I was recently invited to write a short article for the Colorado Doula Association:
Tips for Supporting Survivors of Trauma
During pregnancy and birth women who have a history of trauma, such as sexual abuse, medical trauma and prior birth trauma, can experience emotional and physiological symptoms. As a doula, you are in a unique position to support these women.
It is important to develop a method for assessing trauma. Though some clients will openly share that they have experienced something distressing, many will not. It is a topic that often provokes feelings of shame and fear of judgment. Sometimes it is too painful to talk about. However there are signs that can tell you if your client may be suffering from the effects of trauma.
Hyperarousal – Trauma, though difficult to define, can be thought of as experience that we were unable to process or integrate and instead remains trapped in our nervous system. This is overwhelming because it means we still have the physiological feeling that we need to fight or flee from danger; however because we cannot locate the danger this task is impossible. It’s almost as though part of us doesn’t know that a distressing event is no longer happening. A client having this experience may seem more anxious than expected and have particularly strong physical responses to stress.
Dissociation. In order to survive a distressing event we may mentally or emotionally “leave” our bodies and this may then become a strategy for all future stressful events. As a result, we often struggle with body awareness and connection to our bodies. Direct questions about body sensations may be difficult to answer. Dissociation varies in severity. Emotional numbness, or “checking out” behaviors such as substance abuse, excessive TV watching etc., may be signs of trauma.
Avoidance Behaviors – Avoidance behaviors are our attempt to arrange our lifestyle in such a way as to avoid potentially triggering situations. Some are more obvious, for example, never driving a car for fear of an accident, while others may be more subtle: adopting an excessively agreeable, placating demeanor as a way of avoiding interpersonal stress.
Intrusive thoughts – Some may experience disturbing, involuntary thoughts and/or images that can feel frightening and overwhelming.
The importance of choice – If we’ve experienced trauma, it can be easy to feel trapped or threatened. Giving choices whenever possible throughout the pregnancy and birth process can be tremendously empowering and decrease the chances of activating a trauma response.
I am not my trauma – It is important that survivors of trauma do not feel they are being defined by their trauma. Everyone wishes to be seen for who they truly are as opposed to being reduced to one or more negative experiences. Keeping this in mind can be a good reminder of effective ways to communicate with your client.
Grounding techniques – developing grounding techniques that include breath and visualization often help combat dissociative tendencies and help calm the body in times of hyperarousal. You may want to suggest your client practice these techniques often so that these tools are easily accessible during times of stress.
Refer for mental health services – A trauma-informed therapist can help a client gain awareness, develop positive strategies and decrease symptoms. EMDR is a well-researched form of therapy that allows people the opportunity to reprocess traumatic events, thereby alleviating symptoms. Sandplay therapy and sensorimotor therapy are also particularly helpful with healing trauma.
Learn More – the complexity of trauma goes far beyond the scope of this article. Books such as “Waking the Tiger” by Peter Levine and “The Body Remembers” by Babette Rothschild, are excellent resources. To learn more about EMDR, please visit emdria.org. To learn more about Sandplay: sandplay.org and sensorimotor therapy: sensorimotorpsychotherapy.org.
Submitted by Ruth Weinberg MS, LPC, SP
Ruth is a licensed psychotherapist with over 10 years experience working with children, teens, adults, families and couples. She utilizes EMDR and Sandplay with clients and is on the board of the Colorado Sandplay Therapy Association. Ruth’s specialties include trauma, anxiety, grief and loss, depression and life transitions. She co-facilitates a support group for moms called “The Hidden Feelings of Motherhood”. Next group will be Sunday October 13th 1-4 at Belly Bliss. For more information please contact Ruth at 720-432-1163, firstname.lastname@example.org or visit www.ruthweinberg.com.