It’s no secret a doula’s presence at a birth is beneficial. Having a birth doula’s support has been shown to decrease the need for various interventions and also increases the likelihood of a woman reporting a positive birth experience. But one benefit I believe we aren’t discussing enough is the unique support a birth doula can provide to survivor clients.
Sexual assault is an epidemic. 1 out of every 6 American women has been the victim of an attempted or completed rape. This translates to an assault happening every 98 seconds. These statistics reflect the overwhelming likelihood that many of the women we support in birth will carry a history and it’s important for us to consider how trauma can impact birth.
As all birth workers know, oxytocin is the labor hormone. It helps reduce pain and increases our ability to relax and bond with our babies. We want it to be released in abundance so the natural process of birth can unfold. The unique struggle for survivor women however, is the likelihood of being triggered during birth which can reduce the flow of oxytocin. Let me explain.
Traumatic memories store themselves in the mind and body and can be triggered when we perceive a threat. When a trigger occurs, the body activates the stress response. The fight or flight hormones adrenaline and cortisol are released. These speed up your heart rate and create a hyper alert state which allows you to escape the perceived danger.
Considering the invasive, painful and often fearful procedures that can be common in birth, it is very likely a survivor can be triggered at some point during her labor. Take for example cervical checks. A survivor may perceive these as a threat and her body will in turn activate the stress response described above. This response can interrupt her labor progress as cortisol is released and the flow of oxytocin is decreased. Cortisol and oxytocin are not friends. When one goes up, the other is forced to go down which can often stall the natural birthing process.
All women have the right to birth the way that feels right for them and I believe we as a culture must trust women and their bodies. But when a woman carries a history of trauma, her ability to trust and feel safe can be jeopardized. Birth professionals can play a role in helping survivors regain a sense of control. If we approach our work with a trauma-informed lens, then survivors can feel more supported and empowered.
Trauma-informed care is not only an understanding of trauma, but also involves the care provider’s responsiveness to the impact of trauma. It emphasizes physical, psychological, and emotional safety for the survivor and creates opportunities for survivors to rebuild a sense of control and empowerment.
So how exactly can we practice trauma-informed care and be the BEST Doula? There isn’t a simple answer and I believe we must all be proactive in receiving continued education and training on the most evidence based support techniques available, but I will share a few easy practices anyone can incorporate into their work that can be helpful as we navigate the perinatal period with survivor clients.
Help identify triggers
No survivor is triggered the same, but it’s important to think about the things that could remind clients of their assault. Triggers during the perinatal period can include invasive procedures such as blood draws, IV’s, vaginal exams, continuous monitoring, etc. Even the feeling of a loss of control during labor itself can be triggering. Sensory objects are also common triggers. For example, a survivor that was told by her attacker to “just relax” could be majorly triggered by a care provider using that same language. Again triggers vary greatly, but they can be as simple as a word, sight, smell or touch and support teams can majorly shift a survivor’s experience if we are sensitive and mindful of what triggers exist.
Utilize grounding techniques
Some survivors feel such a loss of control that they may dissociate. Dissociation is not an emotional response, but rather a detachment from reality. The survivor’s mind is literally in an alternate space and witnessing this response can be intimidating. To help them feel more present and in control you can literally help them become grounded again. Have them sit on a chair, talk them through the sensation of feeling their feet firmly planted on the ground and their back against the chair. Walk them through all five senses. What do they hear, smell, see, feel, taste? Encourage them to focus on their breathing and feel each breath travel from their mouth to the bottom of their feet that are steady on the ground. Grounding techniques vary, but in general it is any exercise that can help center and create a sense of safety.
Know therapeutic resources
Staying informed on resources that may be helpful for our clients should always include trauma specific support services. Therapy is an evidence based treatment for trauma, but it’s important to seek a therapist that has experience with trauma and is informed on the most evidence based interventions. If a client is turned off to individual therapy, another option to offer is group therapy. Group treatment is extremely effective and evidence based for survivors. It’s also helpful to know a little bit about the various therapeutic interventions. When people hear the word therapy they often imagine talk therapy where they have to discuss their experience in detail. The thought of having to tell their story can be overwhelming so informing survivors that various therapeutic approaches exist, many of which don’t involve retelling their experience, can ease fears about seeking more support.
Again, there isn’t a simple answer for supporting survivors as they give birth, but it’s a conversation we need to be having and it is my mission to make trauma-informed care common practice in the birth world. If you want to learn more, I highly recommend the book, “When Survivor’s Give Birth” by Simkin & Klaus (required reading for all BEST Doulas).
Alexis is an LCSW, doula, and birth nerd in Austin, Texas. She is a survivor of sexual assault and an advocate for healing through birth. She is the perpetually tired mama to two red-headed babes and survives on all the sarcasm and caffeine as she raises them amidst the chaos. You can find her work in birth and mental health at Birth360. She therapeutically rambles about motherhood and social justice on her blog, Mrs. Mombie. You can also find her daily ramblings and sometimes foul-mouthed shenanigans on her Instagram.