Episode 174 - Buffering for emotional safety at birth
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD, and each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Welcome to today's episode of the Great Birth Rebellion podcast. Today, I've invited Dr. Athena Hammond to have a very detailed conversation about emotional safety in childbirth. We all know the rhetoric of going to hospital so that you're safe during childbirth, but safety is more than just being alive at the end of your birth. Safety is all about emotional, mental wellbeing as well, and so much more.
Mel:
[0:55] But today, that's the topic of our conversation. This is part one of our conversation with Dr. Athena Hammond, Today, we're talking about the root of trauma and distress during childbirth, and then in the next episode, after this one, there'll be part two, where we speak about post-traumatic growth.
Mel:
[1:13] Let's get into it. In the interest of keeping this podcast completely free to you, the listener, this episode has been sponsored by my dear friend.
Mel:
[1:23] Poppy Child from Pop That Mama. Poppy is a doula and a hypnobirthing practitioner. She's been on the podcast before and her online hypnobirthing course, The Birth Box, has my vote. You know how picky I am about letting any sponsors onto this podcast. I have to back them 100% and I get behind the work that Poppy's doing with The Birth Box. It's especially relevant for what we're talking about today and coping with labor with a settled nervous system.
Mel:
[1:55] The work that you could do in the birth box is exactly what's needed to enter into birth with a settled nervous system. You'll learn tools to manage pain, how to stay steady when labor gets intense, and even how to advocate for yourself in tricky situations. It's all about giving you knowledge, confidence, and a mindset that actually works when the big day comes. And there's a little cherry on top, the oxytocin bubble, which is a full album of soundtracks to guide you through labor and help you stay in the zone. The birth box is rated five stars across the board. And with my code, Melanie, you'll get 25% off. So just duck into the show notes, click the button, and you can get your birth box at 25% off, all thanks to Poppy Child from Pop That Mama. Here we go. Welcome, everybody, to the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and today I've invited my very dear friend, Athena Hammond, also Athena's binn.
Mel:
[3:01] An OG Convergence of Rebellious Midwives presenter. She's coming for a third year in a row. Most requested speaker returning to the Convergence of Rebellious Midwives. So you're in for a treat. I'm interviewing Dr. Athena Hammond. So Athena is a midwife, psychotherapist. She specializes in the area of trauma, but she's so much more than that. Athena, welcome to the Great Birth Rebellion podcast.
Athena:
[3:29] Thank you very much, Dr. Melanie Jackson. It's lovely to be here.
Mel:
[3:35] So today I wanted to get you on. I'm going to get you to introduce yourself as well, but specifically about post-traumatic growth, and we'll talk about that term. But the thing that motivated me to bring you onto the podcast is there is an issue of birth trauma in maternity care for both women and healthcare providers. Yet I feel like there's a real gap in understanding the causes, the impact, the aftermath, and possible solutions if you're a woman who's experienced trauma. So today, I want to focus less on the problem that we have of trauma and more so on some solutions. And, you know, these will come out and evolve as we have a conversation, I imagine. So could you kick us off by introducing yourself the way you would have loved to be introduced if I didn't fumble my way through it?
Athena:
[4:32] That didn't feel fumbled at all. Mel and I just had a little moment before we came on air of going, oh, do we say the doctor bit? Like, I don't know, sometimes it makes me feel weird. But that is my official title. I am Dr. Athena Hammond. I am still a registered midwife. I worked for a long time as a doula and I became a midwife and then I went into research and academia. And then I kind of took a little bit of a sideways turn and have ended up over here in this space where I've retrained as a therapist, a psychotherapist. But because of my midwifery background, there's a very natural little kind of niche for me, which is around the space of doing therapy, counselling and therapy with women, people and families through pregnancy, labour and birth and postpartum.
Mel:
[5:25] So you are so ideally positioned in this conversation.
Athena:
[5:29] I'm glad you think so.
Mel:
[5:31] Well, much more than me and even as a midwife myself for 18 years, this topic of how do I help women who feel birth trauma, it still evades me. I think I have a lot of clients come to me who have had traumatic previous births.
Athena:
[5:49] Yeah.
Mel:
[5:50] Yeah. And I think to myself, the best thing I can do for them is to improve the experience that they're about to have with me. But outside of that, I don't really know what more to do for them. As much as I've tried to understand it as a healthcare provider, I just feel like there's significant gaps in my knowledge. So I figured if I'm in that position, probably a number of other care providers are.
Athena:
[6:16] Well, let's see how we go. Hopefully we can shine a little bit of light into some of those dark and mysterious places, but I really hear you. Like there's not a clear way forward there. And, you know, it's really personal. It's really contextual. It's really different for each person. So, yeah, it can be really tricky to just have a kind of dot point list of like what to do if a woman shows up in your practice who's had a previous traumatic birth or potentially has, you know, historical trauma or even kind of complex trauma that's occurred through childhood and into her adult life. It's a big and complicated space. However, it'd be great to talk about some of the really straightforward things that we can do.
Mel:
[7:06] Absolutely. Some of the things that are really within most people's reach.
Athena:
[7:11] Yes.
Mel:
[7:11] Well, why don't we start first by explaining what exactly is birth trauma or trauma in itself? What is that?
Athena:
[7:23] It's such a good question. So I have a way that I think and kind of talk to myself about trauma in general. And then I've got with me my handy little definition that some other very clever people came up with around specifically what birth trauma is. So I think maybe I'll give you both of those.
Mel:
[7:45] Absolutely.
Athena:
[7:46] From my perspective, thinking about trauma in general, what we call trauma is a series of brain and bodily responses to a human experience that feels overwhelming to the point that it sort of overrides our natural ability to cope or to manage. And in that experience, it's very common that we will feel out of control, that we will feel frightened, possibly even terrified, and that we will feel alone. So those events...
Athena:
[8:27] That tend to get labelled as traumatic. It's a tricky little shift to make in your brain, but actually it's not the event that is the trauma. Trauma is what happens inside us in response to the event. And it's actually a really normal human physiological strategy that we use ultimately to protect ourselves from the feeling of overwhelm, the feeling of being out of control, the feeling of being frightened maybe for our lives. It's like the brain and the body goes into a mode that sort of takes us often away in like a dissociative kind of sense. It changes the way that our memory gets laid down. So we have two different ways of laying down memory. When we're involved in a circumstance or an experience that is traumatic, we actually go to what we call implicit memory, which is actually different to our day-to-day memory. There's a whole lot of kind of physiological and psychological changes that occur in those moments. That feels like a lot to say.
Mel:
[9:36] It makes me also think, and I'm glad that you said that about dissociation because that was a word I wrote down while you were talking about trauma. So are you saying that when you feel trauma, it's there to protect you? With that dissociation, it's like this is too much for this person to cope with.
Athena:
[9:56] Yep.
Mel:
[9:57] We're tapping out while this is occurring.
Athena:
[10:01] Yep.
Mel:
[10:02] And then that impacts upon how that person remembers it.
Athena:
[10:06] Yes.
Mel:
[10:07] And this is something that can happen during birth is women re-remember things on their past that they didn't even know were there. Yes.
Athena:
[10:18] Yeah.
Mel:
[10:19] That explains that of what you were just saying.
Athena:
[10:24] Yeah, that is one thing that can absolutely happen. Mm-hmm.
Mel:
[10:28] So then in birth specifically, if women are experiencing something that feels traumatic, they could dissociate, and I've seen women almost go completely blank.
Athena:
[10:39] Yes. Like they've left. Yes.
Mel:
[10:41] What is that doing to their brain at that moment?
Athena:
[10:46] So it's doing a complex range of things to their brain. But the effect of the dissociation, and women will often describe this really clearly, they just feel like they've left their body, sometimes that they've left the building. Some women will say, and you may have heard this, some women will actually say, it was like I was out of my body and I was up on the ceiling and I was watching what was happening from outside myself. And for other women, it's not as straightforward as that or sort of as clear as that. It's a bit more nebulous. It's just this sense of, I don't know where I went, but I just wasn't there anymore. I was gone. I went somewhere else.
Mel:
[11:29] Is that a decision that a woman makes or does that her body does that to and for her?
Athena:
[11:34] Yeah.
Mel:
[11:35] Yeah.
Athena:
[11:36] Yeah. If you have had a history of what we would think of as – so there's different ways of thinking about different types of trauma – Some trauma is repeated over time. Some trauma is just one big kind of acute event. And it's also actually really important to say that some trauma is not about an event that happens. It's actually about things that don't happen. And I see a lot of this actually in the experience of birth trauma. So it's not just what happened. It's also what didn't happen. So what didn't happen might be nobody came to reassure you. Nobody told you that you were going to be okay. Nobody explained to you what was happening. Nobody was kind to you. There's a whole piece around that that's really significant,
Athena:
[12:31] particularly in the hospital birth room.
Mel:
[12:33] Yeah.
Athena:
[12:34] And you will have seen this, Mel, particularly if things start to go a little bit pear-shaped in terms of what's happening in the room, in the hospital. Everybody's attention changes. the energy in the room
Mel:
[12:45] Shifts and.
Athena:
[12:47] Women often feel like there's this whole thing then that doesn't happen which is that nobody comes to them and says this is what's about to go on this is how it might feel for you we're really sorry about this like there's no kind of human contact in those moments
Mel:
[13:02] Some women will feel traumatized by the omission of things in their care or the addition of things in their care that felt traumatic and others will not others will think well that was huge it was it was an emergency or it was really poor care whatever it was and not feel overwhelmed I guess what I'm getting at is that how subjective trauma is especially based on your previous experiences.
Athena:
[13:36] Mm-hmm.
Mel:
[13:37] I just, like, I mean, I can't, this is also something I really struggle with. I don't come from a history of trauma.
Athena:
[13:44] Yeah.
Mel:
[13:44] Not from any person in my life, not from any dramatic events. So I don't understand. I just don't understand. What happens to somebody if they're traumatized? What happens to their life and their brain?
Athena:
[14:03] Yeah, no, it's a really great question. You know, trauma is a kind of, it's a slippery fish. We have all of these criteria and we have, you know, diagnostic criteria. We have symptomology. Like, there's all of these ways in which we can try and define and measure and understand what it is and what it looks like. So, like, we do have a pretty accurate sort of set of, like, symptoms that will occur.
Mel:
[14:33] What are they? What are the symptoms?
Athena:
[14:35] Ah, so.
Mel:
[14:36] Yeah, I mean, if someone's looking down and thinking, oh, my gosh, maybe I'm feeling trauma.
Athena:
[14:41] Hmm.
Mel:
[14:43] Yeah. Is there a criteria for that?
Athena:
[14:45] Yeah, there is. And there's a kind of continuum. Not all trauma is the same and not all people are the same and they don't respond in the same way. So at one end of the criteria, at one end of the continuum, sorry, which we might think of as the kind of pointier end, we have like PTSD. So post-traumatic stress disorder.
Athena:
[15:08] So post-traumatic stress disorder is a series of changes that happen that stay with you, like diagnostically for longer than three months after what we would call the index event. So if the birth is the index event, then we're looking at things that are still happening three months down the track. Women will actually often contact me before then because they have an intuitive sense that is just like something is not right and they're not going to hang around for three months and that's okay. So what that looks like is the diagnostic criteria around PTSD is around four groups of feelings and behaviors. So one is what we call hyperarousal or hypervigilance, which is like somebody put the car alarm on inside you and then they just walked away and the alarm just goes and goes and goes and you don't know how to turn the internal alarm off. So you feel much more worried than is sort of perhaps warranted by the circumstances.
Athena:
[16:19] So hyperarousal is what it sounds like, too much arousal, too much sensitivity to stimulus, too much worry, too much anxiety, too much threat detection. Which is what this is actually based in. So the reason that the car alarm went off is because your nervous system detected a threat.
Athena:
[16:43] And often, when things get really unexpected at birth, whether we're conscious of it or not, what the system perceives is that it's a threat to your life or to your baby's life. Some women can articulate that really clearly and quickly. They're like, I thought I was going to die and I thought my baby was going to die. Other women, it's more nebulous. They're like, I don't know. I just had this feeling something was really off. I just had a sense that everybody knew something that I didn't know, you know, and I started to panic on the inside. So it's not always super clear. So hyperarousal, hypervigilance, avoidance, which is around when we're moving into the territory of post-traumatic stress disorder, women will do pretty much anything to avoid reminders of the birth. Yeah. So this is particularly tricky in birth trauma because, of course, one of the reminders of the birth is your baby. So this can raise a very complex push-pull, and this is where a lot of women go into what women will describe to me. I just had someone come in this week who was just in such distress, and part of what she described is that she loves her baby Okay.
Athena:
[18:08] And she is doing all of the things that her baby requires, but she doesn't feel like the baby is hers. She feels a bit like she's babysitting someone else's baby, is the way she described it to me. So it's not that she's being negligent, and it's not that she's so depressed that she can't functionally look after the baby, but it's almost like she's confused by the baby.
Athena:
[18:35] It's be like whose baby is this i'm not sure if i'm the mother or if i'm just a person who's kind of looking after someone else's baby and doing a beautiful job of delivering the care but there's something missing there's something that feels off so that can be a really specific and tricky aspect of birth trauma that doesn't always show up in other kinds of trauma the other thing women we'll talk about is you know like avoiding the hospital at all costs so of course then we have something really important to think about when we're thinking about next births. I have a client who I've been working with for quite a long time and she would literally take a different route to drive around her suburb because she actually didn't even want to see the sign you know the sign with the blue cross on it that tells you which way to go to the hospital she didn't even want to see that because that would sort of trigger a whole kind of cascade of physiological responses
Athena:
[19:32] in her. So that's avoidance. What else are we thinking about in PTSD? Ah, flashbacks and nightmares. A lot of women who come in to see me are experiencing flashbacks.
Athena:
[19:44] Obviously, when we have a new baby, we've got a lot of sleep disturbance anyway, but women will find that when they do get to sleep, their dreams are hard. Really hard and hard to manage and the flashbacks can be really present a lot of the time or they can be kind of women can kind of move in and out of those so
Mel:
[20:06] Is that like you're awake but your mind keeps going back to the event are they remembering vivid details in flashbacks.
Athena:
[20:13] Usually yes yeah and the other aspect of that is what we call intrusive thoughts yeah so it's like you just no matter how much you want to, it's like you just cannot put it down. It's like it just keeps coming back into your mind. Yeah. So intrusive thoughts are a thing across psychology that's not specific to birth trauma. And some of us may have experienced that previously, you know, when you're really anxious about something and you just kind of can't stop thinking about it. It's like that on steroids. Right. Yeah.
Mel:
[20:44] It's just that constant mental distraction.
Athena:
[20:46] Of having a thing. Exactly. And it's really distressing because you feel like you don't have control over your own mind.
Mel:
[20:53] Yes. And you also don't have room to think about other things.
Athena:
[20:57] Yeah, 100%. Actually, I've got a list here. There's a researcher called Cheryl Beck who was one of the kind of OG birth trauma researchers. She was the one who, in fact, I think it was her first paper was called this. She was sort of the first one who came up with this notion that birth trauma is in the eye of the beholder. Meaning that it's about the experience of the woman or the birthing person, not about some kind of diagnostic criteria that we place on them retrospectively. So, Bec, bless her, this is her list of symptoms of what we will see when women are experiencing birth trauma. I really like this list. I think we sort of can take the diagnostic criteria of PTSD and use that as a kind of framework. but this becomes much more particular to the experiences that we're talking about. So what she describes are persistent thoughts and memories of the birth. It's intrusive. It's persistent. You can't put it down. You can't stop thinking about it. And that's where the flashbacks and nightmares kind of sit in her symptomology with these persistent thoughts and memories.
Athena:
[22:10] Disconnection. So disconnection from self, disconnection from the baby, Often disconnection from partner, disconnection from family, from supports, resources, right? You just feel dissociation. You just feel kind of weirdly like you're not here is one way that birth trauma can show up. Repetitive expression of what happened is how she describes it. So this is another version of like women just can't put it down. Yes. They can't move on. And so often when women come in to see me, the first word that they all use is stuck. I'm stuck. I can't get past it. And really often they will say, like I will ask, you know,
Athena:
[22:57] Have you had any opportunity to talk about this with anybody? Who's been supporting you? Like, how are you resourced? What have you been able to kind of, you know, draw on to kind of support yourself? And often they will say, I needed to come and see you because I just can't stop talking about it. And like, my partner's great and my mum is great and my best friend is great, but I've reached this point where I can see them looking at me just going, that's enough now. People start giving you that look of like, are we still on this? Is this still a thing? And women are like, it is still a thing. I haven't moved anywhere. I'm like still in it.
Mel:
[23:39] So they're still in it. Are they trying to keep talking about it as a way of trying to unstuck it?
Athena:
[23:44] Yeah, I reckon.
Mel:
[23:46] It's almost like I just need to hear something that's going to help me move on from here.
Athena:
[23:50] Mm-hmm. Yes. Yeah, they're kind of searching for something that will allow it to loosen off because it has this really tight kind of hold on them. Okay, back to Beck's list. There are five, so we're up to four. Anger. Aha. Anger towards star, often primarily. Self. Yeah, so women will often be very angry at themselves.
Mel:
[24:20] I should have done something different or did I do something I should have done differently?
Athena:
[24:25] Yes. And for me, this kind of sits in with, we had a brief... Moment of talking about this before we came online, Mel, but for me, this one is kind of intrinsically tied to what I think of as the empowerment rhetoric, right? So, we have a really strong discourse in the birth world that if a woman is prepared enough and empowered enough, that will facilitate her to have a certain kind of birth. And that is sometimes true, but not always. And so I think that's part of why women are so angry at themselves because they're just like, oh, well, clearly I wasn't empowered enough.
Mel:
[25:05] There's certain tools that women can use to navigate and almost manipulate the
Mel:
[25:11] system and curate a situation for themselves that could result in less trauma. But I do think we downplay the power of the system, but also the vulnerability of women during birth, is that you can be in your full right mind now, as I am in my day-to-day life, and rattle off all the ways to avoid situations where I'm going to be out of control and possibly traumatized, but you're in a different world when you're in labor, and it's a vulnerable world where you You don't have your full, the capacity that you learnt strategies under and empowered yourself under don't necessarily exist when you're in labour because you're not in a position to be able to advocate for yourself.
Athena:
[26:03] And another piece that I see that sits alongside that is a lot of the empowerment rhetoric is about education and it's about information. And this sense that you kind of arm yourself with the information. And that's great. Don't get me wrong. I'm not suggesting that everybody should just go in completely, you know, sort of unprepared.
Athena:
[26:30] But that's just one kind of preparation, yeah, and it's very cerebral. It's intellectual and it relies on you being able to access that information at the time.
Athena:
[26:48] Yeah. When in fact, what we know is that your prefrontal cortex is pretty much not going to be available to you. That's part of the physiology of birth, but it's also part of the physiology of trauma. So as you come into a situation where you are detecting threat, so we all use this thing called neuroception, right? All of us have this. And neuroception is a system in our brain that is constantly scanning the environment and the people in it, importantly, for the perception of threat, yeah, so that we can respond appropriately. And this is part of what happens in trauma. That's part of what gets overridden and overwhelmed is our neuroception and he's going bananas, it's like, dude, threat everywhere, all of these people, this whole place, possibly even my partner, I don't know, just the whole thing, right? And at the same time, you're not able to enact any of the kind of naturally occurring or instinctive responses to that threat.
Mel:
[28:03] So normally if we detected danger, we could fight it, escape it, avoid it, stop it. Whereas we can't do that in labour and birth because we're there, we're in it, we're vulnerable, we are stuck in that scenario.
Athena:
[28:21] Exactly. And the extra layer that is even more particular to labour and birth, and this kind of pivots on that vulnerability that you're talking about, not only can we not do any of those things, which as you rightly suggest, they're our like fight, flight, fight, flight, fawn, freeze. Not only can we not do any of those things, but the very people who are in the room with us, who we feel threatened by, have our well-being and our baby's well-being relies on those people.
Mel:
[29:01] This is the other really tricky thing is women go to hospital being told that this is the place where you will be kept safe. And this is why when people say hospital's the safest place to give birth, I challenge that statement over and over and over again, because that's the medical message. We've created these safe buildings with safe practitioners so that you and your baby don't die. Well, guess what? Not dying is one thing, but being kept safe is a completely other thing to not dying.
Athena:
[29:37] I agree.
Mel:
[29:38] Yeah, there's so many elements of safety and I think that's what confuses women is they almost don't understand what they feel about their birth scenario because they so deeply believe that the hospital is the safest place to have a baby. Probably that's why they're there because that's why they believe that. But then they didn't have an experience of safety. And then they get gaslit and said, well, but you're alive. You're alive and your baby is alive. What are you worried about? And it's this massive disconnection between the understanding of you and your baby being alive and the gratitude of that. And actually, you were not kept safe in so many other ways.
Athena:
[30:18] Yes.
Mel:
[30:20] I mean, it's the mental gymnastics of trying to navigate the whole life of birth.
Athena:
[30:26] Right? That is precisely right, Mel. Mental gymnastics is a good way to describe it. So in a therapeutic sense, the way that I would think about it is like trying to hold both. Yeah? So you're trying to hold this belief and construct, yeah, conceptual construct that the hospital is the safest place for you to have the birth. and that you chose it because of that reason. And then you're trying to hold the experience that you had there. And those two things just keep banging into each other, right? Because they're like puzzle pieces that don't fit. It's basically just a giant head fuck, if I'm allowed to say. Yes, I'm allowed to use that kind of outrageous language, right? It's a massive head fuck. And so women talk about this feeling of like having the rug pulled out from under them at a kind of values and beliefs level. I believed this thing. I believed this was the truth. I believed that this was the best thing for me and my baby.
Mel:
[31:25] Yes, and that's where I think maybe some of the anger comes from too is almost being hoodwinked, like it's the bait and switch. You said I should come here because this is where I'd be safe, but then all this stuff happened to me and I didn't feel safe and now I'm left with all this confusing trauma.
Athena:
[31:47] Yeah, 100%.
Mel:
[31:48] Are those the five from Beck? Oh, there's one more. Yeah, let's do the one more because we could easily go down that rabbit hole.
Athena:
[31:56] For a while. Right. So the one more is negative experience of motherhood.
Mel:
[32:01] So we've got, so negative experience of motherhood, the flashbacks and bad dreams.
Athena:
[32:07] Shall I run through them?
Mel:
[32:08] Yeah.
Athena:
[32:09] Persistent thoughts and memories of the birth, including flashbacks and nightmares, a feeling of disconnection, the repetitive expression of what happened, can't put it down, can't stop talking about it, anger, bait and switch, hoodwinked, what I believed doesn't match my experience, anger towards self, family and staff, I often hear a lot of anger towards partners and that's possibly a whole other podcast and negative experience of motherhood.
Mel:
[32:36] Okay, so this is a description of the aftermath of what birth trauma could feel like for women who are trying to pinpoint why do I feel this way?
Athena:
[32:46] Yeah, exactly. And you may not have all of those things occurring simultaneously. You may have only a couple of them or you may find that you kind of cycle through them. I think one of the ways that I think about it in terms of women understanding for themselves whether they may be in a space of trauma it's like either too much or too little is happening so either you're like too escalated too upset too sensitive to like you know more than you would usually feel is warranted in the circumstances like there's too much of everything or there's too little you're really disconnected you're really dissociated you don't have a lot of feelings, you're not sure if the baby's really your baby. I feel like most women can track their kind of normal baseline and whether they feel like they're either above or below that baseline in terms of like too wound up or too kind of disappeared to themselves.
Mel:
[33:55] And how would you differentiate between trauma and profound sort of disappointment experienced? Because there's, I mean, you can be really disappointed and sad about something, but not necessarily traumatized.
Athena:
[34:12] Yeah, I think it's the stuckness.
Mel:
[34:15] Okay.
Athena:
[34:16] Yeah, that's an easy way to think about it. It's the stuckness. Does it come and go? Can you move through it? Does it change according to context and circumstances? Is it better on some days than it is on others? Do you feel overwhelmed by it? Is it consuming you? Precisely. We often talk about tentacles. So it has tentacles. It's creeping into other aspects of your life. It's affecting your relationships. It's affecting your bonding with your baby. It might be affecting your breastfeeding. It's affecting your relationship with your mum. It's making you feel like you're a loser and a failure and you're totally ashamed of yourself. You know, it's greater than the sum of its parts.
Mel:
[34:58] It takes over, yeah.
Athena:
[35:00] And it creeps in. You know, it's kind of a bit insidious.
Mel:
[35:04] So one effect could be that women get stuck. But I have heard of another possibility, trauma, and this is what I'm very interested in. Is this idea of inspiration and growth after trauma, that it becomes a trigger point for an exceptional pivot point in your life. And so I'm curious to know, and I've also heard psychologists talk about, you know, there's a certain type of person that maybe they could predict would have felt trauma from an event and others who they might go, well, look, that person has got, Resilience against traumatic events. These are two separate questions I'm realising now. I'm curious to know what you think about this idea of a type of person or particular traits that becomes resilient against traumatic events. And also the fact we, and we spoke about earlier, the very fact that we need to somehow identify resilient elements that will stop women from becoming traumatised by maternity care. It's just an insane idea that we have to visit. But can you speak to that idea that there is a type of person who would become traumatised and a type that would not?
Athena:
[36:27] So this is really tricky territory.
Mel:
[36:29] Yes, this is why I've gotten here to do the tricky stuff.
Athena:
[36:34] Because like even hearing you say that, Mel, knowing with every bone in my body that you are coming from a place of sound and good intention, even when I hear you say a type of person that will get traumatized and a type of person that will not, I feel myself drawn over into the kind of victim-blaming territory, you know, where I'm just like, oh man, just don't even know how to talk about this in ways that aren't further setting women up to feel like they should be more or different in order to avoid the experience of trauma.
Mel:
[37:13] Which I think is exactly why this is not spoken about is because of this tricky line.
Athena:
[37:21] Yeah.
Mel:
[37:21] And I can separate feelings from words. Sometimes in phrases that I, when I say it, I'm like, I'm not touching any feelings to it, but this is a very emotive topic.
Athena:
[37:34] Yes, it is, which means that it's probably a good thing to bring out into the light a little bit. Yeah. Because we do know, we do know that some people are more, shall we say, protected from the experience of trauma than others. So there are, of course, risk factors or kind of identifiable characteristics that alert us to to the possibility that some people are going to be more prone to experience trauma than others.
Athena:
[38:08] There are long lists of those available all over the place. So that is a true thing. But then, yeah, we come to this part which is like how do we have this discussion without making people feel really shit about themselves, particularly given that like chronic and childhood trauma are not a thing that you chose. It's not a thing that you were responsible for. And yet if you are bringing that with you into your adult life, particularly into the birth room, it is going to have an impact actually on how susceptible you are to experiencing further trauma. So, you know, it's that awful thing of like, oh man, the people who've already had a shit time and are really struggling with this stuff. Now we're like, oh, well, you're probably going to be more likely to get traumatized again. Like it just feels like such a kind of one-two punch, you know. So it is hard to talk about. Can you see it in my body? It's making me feel so uncomfortable.
Mel:
[39:09] I know. And this is, I think, why it's so hard for us to, I guess, strategize around how do we help women. Okay, so this is the big issue.
Mel:
[39:24] We want to help women avoid trauma in childbirth. The most frustrating thing about that is that we even have to consider strategies to help women avoid trauma in birth. That's the first very frustrating thing is that it's almost like we're accepting that there is a possibility and we know one third of women feel traumatized by their birth. We're accepting the possibility that you're going to be at risk of trauma during childbirth. and then we're going one step further after acknowledging that horrific fact, To say here's, and this is where I think the rub is, here's what you can do to try and avoid becoming traumatized by your birth like it's absurd.
Athena:
[40:12] Yeah, right. We're giving you another job to do.
Mel:
[40:15] Right.
Athena:
[40:16] To protect yourself from a thing that shouldn't be happening in the first place.
Mel:
[40:21] Correct. And I spoke to you earlier about, you know, the fact that, you know, I have a 12-year-old son who slowly, slowly over his lifetime, he's going to have more and more access to the internet that I won't have any control over.
Athena:
[40:33] Yes.
Mel:
[40:34] And so part of my job is to say to him, hey, let me teach you about the internet, about certain search terms, about the risks, the shortfalls. There's massive benefits to internet access. However, there's this dark side. And I'm trying to prepare him for the potential dark side to make him wise to it. How can he avoid the common pitfalls? You know, it's not his fault that the internet is a dangerous place but there's things that he can do to prepare and I kind of see it a little bit like that of saying, hey, there are some great things about maternity care that it could be really beneficial to you, but we have to all acknowledge that they're a really hard part, and there's ways that we maybe could prepare ourselves.
Athena:
[41:29] Yeah, I think that's a good analogy. And I guess, you know, really the way that we do that is we just approach it with kindness and goodwill and we try and have the hard conversation.
Mel:
[41:41] We already know there are some things that women can do. We know that continuity of midwifery care is... a known research strategy.
Athena:
[41:50] Yes.
Mel:
[41:51] Is there anything, any other kind of key decisions that women can make that might keep them safer?
Athena:
[41:59] Yes, there are some. As always with everything, it's context specific. However, generally speaking, what we're thinking about here is, okay, so given that the experience of trauma, our internal experience of trauma is mediated by our nervous system and is to do with this idea of threat detection and coping, capacity to cope. One of the things that we can think about beforehand is really just about, this sounds like such a weird and small thing, but is actually around learning to listen to your nervous system. So learning to tune into it, kind of get on that frequency, hear what it is asking for and start finding ways to give it to your nervous system. So another way of thinking about this is practicing identifying your own needs and then fulfilling them. And what we're doing here is we're building a little bit of stamina in your system. We're building a bit of a belief of like, oh, I will probably be okay. Someone will probably be coming and it will be me. I can attend to myself.
Athena:
[43:15] I know how to identify my own needs. I know how to speak for myself. So you can do this in really small ways at home with your family members, with your pets, with your friends. It's this kind of idea about getting on the frequency of your nervous system and giving it the sense of feeling heard and supported. So we know that a huge amount of women when they're describing what happens to them in birth trauma talk about not being heard and not being seen or not feeling heard and not feeling seen. So that's a kind of like ground level trigger for threat detection because it's like, oh, I don't think these people are listening to me.
Athena:
[43:55] Let alone are they going to step forward with some sort of support and confirmation almost of my experience, right? I can already tell that my experience is being kind of shut down and denied just because nobody's seeing or hearing me. So if you can find ways to start giving that to yourself, and again, I'm so hesitant around this stuff because I'm like, man, women have enough things to do, right? I don't want to give them more shit that they have to do, but that's kind of what we're talking about here. So I think you're right, Mel. We kind of have to just be a little bit real about it. One of the ways that I've started thinking and talking about it with women is that the maternity care system is just that. It's a system. Therefore, it has its own processes and procedures and ways of working. And it's just going to keep doing that. And when we come into contact with it, when we come and stand in front of it and go, hi, I'm here, it doesn't actually care. It just is going to keep doing what it does in order for its processes to occur. And that's not to say that no one in the maternity care system cares about you as a consumer.
Athena:
[45:09] You may well encounter people in that system who care a great deal about you and will take very good care of you. But the system itself is not going to alter to accommodate you. You're just going to come into it and then you're going to go again and it's going to keep doing what it does.
Athena:
[45:28] And I do have a sense that that is an important thing for us to understand.
Mel:
[45:34] My work here, and I imagine what's happening with your work too, is just a little bit of an acknowledgement that that system is so big and complex that to think we can change it in our lifetime, more accommodating to women's needs, I'm starting to realise that that's, probably not going to happen at pace and so that if women want to alter the outcomes that are going to occur as they enter that system yes we unfortunately are required to take on the responsibility ourselves if we want meaningful change for ourselves and our experience it it becomes our responsibility because the system hasn't thought oh i wonder if we can do what's best for women, it hasn't. And we're seeing that statistically, we're seeing that. And I feel like we're almost sort of alerting women to like, hey, I know that you think, that you're going to be kept safe on every level in the system, but it's almost like I want to just tell women, don't expect that. Maybe, I don't know. And then to say to women, maybe there's something you can do to keep yourself safe.
Athena:
[46:52] Right it feels so counterintuitive
Mel:
[46:54] But it's almost like as a woman walking through a dark car park we know oh this does not feel like I have to park my car here you know theoretically it's safe probably I will get to my car just fine but I need to be prepared for the possibility that something's lurking that might endanger me and maybe that would change how I behave maybe I'll park it maybe I'll get an escort to my car maybe I won't go out so late at night As women, we're constantly aware of what threatens us and we're constantly making changes to how we behave to keep ourselves safe. And unfortunately, we still have to think about that when we're giving birth, that we're still not entirely safe as women.
Athena:
[47:39] Yes, I think that's a beautiful analogy. You know, it's like this terrible push-pull of like, yeah, how do we find a way to talk about what might happen in the car park without
Athena:
[47:54] frightening the bejesus out of everyone? You know, how do we talk to women about the reality of the fact that, yeah, the system is probably not going to prioritize accommodating your personal needs. Yeah, it's going to prioritize its own requirements because that's what it does. How do we even talk about that without making it seem even more scary to go into the hospital to have a baby, which then makes our nervous systems more on alert, which then makes us more prone to feeling like there's threat everywhere. Like, I don't know how to have this conversation and promote safety at the same time. Does that make sense?
Mel:
[48:37] Totally. It's almost weekly I get messages from people on social media and in emails saying, what you're saying is scaring women. You know, I might say, oh, you know, yeah, you're at more risk of having this in hospital compared to this and they say, you're scaring women. It's like, oh, actually, I mean, this is information. It's not unfactual. It's not a lie. It's evidence-based. You are more at risk of some things in hospitals versus other birthplaces and with different care providers. How do we give this information without terrifying women? In the same way as how do I talk to my daughter about how to keep herself safe in the world without making her terrified to leave the house? I don't know. She would never travel. She would never ride a bike. She would never drive a car if she took every single risk completely to heart as if it was an absolute reality.
Athena:
[49:35] Perhaps that's the key to it, Mel. Perhaps the key to it is these are conversations that we are having because there is no way in which to not have them. But that perhaps what we can say to women is that you don't take this into your heart. You don't take this into yourself. You kind of compartmentalize this, yeah, which almost all of us have the capacity to do. We take this information, we hold it kind of in the back of our mind. It's like, well, okay, I'm just going to have this awareness sitting back there that it's possible that when I go in, things might not feel as safe as I expected. We don't keep it at our forefront of our mind. That's easy for me to say. But I guess this is kind of part of what we're talking about. It's like integration. Yeah. How do we metabolize this information? How do we integrate it and not be overwhelmed by it and keep it in perspective? It's the truth. It's our truth. There's not just one truth.
Athena:
[50:41] It's not the same for everybody. Many of us will have had experiences where we've had and been present at beautiful births in the hospital. And where we started from is, yes, there is a whole bunch of stuff that you can do in that preparation period to not change what the system will do, but to buffer yourself from the actions and activities of the system.
Mel:
[51:12] And one of them was training your nervous system.
Athena:
[51:15] Yes, that's where we started or where we jumped off.
Mel:
[51:18] We did. Yes. In your nervous system is one thing. It's like a muscle.
Athena:
[51:24] Yeah, it is. It's like a muscle, right? So it's literally like it's the threat detection frequency. It's like, oh, okay, that thing that I've just noticed is making me feel a little bit activated. Just to notice, to notice that and then be able to go, oh, rightio, what am I going to do about that? Am I going to like do some kind of embodied stuff and shake it out? Am I going to go outside? Am I going to get in the shower? are like, how can I kind of start to get into this thing of going, I can notice that when my nervous system is activated and I can find some ways to respond to it to help it settle down again. It's working to bring that unstuckness, the unsticking kind of into consciousness rather than it all just happening at a below conscious level.
Athena:
[52:14] So it's really just a thing about noticing. Having said that, I'm aware that just sitting here and saying this right now, that probably doesn't make a whole lot of sense but the other thing that you can do really thinking about what is it that does make you feel safe and I feel I've found over time that I've really gone back to a lot of the kind of old school stuff around this yeah so things like when you're going into the hospital taking in photographs taking in special objects or like amulets things that you can hold or touch or look at or feel to help your nervous system feel safe. One of those is people, right? We can take our people in with us to help us feel safe. Really think about how do you like to be touched? What actually soothes you, helps you to feel safe, helps you to feel comforted, helps you to calm, really get very specific with your people about what those things are.
Athena:
[53:20] Setting yourself up so that you've got some kind of visualization resources. Do yourself a safe place visualization. These are out there, available on the interwebs. You can do it yourself. Just really taking the time to think about where is a place that you feel safe? And then how can you translate some of that and take it with you when you go in? Can you share it with your support people? So, I mean, in some ways I feel like this stuff, you know, when I first sort of started doing this work, I felt very much like this stuff was the sort of weird hippie end of the spectrum and I was like, have you people been in the hospital? Have you seen what happens in there? Like having a safe place visualization, how is that going to help women? But actually what I've learned over time is that if we can help to support and soothe and settle your nervous system, then you are less likely to freeze, dissociate, go into fight flight and if we can keep you a little bit stepped back from those processes or if you can recognize them when they happen then you're going to be less overwhelmed. So that's actually the key piece of this,
Mel:
[54:36] Right? So that means you don't feel a profound traumatic response to a really still shit thing that's happening.
Athena:
[54:45] Yes.
Mel:
[54:45] But it doesn't get stuck.
Athena:
[54:48] Hopefully.
Mel:
[54:49] That's the idea.
Athena:
[54:50] It brings it into conscious awareness instead of it all happening below a conscious level.
Mel:
[54:57] And so we're not suggesting to women that you can train yourself out of so we're not saying don't feel traumatized by something that should feel traumatic because that's a possible thing we're saying build resilience so that you're not traumatized by bad behavior or poor treatment yeah.
Athena:
[55:17] It's not even resilience mel i don't think yes i think of it as protection
Mel:
[55:21] Okay sure.
Athena:
[55:22] Yeah resilience is really particular resilience is about bounce back Yeah, that's what resilience actually is. It's your capacity to come back, to bounce back after a challenging event.
Mel:
[55:36] Right. So you're saying when we work on strategies to ensure our nervous system's not overwhelmed, we won't have the trauma response that occurs from something happening to you?
Athena:
[55:50] I don't know if I can say it as plainly as that because I just don't know that we can guarantee that for a fact, right? But what we can think about is the more you have brought into your own conscious awareness, what it feels like to you when you get activated and how many things you've discovered you can bring in for yourself to help settle yourself down. Most people already know this stuff, but we just don't always hold it very consciously. If you can then bring all of that with you into the room, and when I say all of that, it makes it feel like a truckload of preparation. Than that you have to do, but actually it can just be a few tiny little things. Whenever I talk about this stuff, I'm always reminded of a birth that I was at many years ago. It was a hospital birth and this woman spent most of her active labour in the pool, leaning over the edge of the pool. We were in a hospital setting. She didn't have continuity of care, but she did have two known support people with her. But she spent most of her active labor like hanging over the edge of the pool with a photograph on the floor that she was staring down at. And the photograph was of her other child, her older child. And she was just like that was her safe place. And that is such a simple example.
Athena:
[57:13] Of what we can take in with us that is not all of this like education, information, remember all the things, know the stuff, you know, be ready to advocate. But in fact, what we know about what gets us through the process of labour and birth is our ability to let go, which is in fact that is more facilitative of the physiological process of labour and birth, which is all about letting go doesn't mean that everything is going to go the way that we want it to
Mel:
[57:46] Part of being able to let go is if you feel safe with the people around you which is why we know of the importance of one-to-one care yeah where you know the person who's with you because you go i don't have to be hyper vigilant i do feel safe with this particular person yes and with a with a dialed support person. And last week on the podcast, I had a whole episode about how to be a great support person. And the most of it was, she's not here she's not cognitively available you need to you know if she says no one time you know what your direction is now as a support person she said at the one time that was hard enough now you got to run with it keep her space safe so in this is why we talk about protecting the birth space yeah whoa the woman can let go so that her brain can labor and then yes and labor Yeah, I think it's about creating a circumstance where you don't have to be hypervigilant. So when I talk to women about how do you keep yourself safe from birth trauma, do your very best to create a safe environment that you don't feel inspired to fight.
Athena:
[59:07] And I think if you are, there's this piece about recognising that as a protective device, that your body is taking you to that place because there's a part of you that is trying to protect you. There is a part of you that is going towards fight-flight. There is a part of you that is shutting down. But there may also be a part of you that can come forward and be like, ah, okay, I see that. So it's about that observer mind. Just realizing that this feels like a lot. This feels like a lot for everyone to take on.
Mel:
[59:48] Well, this is the thing with this topic is that I think it takes a lot in order to discuss it and understand it.
Mel:
[59:55] That ends part one of my interview with Dr. Athena Hammond. Stay tuned for next week for the next episode, 175, and we'll be talking about post-traumatic growth. If you feel that you need to speak to somebody about what you've heard on this week's episode, we'll leave some resources in the show notes below and also feel free to access the resource page for this podcast. Just go to melanethemidwife.com. We'll see you in the next episode. To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com and to support the work of this podcast, wear The Rebellion in the form of clothing and other merch at thegreatbirthrebellion.com. Follow me, Mel, @MelanietheMidwife on socials and the show @TheGreatBirthRebellion. All the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
©2025 Melanie The Midwife
