Birth trauma is sadly on the rise.
It is often confused with the symptoms of post natal anxiety and post natal depression. However, the underlying mechanism for the development of trauma is different to that of PNA and PND. And the treatment of trauma must therefore also address it at its roots.
There are various views on what trauma is. It is defined within the psychiatric framework or DSM-5 as a mental health disorder.
There is also a broader definition of trauma based on neurobiology which recognises it as a normal response to an overwhelming situation.
It’s viewed here as an interruption in the completion of a response to feeling threatened, where an event has been “too much, too fast, and too soon.” In other words, it has been too overwhelming, occurred at too fast a pace and too suddenly to be fully processed and integrated. The threat may be physical or psychological, real or perceived.
Regardless of the details of the event, trauma is viewed within this framework as the outcome of the person’s nervous system registering a threat and reacting to it with an incomplete response. This then leaves some of the charge in the nervous system such that the person experiences a continuing threat. And so the nervous system and body constantly brace or contract in readiness. The person’s choices become restricted and they become tethered to situations from the past that are perpetuated in the body.
This neuro-physiological approach to resolving trauma is known as Somatic Experiencing® and was developed by Dr Peter Levine over forty-five years ago. It is underpinned by The Polyvagal Theory of Dr Sephen Porges who studied closely the responses of mammals, including humans, to feeling threatened on any level.
The SE approach also takes into account the person’s baseline capacity or resilience as to the way in which the event will impact. It proposes that as human mammals we are all susceptible to traumas, small or large. And if we carry a great deal of cumulative stress in our bodies, we will naturally be more prone to being triggered by seemingly minor events.
A significant pattern in trauma that is under-recognised is the freeze response which results when we feel captive in a situation and are unable to escape or defend ourselves. There is a great deal of survival energy bound up in this numbed-out state, similar to stepping on the accelerator and brake of a car at the same time. When the energy is not released safely, the freeze state can become our default way of being in the world and wreak havoc on our health and wellbeing.
As trauma is regarded in the SE approach as a response of the autonomic nervous system which is controlled by the more ancient part of the brain, the “reptilian” or “primal” brain, it is argued that healing will be most effective at this level.
It follows from this standpoint that trauma cannot be rationalized or willed away by recreating events, talking or journaling about them, or changing our thoughts and beliefs about how we feel.
Using Somatic Experiencing® or SE, we put pieces of the puzzle together from memories, feelings, images, sensations and spontaneous movements at the somatic or body level which feeds into our cognitive understanding. In this “bottom-up, top-down” way the body is given permission to soften and let go of its holding and bracing from past events over time.
SE is a gentle and empowering approach which views all of our responses as a way in which our nervous system has ensured our survival, even if the prolonged defence and constriction no longer serve a purpose. This then takes some of the blame, guilt and shame out of the situation and helps restore our self-esteem and life force.
A basic premise of the SE approach is to create a sense of safety in the body and nervous system and work only at the pace and intensity that it is ready to handle.
This is known as the person’s window of tolerance and may be not be the level that they themselves may think they’re ready to work at. It is found that if the process is not rushed, the shifts that occur can be easier to integrate and will be more lasting. So in effect, taking small steps will mean that the process of trauma resolution will involve less time overall.
Another principle is that strong emotional release or catharsis is not actively encouraged, not only so that the person’s “witness” is fully present to process shifts, but also because this may take them outside their window of tolerance and work against them by re-traumatising.
In SE the focus is always on how the nervous system is responding and less about meaning-making. However, sessions also involve psycho-education on how it all fits together in the context of the person’s history and specifically challenging events, understanding their stress physiology and individual patterns of containing their feelings to avoid overwhelm. Feelings are validated and the impact of birth trauma is normalised during sessions. The language of the primal brain is sensation, and feelings or emotions are also tracked as body sensations.
During the guided processes body memories may arise as images, symbols, sounds, smells, tastes, and impulses to move the body in particular ways, vocalise or relase emotions, and these then take the lead in the exploration.
When working with birth-related trauma, the first step is to establish the person’s internal and external resources as well as a level of safety and grounding in the body and nervous system. Awareness is placed on places of contrast and shifts – of expansions and contractions in the body.
There is also a noticing of any discharge of energy in the form of heat, change in breathing pattern, heart rate, trembling, sweating, movement of energy and other bodily changes.
We are herd mammals at our core and constantly read one another’s body signals of safety versus danger, often without our conscious awareness. SE practitioners are trained to tune in closely to bodies and nervous systems with awareness of subtle shifts between kinds of activation – relaxed alertness, fight & flight, or freeze & immobilization – as well as overlapping states. Their aim is to be fully present with clients who rely on co-regulation to stabilize their own nervous systems.
In other words they may benefit from the stability and coherence of the practitioner’s nervous system simply by being together in the same space.
Sessions are usually held with clients in seated or lying position. Touch can be incorporated to communicate more directly with the person’s nervous system and give the body permission to let go of its holding patterns and support regulation.
When clients are ready to work directly on birth repair, the birth story is explored sequentially in a conversational way between practitioner and client. When there is some apparent charge in the nervous system such as breathing, heart rate or other changes, the practitioner slows down the segment of the story and helps the client to integrate in specific ways which are more settling and empowering.
At pivotal moments the client may be asked if there are any impulses to move their body in specific ways, effectively completing the defensive survival response which was thwarted in the past. Or if there was something they needed to express in words or sounds, again for completion. And so there may be a sense of completing what didn’t get to happen previously as the person tracks their body for shifts.
The client may tune into how they might have wanted specific individuals in the birth team to have responded in birth. And how they would have liked to assert their boundaries in the space with accompanying words or actions.
The notion of a “competent protector” can be accessed in the imagination with a felt sense of how that being may have brought calm to the situation, and allowing that feeling to settle on the somatic level.
They may reflect on when they first realised that they together with their baby had come through the experience intact. Or if there was anyone who made the experience more bearable – perhaps a kind midwife, their partner, or the feeling of their baby in their arms.
The aim of the repair work is to discharge any bound survival energy from the past and drink in all the goodness that can be found within the experience once everything is slowed down enough to mine some positive moments.
In the process, the client also untangles or “uncouples” from past associations or triggers. These shifts can begin during the sessions but often continue afterwards as the client’s nervous system fully integrates them.
There are special considerations for clients emerging from the freeze, immobilization or dissociation response which is the dominant pattern I personally observe in birth-related trauma where the birthing person feels captive in the situation. To their primal body the freeze state equates to impending death as they cannot fight or escape from the situation. There is often a great deal of fear leading into freeze and this can crop up again as they “thaw” from this numbed-out state during sessions.
At times other traumatic memories can spontaneously arise particularly in relation to the person’s own birth or the crossing of their sexual boundaries in the past. Like birth, these are highly embodied experiences which often involve the same anatomy or primal states thereby activating implicit memories. These then become choice points for further resolution work in the session. If appropriate for the client, incorporating supportive touch in these and birth trauma sessions can add a powerful dimension to completing the past.
Birth trauma on its own is regarded as shock trauma and symptoms are amenable to relatively quick resolution over a number of sessions. However if clients have a history of complex trauma including developmental trauma, a longer timeframe can be expected. SE is also a highly effective approach for clients who are anxious about birthing so that they work prospectively to promote a felt sense of confidence.
The net result with this specialised therapy for trauma is having more energy available to respond to life in the here and now, and not through the lens of past events.
This translates to greater choice, freedom and a sense of aliveness as clients begin to reclaim the parts of themselves that have felt missing or stuck.
Nisha Gill is the founder of Feminine Instincts ~ Melbourne Wellbeing & Birth Services.
She is a Somatic Experiencing® Practitioner and works holistically in the fields of trauma, counselling, birth, bodywork, women’s embodiment and sexuality.
She offers 1:1 sessions in her practice in Melbourne or distance sessions via Zoom/ Skype.