Tuesday, February 8, 2011

A Guide to Holding Birth Trauma

Scary things can happen in birth sometimes. It's not something we like to think about, but the fear of emergencies in birth is something that lurks in the corners of the minds of pregnant women and their caregivers alike.

As doulas, occasionally we are front row centre witnesses for someones trauma. It can feel powerless watching those scary things unfold. We are often grasping at straws in our minds wondering, "What do I do? How can I help fix this?" Well, sometimes we can't. As much as we try to prevent birth trauma by guiding people to empowered choices and as much as we hate for bad things to happen to the couples in our care, the unexpected can occur. We can end up feeling very powerless when an emergency takes place, and it's crucial to know how to anchor ourselves in the eye of the hurricane so as to create the optimal space for healing to begin as soon as possible.

While trauma is occurring:

1) Acknowledge it. We need to look those parents deeply in the eyes, take a breath, and in our own gentle, loving way say, "Yeah. Here we are. That scary place nobody ever wants to go. Breathe, and hold on.". Trying to "make it pretty" when the proverbial poop is hitting the fan, minimizies the experience and only leads to dissociation.

2) Stay present. Breaking down emotionally, getting caught up in those bubbles of fear and drama, and freezing up is not an option. You cannot "check out". You need to open your heart up, waaaayyy up, stay anchored within the chaos, and stay there strongly with your clients. Be totally present, surrounding them with as much love and calm coming out of that open heart space as possible. It may sound flaky, but the emotional tone we set can have the power to keep others calm. As doulas are very much "space holders", what we energetically broadcast into the room can influence how the parents and caregivers respond to the trauma.

3) Reassure when possible. If a woman has to go through a tough obstetric procedure, while we can't make it rosy, we can definitely let her and her partner know all the positive aspects of what is happening, like "You are doing GREAT!", "We can see your baby now, hang on!", "This is the hardest part and it's almost finished." If Baby is an issue, repeating the positive things you hear the caregivers saying can be helpful to parents, such as, "They say your baby's heart rate sounds great." or "Her breathing has improved a lot in the last minute." A blue floppy baby is all a parent will see, and if it is appropriate, letting them know the good stuff that is going on with their newborn while the caregivers are busy focusing on their tiny patient can help promote calm. Often, parents will not receive this information, and their terror of the unknown could otherwise exacerbate their sense of trauma surrounding the memory of their child's first moments of life. Being informed and reassured whenever possible is comforting to parents. The look on the faces of new parents when nobody is actually telling them the baby is breathing with a good heart rate is enough to ensure you as a doula are on top of this.

4) Be loving. Touch the mom, speak to her lovingly, stroke her hair, coo to her. Be loving to her partner. This helps to promote oxytocin and reduce too much adrenaline response. Doing whatever you can to keep that mother/baby hormonal connection intact, even when the baby needs to make a fast birth exit or has just had a difficult passage and is not able to be in the room with her, may help improve her future memory of her birth experience.

5) Trust. Give caregivers ample room and support in their important job of dealing with a medical emergency. Trusting doesn't create the outcome we want, but staying connected to the trust whenever possible that everyone is doing their best, promotes calm, often helping the best care come about. As doulas, our spiritual beliefs are definitely something to draw from at this time, if we are so inclined. The idea of trusting that as we hold the space for our clients and everyone else in the room, all of us are also being held by a loving source, even if what's happening is something we can't make sense of, is something many doulas and caregivers seek comfort in. Knowing deeply we have no ultimate control and that our power lies simply in doing the tasks required, being present, and living this moment as fully as possible, no matter what, is often what helps us all to heal more completely when the emergency is over.

Once trauma has occurred and everyone is left picking up the pieces:

6) Beware of magical thinking. I had a sweet, lovely student end up attending several dramatic C-sections for her first mentored births. After the third, she broke down in sobs, asking, "Is it ME?" The doctor present was loving but firm and gave her a great reality check: "Ah, Sweetheart, you feel like you've earned the black crow award because all you've been present for so far is emergencies. We can all feel like this. Really, though, you're not THAT powerful that you can bring on bad outcomes just by your presence." This is a wise and straight to the point wake up call on those days we are stuck in the past traumatic experience, trying to envision what a different outcome might have been had we heroically jumped in to do the impossible to spare a woman from turmoil. Know what to own, know what to let go of as magical thinking. Help your client avoid falling into this trap too.

7) Don't entertain the "why" and "what if" too much beyond getting to the basic physical reasons something may have happened. Spending hours conjecturing "why" is not healthy, and with doulas/caregivers sometimes even arrogant as we try to throw out many hypotheses that will usually only ever remain hypotheses. It soothes our egos to have a tangible reason for those unexplained traumas, but healing isn't about soothing our egos. Sometimes things are just mysteries, and what's done is done. Sure, when there is evidence for something, it can feel good to know actions were completely justified. However, often there are many pieces of the puzzle missing, and will always be missing. An amazingly wise Abenaki Grandmother told me once, "Every time you ask why, Spirit takes a step back. Who says you get to be privy to why something happens the way it does? Instead, ask, 'What is it I can learn from this experience? Spirit will take a step forward.'"

Many clients after trauma will ask if you think the outcome could have been different had they done something else, for example, let's say, birthed vaginally had they avoided the epidural. You cannot possibly answer this question. Gently point out that wallowing in the whys and what ifs are fodder for self flagellation, and not healing. Embracing the experience for whatever it was, good or bad, making meaning of it, and living fully is usually a better choice for healing. This may only come about after a long period of grieving.

8) Debrief with your clients about their experience. Let them pour out their pain without trying to pretty the experience up for them. Don't join the ranks who say, "Well, at least you have a healthy baby." (if the baby is indeed healthy). Women need to feel "allowed" to grieve the loss of the experience they wanted. It's not selfish to have hoped for a lovely birth. It is heartbreaking to have suffered trauma. Grief is totally appropriate. My dear friend says when something has gone badly, "Dude, that sucks." She says it with absolute compassion, and there is comfort in knowing that someone acknowledges that something plainly sucked as opposed to having someone be chirpy and sunshiny when the real emotional landscape is so obviously grey. We want people we care about so much to feel better, but it's not always possible for a while. Sparing someone from authentic feelings and creating dissociation by interjecting niceties is more about our being uncomfortable with their feelings, and it's the same pattern that contributes to such high epidural rates, "Oh, poor dear, you're suffering. I can't stand to see you in pain. Let's just make it go away."

When the whole thing is talked out and there is more emotional space for perspective, connect them to where they were amazing and graceful in dealing with such challenging circumstances. It's not the same as trying to make it pretty. It's honouring the person's role in authentic and powerful living. They may have felt totally "weak" because they cried and couldn't "get on top" of things. Crying and feeling scared is emphatically NOT weakness. Just as the icon of the Zen woman breathing easily and painlessly through her contractions is not an appropriate image of birthing, neither is the stoic stiff upper lip image for someone who is softer and more sensitive.
Deeply honour how a couple moves through the unique emotional terrain of their unique births.

9) Provide resources. If couples need to seek more counseling about birth trauma or reactions of anxiety and/or depression, knowing which professional avenues to send them down is important. Be very aware of your limitations. Doulas are not therapists, and owning all of your client's emotional process is not appropriate, potentially blocking their healing by not sending them to the proper resources. You can always be available for support, but support doesn't mean owning their healing.

10) Doula heal your Self. When you have been traumatized, it is your mandate to deal with it. You cannot bring past trauma to the next birth and be fully present for the clients in your care. Doulas can and most certainly do experience Post Tramatic Stress Syndrome, whether it be from a true birth emergency to witnessing violently harmful and disrespectful behaviour towards a client. Whatever the reason, it is our responsibility to take the time we need to heal. Write it out. Connect with your own spiritual practices. CALL YOUR SISTERS! A community of doulas is the best way to help each other heal. I'm all about doula-ing the doula and without the support I receive from my community, I would most likely be a gibbering mess today. Reach out, talk it out, and embrace the incredible richness of this life of birth attending. Connect, ultimately, with your Love, as this is what grows when we remain present and seek to heal our own wounds. This Love can serve as a light to those healing their own traumas.