The Seeds of Trauma – Part I: Supporting Birth Trauma as a Doula

I suppose it’s no surprise that over the past seven years, I have gravitated toward providing therapeutic support to birthing persons, their partners and birth professionals in the area of birth trauma processing and recovery. My master’s degree in social work combined with my passion for birth work has provided me with the education and skill to facilitate these therapeutic conversations toward healing. Of course, as with all experiential learning, I’ve gained a lot of insight into this topic over the years and it has influenced how I work with doula clients while wearing my doula hat.
​
I have developed this three-part blog series with the intention of trying to provide some answers to three questions that are posed to me on a regular basis by other doulas. First, as a doula, what can I do to help minimize the risk of birth trauma; Second, How can I best support my client after they have had a traumatic birth experience; and third, how can I protect myself, as a birth professional, from vicarious trauma? There are no quick, easy answers, but I will do my best to share what my experience has taught me, beginning with how a doula can minimize the risk of birth trauma.

In the early days of this work, one thing I struggled to understand was how two people could have very similar birth experiences and yet, one will describe their experience as traumatic, while the other seems to have taken it all in the stride. For example, I have had the experience of working with two different birth doula clients on separate occasions. Both had the same obsterician, the same doula (me), the same induction procedures, the same complications down to the letter, and in the end they both ended up giving birth by cesarean. In debriefing with the first client, it was obvious that she was devastated. She used the following words to describe her experience – “violated”, “just a file number”, “cut open”, “robbed”, “disrespected”. I supported her in the best way I could in those early days, and as a new doula, I remember feeling that I had somehow let her down since she didn’t get the experience she hoped for.Fast forward to my second client with the similar experience. I had prepared myself for the same feelings of loss, trauma, and anger afterward that I assumed this client would also experience – but surprisingly, her attitude was completely different. She was disappointed, sure, but she felt like there was nothing more that could have been done and she was happy to have the experience behind her and move on.  These two practically identical births but vastly different reactions started me on my quest to seek out how this could be so. If the actual events themselves didn’t create the feeling of trauma, what did?

My own research, inquiries, and experience has taught me that one of the biggest influences in birth trauma is the focus, attitudes, and preparation of the birthing person/couple.

How outcome-focused are they in their vision of their birth experience? Are they rigid in their birth planning? Do they express an unwillingness or resistance to acknowledge and appreciate the ‘unknowns’ in labor and birth? Are they open or closed to learning ways of coping with a deterrence in their birth plan (for example, are they skipping the chapter on cesareans because “that won’t happen to me”)?

​ It appeared to me that the more attached a person was to the outcome of their experience, the more likely they were to feel traumatized after the fact if it didn’t go the way they hoped. I consider rigid expectations and lack of well-rounded preparation to be seeds of birth trauma. Once planted, they can take root and grow if other unexpected events are added to the mix – like the client who is adamant that she will give birth at home but ended up needing a transfer; or the client who refuses to acknowledge the possibility of a  cesarean, and yet fails to progress.

What is a doula to do?

So, as a doula, what can you do to help minimize the risk of birth trauma? First of all, it is important to emphasize that, as doulas, we are not responsible for outcomes. We cannot make promises to clients that hiring a doula will mean less interventions, a natural birth experience, a shorter labor, etc. Sure, the research suggests that we can make a difference, but in the end, our role is to provide support and encouragement, to facilitate good communication, and to assist in comfort – NOT to guarantee a client gets what they hope for. Doulas new to the profession are particularly more likely to feel the pressure to promise a certain experience and to feel responsible when they cannot deliver. Be conscious of this impulse.
​
Here are some things you CAN do:

• Facilitate discussions with your clients about the things they have control over (care provider, place of birth, classes they take, books they read) versus the things they cannot control (how long labor will be, when labor will begin, how baby will cope with labor, how their bodies will respond).
• Take a non-outcome-focused stance in prenatals – acknowledge what their wishes are, but also emphasize the importance of planning for how to cope with those unwished-for events, should they arise. Focus on how they can feel satisfied and supported no matter what the outcome.
• Prepare them for the possibility of a cesarean birth or the use of pain medication, even if they believe they will not need the information. I call this the “it won’t happen to me” phenomenon. It is a breeding ground for trauma.
• Suggest they take a non-outcome focused childbirth preparation class. Birthing From Within™ is a good example of a class that focuses on preparing for all possible outcomes.
• Explore not only their hopes but also their fears when it comes to birth. Ask solution-focused questions like “How would you cope if that were to happen?”
• Assist in the development of a clear but flexible birth plan. Watch for unrealistic expectations and address them as they arise.
• Avoid using clichéd affirmations like “Trust Birth” or “Trust your Body” that are outcome-focused and absolute– these can imply to the birthing person that if they just trust enough, they will get the outcome they wish for. This is often not the case, and can lead to feelings of failure and shame when their birth does not go the way they hoped.

As doulas, we have a lot of influence over our clients. They often see us as being ‘in the know’ and look to us for guidance and support. We have the opportunity to make a significant difference in how our clients perceive their birth experiences based on how we approach the preparation phase of our work together. Prepare them. Tackle the hard topics. Encourage them to keep an open mind. Otherwise, I believe we do them a disservice.

Stay tuned for parts two and three of my Birth Trauma series. .

 Jillian Hand, MSW, CD/PCD(DONA) Birthing From Within® Mentor
Jillian is a certified birth and postpartum doula through both Doula Training Canada and DONA International and has a Masters Degree in Social Work  She is one of the original founders of the Doula Collective of Newfoundland and Labrador. Over the years, Jillian has been actively involved in the doula movement both at a local, national and international level. As a Certified Birthing From Within® mentor and doula, and she facilitates childbirth preparation classes that embrace birth as a rite of passage. You can find more information about Jillian here http://www.handtoheart.biz