When women are impacted by birth trauma it can stay with them for many years, influencing their mental health and sense of self. The work of Mary Main et al (2005) in their Adult Attachment Interview demonstrated that a child’s attachment status can be predicted with 85% accuracy by their mother’s state of mind. It is therefore vital that mothers be supported towards emotional health when their wellbeing has such a profound significance for the next generation. This article will look at the what we have learned from running workshops for postpartum mothers, using an approach we call ‘After Birth’ and how midwives might bring elements of it into their practice.
We will always be grateful for the day we sat together at Binnie’s dinning table, drinking tea and co-creating After Birth, honouring and resolving the birth of your baby. Both of us had worked (Binnie for many years) with women who wanted to process their birth trauma on a 1:1 basis, but we were inspired by the concept of women coming together to support each other to release the feelings they had been carrying and being able to see their experiences in a new light.
We created a structure that allows women to share their story in an environment of deep listening and total acceptance, by encouraging them to notice specific aspects of their story related to personal power, connection and fear. The workshop also includes psychospiritual processing work and visualisation and other techniques from hypnotherapy. Our experience has been that through this process, women have been able to release emotion, appreciate a new perspective and come away feeling deeply relieved and renewed. Many report being able to experience relationships more positively. What is interesting to notice is when groups of women come together, a few common themes emerge. For some it is the relationship with the baby/child whose birth had been difficult that is impacted. Others long to have another baby, or even were pregnant and were terrified to give birth again. Some women had been angry at their partner ever since the birth, causing much distance in the relationship and a general lack of connection in the family. Many of these mothers feel guilt and shame around their birth story. There is a theme of feeling inadequate as a woman or having failed to give birth. Another strand was the experience of feeling powerless and like no-one was listening or they weren’t safe. It is remarkably healing for women who have carried these kinds of emotions, often for years, to feel the isolation and shame melt away as they discover how unified they are in these experiences.
How to take the After Birth approach into your practice with women:
When you see a woman postnatally or with a multiparous pregnancy, encourage her to tell her story. It is through telling our stories and being listened to that we heal from trauma, something very much inherent within indigenous culture (Atkinson 2003). It may already come naturally to midwives, who are empathically tuned into women as part of their role, but for those who feel less confident, it may be worth doing some training on how to really listen to someone, (something built into our After Birth study day for birth professionals).
Be aware that if you are meeting a women for the first time during a multiparous labour, being in labour will stir up thoughts and feelings from her last birth. If it appears to be interfering with her labour you may need to help her process what happened last time, ideally in a way that allows her to cry or rage. If a mother has been triggered by during labour, she may dissociate, close her eyes, scream in pain. It can be helpful to help bring her back by reminding her where she is and who she’s with, help her focus on simple details of her current surroundings, remind her she is safe and encourage her to look into your eyes. It is very easy for women to buy into thought forms related to feeling alone and separate. Reminding her that her baby is with her counters the belief that ‘I’ve got to do this all by myself.’
It can be really powerful for a mother to acknowledge that her baby is conscious and how much they love her either during labour or in the postnatal period, if she is struggling after a difficult birth. A baby’s limbic system (the social and emotional centre of the brain, which is constantly scanning for non verbal cues to assess for safety and loving attention) is as mature at birth as an adult’s limbic system (Schore 1996). Babies are just as aware of the emotional content of the relationships around them as any of us. Noticing her baby’s attention and focusing on receiving their love can be supportive to the Motherbaby relationship.
A primiparous woman was experiencing a long, drawn out latent phase. When contractions ground to a halt after labouring through the night, the mother was understandably frustrated and upset. We gathered upstairs in the cosy, safe spare room and she sat against the wall with her partner next to her. We knew that she had suffered previous loss of two babies, due to terminations she hadn’t wanted. Roma asked her to close her eyes and imagine carrying each baby to full term. She guided the mother through a visualisation where she imagined taking each baby into her arms in the moments after birth and saying the words “Thank you for loving me so much, you chose me.” This allowed both parents to cry and within 10 minutes contractions were back in full force.
A multiparous woman was progressing well in labour and appeared to be approaching transition, when all of a sudden, contractions dissipated. After trying a change in positioning, some movement and acupressure to no avail, an hour passed and it seemed nothing would get the labour going. Binnie asked “What has held you back before in your life?” The woman promptly burst into tears and sobbed hard about her relationship with her mother. When she had finished crying and telling her story about how she had always felt held back, she was overwhelmed by a strong urge to push and her baby was born shortly thereafter.
Guidelines for listening:
- Move in close with your warmth, eye contact and attention.
- Remember that the woman who is speaking is and has always been doing her very best (and likewise any of the people she is talking about).
- Avoid any urge to reassure, ask questions or offer advice. Just be with her and allow her depth of feeling.
- When you hear that the message behind what she is expressing is one of loss, guilt or shame, remind her that none of this was her fault, she was doing her absolute best, she is a good mother.
A practice we encourage women to try is telling their child the story of their birth, so that they can support their children to work through any trauma. Dan Siegel in his book Parenting from the Inside Out (2014) suggests telling children stories to help them come to terms with their experiences. For many mothers, this felt a taboo topic in their home and some had anxiety about how they would answer any questions about their child’s birth. Once they had the opportunity to clear some of the shame and guilt they felt, it opened up the possibility of sharing their child’s birth story in a more positive light.
Finally, a hugely important element in healing from birth trauma is self care, which we teach mothers. Mothers need resourced midwives. Midwives are constantly giving, under a great deal of pressure. If you are not receiving adequate support, you can not give it. What daily practices, activities or which people make you feel good? Write a list and start scheduling those things into your diary, daily! In order to build greater capacity to listen to mothers’ stories, as supporters we first need to tell our own stories. Tell the story of your own birth and those of your children. Tell stories about things that have happened to you that you feel distressed about and even tell stories about what really lights you up. One practice that allows us to do this is Listening Partnerships (developed in this form by Wipfler 2006), where you exchange time with another person to listen to each other. Studies suggest that offering focussed, positive regard for another can be therapeutic for resolving difficult experiences (Praszkier 2014).
Guidelines for Listening Partnerships
- Choose someone you think would make a good Listening Partner; it may be a colleague or friend or someone you’ve met online.
- Agree a time to speak each week (or several times a week) in person or by phone/Skype and exchange anything from 10-45 minutes each. Use a timer to make sure turns are fair.
- Use the Guidelines for Listening (above) to convey your warmth and acceptance of the other person. Remember that your attention is enough to unleash their innate intelligence so there’s no need to fix or guide.
- At the end of your partner’s turn it can be helpful to ask them a ‘refresher question’ where you stimulate the prefrontal cortex, to pull them out of their limbic brain. Something like “What postcodes have you lived at?” or “Name some flowers beginning with P.”
Difficult births can have a long lasting and devastating impact on the whole family and subsequent births. The key element of being able to resolve these experiences is through telling our story. Midwives can be a great support to women going through turmoil after birth. Never underestimate the value of a kind word or a few minutes listening. Prioritising taking good care of yourself and telling your own stories allows us to create a listening field for others.
Atkinson, J. (2002) Trauma Trails; recreating songlines, the transgenerational effect of trauma in Indigenous Australia. Melbourne. Spinifex Press.
Main, E. Hesse, and N. Kaplan (2005) “Predictability of Attachment Behaviour and Representational Processes at 1, 6 and 19 Years of Age: The Berkley Longitudinal Study.” In K.E. Grossman, K. Grossman and E. Waters, eds., Attachment from Infancy to Adulthood: The Major Longitudinal Studies, pp. 245-304. New York: Guildford Press.
Praszkier, R (2014) Empathy, mirror neurons and SYNC. Mind and Society, pp1-25. Online.
Schore, A. (1996) The experience-dependent maturation of a regulatory system in the orbital prefrontal cortex and the origin of developmental psychopathology. Development and Psychopathology, 8, pp 59-87.
Siegel, D. and Hartzell, M. (2014) Parenting from the Inside Out: how a deeper self-understanding can help you raise children who thrive pp.270-272 Tenth anniversary edition. London. Penguin Group.
Wipfler, P. (2006) Listening Partnerships for Parents. California. Hand in Hand Parenting.