Hedgenotes — Birth Trauma
Posted by Sarah Stogryn on
To Educate, Support, and Advocate
If you've spent much time in the doula world you'll have come across this idea that the role of a doula is to educate, support, and advocate for their client. Of course its far more nuanced than it first appears. Educate about what specifically? Is there a line between which things can be shared with clients and which things can't? What sort of support? A doula by definition is not medical but is it just 'non-judgmental hand-holding' kind of support or does it mean something deeper and broader? And then there is advocacy. Its probably the benefit I hear people talk about most in online groups "Hire a doula so she can make sure your dr/midwife follows your birth plan. Your doula will speak up for you."
We Are Disconnected From Our Own Power
The single biggest issue which I believe gave rise to doula care as a profession was birthing persons wanting to feel truly safe and loved - the in-your-bones, deep and complete, mind-body-soul kind of safe and loved - but actually feeling pretty powerless.
Women DON'T feel safe in birth anymore - partly because of how systems and institutional policies are prioritized over the needs of individual people, which is manifested through caregiver actions, and partly because they no longer have real life everyday access to aunts, moms, grandmas, older sisters, or community wise women who are intimately familiar with the nature of birth and able to provide knowledge and comfort and love and a sense of security throughout pregnancy, birth, and beyond. We have multiple generations of women now who have been disconnected from their power as a result of their own birth experiences and, splintered connections causing distance (both literal and metaphorical) between families.
Women worry that their birth - which is once in a lifetime and life changing for them - will be just one more on the assembly line where they are forced along at a standard pace, pierced and cut and pressured to fit the mold with no regard for their individual needs, let alone their desires or even their rights. The system is satisfied as long as mother and baby are physically healthy at the end but we know in our hearts that merely surviving birth is far too low a standard. Even the WHO has released new guidelines in 2018 which reflect this deeper understanding of the importance of the birth experience.
Advocacy Does Not Mean Speaking FOR The Birthing Person
So doulas emerged. To educate. To support. And to advocate. But can I tell you something? Contrary to common use, advocacy does not mean speaking FOR the birthing person. I cannot be your voice. In my estimation, a doula who speaks for her client is little better than a caregiver who does. Even when it seems like a doula is so intuitive she can read her clients mind, advocacy is still something we each have to do for ourselves ultimately as we are the only ones who know innately what we need in the moment.
YOU are the boss of your body. It is YOUR baby. They are YOUR choices. A doula can reflect your power back to you. She can hold space. She can ask questions. She can remind you of conversations and plans and options. She can hold you up and she can have your back. But she is not your voice. YOUR voice is the one that needs to be heard. Your presence is the one that needs to be felt.
Going With the Flow Rarely Gets You Where You Want To Go
Far too many women have been led to believe that they can - even should - just 'go with the flow'... they hope despite the fear in their gut, that the standards of care will be enough, and so they don't tap into their own truth. They don't find their voice. They don't advocate for themselves. When you don't make clear the direction you want to travel, you will inevitably find yourself swept along with the system instead and most of the time that leaves you at least a little (but sometimes a lot!) battered and bruised, and it takes you to places you never intended to go.
A doula can help in many ways but is no substitute for the amazing power you already possess within yourself and which is waiting to emerge.
Tamara George of Healing Light Birth Support says it like this: “If you don't advocate for yourself…” (if you are not clear on your needs and desires and make them known) “...someone else will advocate for their wallet at your expense.” (they will take you along for the ride that serves *them* best, not you.)
Find Your Voice. Speak Your Truth. You Know You Best.
Finding *your voice* and speaking *your truth* is so very important in all of life, but especially so in the childbearing years. And while we're being honest about birth - advocating for yourself, hiring a doula, choosing a birth team who supports you fully - none of those things can guarantee outcomes. When you begin to advocate for yourself in pregnancy and birth though, it equips you to then advocate for yourself and your child(ren) for a lifetime and puts you in touch with a power only you possess. Nobody knows what you need to be whole better than you do.
Posted by Sarah Stogryn on
Does every woman deserve a doula? That's a far more complex question than it first appears to be.
Years ago when I took my first doula training course I was taught that “every woman deserves a doula”. Practically speaking what that translated to, was that I as a doula needed to be willing to provide my services to anyone who wanted them and it would be wrong of me to deprive someone of my services “just because” they couldn’t afford it.
I was taught that it was okay to charge a fee if I had to, but I also had to be willing to waive it because otherwise I was being elitist and discriminatory. The ideal though was to provide doula care as a gift to anyone who wanted it.
Somewhere along the way, my thinking shifted a bit. I still believed that “every woman (who wants one) deserves a doula… **but that didn’t mean I had to be a doula for every person who asked**. I started to look at things practically, and recognized that there’s no such thing as free. If the client wasn’t paying for my parking fees and meals and gas and mileage and childcare and supplies and continuing education etc… then I was. Saying it is a “free” birth is deceptive because it makes it seem as though it doesn’t cost anyone anything but that’s just not true.
I did the math quite a number of years ago, and my basic costs at the time came to around $500 per birth. So if my client wasn’t paying for those costs, I was essentially giving them $500+ out of my own pocket. After being burned out by clients who took advantage of that, (another part of doula work you're not 'supposed to' talk about) I eventually stopped offering free or even discounted births. My fee was my fee. And instead I pumped up my website with all sorts of informational resources, and poured time into online groups - providing information free of charge instead (free… there’s that deceptive word again…) I assauged my guilt about not being a doula for everyone by making information available to everyone.
And then - - I stopped actively attending births as a doula. This niggling piece of me woke up and realized that "Every woman deserves a doula" - no matter how you spin it - isn’t actually TRUE. But for someone who had BEEN a doula for 14 years, I still think of myself as a doula, this felt almost like heresy and so I kept my thoughts to myself. I didn’t want it to look like I was throwing my doula friends under the bus.
Until this week. Ang Gallo of Heart & Hustle talked about this in an Instagram video for her new doula training. She opened her video saying essentially that she knew she wasn’t supposed to say it, but Eff It, she was gonna say it anyways. And she proceeded to talk about the “every woman deserves a doula” concept in terms of the harm that this belief does to aspiring doulas. And she’s right. This concept DOES hurt aspiring doulas. It keeps doulas small. It keeps us “in our place”. It makes us doubt our power. It makes us work from a place of scarcity instead of abdundence. But it does even more damage than that.
Women have been serving other women in birth forever. Doulas though, came to be a profession over the last 20 or so years due to the isolation and disrespect and abuse birthing women have experienced in our current system. Professional doulas emerged to fill a void, to stop a gap. But doulas aren't actually the solution. We're a bandaid on a broken system. An awesome bandaid with evidence to support the benefits. Lol. But a bandaid nonetheless.
I’ve been hearing story after story lately of women who hired a doula, and yet their births were still terrible, terrifying, traumatizing. All those statistics you hear about the benefits of hiring a doula - - how they reduce the risk of things like assisted deliveries and cesareans, or the need for pain medications…. It’s all smoke and mirrors. I - as a doula - cannot stop the freight train that is coming at you as a birthing person in our current system. My experiences can let you know the train is coming. I can help support you as it flies by. I can let you know about options other than the train for giving birth, but I can’t actually stop the train. Those statistical benefits doulas provide, its like saying “Here, buy an umbrella to hold while you stand under Niagara Falls. You’ll be 25% less wet.” Really? I mean REALLY? Doulas in our current system are a bandaid at best; an umbrella in a hurricane. Yes we DO make a difference. For those who are giving birth with a very limited or even NO support system a doula can be lifechanging. In a fractured society where we don’t have built-in support from knowledgeable aunts and older sisters and Grandma’s anymore a doula can fill this space. Sometimes having a doula truly changes the course of a person’s birth. I’m not saying we need to toss out the doula care model. I am a doula. I had a doula at my births.
What I am saying is that every birthing person deserves MORE THAN A BANDAID; more than an umbrella under Niagara Falls. Every birthing person deserves to be treated with respect, compassion and dignity. Every birthing person deserves to feel safe and supported in their pregnancy, birth, and postpartum experience. Every birthing person deserves to feel that their needs and desires matter and are a priority to those caring for them.
When we say 'every woman deserves a doula' I’m starting to get the feeling that we're all getting duped. Like, if we're all so focused on doula services and who deserves them and whether they’re paid for or free or independent or hospital-based or mainstream or “rogue”....then maybe we’ll forget about why women needed doulas in the first place and we’ll forget to be angry about a broken maternal-healthcare system and instead turn our anger on each other. If we’re all busy fighting amongst ourselves, the linear, scientific, patriarchal model of birth we have now can just keep barreling along unchecked. What we deserve isn’t a doula. What we deserve is to have our fundamental human rights respected and to be treated with compassion and dignity. That should be the default. And when that’s the default, phrases like “every woman deserves a doula” will become irrelevant, a piece of history.
Would you rather watch/listen than read? Here ya go!
Posted by Sarah Stogryn on
I’d had a rare few minutes to myself in a bookstore and as I was on my way out the door I spied “They All Saw A Cat” by Brendan Wenzel. It is the story of a fish and a dog and a fox and a bat and a bee and a skunk and various other creatures who all saw a cat. While they all “saw a cat”, they each saw the cat differently - some would even say they each saw a different cat. The perspective of the flea is true for the flea but not at all the same as the perspective of the bird or the worm or the child.
In the end the cat sees it's own reflection in water but as the reader we are able to see that even how the cat views itself reflected in the water is different than the image of the cat which is the subject of the reflection.
When it comes to birth trauma, things aren't always as they seem to be.
This isn't unlike birth memories and birth trauma. A birth that is scary and 'traumatic' to an observer might be one that the birthing person themself feels really great about. As a doula I certainly attended births over the years where genuine emergencies occurred or the birthing woman was treated terribly, but in talking with them postpartum they didn't experience their birth as traumatic*. Trauma typically results when the person feels as though their wellbeing or even life, or that of their child, are threatened by what is happening. So if an emergency occurs but the person feels safe, trauma is less likely to occur.
On the flipside, a birth that looks idyllic to an onlooker might be experienced as traumatic by the birthing person, if for any reason they felt unsafe or threatened.
Even births that are supported by midwives and a doula...
where everything is within the realm of normal…
where the birthing person's birth plan is respected...
where they are treated with kindness and respect….
Those kind of “perfect” looking births can still be traumatic.
You see, none of our experiences occur in isolation.
We ‘see’ with our brains not our eyes and we remember things from our past through the filter of our entire life, including events that occurred both before and after this particular event. Every time we look ‘back' on something, each time we pull it up from our mind to remember it, new experiences have been layered over it causing our perspective to shift and colouring what we see now. If we have experienced significantly adverse events at any time those particularly wire our brain to process experiences through a painful lens. Abuse, mental health issues, assault, a prior traumatic birth or postpartum... each of these things and more can be strong triggers for trauma to (re)occur in an otherwise ordinary birth.
The process of labour & birth changes how we perceive what is happening.
Add to that the unique nature of childbirth and things become fuzzier still. In labour our rational thinking brain goes quiet so our intuitive brain can take over... which thoroughly distorts our sense of time and space and even presence. 2 people in the room feels like 20. 5 people could be there yet it feels like we're all alone if they aren't where we need them to be. A friend who never leaves our side makes it feel like we were being watched as they invaded our privacy or like we're wrapped in a cocoon of all-encompassing love. A partner stepping out for 5 minutes to get us tea feels like they abandoned us for an hour. A midwife gently asking “Are you ready for me to…” feels to some of us like we are being rushed along and to others like they were never gonna ask at all. Pushing for hours can feel like minutes and 90 second contraction-expansions with 30 second breaks can feel endless when we’re exhausted. The whole thing can feel like it's happening at warp speed or like cold molasses and neither feeling has anything to do with the clock. It's all a matter of perspective.
Their truth is THE truth to them but it's not always your truth and that's okay.
The birthing person is like the cat walking through the world in our opening story…..
And their experience of birth is absolutely true for them.
Their joy is real. Their trauma and pain are real.
How the bird and the dog… and the partner and the doctor and the sibling
and the photographer and the nurse and the doula
each saw and heard and smelled and felt the birth is ALSO true
BUT only for themselves.
Your truth is not always their truth.
Holding space for their truth.
Holding space for those we care for is an integral part of being a good birthworker and involves suspending our own perspectives, joy, and pain while the birthing person processes theirs. Part of holding space involves seeing their truth with them and not trying to explain it away or overwrite it with our own truth, while simultaneously being available to help them see through alternate lenses if they wish to shift their perspective.
We must remember though that their truth is their truth. Even when their truth sees a villain where we see a hero. Even when their truth sees respect where we see condescension. Their truth is THE truth to them.
If however you are the person who has experienced birth trauma - - don't let anyone try to rewrite your story. Keep looking until you find the space and tools you need for healing. Because ultimately we can only heal ourselves - we are the only ones who can allow light in again. It doesn't matter if others see. It doesn't matter if they understand. And it doesn't matter if your authentic journey to healing causes them to feel guilty or sad or mad or anything else.Those are their feelings to deal with as they process their own role and as they find their own healing. Being validated, supported and held up certainly can make the process "easier" for some (as if anything about trauma is easy!!) and if that validation is important to you then persist in your search for it. Reach out to a birth counsellor, to a peer support group, to an online forum even if that is what you need, and especially if you know you will not be able to get validation or support from those close to you whom you wish could give it most. But know that You are enough. Your story is enough. What you feel is enough of a reason for you to pursue whatever healing you need even if you are the only person in the world who knows it.
A Hard Pill To Swallow
As a birth professional or a family member/friend at the birth, it can be a hard pill to swallow when the birthing person sees your role very differently than you do or when they experience things you did from a place of loving service as negative or even traumatic. We need to have the courage and humility to hold space for their truth and to examine it for areas where we could perhaps prune and grow in future. We also need to have the strength and confidence sometimes to accept that their truth isn't now, and may never be, our own. Just because someone else sees you as a hero or a villain doesn't necessarily mean you are.
We all see the cat. We all see birth.
We all see our own truth.
Postscript & Resources For Further Reading
*It is important to note that many don't begin to understand their birth as traumatic until months or even years later and this is perfectly normal.
It is estimated that roughly ¼ to ⅓ of births are experienced as traumatic by the birthing person, and approximately 1 in 3 who identify as having had a traumatic birth develop post traumatic stress disorder.
A traumatic birth experience impacts how the birthing person sees themself and their child and can impact their ability to bond with their child as well as increases their risk of post traumatic stress disorder, postpartum depression, and other postpartum mood disorders.
If you have had a traumatic birth experience please know that your feelings are valid and real; that you are not alone; that there is help and healing for you.
We also need to acknowledge that it is not only mothers who experience birth trauma. The birthing person's support people can experience trauma. Their caregivers and birth professionals can experience trauma. And there is birth trauma that happens both intergenerationally and culturally.
If you identify as someone who has experienced birth trauma, please consider the following resources to learn more and take a step forward on your path towards healing:
Solace For Mothers (and their Supporters)
How To Heal From A Traumatic Birth & Bond With Your Baby
Postpartum Progress: together, stronger
Birth Trauma Association
Birth Trauma Canada
Childbirth Trauma ToolKit from Improving Birth
Sondra Rose on Healing Birth Trauma for all using tools such as EFT
Kundalini Yoga for Trauma
PATTCh: Prevention & Treatment of Traumatic Childbirth
Ancient Map For Modern Birth by Pam England
Labyrinth of Birth by Pam England
When Survivors Give Birth by Penny Simkin
Birth Trauma by Kim Thomas