Trauma-Informed Birth is Actually a Unicorn

Hi friends!

It’s been a long while since I’ve graced this blog. So long in fact that I came to update my website (go look, I have a clinical supervision page now, yay!) and found this draft I had written in April 2020!!! I was very much pregnant with my pandemic baby then and clearly having lots of feels.

I reread my words and tears filled my eyes as I was brought right back to that time in my life. I was going to leave it as a draft and probably ignore it another 3 years, but my bestie encouraged me to let it live. So here I am publishing it as is.

It isn’t finished and you will see it abruptly ends, but hopefully doing this (+ encouragement from you all!) can give me the push to return to writing and give this beauty the part two it deserves. And not just any part two, but a part two as the me I am now. One that has survived so much more in such a strange hot world. It will be interesting to see what falls to paper on the other side. Stay tuned!

April 9, 2020

I don’t want this to be true. I mean this is what I do for a living. Inform, educate, shift norms, change policy, improve outcomes. It literally runs through my blood. I eat, sleep and breathe educating and advocating for trauma-informed care. But then I became a pregnant person navigating the same systems I tirelessly fight to be different and hot damn were my eyes opened to the realities of how truly fucked up our treatment of pregnant and birthing people (still) is.

What exactly is trauma-informed care? Well it’s not just having knowledge of trauma. NO. It’s awareness + attuned responsiveness. It’s client-centered care. It’s informed consent. Which btw cannot happen via signing a piece of paper. Informed consent is a DISCUSSION. It’s answering questions, offering options, and letting go of your ego long enough to trust and collaborate with the human in front of you. Crazy thought, but they might know a thing or two about the body they own.

Trauma-informed care is collaborative, individualized, and FLEXIBLE. It isn’t based on standards of practice or power-based protocol. NO. It requires challenging deeply rooted, historically fucked up narratives and practices that created rules and regulations around bodies to begin with. It is an investment in yourself and other humans. And more than anything it means facing your own bias, traumas, and discomfort so you can do your work through a lense of compassion, understanding, and HUMANNESS.

It seems basic. Like just connect. Be human. Easy right? *insert sad/defeated/maniacal how the fuck are we still here laugh* Unfortunately, I now have additional lived experience that sucked away so much of the hope I carry around human care becoming standard. In fact, I have many lived experiences that brought me to this work to begin with.

I am a sexual assault survivor, a mental health survivor, and a generational trauma survivor fighting everyday to break cycles passed down. All of this has impacted who I am and how I navigate the world. I’ve done tremendous healing around all it, but the whole body experience of pregnancy, birth and postpartum is always like hold your horses lady, there’s more to unravel here.

Yes, to the epic surprise of my system all that ish decided to tumble into re-consciousness the moment I entered childbearing years. I simultaneously loathed pregnancy and the loss of control I felt in my body yet also fiercely loved the cells multiplying inside me, anxious and determined to protect them from the harms I had endured.

With our first, I was ready and confident in my ability to birth. I read all the books. Took the classes. We even switched providers late in pregnancy when my initial provider refused to share her cesarean stats and told me she was the expert, not me. My new doctor + doula helped me feel safe and secure again, but when it came time for labor my body perceived danger. At the time I didn’t connect my trauma history to what was happening and as a first time parent fear drove me into compliance as we navigated the policies and procedures of a hospital environment.

I was triggered by so much of the medical model of care. I had zero power and felt dehumanized as sheets were pulled back without warning. Nurses would move through the motions without asking or explaining.

Cervical checks were excruciating, my body locked in fight or flight. I sobbed and begged them not to. When they ignored my refusals and gloved up, my body would scoot away to the top of the bed, every inch of me tense with fear. They kept telling me to relax and open my legs. That I was making it worse by not being calm. No one seemed to see this scene as non-consensual or even remotely considered how this was in fact a trauma reaction being met with retraumatization. My body eventually moved into a frozen state, detached and left to relive my rape and the power it took from me.

We made multiple trips to and from the hospital, my body rigid knowing each time we returned they would force their fingers inside me again. To make matters worse my cervix was posterior so multiple nurses would enter my body in search of it’s openness. At one point they brought in the nurse with “long fingers”, two other nurses holding me down and telling me to “just relax” while her gift of length would only find my cervix still closed.

After 3 days of exhausting every trick possible, I was given the label “failure to progress”. A term I now have come to believe is actually a failure on providers and birthing spaces to create safety vs. a brokenness they dump on patients they don’t understand or find “difficult”. The term did it’s job and created a narrative in my brain that my body was in fact broken. A narrative that would follow me into my next birth and beyond.

I was determined to make my second birth different. We chose a birth center and doula. I saw a therapist. I encapsulated my placenta and we tried to make better postpartum plans (turns out these were still majorly lacking). I met all the midwives and discussed at length my trauma history, my previous birth, my potential triggers, and the needs I had in order to have a more positive birth experience.

Despite our best efforts, the system failed us. Again. I often refer to my second birth as bad luck, but no. Harmful systems don’t just magically become unharmful because you are more informed and better equipped at advocating for yourself.

The second time around my water broke to start my labor. The midwife on-call put my body on a time clock because of risk of infection. This was a new midwife for us. One that had only recently joined the practice and we didn’t know well. She clearly also didn’t know me well and ignored our preference to limit cervical checks. A practice that is even less evidence based considering my waters had broken.

After “allowing” us to labor for most of the day, the midwife wanted to check me one final time to determine if we should begin the transfer process before traffic became an issue. I had only progressed to 2-3 cm and this final check combined with the knowing I would now be forced to enter a hospital environment again sent me into a panic. Similar to my first birth, I felt outside my body, again reminded of my rape and the powerlessness that consumed me.

I could hear everyone talking in hushed tones, making a plan I didn’t agree with. Since this midwife was new to the area she didn’t want us to go to the hospital we had planned to utilize from the beginning. She had never been there and was pushing for us to go to a hospital she was more familiar with. Inside I was screaming no stick to the plan, but laboring folks can’t always verbalize the narrative happening in their brain. They are kind of busy doing a big thing. Add in the fact that I was in a trauma response and it felt as if I was a prisoner in my own birth.

Despite my internal pleas of refusal, it was off to a foreign hospital we went. I was immediately labeled “difficult”. They wanted me in a wheelchair then in the bed laying flat. I couldn’t comply with anything they requested. The contractions had gotten so intense that it felt as if I might die if I didn’t remain standing and focused. I was in survival mode. Because of my non-compliance our quality of care increasingly declined. Nurses talked down to us, reminding me frequently that I needed to stop doing what my body was instinctually doing so they could prod and poke me as the system had taught them was necessary.

Why I Hate Baby Showers

I suppose hate is a harsh sentiment. I don’t really hate them. They are a wonderful gesture from family and friends. A celebration coordinated with love and good intention. It is also tremendously helpful to shower new parents (especially first timers) with the slew of new gear they will need to raise a tiny human. I was fortunate enough to be showered twice while pregnant with our first and those gatherings left me feeling overwhelmingly loved. I think my baby shower beef might be an AND/BOTH situation. I think it’s wonderful to celebrate parents with a shower AND/BOTH we should work a little harder to hold parents a bit more intentionally.

Pregnancy is hard. Your body is no longer your own and you are navigating the depths of so many unknowns. It’s the beginning of this mystical journey where control is scarce and comments about your body are disgustingly abundant. There were/are times I feel like an incubator. A vessel that just needs to be happy and grateful and stop eating soft cheese. The person I was before conception becomes invisible, unseen as a whole human with anxiety or fears around what’s to come. Here’s where baby showers miss the mark for me. They are too full of small talk and melted candy in diapers to give space to the tremendous depth of emotion and human experience happening within the pregnant person.

So wtf do we do about this conundrum? I don’t think the answer is boycotting baby showers, again AND/BOTH happening in my brain right now, but I think the simplest answer is talking more about the range of emotions and needs that surface in the perinatal period. Instead of asking a pregnant person what they are having (it’s a human btw) or telling them, “you better sleep now” or inquiring about their nursery theme, what if we also spent as much energy asking them what emotions have surfaced this week or what their postpartum plans might be or how we can help to optimize sleep and ensure their needs are being met in the chaos too?

The hard truth is baby showers (all good intentions aside) tend to amplify this message that a healthy baby is all that matters. Not only is this narrative false, it is also incredibly harmful. Up to 1 in 5 of us will experience a perinatal mood or anxiety disorder (PMAD) in pregnancy or postpartum and that number increases to 1 in 3 for persons of color. These numbers are significant on their own, but as is true with most statistics around mental health, reporting is notoriously low (hello stigma and shame) making me constantly wonder how much more adverse experiences really are.

And it’s not just baby showers that perpetuate this narrative. Our culture in general places more emphasis on pregnancy and birth than postpartum. Simple look at the numerous prenatal/infant visits that are the standard of care compared to the SINGLE postpartum visit scheduled by doctors. Even worse, until more recently, these visits didn’t necessarily include a screening or conversation around emotional or mental health needs! Instead they are often approached as a box to check off, ok you can have sex and exercise again, want some birth control? Good luck!

Even at it’s best, postpartum is hard and parents desperately need nurturing that is not only denied by our culture, but also often expected for parents themselves to ignore. Parents need to be reminded that their feelings and needs matter. We shouldn’t be invading hospital rooms and homes just to see and swoon over the baby. We shouldn’t be asking how everyone is sleeping (newsflash they aren’t) or holding a baby and then leaving. We need to show up more intentionally for families.

Bring a meal, fill up their water jug and heat them a plate, fold some laundry, walk the dog, but most of all ask about (and then VALIDATE) feelings. If a birthing person says they are disappointed by their birth, don’t say anything. Just hold space, let them cry, tell them you understand. We can have gratitude for a healthy baby while also being allowed space to process fear or sadness. If a parent tells you raising humans is hard and they feel overwhelmed, don’t try to fix it or give opinions or shoulds. Just listen, validate, and highlight their strengths. You are doing a good job goes a long way.

There are plenty of additional ways to honor new parents and address the full spectrum of needs in this stage of life. I’ve seen lots of talk about postpartum parties and diaper bombs or something I personally do is never only bring a gift for baby to a baby shower. I always work hard to include a gift for the parent. I gifted an entire postpartum kit (think mesh panties, tucks pads, nipple cream, etc.) to my bestie at her shower, but the good news is you don’t even have to gather these items on your own, you can find similar kits already curated from various sources!

A few of my faves include the Frida Mom Postpartum Recovery Kit, La Mama Care Postpartum Care Kits or Cater to Mom Postpartum Subscription Boxes. Other options include gifting postpartum doula care, a postpartum massage, or cleaning or laundry services (I recently discovered The Cesta in Austin and they are legit!). Organize a meal train or gift meal delivery, offer to entertain older kids or snag some wipes on your next Costco run and just drop them on the porch. The options are endless and frankly, necessary for new family survival.

Another beautiful option and one I’m lucky enough to get to enjoy this third time around (thanks friends!) is what is known as a parent-to-be blessing or mother’s blessing. A mother’s blessing simply celebrates the expectant parent and is meant to inspire and encourage them before their birth journey. I even got creative when my bestie was expecting her second and incorporated this practice into her baby shower so she could have both! AND/BOTH y’all, we can do it!

The reality is we are not meant to parent in isolation and it’s 100% impossible for a new family to meet all the needs of their baby (plus older kids), themselves and their home all at once. We are a species built for connection and families need to be seen, heard and held for the whole system they are. Our culture has a shit ton of unlearning and legitimate policy change (um paid family leave anyone?!) to incorporate before norms can shift as a community, but until then let’s rethink our approach to the baby shower and consider other ways to more intentionally love on new parents and the shit show they are navigating.

Exclusive Pumping Mamas: Your Journey Matters Too

August is National Breastfeeding Awareness Month and the final week of the month is Black Breastfeeding Week. Black Breastfeeding Week was created because of the gaping racial disparity in breastfeeding rates. The most recent CDC data show that 75% of white women have ever breastfed versus 58.9% of black women. The CDC also reports that increased breastfeeding among black women could decrease infant mortality rates by as much as 50%.

These stats and awareness movements are not meant to create a divide among mothers. All of us are doing the best we can. Each of our journey's is unique and valid and the most important thing is to feed our babies, however that may look. There are still gaps that exist though. Misinformation, lack of support, cultural barriers, and inequities in care all contribute to decreased rates of breastfeeding and unless we talk more openly about our struggles, then change and healing will never take place.

Today, I am honored to share with you the powerful words of my dear friend and fellow mama, Alicia Knight. Alicia's raw and open account of her breastfeeding journey was inspired during breastfeeding week a couple years ago. She felt left out and not represented as an exclusive pumping mama. She told me how she needed to get her story out of her brain so she too could feel that she belonged. She needed to say out loud that her way was valid and real.

Exclusive pumping mamas, your journey matters too.

by Alicia Knight

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Sometimes breastfeeding looks like this. It's not nearly the bonding experience it is for some mothers. It doesn't involve significant amounts of skin to skin or late night feeding sessions nestled in the recliner in your baby’s room, just the two of you. It starts out with multiple lactation consultant visits assisting with positions, suggesting feeding your baby through a syringe - like a cat - to avoid nipple confusion. It’s waiting for your milk to come in, waiting 6 days to be exact, where is it?! It's being full of fear every time your baby starts crying for milk. Sometimes, it sounds like a lactation consultant telling you "if you feel that your baby is hungry, you need to feed your baby".  It looks like your supportive husband standing in close distance during breastfeeding sessions, attempting not to hover, with a bottle of formula just waiting for you to say pop the lid and feed the baby as you sob at your inability to perform.  It’s also coming to the realization that what you are doing is not working. The way you envisioned it may not work out. You may feel like a failure who can't do what you feel was intended of women. The significant bleeding, threat of infection, nipple shape and undetected lip and tongue ties are keeping you from getting there. 

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So you get the hospital grade pump and keep going for your baby. You refuse to give up, even if it's not what you expected. You continue to feel defeated every time he cries for milk and every time you hook up to that pump. The panic and uncertainty that take over are immense and overwhelming. But you keep doing it for him and you keep doing it for you. You pump around the clock, setting alarm after alarm, cleaning pump part after pump part, adding One. More. Schedule. into your already schedule filled life as the mother of a newborn. You spend spare time bagging milk and writing down the amount of breast milk he took and when. You still get engorged, leak through your clothes and wear breast pads but with little of the bonding that other mothers who feed their babies from their breasts may feel.  You feed your baby less, because you are busy pumping while others have that chance.

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But you keep going - keep cleaning, keep bagging, keep pumping for your baby. You pump in cars and locked closets, nursing rooms of fancy department stores and random dressing rooms sometimes while a screaming baby is sitting next to you waiting for milk. This is not what you intended, but this is your reality. It is not easy and you feel open, raw, and exposed every time you give your son a bottle of liquid gold. We only made it two weeks at the breast, but we made it 9 months of exclusively pumping and 13 months on my frozen breast milk. My overwhelming supply was kept in deep freezers at two locations. I fed my baby plus three other babies for months. I nourished in a way that I never imagined, in a different way, a better way for my family. We all do what we can to feed our babies, regardless of the source. Breast, bottled breast milk, donated breast milk, formula. But to my mamas, the exclusively pumping mamas out there, I see you. I see you struggling, unsure and feeling full of inadequacy and guilt for what your breastfeeding relationship could have been. I see you fighting this fight and doing what you feel is best for your baby.  I see your love. Keep going, keep pumping, keep feeding - don't let anyone tell you your way is not the right way. Your way is right for you and that's all that matters.

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Alicia is a Licensed Psychologist and Licensed Specialist in School Psychology with a Ph.D. in School Psychology. She lives in Houston, TX with her husband, and sons, 3.5 and 8 months old. Alicia spends her time helping students to access behavioral and mental health supports and services within the public school system. She survives on sticky kisses from both munchkins, book marathons with her oldest, and pounding the pavement in her Brooks whenever she can. Her dream job is to someday work at We Got Y’all mostly because she loves their mission but also because Issa Rae should be her BFF. Alicia loves binge watching anything with her husband after the kids are asleep – sometimes it takes 3 days to get through one episode but hey, mama is tired.

A book Review

Alright y'all. If you haven't figured out by now, I'm a major birth nerd. The science of making, growing and bringing life into this world gets me straight giddy. What might surprise you though, is I wasn't always this way. Not one bit. In fact, like many other folks in this culture, I thought birth was scary AF.

The thought of a giant human head coming out my vagina sent me in a spiral of anxiety. I actually made fun of "natural" folks and had a completely inaccurate image of unmedicated birth in my head. If you didn't want an epidural then I thought you were nut bags and when I heard the words home and birth used consecutively, well I just couldn't even fathom. Babies were supposed to be delivered by doctors in hospitals and anything outside of that "norm" was just insane.

Thankfully, I came out of that ignorance and proactively grew a better understanding of the biological process of birth. Proactive is the key word here. Sadly, our culture still places a great deal of fear around birth and many of the information parents receive fails to provide evidence-based options that empower informed choice. In fact, many of the guidebooks come from male physicians deeply entrenched in the money driven medical model of care. So unless you seek out the information on your own, you can be given a very skewed and limited picture of what birth really looks like.

Cue Mama Natural. Mama Natural was founded by Genevieve Howland who began her mission to empower and inform through her blog and YouTube channel, but as her community continued to grow and more folks rallied behind the idea of taking back their pregnancy and childbirth, so did the invaluable resources she created to make natural pregnancy and childbirth more accessible and commonplace. Her vision now includes online child birth classes and this comprehensive week-by-week guidebook. Move over What to Expect When You Are Expecting, The Mama Natural Week-by-Week Guide to Pregnancy & Childbirth is taking over

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Before I keep chatting all the juicy goodness of this book, let me throw out a disclaimer. Being informed on the normal process of pregnancy and birth does not mean you are anti-medical intervention. You can value informed choice and also value life-saving technology, those two ideas are not mutually exclusive. But alas, that's part of the reason our culture has yet to embrace unmedicated birth and still fears so much of the process. The reality is birth is unpredictable. We can't control it. What we can do though is educate ourselves on the process, and the more we do, the less fear we will have as the journey unfolds - however that may be.

This is the number one reason I love this book. Genevieve explains that "it's neither possible nor safe for every woman to have a 100 percent intervention-free experience" and she thoughtfully guides us through each week of pregnancy, delivery, and beyond. Genevieve is not here to judge and doesn't believe there is one "right" way to birth, making this book beneficial to everyone. Genevieve empowers readers through evidence-based information on not only why you would want a more natural pregnancy and childbirth but also how you can prepare your mind and body to achieve one.

The book is organized in a simple, week-by-week format that makes it easy to skim for the information most relevant to you. It has 6 sections:

  • The first trimester (weeks 1-13)

  • The second trimester (weeks 14-27)

  • The third trimester (weeks 28-42+)

  • Special delivery (labor stages, newborn procedures/tests, breastfeeding & postpartum recovery)

  • What to ask your prospective midwife or doula (plus questions to ask when touring hospitals & birth centers)

  • Pregnancy loss (miscarriage & stillbirth)

The first three sections cover everything you might want to consider as your pregnancy progresses while "special delivery" delves into what you can expect in each stage of labor and how you can manage pain or get baby moving down. It also explains many of the common newborn procedures and tests as well as breastfeeding and baby wearing tips and postpartum recovery considerations. The doula in me loves that she includes a section all about hiring us (!!!) and the social worker in me is thrilled she took space to cover loss.

Other than the insane amount of info this book provides on our bodies and overall wellness, I also geeked the eff out over these cool features:

  • Super kickass illustrations like this one:

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  • A "to-do-list" at the end of each pregnancy week!

  • A "nom of the week" aka delicious and nutritious recipes to try!

  • An entire week dedicated to the gentle cesarean!

  • Testimonials!

  • Positive affirmations sprinkled throughout like this one:

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I do want to point out one thing I think needs to be expanded on and shocker, it has to do with mental health. Genevieve was thoughtful in her inclusion of postpartum depression, but perinatal mental health includes so much more.

First off, it doesn't just occur in the postpartum period. We can also experience mood disorders in pregnancy. Real life y'all. It's common and we need to move away from the term "postpartum" when referring to perinatal mental health because it doesn't accurately depict the whole spectrum of mental illness.

Even more, it is not limited to depression. Depression is the trendy term. I'm not sure why, but it's what we think of when we hear "postpartum", but a woman's experience in the perinatal period can include symptoms of depression, anxiety, PTSD, OCD, or even psychosis.

It's also important to note that when the media is reporting on postpartum depression, they typically only highlight cases of psychosis (think Andrea Yates). This is dangerous because not only does it ignore what the majority of folks are dealing with, but also stigmatizes the illness and discourages anyone from seeking help. The reality is postpartum psychosis is rare compared to the rates of postpartum depression or anxiety and no matter which form of illness someone struggles with, with help, you can get well.

*Mama Natural sent me a copy of her book to review, but as always all opinions are my own.