Becoming a Trauma-Informed Doula

feature

BECOMING A TRAUMAINFORMED DOULA

by Kenya M. Fairley, MSEd, CD(DONA), CD(CHB)

22 International Doula

Have you ever supported clients who seemed extremely distant and disconnected from their bodies, their birth and their babies? Or struggled to help a client who was spiraling out of control during her labor and going into a deep well that you couldn’t help her climb out of?

Worked with a client who had troubling responses to typical postpartum baby issues? Or maybe someone who had very strict, prescriptive ways to care for the newborn that seemed excessive or anxiety-ridden? In reflection, did you wonder what was going on beneath the surface? Did you wish you had more information to be of greater help to your client?

It is highly likely that you were supporting a client who had a trauma history that deeply impacted labor, childbirth, postpartum recovery and the new parenting phase. Unresolved trauma can surface in unexpected ways for those whom we serve as birth and postpartum doulas.

Trauma is an intensely stressful or distressing event that may lead to increased feelings of anxiety, and that changes one’s perception of his or her own mortality, safety and security in the world. Many people who experience a traumatic event1 go on to recover with minimal long-term impacts to their daily lives, such as recovering from a car accident, a natural disaster, a serious physical illness, or the loss of a loved one.

However, some people experience more acute or cyclical forms of trauma, experiencing life-long impacts to their routine functioning and how they move about in this world, like survivors of childhood sexual abuse, rape, domestic violence, homelessness, or deep poverty. www.DONA.org 23

Neither response is right or wrong — they both just are. We each vary in our levels of resilience and ability to cope and adapt to drastically altered circumstances.

Being trauma-informed is the concept of realizing the widespread impact of trauma, understanding potential paths for recovery and actively seeking to resist retraumatizing clients, families, staff and others.2 Many people who have experienced trauma continue to go through the mechanics of day-to-day living without the benefit of time, space and effective support systems to heal from their trauma experience. Operating with that understanding allows us to treat others and ourselves with greater care and empathy.

In addition, one aspect of being a trauma-informed doula is acknowledging that there are unique experiences and traumas that birthing people go through that have a profound impact on how they labor, how they give birth and the bonds they build with their newborns afterward. For example, there may be challenges with becoming pregnant, forging through the emotional and physical regiment of fertility treatments,

24 International Doula

sustaining a pregnancy, experiencing miscarriage or pregnancy loss, being silenced by medical care providers, having a long and difficult labor or a fast and unhinged labor, not being able to nurse your baby in the desired way, facing judgment and ignorance as someone who identifies along the LGBTQ spectrum, and others related to pregnancy and birth.

As someone who has experienced multiple traumas firsthand, I often speak from a place of my own understanding. I grew up poor, surrounded by domestic violence for many years as a child and as an adult; I was raped by someone whom I thought truly cared for me; and I have been through a miscarriage at a time in my life where the pregnancy had come as a new hope after decades of inability to get pregnant. I’ve learned that, through all traumas, we tend to lose some aspects of time and need help placing those experiences into perspective. Reacting to what has happened to us as survivors of trauma includes reconciling the loss of spoken/unspoken hopes and dreams of what you’ve sacrificed and what you feel you’ve earned. It means wrestling with the pain and reshaping it to make yourself whole again. Having the care and guidance of a trusted companion, such as a doula who is not a relative and is trained to assist pregnant people during their childbearing time, can have an immense, lifechanging effect.

At our core as doulas, we are helpers and caregivers; we are nurturers and space holders; we guide and support our clients toward their own understanding.

Unless you yourself have had a personal experience with trauma, you may never have thought about it as a topic that would affect your doula work, and it can be an uncomfortable subject to discuss. For those clients who choose to share their trauma experiences with us, we have an opportunity as birth or postpartum doulas to walk with our clients along their path of healing.

Let’s explore five things doulas can do to support our clients who have disclosed that their trauma experience is impacting their pregnancy, labor, childbirth and newborn parenting. These five things can also apply to those whom we strongly suspect are having trauma echoes;3 however, our role as doulas is not to probe past the point of client comfort levels to find out more about what happened to them. Rather, it is to be aware, educated and responsive to the trauma echoes we may see in our clients.

Break open your heart.

Connect with your client, human to human. Allow yourself to empathize deeply with the uncertainty and imbalance your client may be working through.

Pregnancy comes with so many unknowns and decisions that must be made in a timely manner. That in itself can be troubling for someone who has experienced severe trauma or multiple traumas in their lifetime. Perhaps the journey to pregnancy was riddled with fertility problems, including constant emotional highs and lows. Perhaps your client is still healing from having a recent miscarriage, or a miscarriage where she had to be the one to make the decision to terminate. If your client has experienced intimate partner violence or sexual assault, consider all that has been taken away by force: trust, safety, security, confidence, knowing what is true.

In any of these scenarios, in your role as a doula, how can you help restore that which has been stolen? Begin to step into your clients’ shoes and open yourself to being present with them and holding space for them along this part of their journey.

Set aside your agenda.

Supporting someone who has experienced trauma means letting go of having all of the answers or knowing the right thing do. Let go of fixing and allow the process to unfold in the way that it needs to for your client.

In our doula practice, we learn that various comfort measures and position changes will ease the discomfort of labor for our clients at different stages. It is the same with supporting those healing from trauma — the needs and types of support may change as you continue to be in relationship with your clients.

At times they may be full of questions,

www.DONA.org 25

feature

The International Doula is your magazine!

Submissions are welcomed in the following areas: • Feature articles and research • Essays and poetry • Artwork and photography • Book or video reviews Your work could be published on these pages. For contributor guidelines or a conversation about your ideas, email IDEditor@dona.org.

VOLUNTEER WITH DONA INTERNATIONAL In addition to our professional staff, we have doulas from around the world who contribute on committees and on the board of directors.

IT’S A FUN WAY TO CONNECT! Open positions are listed at dona.org/the-donaadvantage/get-involved.

26 International Doula

as knowing what to expect can be settling for someone anxious about the unknown. This feeling is heightened when recovering from trauma.

Other times, your client may need your presence to be gentle and quiet — having you there as a strong but silent presence can be comforting. And at other times, our clients will need us to help them help themselves and regain control of their bodies and their birth experience. This is when a steady, reassuring take-charge tone can help your client refocus, recenter and become grounded in the present moment. At all times, our goal should be restoring agency — an awareness of one’s capacity to initiate and exert control over their own thoughts, beliefs, actions and decision-making power within their lives — back to our clients.

IT CAN BE HELPFUL TO LEAD OUR CLIENTS THROUGH, OR PROVIDE INFORMATION FOR THEM, ON RITUALS OF RELEASE THAT CAN HELP WITH THEIR HEALING PROCESS.

Validate and listen.

For many survivors of trauma, part of the journey to healing includes needing to regain permission to feel worthy and deserving of good things. Trying to make sense of the trauma raises so many questions of, why me? Survivors tend to internalize the hurt that happened to them, whether because they were told repeatedly by an abusive partner that it was all their fault, or because societal beliefs support a culture of rape that questions victims over offenders, or because of the challenges of becoming pregnant when our bodies let us down.

No matter what led to these feelings, it remains that survivors often must be intentional about feeling worthy of having a positive birth experience, of being loved by their newborn, of being gentle with themselves. As doulas, we can sit with our clients and allow them a safe space to voice their fears, concerns, worries, joys and celebratory milestones.

We can listen and normalize what they are going through. Here are a few tips to keep in mind.

• Use discernment and discuss in private away from others.

• Respect client boundaries and

confidentiality.

• Be mindful of your body language and reactions to what is being shared; try not to overreact or underreact to what you are hearing.

• Don’t let ambivalence or fear inhibit your responsiveness.

• Ask, with genuine compassion, “Can you tell me more about what happened to you? What was that experience like for you? How did your life change after that?”

• Do not expect immediate disclosure; it may come later as trust builds over time.

• Be careful about labeling what you are seeing or hearing. We often don’t know the whole picture — nor are we entitled to.

Affirm and pour into.

See your clients — look into their eyes and truly see them until they know they are not alone. I believe that doula work is heart work and requires us to give of ourselves in ways that we might not always give. For our clients who have

experienced trauma, we need to affirm that they are deserving of all their heart desires. It can be helpful to lead our clients through, or provide information for them, on rituals of release that can help with their healing process. The ritual does not have to be ceremonious or overly complicated, it only needs to allow the person to feel they have released the negative energy or spirits they are holding onto and reclaim a renewed and restored presence of mind.

A simple, guided ritual can be found at The Girl Who Knows, Release. Receive.

Repeat: a ritual for letting go [https:// thegirlwhoknows.com/letting-go-ritual/].

There are many similar rituals, but this one can be done in stages or all at once.

After spending a few minutes meditating, light a candle and become grounded in the space. On a slip, or several slips, of paper, write out, “If I could release one thing, it would be … ” Then write out, as

many times as you need to, the experiences and fears being released.

Next, write the words, “With gratitude and with love and with compassion for all involved, I Release I Release I Release.” Repeat it aloud. Do so as many times as needed for as long as needed. When you are ready, take up the paper with all that is being released and blow on it with power as a symbol and ritual of releasing it for the last time. Take the paper and burn it, or shred it, rip it up, ball it up and throw it away, or bury it in the ground.

Visualize the newness that you are creating and meditate or journal about it for another several minutes. To close out the ritual, say a prayer or read a poem that sets your intentions moving forward and blow out the candle, walking away with a renewed sense of direction.

Other rituals may include creating art or song, writing a letter to yourself or someone else (including your unborn child), planting a seed or flower, or simply lighting a candle every night and saying a prayer. Help your clients find what works best for them.

Choosing to live with intention and happiness every day can be a ritual of release and healing, as well. Some clients may ask for mental health support as part of

www.DONA.org 27

feature

their healing journey; it is best to include on your resource list therapists that specialize in fertility issues, sexual and domestic violence trauma, and grief or pregnancy loss.

DONA International members receive discounts on Office Max/Office Depot products and printing services.

To find discount details, log on to the member portal at DONA.org or text DONASPC to 555-888.

Canadian members, we are still working to find a similar discount for you. If you have a contact at a large company or would like to help with this effort, email PublicRelations@DONA.org.

ON-DEMAND WEBINARS

FROM BIRTH TO BREASTFEEDING to business, DONA International’s on-demand webinars are designed to meet the needs of both new and experienced doulas.

Our webinars are a great (and affordable) resource for continuing education hours.

Members receive pricing discounts! www.dona.org/continuing-education/

28 International Doula

Process what you’ve witnessed.

While maintaining the confidentiality and details of what happened to your client, reach into your doula support network and debrief the experience for yourself.

Talking with your trainer, mentor, backup, or other trusted colleague can be restorative and help sustain your practice.

Hearing about and witnessing how trauma experiences impact another person’s life can lead to vicarious trauma, meaning that, as the professional support person, you may begin to relive aspects of the person’s trauma that you’ve heard about or witnessed, and you may have troubling reactions to it. Cumulative effects of vicarious trauma appear as emotional numbness, withdrawal, bad dreams, increased negative view of the world, feeling disconnected from loved ones and feeling unsafe. This is normal and manageable.

Be honest with what you’re feeling and give yourself time to step away from it. Understand how the stress is affecting you and intensify your self-care practices, process the experience and transform it into positive meaning, look deeper into the lessons learned and challenge yourself to grow professionally from the support you provided and the clients you work with.

In some instances, if needed, seek out emotional health support from a therapist.

As part of building our doula practice, it is important to set aside time to gain perspective and increase emotional fortitude. Keeping a journal, for use after each birth, postpartum session, or periodically when needed, can aid us in reflecting and learning from our experiences.

As doulas, we often share a deep connection with our clients and spend a great deal of time with them in

intimate settings. Engaging with those we serve in trauma-informed ways can decrease isolation and stigma for trauma survivors, attest to the value of their lived experiences and validate that they are worth being cared for. Being a traumainformed doula is a continuous learning process of restoring agency to birthing and parenting people, and holding space for their healing to unfold and be affirmed in the way that it needs to for their own health and well-being.

RESOURCES: 1. Between 1995-1997, over 17,000 people completed confidential surveys about their childhood experiences and current health status and behaviors. Almost two-thirds of adults surveyed reported at least one Adverse Childhood Experience (ACEs), such as abuse, household challenges, or neglect, and the majority of respondents who reported at least one reported experiencing more than one. All ACEs have a lifelong impact on risky behavior, psychological issues, serious illness and more. Read more about the ACEs Study at https://www.cdc.gov/ violenceprevention/acestudy/.

2. Being trauma-informed as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) at http://www.samhsa. gov/nctic/trauma-interventions.

3. A trauma echo is a trigger or reminder of experiencing a traumatic event such as sights, sounds, smells, places, people, physical items, or similar circumstances that are reminiscent of the actual event.

Kenya M. Fairley is a DONA certified birth doula, trainer, advocate and author of With Harp

& Sword: A Doula’s Guide to Providing Trauma-Informed Birth Support. Learn more about incorporating traumainformed practices into your doula work, access a resource listing and find a tip sheet on doula self-care at www.kenyathedoula.com.