The Gentle Path to Healing Birth Trauma
An interview with Athena Hammond, Midwife and Psychotherapist
What inspired you to support women in healing from birth trauma?
Answering this question feels a bit like unwinding a big ball of wool – how far back do I go? My own experience giving birth to my son (now 27 years old) was certainly a major influence that set me on this unexpected path. I thought I was going to be a writer, and was studying creative arts at university when I fell pregnant. I planned a homebirth, ended up transferring to hospital, and had a very distressing experience ending in an epidural and a forceps procedure. Afterward, I took home a baby that I loved and delighted in, but also a cloak of shame and disbelief. How could it have gone so terribly wrong?
Then, when my son was about 18 months old, a friend recommended I see a therapist who specialised in pregnancy and birth. This connection with a wonderful therapist, who turned into an important mentor, inspired me to do my doula training, then my midwifery degree, and then to do my PhD and work in research. But the more I came up close to what happens to women and midwives in the maternity care system, the more fired up I got about acknowledging the impact of trauma. So, back to university again to do my Masters in psychotherapy and counselling – and now here I am. What drives me is a desire to help undo the damage caused by overmedicalisation and a lack of respectful, compassionate care for women and families.
How would you explain birth trauma to someone who is new to the “concept”?
What we call ‘trauma’ is a series of brain and bodily responses to situations that feel overwhelming, threatening, and out of our control. Trauma is what happens inside us when we experience something that wipes out our capacity to cope, rendering us helpless, disconnected and unable to access our usual psychological resources that bring a sense of control and safety. The impacts of trauma can change the way we feel, communicate, think, and experience our bodies and the world. Sometimes, trauma happens during the process of labour and birth – this is birth trauma.
Birth trauma is generally considered to be defined by the person experiencing it – if someone thinks their birth experience was traumatic, it was. Most people know very quickly that something disturbing is happening when birth trauma occurs. They might not have the language to describe it, or the opportunity to voice it, but they know that things feel dangerous and wrong in a fundamental way. Commonly, women describe feeling disrespected, ignored, frightened, confused, alone, abandoned, silenced and frozen when birth trauma arises.
What are some common signs of unresolved birth trauma, and how can it affect mothers emotionally, physically, or in future pregnancies?
Birth trauma can show up in lots of different ways – some of these have been organised into criteria such as in the City Birth Trauma Scale, which can be helpful as a starting point. Women may have really big feelings that they feel stuck in – like anger, grief, shame, and an overwhelming sense of failure. Or they may feel very little and describe being stuck in a place of disconnection and numbness. They may experience persistent, intrusive thoughts and memories about the birth including flashbacks and nightmares. They may feel driven to talk about the birth over and over again, or alternately they may avoid any reminders or conversations about birth. On a day to day level, the most common signs that I see in my practice are hypervigilance, intrusive thoughts, high anxiety, grief, anger & disconnection from self and others.
The effects and impacts of birth trauma are pervasive and can include; erosion of trust in self and others, difficulties with relationships and intimacy, hard times with bonding and breastfeeding, loss of identity, negative experiences of motherhood, fear of childbirth, ongoing anxiety, guilt & shame. These experiences can significantly alter women’s notion of whether or not it is safe for them to be pregnant, or to give birth again. Depending on the level of support and resources available, some women may use these experiences as motivation to plan a different kind of birth, or choose a different model of care next time.
Physically, trauma can take a toll on women and birthing people. There may be injuries or interventions to recover from, or psychological trauma that impacts health and wellbeing in a range of ways including fatigue, mental exhaustion, sleep & memory problems, nutrition and digestion issues, difficulty with concentration, panic attacks and heart issues.
Is there a way to reduce the risk of experiencing birth trauma?
There are so many ways to reduce the risk of experiencing birth trauma. However, we need to acknowledge that we are not starting from a level playing field. Indigenous women, women of colour, refugee and migrant women, women with previous mental illness and women who have experienced childhood sexual abuse or intimate partner violence are all more likely to experience birth trauma and/or birth related PTSD. These women in particular should receive care that recognises and responds to past trauma, as well as actively planning to minimise retraumatisation.
The most fundamental way to reduce the risk of birth trauma, is for all midwives, obstetricians and maternity care staff to provide compassionate, relationship focused and trauma aware care to women and families.
For women and birthing people, some things that can be protective are: choose a continuity of midwifery care model; choose care providers who are familiar with trauma informed care; trust your gut; become familiar with your own nervous system – what sets you off, what settles you down; be honest with your support people about what you need; before the birth, practice and rehearse what you will say at the hospital if you need help, want more information, or need things to slow down; invest in a good doula; read and listen to good quality birth preparation; have a Plan B; utilise counselling & therapy to attend to any trauma history you are carrying; figure out what helps you feel safe and share it with your birth team; talk to people; make connections; if you have a trauma history, and feel safe enough to do so, let your midwife know about it and make a plan together.
When I write letters to the hospital on behalf of my traumatised clients who are planning a next birth, I might include a plan like the following – you could ask a counsellor to do the same for you:
“Can we please have a known and trusted person present at all times; informed consent for all procedures; ask ‘are you ready?’ before all procedures begin; all staff to introduce themselves and explain their role; regular check-ins to see if all is okay; no raised voices unless absolutely necessary; keep support people updated and involved. Please help us provide a safe and satisfying experience for this person and their family.”
What gentle practices or therapies can help mothers begin to heal from a difficult birth experience?
This is very individual and depends on what each person finds reassuring, safe and comforting. Most practices that settle the nervous system (hundreds of these are available online) would be worth exploring. The practice of EFT Tapping is very gentle, quick and easy – and has a pretty good evidence base. Breathwork and yoga can also be super helpful. Journalling, and the practice of seeking ‘glimmers’ (small moments of awe, safety and joy) can help your nervous system to begin to recognise that the danger has passed. If you are experiencing flashbacks, you can try a flashback protocol, such as the one designed by Babette Rothschild – although I would recommend you seek the services of a counsellor or therapist to support you with this in the long term. Talking to friends and loved ones who can listen without judgement can be very helpful. Also dancing, singing, walking, being in nature, laying on the grass, swimming and gentle bodywork may be helpful.
What role does emotional support (from partners, family, or professionals) play in the healing journey?
Emotional support is absolutely crucial – it is an intrinsic part of what helps the body and brain to come back to an experience of safety. Even when we don’t know what to do or say, just being open for compassionate connection will be a great help.
How can healing from trauma empower women to feel more confident in future birth experiences?
I think we need to be a little bit cautious about the emphasis on ‘healing’ from birth trauma. I would maybe use the language of ‘attending’ to the trauma instead. Much like grief, I believe we can grow around our trauma, without it explicitly being healed. Women can find meaning, restoration and reconnection in many different ways after a traumatic birth. By offering women the opportunity to attend to the trauma, we can help them move towards a place where they feel seen, heard, respected, validated and like repair and regulation can begin to occur. To me, this is the process that restores women’s sense of self, as well as the dignity and confidence that can inform their next birth experience, or their experience of themselves in the world as they move onward.
Where can mothers learn more about your work or connect with your services for personalised support in healing birth trauma?
You are very welcome to connect with me through my website thebirthcounsel.com.au
