An insight into trauma

What is trauma?

When you think of trauma, perhaps events like natural disasters, combat, accidents, terrorist attacks, violent physical or sexual assaults may come to mind.

However, a broader view of trauma includes those experiences that are extremely upsetting, difficult to comprehend, overwhelm your belief that you can cope (even if only for a moment), and produces lasting psychological and physical symptoms.

Experiencing a traumatic event can happen to anybody, anywhere and at any time.

It is very normal following a traumatic event to not feel very normal at all! In the hours, days and perhaps even months following it may feel as though your world has been turned upside down. Beliefs you held about yourself, your safety, your future, those around you, and life in general may become shattered.

Any two people exposed to a similar trauma may respond in remarkably different ways. Some may experience mild, short-term symptoms, others more severe, persistent symptoms that may warrant a diagnosis of Post-Traumatic Stress Disorder (PTSD), depression, or an anxiety disorder.

One common, yet extraordinarily complex and potentially traumatic life event is childbirth. Pregnancy, childbirth, and the post-partum period is typically a vulnerable time for mothers and their supports. Experiences during this time can lead mothers and their supports down very different paths – possibly joyous, possibly distressed, or possibly a complicated mixture.

Feeling strong in your mind, having a sense of physical safety, and having the right supports are particularly important around childbirth. However, this ideal can be hard to achieve, especially when you are trying to recover from the major physical changes that come from growing and delivering a tiny human, pain, hormonal changes, exhaustion, learning new roles, possible financial stress, differences between how you thought things would be and how they actually are, possible unsolicited advice or lack of support from others, and minimal acknowledgement or even invalidation of the fear, panic, loss of control and/or dignity that you may have felt. All of these things can compound to add to or worsen trauma.

To date, more attention appears to have be paid to the physical effects of birth trauma on the mother and the infant, with little consideration to the psychological impact of birth trauma. Consequently, the emotional, social, and spiritual impacts of trauma experienced in pregnancy, childbirth and the post-partum period may be underestimated and misunderstood.

What happens when we experience trauma

The effects of trauma on your mind and body are complex. There are many moments related to childbirth that may be intensely upsetting, overwhelming and difficult to comprehend.

Feeling vulnerable can be common, as can moments where you may believe there to be an immediate threat either to your own or your baby's life.

When faced with an immediate threat, your inbuilt survival system kicks in to protect you from harm. This survival system is known as the ‘fight-flight-freeze’ response and has been with humans since we lived in caves – it’s a very normal response!

If you think there is a chance at defeating the threat you may try to defend yourself (fight); if the threat seems too powerful to overcome you may attempt to run away (flight); and if you think you cannot defend yourself or run away, then you may shut down and go numb (freeze).

All these responses are adaptive and normal. During the fight-flight-freeze response you may experience the following:

Heart pounding, arms and/or legs may shake, feel weak like “jelly”. This is due to the heart pumping faster to push blood into your muscles to enhance your ability to run away or fight.
Nausea or “butterflies” in your tummy, and/or sudden need to empty your bladder or bowel. This is due to blood being diverted away from organs that you don’t need for your immediate survival (e.g., the digestive system).
Dry mouth, dizziness, or lightheadedness, which is the result of breathing faster to try take in as much oxygen as possible so that it can be sent to the brain to increase your alertness and sharpen your senses (e.g., vision).
Feeling disconnected from yourself, or your mind may go blank, and organising your thoughts, words or behaviours becomes difficult. This is due to the parts of our brain associated with survival needing to dominate and making the others “shut down”.

Usually when a threat has passed your body and mind come back to a calmer more balanced space. However, following significant trauma this balance may become disrupted temporarily.

Common and normal ways we may respond to trauma include, but are not limited to:

Increased feelings of fear, vulnerability, despair, hopelessness, helplessness, isolation, guilt, shame, irritability, anger, resentment, loss, grief, abandonment, numbness, sadness.
Isolating from whānau and friends, “snapping” at others, reduced interest in activities previously enjoyed, withdrawal from your usual daily routines and self-care, seeking reassurance from others, checking behaviours, avoiding people, places or reminders of the traumatic event, feeling jumpy and on edge, increased alcohol/substance use, and engaging in self-destructive or dangerous behaviours.
Difficulty concentrating, having trouble falling or staying asleep (outside the norms of newborn life!), intrusive thoughts of the event, nightmares, memory lapses (particularly significant aspects of the traumatic event), feeling detached from your body or mind (e.g., as if you were in a dream or time was moving slowly) or detached from your surroundings (the world around you may feel distant, distorted or unreal)
Negative beliefs about yourself (e.g., that you are damaged, bad, cursed, undeserving, inadequate, or overly responsible for the event), others (e.g., I can’t trust anyone ever again, no-one will ever understand, my baby is better off without me), thoughts of harming yourself or others.
Questioning/doubting your purpose and/or the meaning of the event, questioning your identity (e.g., who am I, do I really matter, what am I doing with my life?). Thinking you are the only person that this has ever happened to.
In addition, if you are experiencing birth trauma you may be avoidant/feel distant from your infant. Or perhaps you feel on edge and over-protective of your infant. You may fear future pregnancies.

Healing from trauma is possible

People can and do recover from trauma. For the majority, most, if not all these symptoms will resolve naturally within a few days or weeks. However, for some these responses will continue for longer than a month and may indicate the development of PTSD, post-natal depression, post-natal anxiety and/or post-partum psychosis.

If you don’t feel like yourself after a month following your negative or traumatic birth experience, it is advisable to contact your local GP to discuss your experiences and, if necessary, what specialist support is available (e.g., talking therapies, medication, support groups).

Getting appropriate, individualised support can restore a sense of safety to your mind, body and brain. Although your brain is wired for survival, it is also wired for resiliency and a desire to heal itself.

Under the right circumstances, many of those who have experienced trauma, including birth trauma, can emerge from the distress with positive and profound changes, also known as ‘post-traumatic growth’. People may experience a new appreciation of life, more meaningful relationships with themselves and others, a sense of new possibilities, or spiritual changes.

Though trauma happens moving forward and healing is certainly possible.

Please see our External Resources page for support options.

Huge thanks to Lucy for contributing this piece. Lucy is a psychologist who lives and works in Canterbury. My Birth Story is hugely grateful for her contribution of the Insights piece.

References

Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework. Psychological Medicine, 46 (6), 1121-1134.
Ayers, S. & Ford, E. (2012). PTSD following childbirth. In: C. R. Martin (Ed.), Perinatal mental health: a clinical guide (pp. 155-164). M & K Update.
Beck, C. T., & Watson, S. (2016). Posttraumatic growth after birth trauma: “I was broken, now I am unbreakable”. The American Journal of Maternal Child Nursing, 41 (5), 264-271.
Briere, J.N., & Scott, C. (2014). Principles of Trauma Therapy: A guide to symptoms, evaluation, and treatment. Thousand Oaks, US: SAGE publications.
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. New York: Viking.