By Ali Weatherford with  Lacey Castilleja Fisher, LPC-S, RPT-S, PMH-C

Traumatic childbirth is something that happens. Sometimes that’s because of truly life-threatening situations, but more often it’s other things that happen. Those things might be perceived as life-threatening, even if they’re not, for any number of reasons. Those things might even be reminders of something scary that happened in the past. A lot of times, these situations get out of hand because people don’t have a proper understanding of what is happening, or because they don’t have a good support system. 

The term “trauma” gets tossed around a lot in common conversation, especially lately. Some people have a very broad understanding of what it is while others have a very narrow definition.

What is Trauma?

An official dictionary definition says that trauma is “a deeply distressing or disturbing experience.”

That is pretty broad, actually. And it can mean very different things to different people. One person can experience strong turbulence on an airplane as no big deal while another person on the next row may experience extreme distress. It might be that person had been on a plane that crashed before, or they lost a family member to a plane crash. The reasons don’t really matter. What is most important is how that person feels at that moment.

They will have physiological symptoms with this level of distress. They may experience heart palpitations or a rapid heartbeat, trouble breathing, raised blood pressure, sweating, blurred vision, muscle tension. They may have the unshakable belief that they are about to die. The present experience may not be enough to cause an initial trauma for most people, but for someone with a past trauma, it is a problem. This is why we can never decide what is or isn’t traumatic for someone else.

Triggering Past Trauma

These situations where someone re-experiences a past trauma can have a big impact on their current and future experience. They may develop associations between that sense of their mortality and anything related to that flight. It might be the sights and sounds of an airplane. It might be the smell of the perfume that the person sitting next to them was wearing. Any similar sights, sounds or smells might produce some of those same physiological effects. Any of those things may forever trigger panic for that person. If a nurse at the hospital is wearing the same perfume, it might trigger a response that they then associate with their experience of being in the hospital for labor. That new situation becomes something stressful just because of that association.

Now imagine being someone who was sexually assaulted or molested as a child. Imagine being someone who experienced waking up during a surgery. Imagine being someone who watched a loved one die while getting medical care in a hospital. These and SO MANY other situations can cause trauma. Then imagine getting pregnant and knowing that you are facing maternity care and a hospital stay. These people may have triggers that can be very easily touched during labor and birth.

Trauma Informed Care

Trauma-informed care is what all health care providers should aspire to give. There are many training programs out there that can help health care providers avoid re-traumatizing their patients.

The very good news is that even though you can’t always predict what will trigger someone, it doesn’t take much to prevent most of it. A lot of it is already the kind of care that is required by law. The “law” or practice of getting informed consent says that health care practitioners must provide complete information to a patient about an intervention and then wait for consent before administering the treatment or assessment. That means that they should have a detailed conversation with their patient. They should tell them about what it will be like, how long it will take, the benefits and risks. They should also go over alternative options if their patient is unsure. Just the process of having this informed consent conversation might be enough to avoid triggers and keep away panic.

Birth Trauma

Statistically, about 70% of people have experienced some kind of trauma that could cause distress during the labor and birth process. Sadly, that’s a very big number.

Some examples include:

  • Rape
  • Sexual assault
  • Assault
  • Sexual harassment
  • Domestic violence
  • Child abuse and neglect
  • Child sexual abuse
  • Serious injury and hospitalization of self
  • Serious injury and hospitalization of a loved one
  • Surgery
  • Assault by a medical care provider
  • Medical related trauma

There are a lot of things in a hospital or birth setting that could trigger memories of these traumas or a trauma response. The following is not an exhaustive list but includes some of the more common and obvious situations that could cause trauma in the birth setting. When someone who has had one of these traumatic experiences gets pregnant and needs to receive prenatal care and hospitalization for labor and birth, these are just some of the many things that are common triggers.

Some of these things include:

  • Cervical checks
  • Being touched in any way, but around the genitals especially
  • Being confined to bed with restraints such as arm straps or stirrups
  • Feeling out of control
  • Lack of privacy
  • Not having an understanding of what is happening to their bodies – lack of communication
  • The sound of codes being called over the speaker system
  • Needles
  • Sharp objects for cutting
  • People wearing lab coats or scrubs or other safety equipment such as masks or gloves
  • Beeping machines
  • The smell of disinfectant
  • Nudity
  • Blood

The list could go on. It’s clear that maternity care settings may offer many triggers for some people. It’s very important to understand your particular situation and what your triggers might be. Good communication with your care providers might be helpful, but you are under NO obligation to share more than you’re comfortable.

Birth Plans

Making a birth plan is a great way to start. You can do this yourself, with a loved one, or with a doula. It’s best to start by taking a childbirth preparation class. This will help you understand the process of labor and birth better so you’ll have some reasonable expectations. It’s also a great idea to take a tour of the facility where you’re planning to give birth.

On a birth plan, you can list all things you’d like to focus on and all the things you’d like to avoid. You can go over that with your care provider at prenatal visits to see what they might be able to help you with and to make sure all of the things are available in your birth setting. Again, you may like to explain why you need certain things, but you don’t have to. Good trauma-informed care also means accepting the preferences of their patients without having to be convinced of the validity of those preferences.

Therapy and Support

In addition to having a solid birth plan, it can be a great idea to look into therapy or support groups. You can talk to people who have had similar experiences and have similar concerns. You can talk to a professional with the skills to make you feel more confident about your pregnancy and upcoming birth. They can offer suggestions for things you can do to keep anxiety levels down as you prepare for birth, and possibly even some things you might like to add to your birth plan.

If you have a supportive partner, they may be able to help you in many ways. If you feel comfortable talking to your partner about your concerns, it might help to verbalize those things to a safe person.

Whether you’re able to share details or not, a supportive partner can be a great advocate for you. They can help you make a birth plan, and even more importantly they can learn it. They can memorize that plan because they understand it’s very important to you that certain things happen or don’t happen. They can be vigilant during your prenatal care and labor so they can catch any issues that might come up and handle it in a way that means you don’t have to.

For example, if you are aware that cervical exams are triggering for you, you might include a line item on your birth plan that says you’d like to minimize those checks to only those that are absolutely necessary. Your partner can be on the lookout for any unnecessary cervical checks. During a check that you consent to, your partner may also step in and ask questions so the provider understands that you’d like to know exactly what is happening during the procedure. They might ask questions for you like:

  • How long will this take?
  • What positions are available for this procedure?
  • What are you going to touch first? And then?
  • What will this feel like?

Having your partner ask questions can sometimes prompt the provider to be very communicative during the procedure. For a lot of people, this level of communication can prevent triggering the trauma response. It can reduce the feeling that you are not in control while someone is touching your body. It can remove the sense that something is happening that you don’t understand. That can be very comforting to people dealing with certain types of trauma.

Trauma Response Symptoms

I think it’s great to recognize that there are so many ways to help you move through the experience of pregnancy and birth without feeling overly anxious or traumatized. With great support and some preparation, this is definitely possible. It’s also great to have some tools available to you in the case that you do get triggered. It’s important to recognize what happens when you’re having a trauma response. Some of the more common signs include:

  • Freezing
  • Withdrawal
  • Inability to communicate or make decisions
  • Zoning out
  • Flashbacks or feeling disconnected from the present moment or reality
  • Anxiety symptoms
  • Irritability or anger

If you know how you tend to respond or how you might respond, it’s great to communicate this with someone on your team if you can. It can help them to know what to look for so they can be available to help change the situation with you. Some tips for stopping the trauma response include using physical cues to draw you back to what is actually happening. These might include:

  • Smells that are calming to you
  • Being touched in a particular way
  • Squeezing a toy or someone’s hand
  • A certain song or sound
  • A cold or warm compress or drink

Postpartum Responses

Since it’s not always possible to avoid being triggered, it’s also great to recognize what might happen later and seek help. If your birth experience does feel too hard or even traumatic, you may experience some symptoms afterwards. Some of the symptoms of trauma can resemble postpartum mood disorders such as depression, anxiety, and OCD. For birth-related trauma, AND for postpartum mood disorders, it’s a great idea to get help from a perinatal mental health professional. They can help you distinguish between a mood disorder and a trauma response. They can help you process any trauma, and that can go a long way in helping you achieve some peace and continue your parenting with more ease.

Breastfeeding and Trauma

Breastfeeding can sometimes be triggering too. If you’re concerned about this, it’s a great idea to be thinking about it. Taking classes to prepare might be helpful, but it’s also sometimes a ‘wait and see’ sort of situation. For a lot of people, actual breastfeeding is not as triggering as the thought of breastfeeding was.

If you visit with a lactation consultant, they should offer good trauma-informed care so that your visit is less likely to be triggering. They should offer plenty of explanation and communication about what is involved in a consultation beforehand and as the session progresses. They can either not touch you at all if you prefer, or only touch with permission and lots of communication. You should also have as much privacy as you need.

The good news is that birth, babies, and breastfeeding can often change things for the better. Pregnancy, birth and having a baby might provide an alternate way of viewing your body. It can be triggering, but it can also give you a new perspective. Your body does something new and amazing. You become a parent. All of this can help develop a new kind of self-confidence which might help you work through past traumas and mov