birth, doula, Healing, Honesty, Intention, Loving Kindness, Practice

Trigger warning: trauma, doctors, hospital, birth, sex It is very important to me to approach all of the work that I do from a trauma-informed perspective. Whether it is asking for consent before touching a student in yoga class, offering self-regulation skills to those I work with, or preparing clients for potential triggers*, I do my best to incorporate my on-going learning in the field of trauma into my professional practices. Recently, I began taking trauma classes for professionals through Lakeside Global Institute (formerly IFP), and have been layering in what I am learning with my preexisting trauma-informed approaches. One of the biggest impacts these classes have had on me so far is the ability to speak to why I do things differently than other professionals like me.  Why remind yoga students over and over that everything I offer in class is optional? Why ask about family relationships on my doula client intake forms, or wait until the third and final prenatal meeting to practice hands-on skills with my birth clients? It has also given me the language and understanding to better explain why trauma should be considered when understanding that doulas are a necessity, not a luxury. The scope of this post will be specific to birth doulas. I feel obligated to insert the following disclaimer: I have now put myself in an interesting place, because I am saying that there is a need for birth doulas, and that they are a necessity… but I also deeply believe that the cultural narrative surrounding birth is flawed because it necessitates the help and presence of professionals and paraprofessionals during childbirth. I believe that instinct alone CAN be enough to guide someone through labor, but because birth has become medicalized and pathologize-d, and because most folks feel safest under the observation of a medical professional during childbirth, I am making the assumption that the majority of those who might read this would plan to give birth in a hospital, birth center, or under the care of a midwife at a home birth. Do I think that you need a doula order to have a positive birth experience? In the deepest sense, no, but in the cultural sense yes. That being said, through a trauma lens… what makes doulas a necessity?

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Evidence Supports the Use of A Birth Doula Did you know that there have been 25 randomized, controlled trials that studied the effects of continuous labor support, including doulas? The 2017 Cochrane Review compiled the results of these studies. Overall, those who received labor support had a decrease in unwanted medical intervention (including a 39% decrease in the chance of unplanned c-section), and overall less anxiety AND less pain. Any measurable differences between those assigned labor support or those who went without, were more significant when the assigned support was a trained doula. When considering trauma, the most relevant piece of data from this review is the significant decrease in a person’s feeling of dissatisfaction with their childbirth experience… a 31% decrease in those who were supported by a doula. Now, the word “dissatisfaction,” leaves a lot open to interpretation. Let me put it this way… childbirth is demanding physically, emotionally, mentally, energetically, financially, relationally… the list goes on. This isn’t a shrug your shoulders kind of dissatisfaction, as you mutter, “Eh, we’ll get it right next time. Easy come, easy go.” This isn’t a time to be polite about the small intrusions or discomforts. Trauma is sensory. It is stored in our bodies in a way that can feel mysterious because it exists beneath conscious thought. You had better believe that someone touching you in an unwanted way (especially invasively or internally), talking to you in a way that distracts (especially in an inappropriate tone or using thoughtless language), smelling strongly near you, or being in your sensory space in any way that is overwhelming, will be much more intense when you are in labor, and the impacts may be longer-lasting. Now, add in that labor is always unpredictable. Whether you are having your first child, or your fifth, you have no idea what this experience will bring. New sensations and signs of labor, new timelines, and new thought patterns can throw us into an alarmed or fearful state. When we lose the ability to think clearly due to fear, everything starts to feel like a potential danger. In a medicalized labor setting the sensory overload and feeling of fear could be amplified. To give an oversimplified example, if you are being monitored, there might be the constant sound of your baby’s heart rate, and periodic beeping from the monitor when it is out of paper, or the band slips off of your belly and it can’t get a read. The loud beeping continues until someone is comes in to stop it, and while they’re in your room they likely also touch you and ask you questions. Double or triple that pattern of alarming sound, medical disruption, and the anxiety it might cause if you are receiving IV fluids or medication. With each disruptive trigger, you might drop into a lower brain state. You forget the tools you prepared to help you through labor – your breath, your affirmations, your movements – and minutes start to feel like hours. A doula can help you self-regulate. No matter your labor setting, the level of medical intervention you choose, or the unpredicted twists and turns of labor, your doula will remind you of your coping mechanisms. A doula can also help you improve the sensory setting. Whether its turning down the lights, or coaching your partner when and how to best communicate with you, or asking the nurse to please wait until this contraction is over before they try to place that IV. The little things that a trained doula knows to look for and prepare for make a big difference when it comes to how the memory of your labor experience will be stored and processed.

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Benefits the Development of Your Child Did you know that your baby begins storing emotional memories in the 3rd trimester of pregnancy? And, emotional memories are the longest lasting memories? And, the younger a person, the greater an impact that trauma has? The way that you feel in the final weeks of pregnancy can have lasting impacts on the development of your child. When the brain is sent signals of stress or fear, development is focused in the brain stem and midbrain. Survival becomes the goal. We want our children to thrive, not simply survive! Often, stress in the 3rd trimester is related to preparation for labor. Perhaps you’re beginning to question your abilities or your level of preparedness. A doula will not only spend time in prenatal meetings helping you to prepare in the way that is best for you, but they can also answer any lingering questions. Many birth doulas are also childbirth educators, so they are a wealth of information to supplement any classes you may have taken, or books/blogs you are reading. Having a professional who will answer your texts, calls and emails, and who will validate your ability to birth and to parent makes a huge difference in your stress level in the final weeks of pregnancy. The increased positivity will help your baby store memories that are positive, too. When the brain learns love, rather than fear while still in utero, it sends a very powerful message – grow, develop, be unafraid, there is a lovely world waiting to meet you.

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Helps Mitigate the Impact of Transgenerational Trauma Did you know that trauma can be passed down? We might be okay with our children having our green eyes, or creative mind, but we probably want to prevent them from feeling the hurt that we have felt in our own lives. If you have a traumatic labor, then your baby has a traumatic birth. It is that simple. If you do not adequately process your traumatic experience in childbirth, it will perpetuate. Both you and your baby can avoid unnecessary trauma, and heal from unavoidable trauma with the help of a trauma-informed doula. As a trauma-informed doula, often this means that I refer clients to professionals with higher levels of training and capacity than myself. We don’t know what we don’t know. Someone who can help you identify what is traumatic, and seek out the appropriate path towards healing is invaluable.

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Long Term Financial Benefits Did you know that from a systems perspective, it is more socially and fiscally sustainable to identify, prevent and heal trauma, than it is to ignore it and find quick fixes for trauma symptoms? Okay, that was a mouthful. I want to avoid getting into unrelated politics here, so let me just say this… There is a cultural tendency to ignore trauma. Sometimes,  this is because we don’t recognize it for what it is, so how could we possibly identify it? Instead, we see and treat the symptoms of trauma. We see a new parent struggling with postpartum depression, and a doctor who prescribes drugs instead of nutritional balance in order to address hormones and mood. We see a new parent return to work after minimal parental leave, and get penalized for shirking their professional responsibilities as they adjust to a major life change. We see someone who has given birth unready to return to their pre-baby sex life, and a partner, friend, or family member say, “well your doctor cleared you for sex, didn’t they?” Consider, too, the way that any trauma in a growing child might be misunderstood and improperly treated over time. Where is the financial element in these social trends? There are layers and layers to this, so to oversimplify… drugs cost money, an inefficient workforce costs money, families in turmoil or separation cost money. Trauma impacts all of us, whether directly or indirectly. It takes a toll on our families and our societies if it continues on ignored. If we can properly prevent and heal individuals from their traumas, everyone benefits.

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Remember that disclaimer I started with? I just want to remind you that you CAN do this! You can give birth, and you can parent! You are also capable of doing this without the input of an outside professional. But, we all like to feel heard, seen, and supported. Feeling heard, seen, and supported should not be a best case scenario, it should be a reality that you demand. A doula can help you create that reality, regardless of your intentions or preferences for labor. If for no other reason, consider a birth doula as a necessity – not a luxury – through the lens of trauma. As always, choose Love Over Fear. *This post does not include explicit discussion of how past traumas might be triggered in pregnancy, childbirth, and postpartum.