Birth Doula Support and Parental Education Classes

Birth trauma, high risk, and where/how/with who, to have your baby?

We’re jumping right into the hard stuff today. I invite you to grab a soft pillow, your favorite beverage, a warm blanket, and check in with yourself before proceeding. This may bring up strong feelings for you, so if you are not in the emotional or mental state to process negative feelings you may experience, please listen to yourself. You deserve to have space for whatever you are feeling.

For some moms, pregnancy and giving birth are beautiful experiences that occur without issues, traumas, or negative connotations revolving around birth, their care, or the immediate postpartum period. However, did you know that according to the National Institutes of Health (1), up to 45% of new mothers report experiencing birth trauma? This statistic doesn’t only refer to first time moms, but ALL moms who are newly/freshly postpartum.

In up to 45% of moms, regardless of if it’s their first baby, their third or more, whether they are low risk or high risk, whether they experienced a vaginal or a cesarean birth, they will experience some sort of perinatal trauma. That’s heavy, incredibly heartbreaking, and completely unnecessary. It makes me legitimately angry and feels so impossible to process, but for so many it is their reality. That number should be SO much lower, and it is completely unacceptable, but it is a testament to our shortcomings as a society. We are failing moms when they need us the absolute most. We are failing them, their families, their babies, their futures.

Birth trauma not only directly affects the woman who is giving birth, it inhibits breastfeeding success (2,3), causes PTSD (4), contributes to low birth weight (5), causes mental health disorders in future pregnancies and postpartum (6,7), affects fathers (8), affects fertility and planning family size (tokophobia) (9), and affects mother/child bonding (10, 11, 12, 13, 14). This is not an exhaustive list, but these points alone should give you pause and make you question what we have accepted as status quo.

Traditionally, birth trauma was viewed or associated with how a woman gave birth, or ‘what happened to make a birth traumatic’, i.e., such as assisted delivery, type of delivery, etc., but we have since learned that HOW a woman is treated while giving birth can also contribute to birth trauma (15). Obstetrical violence, fear-based language, coercion, lack of shared decision making, and other modalities of emotional, physical, and physiological assault can lead to a mother experiencing birth trauma. HOW a mother is treated during her prenatal, labor, delivery, and postpartum care by any medical professional, can greatly affect how she feels about her experience (16,17,18). Birth trauma should be recognized by what the mother is telling us of her experience, not by our perception of what she experienced.

We have also learned that birth trauma might not be immediately recognized, typically due to pressure from family, friends, and medical staff, to be happy/relieved/thankful that mom and baby are “okay” (19). There is an increasing, and utterly dismissive, trend of negating a mother’s experience and retelling of her birth, by using trite statements such as “at least you and the baby are ok” or “at least it all worked out” or even worse “but you survived”. How we support a mom and her baby through birth, how well we listen to the words she says, and whether we watch what she is sharing with us through her body language, will affect the competency of how we interact with mothers.

We know that midwifery care is proven in most cases to reduce the risk of birth trauma and increase birth satisfaction rates (20,21), however we would be remiss and negligent to say that mothers and babies have not experienced birth trauma under a midwife’s care, or that hiring a midwife will automatically ensure you do not experience trauma.

Not all moms wish to or can deliver under midwifery care. We must consider financial barriers such as insurance not covering a home birth or birth center (but let’s chat about this another day!), inability to afford out of pocket costs, extenuating circumstances such as a lack of midwifery care, prior poor experiences with a midwife, various restrictions on or lack of healthcare options, prior type of delivery, health diagnosis, or pregnancy risk status, etc.

So, what do we do? If not every woman can give birth with a midwife, or if she doesn’t want to give birth with a midwife, what does that mean for mothers who choose to or need to give birth in a hospital without a midwife attending? Is she destined to experience birth trauma? A lowered birth satisfaction rate? Is she predetermined to have a traumatic experience that will forever change her-story?

How do we change the face of birth satisfaction? How do we actively work on lowering the percentage of birth trauma that mothers everywhere are facing? What do we need to do to be better for the moms who put their trust in us during pregnancy and birth?

Studies (22,23) have been conducted to see what would help make subsequent deliveries following prior birth trauma have higher maternal satisfaction ratings and lower negative outcomes, and the answers are resoundingly clear. Giving mothers their autonomy back through evidence-based care, shared decision making, informed consent, active listening, and using the BRAIN approach (benefits, risks, alternatives, intuition, nothing); not resorting to fear based language, utilizing fewer interventions, managing their pain levels better, providing better education and support, and achieving a healing birth experience, would all greatly increase their birth satisfaction while lowering maternal perceived and experienced birth trauma.

Now that we know how to positively affect births, how do we achieve this? For some, it’s hiring a new care provider. For others, it’s changing where they plan to give birth. For some, it might look like opting to get an epidural. For others, it may look like planning a VBAC or planned cesarean following an emergency C-section due to an unsuccessful induction or the cascade of interventions (yet another topic for a different day!). Even other moms may take various classes, participate in mental health therapy, or choose other coping strategies.

However, for many moms, they don’t even know where to begin. Hiring a doula who is trauma informed and experienced in in-hospital, high risk, and OB attended birth, can greatly affect your birth outcome and satisfaction, and is one place to begin that I suggest to every mom. Properly preparing with out of hospital childbirth education, and entering your birth space with a dedicated, continuous support person aka doula (ME!), can lower your risk of intervention and birth trauma, need for pain management, and occurrence of postpartum mood disorders; while simultaneously increasing your birth satisfaction, baby’s APGAR scores, AND breastfeeding success (24,25,26,27).

Since 2010, I have had a special interest in high risk, in hospital, after loss, or after infertility birth. I have taken extensive education to support this unique and incredible niche of mothers and have fought to ensure they have satisfactory birth experiences, regardless of their birth story outcomes. I typically, not exclusively, work with mothers who have experienced birth trauma in the past, have a high-risk pregnancy status for whatever reason, or are pregnant following loss or fertility treatments. I find that the high-risk moms, the birth trauma survivors, and those planning in-hospital births, tend to be overlooked by most of my peers, or are not fully understood and supported as they deserve to be. I am an Evidence Based Birth professional member and a graduate of Birth Monopoly for the very reason that I am working to change the experience of these amazing moms and their babies. My life’s driving passion is to change what you think of when you think of hospital birth, and especially what you think of when you picture a healing birth after trauma.

This year, I had the absolute honor and pleasure of being approached by a lovely mama who was looking to hire a doula. She began to share her story with me, the tale of her pregnancies and deliveries. She shared her heart with me, her worries, her fears. She told me of the trauma she carried in her heart, the fear that stole her peace and her joy, and the doubts of her own abilities. This brave, beautiful, incredible mama told me of her two-time failed induction that ended in a cesarean during her first birth. She told me of her sweet innocent angel daughter born into heaven, stillborn during the beginning of the covid pandemic, during her second birth. She shared of her episiotomy and assisted delivery full of trauma with her third delivery. Her words were of feeling like birth happened TO her, and things that occurred were done TO her, instead of her feeling like an active participant in her births, were difficult to hear, but important and necessary to understand exactly what her lived experience is. Absorbing the fact she wondered why she would “do this to myself again, why would I want to give birth again?” was real, raw, and her undeniable truth. No matter how uncomfortable anyone else might feel, it pales in comparison to the weight she carries every day, the memories of her births that replay in her mind, the secrets she stores in her heart.

We had extensive prenatal meetings and communicated frequently, discussing what it would take to ensure she had a healing birth experience and was able to take her power back. We made her birth plan and we wrote down her birth preferences. After one of our prenatal meetings, I was sitting and thinking about some of the things she told me. I decided to offer her something I have rarely offered in my years as a doula – to have two doulas attend her birth. Why two doulas? Well, why just one scoop of ice cream, amiright? No, in all seriousness, I believed that both her and her family would benefit from the presence of two trained individuals, providing constant, continuous physical and emotional support during labor. You see, like mentioned above, birth trauma doesn’t only affect mom. It affects dad too and whoever else may be present. In this case with my client, her husband and her mother, who supported her through previous births, had their own trauma from what they experienced as a family.

Being able to focus solely on my client as she labored and brought her baby earthside, while having my trusted and capable colleague, friend, and professional partner support her family through labor, would allow me the liberty to be fully present with her, yet ensure that other family members present are equally supported through their own experiences. I have always insisted that at each birth I attend, it must be family centered, parent first, care. How could I fully commit and deliver, when I am one, and they are many? We must all know, acknowledge, and admit our limitations. I knew this was the perfect time to bring in Laura to assist me. I asked my client, explained how it would work, and she was instantly on board.

When her birthing season came, there were a lot of feelings. Past traumas, doubts, fears, worries, and anxieties began to surface. A demanding labor would walk her to the brink of her capabilities, require all her strength and resilience, and test her faith. We watched her fight, battle, soar, and succeed. She faced her giants, overcame her mountains, stood in the face of her trauma, and SHE WON. She birthed her baby, on her terms, in her way, in her time (in the middle of a tornado evacuation no less!), with her faith in God, safely in her husband’s tender arms, supported by her doctor, under her mom’s loving watch, surrounded by her doula team – Laura and myself, in a room filled with joy and relief.

Magical. Incredible. Empowering. Inspiring. Fierce. Strong.

There were tears of joy and laughter. There was tiredness and relief. There was love and thankfulness. But most importantly, there was peace. Healing. Release. She stood for what she wanted. She created a team that supported her decisions. She was empowered. We advocated for her wishes. We listened to her and encouraged her to use her autonomy and her voice. And with all the grace and beauty you can imagine, she emerged from her birth, victorious, triumphant, and whole. Mind, body, spirit.

I get chills thinking about it! I have attended many births over the last 13 years, and I have been a part of many stories, but none of them have imprinted on my heart like this sweet family. To see someone with such a story, with so much pain, heartbreak, and trauma surrounding their birth experiences, have such a fully healing birth, is humbling.

Our sweet client reached out to us and shared these words – “I have been thinking to myself, “I can do that again.” And that is a huge thing because I haven’t felt that way after any other birth.”

WHEW. When I said my heart got all achy tingly and the tears welled up! This is why I do what I do. THIS is why I have a passion for mamas and their babies and the families that love them.

And, this is also why, under the umbrella of In the Waiting, a Christian Birth and Bereavement Doula Collective, we – Sarah with Heritage Consulting STL, and Laura with Laura Luer Doula Services, are ecstatic to announce that we are now offering Duo Doula services for families looking for a team of doulas dedicated to working with you and your family to improve birth outcomes, birth satisfaction rates, and lower birth trauma risk. We are offering this package for a limited time at an introductory rate of $1,800.00 for all remaining birth dates in 2023, before launching at the full cost of $2,200.00 beginning in 2024!

Your Dou Doula support comes with three prenatal visits, childbirth education, birth preparation, comfort measure techniques, a birth plan and preferences meeting, a visual birth plan, customized birth affirmations, text/phone/email support throughout your pregnancy, preferred provider referral sheet, continuous in person labor support, up to three hours of support during the immediate postpartum golden hours, lactation support immediately following birth, a fully edited mini storyline birth gallery, one postpartum debriefing visit, virtual support through your entire fourth trimester for the first three months following birth, and access to a large lending library of books and resources, in addition to babywearing and biologically normal infant sleep support for your little one.

Holding space, healing trauma. One birth at a time.

Thank you so much for coming along with me today, for your time, and as always, for your continued support. It is such a joy, honor, and pleasure, to work with your families and I am so grateful to each of you!

All my love,

Doula Sarah

Disclaimer: WHERE (home, birth center, or hospital) you give birth matters much less than WHO you give birth with - whether it is a trusted OB, family MD, CNM/CPM, or traditional midwife - and is a decision that you should make carefully and with thorough consideration to what your birth goals are. Regardless of who you choose to provide your care and where you decide to birth your baby, there will always be a risk for unsatisfactory outcomes, changes to your birth plan, emergencies, etc., however, we must do our best to mitigate and lower the chance of negative outcomes and experiences as much as possible.

One such example is in the case of a mother who is looking to have a VBAC, or a vaginal birth after a cesarean. Having a VBAC supportive provider is much different than having a VBAC tolerant provider and will greatly determine the way a mother is supported and encouraged during her pregnancy. Are they scheduling a C-section “just in case” long before your TOLAC (trial of labor after a cesarean)? Do they used fear-based language such as “let’s just wait and see?” Again, this is a topic we will cover another day! Stay tuned and sign up for our email list!

References:

Birth Trauma & Doula care