Trauma-Informed Care put into Practice

A trauma-informed approach is defined as a strength-based program or system that realizes the widespread impact of trauma and understands potential paths for recovery, the signs and symptoms of trauma in clients, and others involved in the system; it then responds by integrating this knowledge into its practices and seeks to actively resist re-traumatization

I’m so glad that there has been a movement to implementing trauma-informed principles in all sorts of workplaces. Yoga classes, massage and physiotherapy, dental clinics, schools, and family lawyers have all made commitments to be more trauma-informed. While therapists may work with people who have experienced trauma, that does not always come with being trauma-informed. One would assume it’s part and parcel. That is not always the case, unfortunately. Further, sometimes the therapist is but their office or clinic does not work from a trauma-informed practice. Over the years of my work, I have both learned and implemented key principles and practices to ensure that my work is trauma-informed. For me, that includes doing what I can to help people I support feel safe and respected by me, that they are valued as the expert in their lives (versus me as a professional), their voice is empowered and have choices, as well as working from an intersectional anti-oppression framework: I work with compassion, collaboration and non-judgment. Being trauma-informed for me also includes knowing that everyone has a right to resilience and recovery/healing and trust is earned. I also know about the impact of trauma on people and have tools to assess for the symptoms.

As a Feminist Therapist for over 20 years, I strongly believe that being trauma-informed is deeply connected to my work: I’ve been a trauma-focused therapist for over 15 years. For instance, I know that people who identify as women (whether it is cis-gendered, trans or genderqueer, non-binary) experience gender-based violence at a far greater and disproportionate amount compared to their male peers. When I work with a new client, this informs my work – while she may be coming to me for support about adjusting to parenthood, she may have witnessed or experienced violence first-hand in her past. This may implicitly impact how she sees her role, workload, and role as a parent. Unresolved trauma lives and manifests in our bodies and lives in a way that keeps the trauma storied part of us activated.

Further, as a therapist who works with sexual violence, I also know that people who are giving birth who have a history of sexual assault may be very likely to experience triggers during pregnancy and birth – the birth process can be quite re-traumatizing in fact. This includes both the birth itself as well as the early postpartum period.

There are so many good models of trauma-informed care (TIC). I have put together this one with the 6 key principles that inform my work. For instance, I take the intake and assessment process slow. I don’t expect clients to share with me their history of trauma in the first 1-3 sessions (typically it’s seen as required information in order to get service). That disclosure should come with time, established trust and rapport, and the development of a relationship. I am a relational therapist – I value alchemy between us, I self-disclose my own lived experience at times (i.e my own miscarriage loss), and I am committed to work from a place of non-judgment and compassion. We build our work together on compassion and collaboration and they navigate how the sessions go – be it how and where they sit in the room, and what they want to talk about in session. As I’m trained in several therapy modalities, I also believe it’s important to use what is best for my clients, and would refer to someone else if it’s not the right fit.

Being a trauma therapist does not mean I expect to hear the trauma story itself. In fact, that may not happen at all. To me, being a trauma-informed trauma therapist means I work to help people access their resources (strategies that are physical, relational, spiritual, emotional and mental) so that they can find ways to integrate their trauma part (i.e traumatic birth experience) into their everyday life now, so that it doesn’t remain a fragmented part that still triggers them when it’s the anniversary/birthday. As trust is earned, it’s important to me that we build this connection slowly, and pace the trauma work so that people feel safe when they leave their session with me. While I don’t think anyone can guarantee a 100% safe place, I make it a practice to do my best to collaborate my clients.

Trauma-informed care for me also means that the person seeking my support is the expert in their own life – Clients are their own expert. I am just a guide that is there to support them. I don’t carry any expectations of my own. I also bear witness to the various social locations and how that can impact their healing i.e from birth trauma and the intersection if they are a racialized or otherwise marginalized person. I also overtly acknowledge my privilege as a white cis-gendered woman, who also has power as a psychotherapist. I make this intersection explicit in my work by naming the oppression for what it is, instead of minimizing. Making links to the systemic forms of discrimination is an important practice of TIC as it holds space for multiple truths instead of internalizing shame and guilt.

Working from a trauma-informed place also means that I am an advocate if the people i support need or request it. I share resources with you if part of your chosen healing journey includes taking legal action. There are great organizations and advocates that can support someone in their healing process. As big component of post-traumatic growth is when survivors advocate not only for themselves but others as well. That’s why movements like #metoo and Birth Monopoly are so powerful. It is inherently healing to feel interconnectedness with others who have similar stories. It’s part of my role and responsibility to share these resources with the people i support. I also bring it into my practice even when people don’t ask for it overtly – we don’t know what we don’t know is available as a resource.

Trauma-informed practice also includes how I take care of myself as I can be impacted by vicarious trauma. I have tools, activities, and regular practice of self-care. I also think it’s necessary to keep learning about my work, and push myself to be even better as a therapist. I seek out peer and clinical consultation and believe that all therapists need to do this, regardless of them being in practice for 5 or 25 years.

When you are seeking support from a therapist or practitioner, ask them what their definition of trauma-informed care is. If they don’t have one, that may be a sign that they are not thinking of the inherent impact and context of trauma. Not everyone works in a trauma-focused profession but if they are not at least trauma-informed in the practice, that means they are not keeping your safety and needs at their forefront of their work. Trauma does not have to be complex and Big T, but anyone who has lost a job, grieved the death of a loved one (including a pet), moved to a new city with no support, had a significant injury or illness have all experienced trauma that still lives in their body.

We deserve better. We deserve to get support that honours what our body knows. As Pat Ogden has so wisely shared, “the body always leads us home.”

The C-Section Club

I have mixed feelings about clubs. I never was a Girl Scout, in choir or on sports teams as a kid. I was a dancer though, but that doesn’t seem like the same kind of club or group like the others. For one thing, the rules and homogeneity that seemed to go along with it felt too forced. And just because one kid likes to play soccer, that doesn’t mean she likes the same music or food as another. And it felt like we had to be the same all the time, like Stepford Wives. I could be wrong though.

One club I never thought I’d join is the C-Section Club. Looking back, i guess it was inevitable: my mom is a 2-time club member herself. I know that cesareans are not exactly hereditary or contagious but it sure seems like they are. Friends who gave birth right before I did also had c-sections. A distant relative on my partner’s side said after the birth, “well of course she (meaning me) had a cesarean, look how small she is (I’m 5”1)!”

And yet I kept turning a blissful and determined eye away from allowing a c-section to be an option. I chose not to fully integrate the conversations about c-sections that were happening at my birth prep class. I skimmed over those chapters in the books I had.

Fast forward to the weekend of the birth of my first child. After 36 hours of early labour, a part of me knew the birth I wanted wasn’t going to happen. A part of my body also trusted that what I was feeling was not within the realm of normal. And yet when my care was transferred from midwife to OB, I was resistant. Who was this person to me? I’ve never met her and she surely did not know my birth plan or dreams. When she confirmed that I was not progressing at stage 2 (what the fuck does the mean anyway!?), they strongly suggested I get an epidural. And then a c-section a mere few hours later. I wish I trusted my body just needed to rest, and that my sweet baby was so eager to meet me so got stuck in the canal, and that my body got swollen from his eagerness. While the decision was ultimately mine, one thing I struggled with is that I never felt a bond or trust in this doctor. And that she did not have my best interest in mind. This is when my birth story turned from something sacred to something hard: I lost my voice and trust in what my body could do. Because I was told I couldn’t do it.

This post is not necessarily a birth story of my first (I did share a bit here), but rather a chance to acknowledge how some of us feel when we don’t get the birth we want. It’s a place to start that work. I know a lot of us feel like the end result of healthy baby healthy parent is paramount, and yet I can’t minimize the mixed feelings we experience when we go through an experience that is out of our control.

Since it’s Cesarean Awareness Month, I wanted to take a moment to acknowledge that each birth is unique, sacred and magical. They are also scary, painful and intense. Most of all, each is real and natural. I hate how vaginal births or unmedicated births are sometimes mistakenly called natural births, like medically supported or c-sections are any less natural. In an article full of helpful tips for people who are pregnant, Erica Chidi Cohen, one of the founders of Loom (an amazing pregnancy, parenthood and reproductive health clinic in LA) shared this great thought:

We need to stop using the term “natural birth.” The concept of natural birth is divisive and inherently competitive. All birth is natural. It’s as simple as that. If you want to have the intense sensations of labor and you’re coping well, go for it! If you have a hard time with pain or you have bad associations from trauma, that’s totally okay. You have the inherent right to choose how you want to navigate your birth experience, and those choices should be free of judgment. You should be celebrated for moving through the process of pregnancy and birth, however it unfolds, unmedicated, medicated or cesarean. THERE IS NO UNNATURAL BIRTH. It’s not Westworld. It’s all natural.

I also really love the work of January Harshe and the Birth without Fear movement. The quote above is one of my fave ones from her. And yet so many of feel pressure to birth a unicorn.

Here’s why our well-intentioned comments about someone else’s experience can be problematic: it doesn’t take into account their potential birth trauma and how it’s linked to consent and body trust issues. We hear about birth trauma that relates to obviously upsetting experiences of injury or even infant death. But another type of birth trauma is one where the birther has their voice taken from them, and instead the medical expert is calling all the shots. When some of us have experienced sexual violence and later in life get pregnant, this new experience can bring up former body memories and triggers.

We are also told that our bodies are meant to birth babies, and there is an assumption that people who birth vaginally are stronger. Not only did my body not fail me, I am incredibly strong because I grew humans in my body and then birthed them. And yet, I like so many others are made to feel inadequate, scarred and less than. We are already at odds the day we become parents when we birth via C-section; talk about being set up to fail.

So this month is all about honouring our path to birth babies and to be recognized for the hard work it is to have such major surgery on our baby’s first day earthside. I wear my scar proudly – to me it’s not a battle scar but a reminder of my strength and resilience. I’ve reclaimed it and it works for me.

My Birth Story: Birth of a Mama

My eldest child was born 8 years ago this week. Looking back on the birth, i credit the experience i had personally with what motivated me to do the work i do. It wasn’t the birth i wanted, and while i have moments of it that i treasure to this day, parts of it were really scary and it’s taking me time to heal from them. I know i’m one of the lucky ones and my birth trauma is my own story. I also know that i have more tools on hand to heal and delve into the trauma than most of us have. Please read on only if you want to.

I went into early labour on the Friday of Pride weekend. It was exactly my estimated due date so i was pretty excited about that. The labour slowed over the course of the Saturday, so i napped, watched Goonies (my all time favourite movie growing up so i thought i could get into it). Looking back on it, i can’t believe we didn’t name our baby Mickey or Andy or even Sloth. I remember the awesome Labour Mix my partner made (a former DJ and full-time lover of music). I remember the nice bath. I remember snacking on cold drinks and smoothies, walking at 10PM and 2AM. And then things started to turn in the wee hours of Sunday morning. By then our amazing Midwife Mary was with us. The pains of labour just seemed to intensify in a way that i knew wasn’t what i needed to feel. Next thing i knew we were rushing to the hospital at 4AM, after seeing what we thought was meconium. It turned out not to be, but it was a preamble to needing to be at the hospital i guess.

Between 5AM and 11AM my care had to be transferred over to an OB doc. This was devastation #1. I so admired my team of midwives and felt so connected to them, having to be transferred felt like a betrayal even though my Wise Mind knew it was necessary. The doc did not have the same bedside manner or a trauma-informed framework. Ironically, it was the anesthesiologist that helped me get through the discussion that i ‘needed’ to have an emergency C-section. I remember being told that my son’s head was stuck and i was too swollen to give birth vaginally. I remember thinking that in his excitement to meet me, my baby turned a bit too much and got stuck. I remember the pain before the epidural and thinking ‘there is no way that those of us that birth can do this.’ The pain was surreal.

Devastation #2 was to learn that i had to have a C-section. Just like my mother did with me. I had prepped my body to birth vaginally. I had convinced myself of this, so did not read enough of a birth plan for C-section. I had no idea that i would be strapped down, that the medical team would be too busy chatting about their weekend plans, that i couldn’t immediately hold my new baby, and that skin to skin was impossible until in the recovery room. Devastation #3 is learning that my arms had to be strapped down. #4 was learning that i couldn’t hold my newborn. #5 was knowing that my partner’s role in the room was even less active. And devastation #6 was realizing that my voice just didn’t matter in that room. I was not an equal or key planner in the birth of my baby. In the birth of me as a mama.

My baby was born that Sunday afternoon, just as the Pride parade was starting. We saw a rainbow out of our minuscule window. It overlooked the lake and i worked hard to rid the delivery/surgery room from my mind. My baby and i worked hard on our latch, our breastfeeding, our bonding. We worked on our rest and healing. We stayed at the hospital for 3 days. We stayed together in our small shared room. We saw other families come in and out. I worked on getting to the bathroom. Devastation #7 is learning the incredible feat of getting out of bed to walk across the room to pee. Devastation #8 is being told i had to work on a poo before leaving the hospital. Yikes, how was that supposed to happen. Devastation #9 is being told that my baby wasn’t latching so wasn’t getting what he needed – i have had my period and big boobs since the age of 9, if nothing else my body was born to breastfeed! He had one dose of formula to get us through that night shift with that 1 nurse. And then i worked my butt off to get him to latch.

What i loved – having friends visit on Day 2 and 3, bringing us homemade food and changes of clothes, seeing my parents hold their new grandson, not having to change the meconium diapers, being able to just nap, nurse, and snack for a week. I loved being able to reflect on my strength, and to ask for help. I love that i had a team of cheerleaders who were at my side through it all. Recreating the birth story i wanted as soon as we got home. Looking at and mesmerizing all the details on my new baby’s face. His feet – oh my goodness, newborn feet!

In my work as a therapist who supports others who have birthed, i bring my tools for triggers, negative thoughts, anxiety attacks. I carry with me the story of resilience, be it a birth tunnel, a birth house. I have visited the rooms that i needed, and i have come out of the tunnel to the other side, where there is light and strength. After my first-born’s birth, i did the work i needed to in order to reclaim the birth. I did the work so that i could birth again – and this time it was a planned home birth. Beside the birth pool, in the kitchen, under a full moon. That is another story for another time. But i did the work to get there. It can be done.

Now 8 years later, we have to go to the same hospital for the periodic emergency trip (hello parenthood) and the former birth ward is gone. I hear it’s better and the team is more aware. I hear that good changes have been made so that women are part of their birth even when it’s a more medical one. My birth story includes a chapter that was scary and made me feel silenced and irrelevant. I realized after that process of becoming a mother that i would work hard on not being silenced and pushed aside. I need to be an advocate for my children, for me, and for you. I want to be that support.

We are the authors of our stories and they are powerful – there is no right or wrong story. May yours bring you strength.