As doulas, we are given the opportunity to provide support and hopefully enhance the birth experience of our clients. As I’ve outlined in my previous blog post, The Seeds of Birth Trauma, doulas can have some influence on how we prepare our clients to minimize some of their risk in experiencing birth trauma. Unfortunately though, even with this preparation, the unexpected can happen, and our clients come through the experience feeling traumatized. Also, it is not uncommon for people to hire doulas only after they have already experienced a traumatic birth, and we are then put in the position of supporting them through processing that previous birth before moving on to their next one.
So, as a doula, how can we best support our clients after they have already experienced a traumatic birth?
Before I continue, I want to address the topic of obstetrical violence that is still prevalent in western birth culture. Throughout this post, you will see that I reference a client’s expectations, shame, and self-beliefs which I believe can often be the origin of the trauma taking root. That being said, I in no way mean to minimize the seriousness and devastation that comes from obstetrically violent acts which happen all too often to birthing persons in our culture. Part of our role as doulas is to uphold the importance of informed consent and supporting our clients’ autonomy. For more information on obstetrical violence and what we can do about it, go to www.birthmonopoly.com.
In my work both as a doula and therapist, there are a number of things I have learned about birth trauma. First, the people that supported the traumatized person through the experience, whether that be a doula, or partner, or family member, may not be the most appropriate person to help her process the trauma. As a doula who attended her birth, YOU are part of her trauma story, even if you did not contribute to the trauma. In speaking about her experience, she will likely edit her version to avoid hurt feelings, or blame, or guilt whether this is conscious or not. It is also possible that she could associate you with the traumatic experience and speaking to you specifically about it may not be helpful for her. As her doula, it is important to have this self-awareness, not to take it personal, and offer to refer her to someone who is outside the story circle that has the experience and skill to assist her in healing.
Second, I’ve learned that telling a traumatizing birth story over and over again is rarely helpful in healing. Retelling the trauma in detail over and over in the same way engrains the story in our psyche and solidifies the negative self-beliefs we have taken from it. It can often lead to us feeling ‘stuck’ and unable to move forward. A process developed by Pam England, creator and author of Birthing From Within, called Birth Story Medicine has been invaluable to me in assisting women find new ways of telling their stories.
As a doula, if you have a client who has had a previous traumatic birth, encouraging her to tell her story in a different way and shifting focus can lead to a new perspective. For example, instead of retelling their story as they always have from start to finish, I ask clients to choose a moment from their birth that was difficult for them and retell THAT moment, as a snapshot, preferably in the present tense as if it is happening right now. I focus on how they are feeling in that moment, what emotions are they experiencing, and most importantly, what do they believe about themselves because this has happened to them. In other words, what self-belief are they holding on to – “Because this happened to me, I am ______________”. Some women will identify feeling weak, unworthy, powerless, stupid, irresponsible, not a good mother, etc. When they are able to identify that belief, it often has a visceral reaction and triggers an emotional response such as tearfulness, panic, anger.
Once that self-belief is identified, using some solution-focused questions to find exceptions to that self-belief can lead to a shift in perspective. For example, asking questions like “what’s one thing you did well/that surprised you/that you thought you couldn’t do but did anyway?” can help them see that there is something MORE true about themselves that’s more positive, more realistic. Focusing on what they want to begin believing about themselves when they think of this moment is a good start. For more information on solution-focused questions and dialogue, I would recommend the book Brief Coaching for Lasting Solutions by Insoo Kim Berg and Peter Szabo.
Often times, that self-belief has an element of shame for the traumatized person. Brene Brown, social worker and shame researcher, defines shame as the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging (pg 5). It is also valuable to distinguish between guilt and shame as they both have a very different impact on how we view ourselves. Brown states that “guilt and shame are both emotions of self-evaluation; however that is where the similarities end. The majority of shame researchers agree that the difference between shame and guilt is best understand as the differences between “I am bad” (shame) and “I did something bad” (guilt). Shame is about who we are and guilt is about our behaviours.” (p 13). [Read more from Brene Brown in her book I thought it was just me (But it isn’t)]
In my experience, the self-relief that stems from birth trauma is rooted in shame. Identifying the belief and acknowledging the emotion attached to it as ‘shame’ is the first step in building our shame resilience. Brown defines shame resilience as that ability to recognize shame when we experience it, and move through it in a constructive way that allows us to maintain our authenticity and grow from our experiences. She identifies four elements to building shame resilience which I have personally found invaluable in assisting birthing persons in working through their negative self-beliefs that stem from their birth experience.
These elements are:
You can find more in-depth training in Birth Story Medicine® at https://www.sevengatesmedia.com/. I highly recommend this life-changing course.
This series of blog posts is brought to you from our East Coast instructor Jillian Hand. Jillian shares her perspective on trauma from the lens of social worker and doula in this 3 part series we will benefit from her personal and professional experiences.
Jillian is a certified birth and postpartum doula through both Doula Training Canada and DONA International and have been involved in the local birth community since 2007. She is one of the original founders of the Doula Collective of Newfoundland and Labrador. Over the years, she has been actively involved in the doula movement both at a local, national and international level. You can find out more about her through her business page Hand to Heart in St. John's NL. www.handtoheart.biz/
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