization of calcium, silica is essential for proper growth and development of hair, skin, and nails. Also used for ovarian, uterine, and general glandular disorders.
- Red Raspberry Leaf (Rubus idaeus): A mild, nutritive herb used to promote general well-being and immune support, rich in vitamins A, C, and B complex, and the minerals calcium, phosphorus, manganese, potassium, and iron. High in the mineral manganese, which encourages healthy bonding (of special value for expectant mothers). Used during pregnancy to support proper nutrition and effective and timely labor. This species of raspberry is used to help stabilize pregnancy, prevent miscarriage, ease morning sickness, and prevent hemorrhage. Red raspberry leaf also helps ease cold and fever symptoms, colic, diarrhea, and dysentery (lovely for infants).
- Motherwort (Leonurus cardiaca): Called “the lion-hearted,” motherwort is a mother’s true ally, soothing anxiety, especially when related to hormonal imbalances. It’s known to ease tension, calm muscle spasms, ease anxiety-related heart palpitations, strengthen the heart muscle, and support healthy circulation. It’s wonderful for calming the emotional intensity that is amplified by female hormones, such as sharp grief during PMS or postpartum blues.
- Chamomile (Anthemis nobilis): Calming to shattered nerves, chamomile is renowned for gently reducing stress and anxiety. Relieves indigestion and flatulence; aids sleep; helpful for colitis, diverticulitis, fevers, and headaches; useful for reducing inflammation and easing menstrual cramps.
- Passionflower (Passiflora): A versatile herb, used for stress reduction, calming without sedation, and overcoming insomnia when combined with other calming herbs such as valerian and lemon balm. Considered a safe and effective remedy for anxiety and often used to help normalize moderate gestational hypertension.
In terms of preparation, it may be the herb’s bark, root, flower, leaf, or whole plant that is harvested and consumed fresh, dried for future use, or made into tinctures. A tincture is a liquid extract made by soaking herbs in alcohol or other liquids to extract its active ingredients.
Another common preparation is the infusion. Infusions are made by stirring the herb(s) of choice into boiling water, and then letting it sit, covered and off the heat, for 4–12 hours. The amount is not exact; try starting with 1/2–1 cup dried plant matter to 1/2 gallon of water. After the herbs are strained and then squeezed out, this deeply nourishing liquid, rich in minerals, can be refrigerated and used over the course of the next few days. An infusion sweetened with honey is a lovely thing to bring to an upset or grieving mother—settling, nourishing, loving, and easy to use.
The natural healing force within each of us is the greatest force in getting well.
Naturopathy brings another set of tools to those who are grieving or traumatized. Natural remedies bring a balanced approach to physical, emotional, mental, and spiritual wellness through substances from nature. Homeopathic and flower preparations are highly dilute remedies; essential oils are highly concentrated forms.
Homeopathic Remedies: Homeopathy is a safe, gentle, and natural therapeutic method that uses highly diluted natural substances to relieve symptoms. The active ingredients in homeopathic medicines are dilute properties from plants, animals, and minerals that relieve the same symptoms they would cause at full strength (e.g., a micro-dose of coffee bean helps nervousness).
Since homeopathic remedies are devoid of all chemical toxicity—they are essentially the energy signature of the substance—homeopathy is the ideal system of care for people of all ages, even the most sensitive like an expectant mother or a newborn baby. They have no interactions with conventional medications or herbal remedies and they do not mask symptoms.
Some highly effective homeopathic remedies used for grief and trauma include:
- Aconite: Shock, sudden events, pale and shaken, wide-eyed—think of the baby after an “emergency c-section,” mom after a shocking sudden hemorrhage, plunging heart tones that bring everyone racing, close calls. Fear. Feel like they were going to die.
- Arnica: Famous for any situation that may involve bruising. Long strenuous labors, instrument deliveries or dystocias, extreme molding, extreme pushing, burst blood vessels in mother or baby eyes; arnica is essential after a vacuum extraction, in particular. Good for sore babies, mothers, and midwives.
- Topically, arnica salve or oil may be applied on baby’s head and shoulders, mother’s hips or pelvis. Never apply Arnica topically on broken skin or an open wound.
- Bellis: Known as “arnica for the uterus/abdomen”—think manual removal of placenta, D&C, or lots of handling such as in suprapubic pressure. Also may be indicated in the mom whose postpartum discharge continues for an unusually long time.
- Hypericum: For trauma to nerves, to restore cut nerve endings and crushing injuries. Think pain after cesarean delivery, perineal repairs, and circumcision. Anytime something is torn, cut, and/or sewed. Especially for a baby with brachial injuries after a dystocia or traumatic delivery.
- Ignatia: For those with a broken heart. Birth outcomes fall short of mom’s ideal or perhaps of her romanticized view of birth. Sleepless from grief, acute grief states with weeping and much sighing, postpartum depression.
- Sabina: #1 remedy to assist miscarriage with bright red bleeding mixed with clots, retained placenta, chronic tendency to miscarry in third month. Has been effective in extended off/on bleeding days after miscarriages.
- Staphasagaria: Trauma of cut or torn tissues, after any surgery or procedure. Especially for those who experienced birth as a form of abuse, even like rape, or when there has been a history of abuse. Consider using when there is obstructed labor in an abused woman with suppressed anger. Has been known to relieve pain in incision sites even years later.
A dose is generally 3–4 pellets for an adult, and 1–2 pellets for an infant/child. The most commonly available potency is 30C; experienced practitioners may prefer 200C potency for acute situations. Some prefer to dose an infant with a few pellets dissolved in a shot glass size container of non-chlorinated water, then administered by the drop. As an energetic remedy, homeopathy’s balancing action is stronger when administered more often, not in greater amounts.
Flower Remedies: Flower remedies are prepared in much the same way as homeopathics. These highly dilute preparations are made with flowers, each one working on a unique mental and emotional state to support rebalancing. They are also completely safe for mother/baby. I suggest to all parents that they have one of the following as part of their birth or family first aid kit.
- Rescue Remedy (Bach)
- Five Flower Remedy (FES)
- Distress Remedy (Nature’s Sunshine/NSP)
These are different brands of a similar blend. This famous combination is indicated in times of extreme stress, overwhelm, emotional distress, shock, sorrow, and/or grief. They are brilliantly effective, non-addictive, and a primary tool in any doula or midwife bag to help restore emotional balance. They come most often as a liquid; the drops can be taken directly by mouth, added to a water bottle, dripped on a baby’s head, or sprayed in a room or a bath.
The Do-over Herbal Bath
Every moment is a fresh beginning.—TS Eliot
Mothers and midwives love to use the postpartum herbal bath to heal perineums and the babies’ umbilicus. When properly done, it helps prevent infection and does a beautiful job healing bruised or torn tissues.
The “do-over herbal bath” was developed for those mothers who bring their babies home from the hospital, but experience some significant separation or the loss of a planned homebirth. Often at one, two, or more weeks later they begin expressing deep sadness at missing their dreamed-of first moments after birth.
Mothers have intuitively taken the do-over bath quite seriously, often waiting days or weeks until they feel ready for this symbolic fresh start. The midwife or doula can come and do this bath for them. Clear the house of hubbub, light candles, and perhaps get the camera ready for the traditional baby-in-the-bath picture. A good time of day is often after lunch or later evening, when they can go right to bed afterward. Get the bathroom nice and warm and smelling good.
Install mother in the bath and let her have the time she needs alone, if any, and then bring in baby, as well. There should not be a lot of chatting from our side… this is an opportunity for the mother to re-see her baby for “the first time,” in a simple sacred ceremony of her own making. They are in the bath together as long as they wish, sometimes asking to be alone in the bathroom, other times wanting a quiet presence with them. We admire the baby and mark the end of what may have been a turbulent or frightening time. Somewhere on this day, it may be appropriate to gently say, “So, the birth is over now. You made it.”
Diaper the baby, if she wishes, wrap them both warmly, and put them to bed for a nice naked “getting to know each other” and cuddling.
The properly done herbal bath includes:
- A careful cleaning of the tub with baking soda (not chemical cleaners) along with removal of any items that could contain mildew, such as children’s toys and mats.
- Inclusion of at least a 1/4 to 1/2 cup of salt, which helps make the bath “anti-bacterial” and safe for still-open moms or healing wounds. A mom with stitches less than 10 days old should limit the soak to 10–15 minutes max, to avoid premature dissolving.
The usual ingredients include a combination of calendula or yarrow flowers, lavender flowers, comfrey root, comfrey or plantain leaves, and salt. Some practitioners also use witch hazel, chamomile or myrrh powder, or crushed garlic. In addition, if dealing with depression, consider adding rose petals for additional aromatherapy uplift. About four cups total plant material is then added to boiling water in their largest spaghetti pot, covered, simmered for an hour or removed from heat and steeped overnight.
It’s nice to offer the mom a folded dark towel to sit on.
All sentient beings do better if they know what is going to happen next.
Remember that in utero the baby is conscious, aware, super-sensitive, intelligent, and building neural connections. He/she is laying down memory and this continues after birth. It’s important to encourage parents to talk to the baby, listen to the baby, and acknowledge the baby’s experience. This is not only essential under serious conditions, but critical in everyday moments, as well. As a midwife, I always address the baby out loud and wait for a sense of welcome and willingness before physically laying hands on mama’s tummy. Parents are delighted to see the happy recognition on their baby’s face when we “chat” at their six-week check-up.
The mother-baby unit is two people having experiences and emotional reactions together. If it’s been frightening, painful or upsetting for the mother, the baby also experiences fear … but without the understanding of why. We all can endure quite a lot if we know what’s going on and our experience is kindly acknowledged. Some ways parents and care providers can ease the burden of trauma in the moment and later for the baby are to tell the baby:
- What you are going to do before you
- What is going on.
- What you want her to do.
- The story of what happened; letting the baby know “I’m sorry (this) happened; it’s not your fault….”
When 4-year-old Charlie was asked if he remembered his homebirth, he immediately responded, “Yah! I was coming down the tube and midwife Beth said to go back up and come another way. So I went up, and then I came down the slide!” While he had never been told this, his mama labored vigorously with him for 18 hours. After many creative approaches to his oblique position, he and I (and his mother) did indeed have a discussion. Labor ceased for a week, then resumed with Charlie in an ideal position. He was born four effective hours later.
We may rightly worry about the negative effects of separation or traumatic birth events on mother-baby relationships, but we can be reassured that all is not lost, or as I’ve told some clients, “This is not a deal-breaker.” Karen Strange, who teaches birth attendants about neonate transitions at birth, along with neonatal resuscitation, says about such moments:
Ruptures are mis-attunements, misunderstandings, misconnections, miscommunication, and/or interruptions in a sequence. Ruptures happen all the time: in utero, during labor, after the birth, as we grow up and in all of our relationships. Repairs can happen whenever there is a rupture. First, the mother needs to “make sense” of the experience (integrate) so that she becomes a safe place for the baby/child.
It’s not just what you do or say that matters, but rather how you are on the inside. How are you on the inside? If you take a breath and ground, you the mother, can then say “I’m sorry that happened to you, I did not know” or “I was sad (tired, angry, confused) and I know you felt that. It is not about you (again, differentiation) but rather about me and my…” Then, you could also say something like “I love you; you are safe now.”
These are all examples of repairs. Repairs lead to stronger attachment and trust than if the rupture had never occurred. Repairs can be done at any age (2019).
Another healing approach that effectively resolves trauma without retraumatizing is resonance repatterning, which uses bio-feedback to shift our resonance from highly charged feelings and memory imprints. There are practitioners around the world who work in person or by phone/Internet.
Healing is a sign of life’s desire to refresh and renew itself.
—James E. Miller
Midwives have traditionally worked through the life cycle with families. It’s sad work to help a mother wrap a tiny miscarried babe, conduct the family’s service for their stillborn infant, or hold a mama through her wrenching sobs. When I dreamed of becoming a midwife, this was not of what I dreamed. Yet, this is the work of love and, I believe, the full blossom of midwifery.
This also means that we are obligated to tend to our own well-being and recovery, so that we may be conscious, flexible, and sturdy in the face of the strong winds that will invariably blow. Try a few of these tools on yourself and see which ones you have a special affinity for or that you might make your own.
Time is one of the great healing elements, but it cannot be managed or short-changed. Especially as busy midwives and doulas, we must make the space and take the time to process and heal as we go along as well, lest our ability to be present be lost or become too costly to our health and lives.
While the experience of trauma and grief in the childbearing year may be an especially wrenching heartache, we as birth workers are uniquely positioned to honor and potentially ease the painful journeys our clients may travel. We are also uniquely positioned to offer comfort and care and to bring healing tools to the family long after the medical team is done or their community has moved on. I propose that this is not only about sadness, but that by working on ourselves through the process and bringing additional tools to the situation we also have the opportunity to lighten hearts and empower families through conscious, caring, and fulfilling work.Sources:
- Brennan, Patty. 2018. Homeopathy for the Birth Bag, 5th Ed. Ann Arbor: Dream Street Press.
- Groves, Maria. 2016. Body Into Balance: An Herbal Guide to Holistic Self-Care. Massachusetts: Storey Publishing.
- Higley, Connie and Alan. 2018. Reference Guide for Essential Oils. Spanish Fork, Utah: Abundant Health.
- Miller, James E. 2012. The Art of Being a Healing Presence: A Guide for Those in Caring Relationships. Fort Wayne, Indiana: Willowgreen Publishing.
- Strange, Karen. 2019. “Simple Tools for Mothers.” Accessed March 1, 2019. karenstrange.com/resuscitationresources.
- “Trauma-Informed Care in Behavioral Health Services, TIP 57.” 2014. SAMHSA Publication ID: SMA14-4816. Accessed February 28, 2019. ncbi.nlm.nih.gov/books/NBK207191/.
- Wordsworth, Chloe Faith. 2014. Spiral Up! 127 Energizing Options to be your best right now. Birmingham, UK: Resonance Publishing.