Episode 175 - Post traumatic growth
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.
Mel:
[0:24] Hello and welcome to today's episode of the Great Birth Rebellion podcast. I'm your host, Dr. Melanie Jackson, and this is part two of my discussion with Dr. Athena Hammond. She is a psychotherapist and more specifically a trauma therapist. Last episode, we spoke about buffering for emotional safety at childbirth, and she spoke about the fundamental elements that can lead to feeling traumatized by your birth experience and how you can buffer against those. Today, we speak about the concept and idea of post-traumatic growth. There is one possibility from trauma and that is the feeling of inner destruction. The other possibility is the option of post-traumatic growth and that's what we discussed today in this episode. If these episodes have been really tricky for you to listen to and you feel like maybe there's some trauma resulting from your birth or anything else in your life, we've got some resources in the show notes that can help you work through those.
Mel:
[1:28] This is this week's episode of the Great Birth Rebellion podcast with Dr. Athena Hammond, where we speak about post-traumatic growth.
Mel:
[1:35] In the interest of keeping this podcast completely free to you, the listener, this episode has been sponsored by my dear friend, 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. 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.
Mel:
[3:11] Can we introduce the idea of post-traumatic growth? Because we don't all have to feel trauma, get stuck, and have a pathological result.
Athena:
[3:22] Yes.
Mel:
[3:23] It's another option.
Athena:
[3:24] Absolutely.
Mel:
[3:25] You know, it's very dire at the moment, and I think that's where people get stuck with the conversations about birth trauma is that it can be very dire and that it requires recovery and healing. But what else could happen if you feel trauma?
Athena:
[3:42] Hmm. So you're right. There is absolutely a defined phenomena called post-traumatic growth. Yeah. It's a thing. It's a real thing. It's premised on the idea, as you say, Mel, that after trauma, There can be a change or changes in a person or a system like a family, but there can be change that occurs that is kind of expansive. And in some ways, that's one way of thinking about it is that when we're stuck in the trauma, it's a kind of contraction, like it keeps us contained. Post-traumatic growth is the idea that from there, we can potentially move into a place that is more expansive and allows more breadth of experience to kind of come into play. It's interesting. I was talking to my partner, Max, about post-traumatic growth and she said to me, post-traumatic growth, that's a weird thing to call it. Why don't we call it wisdom from experience?
Mel:
[4:45] I mean, well, that's what happened. Do you think I felt this thing? Now I have some new information, a new experience from which to draw when making decisions about next step.
Athena:
[4:58] Yeah, I think there is something there. And the literature, so like to go to the research, right, because, you know, we can't help ourselves. Of course, post-traumatic growth, because it's become a thing, people want to research it and therefore they want to measure it and they want to define it. And so we do have some stuff available that kind of takes us into those directions. So there is like an inventory of post-traumatic growth. Which is a way of defining and measuring post-traumatic growth.
Mel:
[5:28] So someone's come up with a tool that measures post-traumatic growth.
Athena:
[5:33] Yeah.
Mel:
[5:33] No idea, but yes, I would love to hear about that.
Athena:
[5:37] Yeah, there's these guys. I think they started working in about the mid-90s. Tedeschi and Calhoun, I think they are, and they've done a series of research that, According to them, what the inventory says that we're looking for is a positive response or a positive change in these factors. I'll read them to you.
Athena:
[6:02] Appreciation of life, relationships with others, new possibilities in life.
Athena:
[6:10] Personal strength, and spiritual change. So this is in the general trauma population. what they reckon is about a half to a third of people who experience trauma will go on to experience some kind of post-traumatic growth and so if we go back to Bec for a minute the birth trauma researcher that we were talking about earlier she has done a little bit of work on post-traumatic growth in specific birth trauma populations and it's really important to note that one of the things that she is very clear about is that we mustn't set this up as an expectation because in fact for women who have experienced birth trauma it is not that like it's not a kind of guaranteed part of the process and I think one of the reasons for that is that often there is a complex trauma history when we experience birth trauma we know that that's more likely to happen when we bring a complex trauma history with us.
Athena:
[7:17] Into our experience of labour and birth. And so it's not as straightforward as just there was one acute traumatic experience and now you get to grow from that. It can be, you know what, there's actually been something happening here for a long time. That doesn't mean growth cannot occur, but it might not look like what the inventory says it's going to look like.
Mel:
[7:41] So is post-traumatic? growth, a more likely circumstance in a singular way. Event, never sustained trauma.
Athena:
[7:51] Do you know what? As I was coming in here to talk to you today, I was like, oh, I really wish I had spent some time last night online trying
Athena:
[8:01] to find out the answer to that exact question. My instinct and based on kind of what I know and how I work, my instinct is that post-traumatic growth is probably more likely after an acute trauma, rather than a complex trauma that occurs over time, which is not to say that that cannot happen.
Mel:
[8:24] This is the grayness of this whole area. Right?
Athena:
[8:28] But it is a thing. One of the reasons that I'm hesitant about talking about it as a thing is once again, like I don't want to give women another job to do. I don't want post-traumatic growth to become the new self-care, right? It's like, oh, my God, I have my traumatic experience and now I have to go and heal and then I have to do my post-traumatic growth. It's like, dude, it's not another job for women to have to do.
Mel:
[8:53] It sounds to me like it's a moment that adds to your motivation for wanting to do something. It's not like consciously go, well, now I'm on my post-traumatic growth journey.
Athena:
[9:09] I think about it like when we're working with grief, there's a thing in grief that we call the dual process model. And essentially it's just two big circles. and one circle is what they call loss orientation and the other circle is what they call restoration orientation. And when we think about grief, one of the ways that we talk about it is that we're constantly moving from one of those circles to the other, right? We have this bouncing back and forth.
Athena:
[9:40] Some days, some minutes, some hours, we're going to be really in the loss, really focused on the loss. It's going to feel like that's all there is. we're just really overcome with the grief and on other days or moments or weeks or periods of time we're going to be more oriented to this idea of restoration oh actually what can I do or what am I doing in this moment that is helping me to feel like I can take the grief with me but also find restorative action I think about post-traumatic growth more like that so rather than it even being a sequence, it's just like, you know what, it's something that's probably always there, like the possibility and potential for it is always there. But it's not an either or. It's not like you either get birth trauma or you get post-traumatic growth. I think we're probably going to move in and out in that dual process manner, like we're going to be holding both a lot of the time, is my sense.
Mel:
[10:46] Yes. Well, and I wonder if over time people look back at the traumatic event and can see the result of it. some of which are positive, some of which are negative. You know, and you mentioned before we were recording that it's quite possible that the events that occurred around your birth have led you to the exact situation you are in today, this career, this way of living, and that could be interpreted as a post-traumatic growth situation.
Athena:
[11:20] Yeah.
Mel:
[11:22] And potentially we could look back on certain situations and think, well, if that hadn't happened, then this wouldn't have happened. So I'm kind of weirdly grateful for an event in my life that created a particular change. Yeah. Again, I'm speaking from a background of not personally understanding.
Athena:
[11:45] Yeah. So I wonder, I mean, you know, Mel, you and I have known each other for a long time and, you know I don't usually talk very much about my personal circumstances, but just as I'm listening to you saying that, My situation is really different to yours because I hear you, right? We all sit in a different place with this. So I am one of the, where are we now? Is it one in five women, I think? No, one in 10. One in 10 women who have experienced childhood sexual assault. And I grew up in a family where there was a lot of dysfunction. So I have what we might think of as a kind of chronic trauma history. And when I came to labour and birth, which I did when I was very young, I was only 26 when I got pregnant. It seemed to me like I was very mature and I knew everything in the whole world at that point in time, but I now look back on it and think, oh, my God, that was just like a baby. So I was pretty young. But when I came into labour and birth and I was having planned home birth.
Athena:
[12:53] So, you know, I had continuity of care. In retrospect, I actually didn't have a great connection with my midwife. Sorry, Robin, if you're listening to this. But I had kind of done the things. You know, I went to the independent birth classes. I prepared for my home birth, all of the things. Long story short, I ended up with a hospital transfer and a very distressing experience, which ended in an epidural and a forceps procedure for my son to be born. So my son's now 27. And I remember very clearly when I went to leave the hospital, I remember very clearly this sense of like, how do I hold these two things? How do I hold...
Athena:
[13:37] Loving this baby so much, loving and adoring this little baby so much, and feeling like so much guilt and shame and so triggered around my childhood experiences. It's like, how can these things possibly go together? I don't understand how these things can kind of coexist in the world. And now I hear that from other women quite a lot. Yeah. And that's a lot of the work that I do, that we do, I do with women, is trying to come to some place of, it's not even resolution, I guess it's acceptance, that there is more than one truth and that these things are going to coexist in us and we have to find a way to expand to allow them to both be.
Athena:
[14:29] Find some level of acceptance for both. But when I came out and through that experience, I also became very very angry about just like are you serious like are you serious that's that's what happens in there that's what we do to women like if that happened to me that can happen to anyone right I did the things I went to the classes I planned the home birth look what I ended up with and so I got very very angry I didn't think I was going to be a midwife I thought I was going to be a writer I was at university doing a creative arts degree when I had my baby But that anger and that traumatic experience really did propel me in a way that was almost beyond my control. Like it really propelled me onto a different pathway. And having come from a background of trauma and holding my own trauma history, I, it was so clear to me how present that had been at the labour and birth and how utterly unprepared I was for the fact that that would happen.
Mel:
[15:37] Is there anything you could have done to prepare?
Athena:
[15:42] It's a really good question. Certainly at the time, I didn't know. When I look at it now, I think, well, part of it is age and experience. Like I was really young. I'd never had any therapy. You know, if I could somehow magically mess with the timeline and, like, go back now to that age but take with me all of the therapy that I've had up until this point of my life, like, that would have been super helpful. But, you know, we can only know what we know when we know it. I think there are definitely things that I could have done differently. Unfortunately, I didn't have the awareness to access any of those. But in retrospect, yeah, I could have been a lot better supported. I could have had a much more connected relationship with my primary support person. I could have maybe tried to find a way to express what was happening to me during the labour and birth, but I just genuinely had no words and no kind of context or reference for that.
Athena:
[16:47] It's something that I talk about really rarely. So like the idea of then doing it in that incredibly vulnerable state during labor, like it's just not a thing. And so I guess part of where I've come to from that is to be a huge proponent for women of like go and do some work around your stuff. Find a therapist, find a supportive mums group, find, I don't know, whoever it is that you can find to help you to look at and feel into your own stuff, yeah, to try and clear that out of the way a little bit because it does have a contributing effect to how we can be. And that's what we know, right? We know that one of the circumstances that greatly increased the chance of experiencing birth trauma is a history of intimate partner violence, sexual violence or childhood sexual assault. And that's partly because when you have been through those kinds of experiences, you have a nervous system that is really sensitive to threat. Makes total sense. Yes. So you really want to try and find some help and support to establish some ways to settle down your nervous system before you go in to have your baby. If you can, it's not going to be available to everyone.
Mel:
[18:15] Thanks for sharing your story. I do think that it will be of value to women listening to know about that.
Athena:
[18:25] Thanks, Mel. had.
Mel:
[18:27] A another word that you would want to give it post-traumatic if post-traumatic growth isn't
Athena:
[18:33] What would.
Mel:
[18:35] You call it I mean what yeah what can women potentially
Athena:
[18:39] Oh okay so this is just like really showing my stripes as a terrible sort of research nerd so when I think about post-traumatic growth what I actually think about oh my god I can't believe I'm just going to drop another complicated concept on everybody. So, when I did my PhD, one of the things that I wrote about a lot was this thing called salutogenesis.
Mel:
[19:05] Okay. Salutogenesis is the word,
Athena:
[19:08] Everybody. Salutogenesis. Okay. So, salutogenesis. Is the study of, or a theory, no, that's not true. It's the theory about, so salutogenesis is a theory about what supports us to thrive and flourish in the face of hardship. So salutogenesis, in a nutshell, it's often described as the opposite of pathogenesis, right? So pathogenesis is identifying the things that make us sick and unwell, salutogenesis is identifying the things that support our health and wellness.
Mel:
[19:48] In the face of something that's a cure?
Athena:
[19:52] Yes. Well, just in general, but specifically in the face of challenge and hardship. So the original research around salutogenesis was done by this guy called Anton Antonovsky. And what he actually looked at was Holocaust survivors. And he was really interested in the idea that from this population of people who had survived the Holocaust, some people went on to thrive and live well, happy, healthy lives, and other people were so distraught and diminished by that experience that they'd really never recovered. That was what kind of brought him into the space. So, in Antonovsky's theory, there are three things that he talks about that are the basis of salutogenesis, right? He calls it sense of coherence. If we have a sense of coherence, that's what helps us to thrive, to flourish, to grow in and around traumatic or difficult events. So, let me look at my notes so I get this right. It's the best. I love this guy. I love this theory. He's not alive anymore, but Manny did some great work. So in order to experience a sense of coherence, there's three things that need to happen for us. The events or what is happening needs to be comprehensible.
Athena:
[21:20] Manageable, and meaningful. So whatever is going on around us, when the things start to go pear-shaped, it needs to be comprehensible, meaning we can comprehend it, we can make sense of it, right? We understand what is going on.
Mel:
[21:38] Is this the awareness you were talking about where basically you go, I am recognizing that my nervous system is overwhelmed because this is a stressful and traumatic situation.
Athena:
[21:51] Yes, Mel.
Mel:
[21:53] Okay.
Athena:
[21:54] Thank you for joining those dots. That's exactly it. So in therapy, there's a whole other thing which we talk about as name it to tame it, right? If you can identify it, give language to it and say it to someone, even if it's to yourself, that really helps your system to understand. It can comprehend.
Mel:
[22:18] So, this is possibly the piece that you already mentioned what was missing from your birth experience was comprehension. I did not comprehend where all of the input was coming from. Why am I feeling like that?
Athena:
[22:31] Exactly. That's exactly it. Thank you. Comprehension. Comprehensible. Needs to make sense. We need to understand it. Manageable. So, we need to be able to cope with it. It needs to be manageable to us in some way. And I think the thing I want to stress there is that that can also mean that we're given an opportunity to expand in that moment in order to manage it. And I guess that's part of what I see in what is missing in the hospital birth room in particular, Rather than women being given the opportunity to expand and to cope with the very difficult thing, often the environment and the interpersonal space does not support any of that to happen.
Mel:
[23:21] Is that where we would feel out of control to be able to change anything in that scenario?
Athena:
[23:28] Yes, exactly. So if we have no control, how are we going to manage?
Mel:
[23:33] Because we've got no resources because is this a scenario where a woman might find a new place in herself where she thinks whoa look at what i just did in the face of adversity i found a new i unlocked a new area of capacity or piece of strength that i didn't realize i had yes
Athena:
[23:55] Absolutely And or I, like, resourced myself by using a connection or using a relationship or, like, asking for something that I needed. Yeah, so it can be internal or it can be external.
Mel:
[24:09] Right. So it could be saying to your partner or your midwife, like, do not let that person back in the room.
Athena:
[24:15] Yeah.
Mel:
[24:15] You know, as a very specific example. Yes. I'm going to make sure that person doesn't reenter the space and the woman's like, there you go, kept myself safe in that room.
Athena:
[24:26] Exactly. Nervous system goes, oh, good, you're still online. You're still here. Right. You haven't been overwhelmed.
Mel:
[24:33] Okay, so comprehensible and manageable.
Athena:
[24:37] Third one, meaningful. So we have to be able to make meaning out of it. I guess I think of this a little bit like metabolizing, like integrating. This stuff is happening. I'm not really sure what's going on. It doesn't make a lot of sense to me, but I'm going to need to make some meaning from it. And I think this is the one where we need staff the most or a doula or a support person. This one is probably trickier in the moment to do for yourself.
Mel:
[25:05] Yeah.
Athena:
[25:06] I think this is the one where you need someone to say, this is happening for this reason.
Mel:
[25:11] So could this be like a emergency situation, for example, and saying to a woman, hey, this thing is happening. What I feel I need to do is A, B and C. I think it's really going to hurt for about a minute when I do this. And the woman's like, right, let's do it. I see why we need to do this. It could be a very upsetting slash traumatic experience, but there's a reason that this is happening. Could that be the type of meaning that we attach to something?
Athena:
[25:52] I think so. Like for me, that feels a bit more like comprehensible. It's like understanding. Do you know what I mean?
Mel:
[25:58] Yes.
Athena:
[25:58] I kind of wonder with meaning, the meaning making, if it's a little bit like the post-traumatic growth, it's kind of what happens afterwards. But in the moment, like this would be something for everyone to have a think about, right? In the moment, what might help you to make meaning from what is happening? And maybe even it's like a little bit of, you know, I'm not trained as a cognitive behavioural therapist. I don't work in that way. But one of the premises of cognitive behavioural therapy is that if we can sort of adjust the way that you think, that's going to adjust the way that you feel and that will adjust the way that you behave. So meaning making can kind of sit in there too. If the meaning that you're making is I'm about to die and my baby's about to die, if someone else can come in and gently redirect that for you like oh you might be feeling like really terrible things are happening i want to let you know that what this really means is that we're going to try this next and that you're going to be okay and your baby's going to be okay it's like someone kind of giving you some stepping stones to potentially the word that's coming to me is reframe, but I hate the word reframe.
Mel:
[27:15] I know. A little bit like gaslight yourself.
Athena:
[27:18] Exactly.
Mel:
[27:20] I know. I speak to women sometimes who have had what they would describe as a disappointing moment in their birth or a scenario. And I'm always hesitant to say to them, hey, you know, the story that you keep telling yourself in these early weeks is the one you're going to remember. So without trying to sound like I'm trying to deny their experience or make them kind of forget about it somehow, trying to talk to them about, hey, how could you tell your story that when you tell it in three years time, the bits you remember will be the bits that you keep repeating and you can actually potentially let the disappointing bits fade from your memory. You know, there are parts of my own birth, even though they were great, that I think, oh, I didn't like that when that happened. But if I kept telling that story, that's the part that I felt would really, really stick.
Mel:
[28:20] I forget about them, but it's not a defining part of my birth experience. Experience like I hold on to you oh yeah Charlie was 36 weeks when I went into labor it took 37 hours an acupuncturist came there was a perineal perineal needle that occurred and then I pushed for two and a half hours and out he came that is a summary of the story I told about that 37 hours there's lots I could have focused on eight hours of no contracting and how hard it was to walk with a full bladder even though we're trying to get labor going like I could you know and so I very reluctantly encourage women to tell their story in a way they want to remember it that's the kind of thing that sticks but then walking this really fine line of not getting this vince themselves out of things that that maybe they have to work on
Athena:
[29:15] Yeah I really hear that it's yeah it's a fine line and I agree with you there's something that we want to be really careful of here not to diminish and not to minimize and not to override and yet, Perhaps it's about multiple versions or kind of alternative versions. Yeah. You know, there's more than one way to tell the story. There's more than one way to experience, you know. It's like that thing if we asked the other people in the room, everyone would tell the story in a different way.
Mel:
[29:48] Yes.
Athena:
[29:48] So I think, again, it comes back to that thing about expansion. It's like just can we make room for more possibility? Can we make sort of this more spacious place for this stuff to live rather than that very stuck very rigid there's only one truth there's only one story there's only one way because that in itself is part of the traumatic response that rigidity the.
Mel:
[30:14] Stuckness that you were talking the stuckness earlier and i think this is really highlighted is it sounds like trauma can't be solved
Athena:
[30:23] On your own.
Mel:
[30:25] The acknowledgement that you've been through something like that, the comprehension that you were talking about, and the meaning I imagine is going to come from the work that happens afterwards with people such as yourself who will have an understanding, who help to give words to it. It made me think of something that is in no way as traumatic as the things we've been speaking about. Yeah. A few months ago, I went through a very, very upsetting, shocking kind of meeting with the Nursing Midwifery Council.
Mel:
[31:00] Very emotionally jolting, could not understand what was going on. I was the support person who was there. Hannah was with me and I said, what is happening? And she said, it's okay. I said, I don't know what's going on. And she said, no, you're doing just fine. She said, look, this meeting needs to end because she could see how it was all going. And as I spoke to people afterwards, you know, I'm part of lots of big midwifery groups that have this lovely, huge midwifery support network.
Mel:
[31:33] And the main thing everyone kept saying was, Mel, we're actually so glad this has happened to you and not somebody else. And they always prefaced it by I know this is going to sound bad but if it was going to happen to anyone we're glad this happened to you because you're resourced to do something about it I got fired up right which is what I do I can't let a thing go the anger built and I thought what am I do with this right I am ready for battle like this was going right let's go this is I get motivated by adversity like that's just an inbuilt in me I write adversity I'm like let's do it this is fantastic um so I feel like I have some kind of propensity towards some kind of growth or expansion, or I'm highly motivated by those events. And I think that's what they were saying. What they were seeing was, Mel, you are going to use this scenario.
Athena:
[32:41] Yeah.
Mel:
[32:41] Do something epic. We know that. They're like, we know it's hard. We know it's hard. But... We trust that if any, if this was going to happen to anyone, you are going to use this to its full potential. And so that's when you said attaching meaning to something.
Athena:
[33:00] And what I hear there is like other people stepping in to do that meaning making with you. Yeah. Yeah. You're not left alone with it. It's just, you know, it's just like everything else. There's just this huge spectrum, huge continuum of experience. Birth trauma is not just one thing. I've been really noticing lately that I'm not even loving the term birth trauma because it feels like that to me. It feels like one static, definable thing that you either have or you don't have. There's just not enough nuance in it for me. There's not enough nuance and there's not enough recognition of the fact that we're all on this continuum of the experiences that we carry from giving birth to babies and that we can move up and down it. Yeah. Even if we think about the story that you just told, right? At one minute, you're down the pointy end of the continuum going, oh my God, I can't make any meaning from this. I can't comprehend it. I don't understand what's going on. Very shortly afterwards, you're somewhere else.
Mel:
[34:07] Yes.
Athena:
[34:07] And you've got a whole other thing going on, right?
Mel:
[34:10] Flick right back there. If I think about meeting, you know, I can feel my heart racing and I'm in cold sweats and I'm thinking about being deregistered and what am I going to do if I'm never a midwife again? Yes. And then in the next minute, I'm like, I'm about to take over the world. I'm going to take down the system. I'm going to become the boss of something. I don't, you know, it's just like, What a rollercoaster.
Athena:
[34:34] Right. And that's your, you clearly have a propensity in your temperament to go towards fight.
Mel:
[34:40] Yes.
Athena:
[34:41] Yeah. When we think about fight, flight, freeze, fall, that is an absolute beautiful description of someone who's temperamental leaning. In a kind of situation of stress is to go towards fight.
Mel:
[34:57] Yeah.
Athena:
[34:58] Not fight like in a vicious way, but fight how you described. I am here for it. I am showing up. I am going to get some shit done. I'm right. Let's go. But really interesting to hear that, yeah, you can feel that you can move up and down that continuum. And I guess in a way when we talk about post-traumatic growth, I just, I have the same sort of concern. It's like it's not just one thing. It doesn't just happen in one way at one time to one type of person.
Mel:
[35:28] Yeah.
Athena:
[35:29] Right? It's more, again, back to that dual process model. It's going to all be happening at the same time and you are going to find that slowly you will move backwards and forwards between those things.
Mel:
[35:41] And I think it's not going to happen in a week or a month from the event either. It's like looking back and going, oh, I can see how that threaded through various and choices that I made and events that occurred because of,
Mel:
[35:59] but I imagine it's a looking back at that journey where you realise how it affected you.
Athena:
[36:06] I think so. So I think it requires some kind of, like often when I'm working with people, we talk about the notion of moving through time and space. And my sense is that to go from a place where you've had an experience of trauma, particularly at labor and birth or during labor and birth, we do need to kind of move through time and space in order to start to come to somewhere else. And even when we think about that notion of stuckness, that's the sense that I get. It's like you're stuck in time and place. You keep on replaying, talking about the intrusive thoughts. It's not conscious. It's no one's fault. They're not doing it on purpose. But part of the whole idea of the way that I work with people is to try and loosen off and open up this capacity to be able to move a little bit more freely up and down that continuum through time and space, through different layers of meaning, finding more nuance in the experience, sinking down through the layers with the understanding that you can also then come back up.
Athena:
[37:17] And we're trying to learn how to do that dance together of like, can I sink into all that stuff that we don't want to diminish or minimize, the fear, the pain, the disappointment, the rage, can we sink into that and also come back out the other side over and over again, not just once. It's not just I was traumatized and now I'm in post-traumatic growth. It's like, you know what, we're just doing these once. all the time.
Mel:
[37:47] This acknowledgement that it's forever part of your story. It's not like you could ever go, right, yeah, I've let go of that trauma. It no longer exists.
Athena:
[37:56] You can come to a place where it's no longer alive in your body, but yes, cognitively, you probably won't come to a place where it is completely gone and forgotten. But what it can be is coming back to that idea of metabolized, integrated. Like you said, it's becoming part of you it's become part of who you are what you've experienced where you've been.
Mel:
[38:19] That word, the way that you described that then, that it's not alive in your body. It's acknowledgement that it occurred.
Athena:
[38:27] Yeah.
Mel:
[38:27] It's not alive in your body. And I think, and, you know, earlier you described it as sort of pervasive tentacles through everything. Imagine this little, this plump octopus just shriveling up. It's kind of still the skeletons are there, but it's not acting on you any longer.
Athena:
[38:49] Yes, that's kind of what we're working towards in the kind of therapy that I do with women. It's exactly it. It's like, you know what, we can't eradicate it, but how can we help it to, yeah, shrink its sphere of influence or its kind of dominion over you? And ironically, it took me a long time to get my head around this, but ironically, it seems that the way to do that is actually by paying attention to it rather than by trying to keep it out of your conscious mind.
Mel:
[39:26] You don't want to distract yourself from it. You want to meet it head on.
Athena:
[39:30] I don't know if head on, just maybe a couple of steps back from head on. I hear that warrior part of you again, Mel. Where's that octopus? I'm going to go and fucking get that octopus i know i.
Mel:
[39:41] Just want to smash it how do i mean it where is it i'm like
Athena:
[39:44] Take me to the octopus cave that's.
Mel:
[39:48] What i wanted to do i did
Athena:
[39:50] Think think a few steps back think like maybe what we might want to do to start is just get a set of binoculars and see if we can see the octopus from a safe distance okay then we can decide, whether we want to go and smash the octopus or not.
Mel:
[40:08] That's a lot about myself. The last thing I want to ask you is I imagine there are women who have listened to this and they've realised they are appearing at their octopus through binoculars, having realised that there's something to look at, not having realised before.
Athena:
[40:25] Yeah.
Mel:
[40:26] Who should women speak to? Because I think, and I don't want to make it sound like, I feel like professionals need to help women with this. I don't think this is like anyone with an idea that they can help can just help. Who can women see about this if they're looking through the binoculars and going, shit, I have an octagon?
Athena:
[40:49] I feel the denticles.
Mel:
[40:51] What she's saying is where I'm at. Who can they get help from?
Athena:
[40:55] Oh, God, it's such a good question, Mel. Okay, so there's a range of things that are available to different people in different places. Of course, unfortunately, as with most health services, the more regional and rural you are, the less likely you're going to have access to in-person services, but there's a lot of stuff online. If you just go online and Google support for birth trauma, you will get a whole range of stuff that comes up. Yeah, so rather than me talk you through all of that, that's probably the easiest way to do that.
Mel:
[41:29] Are they looking at counsellors, psychologists? Who would be the ideal professional?
Athena:
[41:36] There are counsellors and psychologists who specialise in perinatal mental health. Some of those are going to be really tuned into birth trauma. Some of them are going to be less so because sometimes their focus is more on postnatal depression and pre- and postnatal anxiety. And I've met some of those folks who are a bit like, oh, birth trauma is kind of like it's a little bit off to one side for us. It's not really where we sit. So explore that would be what I would suggest. There are absolutely perinatal psychologists out there who are going to be able to help you. You can go and look at the COPE, the Center for Perinatal Excellence. Go and have a look at their website. There's Gidget, Gidget House Services. So Gidget started small, has become massive. They specialize in pregnancy, birth and postnatal psychology. So the model that they use is that they have psychologists available who have particular training in these areas and you can go and get a mental health care plan and access their services for 10 sessions. Having said that, I think it's probably fair to say that I talked to quite a lot of people who have engaged with psychologists who have some training in the area, it's not always exactly what women are looking for. So you kind of have to shop around, yeah?
Mel:
[43:04] Any other service, isn't it?
Athena:
[43:06] It really is. You've got to find your person.
Mel:
[43:09] Yeah, and they could be excellent and the other one could completely dismiss where you want to go.
Athena:
[43:14] Yeah, right? There's also more and more people out there like me. And in fact, this is something that –, Okay, I'm just going to say it. This is something that I've been thinking about is that we need to find a way to bring people together. Like when I go and speak at conferences or, you know, I'm getting more and more emails and more and more contact from midwives who are moving over into counselling and psychotherapy. It's becoming a little bit of a pathway, which is fantastic. And it makes total sense because there's a whole lot of implicit counselling in midwifery as a profession, right? We're all doing it all the time. So seek out, if you can, someone who has midwifery experience because that means that they're going to really understand the ins and outs of the maternity care system as well as the ins and outs of your experiences at birth. There's a few more of us around. I'm going to put a little flag in this and do a little public accountability. So I am going to try. No, I'm not allowed to say try. I am going to see if I can bring together those people in some sort of platform or format where they're easily accessible.
Mel:
[44:24] That people could search for.
Athena:
[44:25] That's what it's called, Mel. Database.
Mel:
[44:27] So almost like, it's like finding a doula, finding a private midwife, finding.
Athena:
[44:33] Yes. Finding someone who understands midwifery and understands psychotherapy. Yes. There are slowly more and more of us. So if you can seek out someone like that, there are also peer support services. There's quite good evidence to support the peer support services and there are now more and more people who offer debriefing.
Mel:
[44:51] Yes, that's what my question was is, is debriefing enough? Because I know there's a lot of women who pursue debriefing. I'm going to unpack it, leave it all there and then get on with life.
Athena:
[45:04] So I have really mixed feelings about debriefing.
Mel:
[45:07] Yeah, so do I.
Athena:
[45:08] And the research findings are ambiguous around debriefing. My sense around debriefing is... It can probably be helpful in some, well, it can definitely be helpful in some circumstances for some people if it is done at the right time with the right person.
Mel:
[45:25] Yes, I agree with you there. And I think the with the right person thing is such an important key. There's definitely a buzz at the moment of all kinds of people becoming qualified in birth debriefing and I'm thinking, oh,
Athena:
[45:38] Should we be.
Mel:
[45:39] Flippant about birth debrief training considering how important the person is to the process.
Athena:
[45:46] Yes. And in fact, when you look at the clinical guidelines, there is a specific recommendation or suggestion in there which says that a one-off, one-time debriefing where people are encouraged to relive the experience that they had does more harm than good and should be avoided. So if we are using debriefing as a sort of model and again it's one of these things I feel a bit like debriefing is now getting co-opted by the hospital system yes right it's becoming which in some ways is amazing it's like yes of course we want a debriefing clinic in the hospital of course we want women to be able to talk about what's going on but from a trauma-informed care perspective like having that stuff in the hospital with the same people who looked after you not not Not a great way to approach that. It's a it's again it's like an evolving kind of tricky space it's something that we want women to have access to but it really needs to be done the right way because the one thing that the evidence does tell us is that when it's not done well it's re-traumatizing so it makes things worse and.
Mel:
[46:59] It can't be done out of rote processing like okay you've had this kind of birth now you get you get an appointment at the birth former clinic
Athena:
[47:07] Yeah right and I was listening to I was at a postnatal conference a couple of weeks ago and an obstetrician who I know who works up here. I live up in the Northern Rivers and so, She gave a presentation about debriefing because they've been doing it at their hospital. And she made an excellent point. And she said, you know, the women who are really traumatized, we won't hear from them.
Athena:
[47:30] They're not going to come back. They do not want to talk to us. And I think that's a really important thing to remember. And so debriefing, I think, can be very effective in a certain context. It can be very clarifying. I think it's super helpful to sit down with a midwife and go, what was that? Why did that happen? How did that? But I think one of the things that gets up my nose about it is that it's kind of presented as an end point, whereas to me, those conversations should be the
Athena:
[48:01] beginning of something. They should be the beginning of a restorative experience where you get to be in a safe relationship with someone who can help you to do that sense of coherent stuff, make it comprehensible, make it manageable, make it meaningful. It's so crazy, right, to come back to this idea of salutogenesis, which literally was one of the first theories that I encountered like decades ago when I was doing my research. And somehow I've come around this bizarre full circle and I'm back in this place where I'm like, actually, when you're asking me questions about how do women prepare? Like, that's the stuff.
Mel:
[48:42] So, lutogenesis. And the interesting part of it for me too was that it was done on Holocaust survivors. That was the question is why did some of them become destroyed and why could some of them come out? And thrive. Even just the acknowledgement that that's possible, I think, to say, wow, if trauma doesn't only have to be destructive, there's a reconstructive capacity.
Athena:
[49:13] Absolutely. And in fact, perhaps a nice thing to bring in here as I feel is kind of wrapping up is that my favourite researcher and writer on trauma is a woman called Judith Herman.
Athena:
[49:27] She wrote an incredible book called Trauma and Recovery quite a long time ago. So Judith Herman was one of the first people who laid out what you're talking about, Mel, kind of like this map of this idea that there is a way to recover. Yeah, there is a way to come back. And so she talks about three phases of recovering from trauma. One is safety and stabilization, right? And so that is literally just about dealing with that stuff that's really alive in your system. How do we help you to feel safe again? How do we stabilize your environment and your inner resources so that you can just start to like not be freaking out, basically. Your nervous system can start to not be freaking out. The second phase is remembrance and mourning. So it's about being sort of held and supported whilst you go back, not to relive the experience. I don't work in a way where we do reliving, but to remember and to mourn the loss really is, you know, it's really similar to grief. There's a huge grief component here. And then the third phase is reconnection and integration. Okay.
Athena:
[50:44] So reconnecting to self, reconnecting to others, finding a way to, you know, again, in grief, they say, grow around it. You're not going to make it disappear. The grief is never going to disappear, but you're going to find a way to grow around it. Yeah, I think it's probably quite similar here. And so for me, But debriefing is not going to give you the time and the space to move through those three processes. Yeah. And that's okay because it's not supposed to. But just to be very clear with women that that's not the intention around debriefing or it shouldn't be.
Mel:
[51:22] Well, it's not the magic pill. I think because this is such an emotional and hard thing for people to do. I mean, just as you said those words about the process of recovery, I just in my mind thought, wow, this is going to take some bravery and courage to meet those feelings and how much we would desperately wish that one little
Mel:
[51:45] thing was the magic pill, the solution. But it sounds like you have to go on the journey.
Athena:
[51:51] I think so. Of course, that's the way I feel about it because I'm a therapist. So, like, that's going to be my take on it. Let's be frank. But I'm also really aware that there are a lot of women out there who say, I went and had a debriefing session. It was incredibly helpful. I felt okay. It's all good. Yeah. So it's just really about, it's a little bit like having a baby at all. You know, it's just like whatever gets you through.
Mel:
[52:16] Yes.
Athena:
[52:18] Whatever you need to do in order to survive, you just do that. Yeah. Just do it and accept it and embrace it and allow that to be okay for you. wow.
Mel:
[52:29] That was a journey and
Athena:
[52:31] It was a big conversation i loved it i think this is where.
Mel:
[52:36] The conversations need to be there's no tick list there's no checker box there's no clear path
Athena:
[52:42] It's you know it's an exploration and that's it's all it is and there is no right way and wrong way there is just like test it out see what works for you if that's not enough or that doesn't feel right keep going, Yeah, keep going, keep exploring, keep seeing what you can find, read stuff, talk to people, get online, find a therapist if that's what you feel like you need, have a debrief if that's what you feel like you need. It's like just this thing, maybe it's just about the permission.
Mel:
[53:11] It feels sadness for women who've had these traumatic events imposed upon them and now they're left with the consequences and the cost in so many ways of having to navigate it. So I just really want to, my heart's just going out at the moment to women who are listening and thinking, I didn't do this to myself. And yet here I am having to be one who deals with it.
Athena:
[53:39] Yeah, thank you for that acknowledgement. It's very timely and really accurate. You're right. The fact that we have to sit here and make these suggestions and give these, you know, it's just like, yeah, really? is this where we've come to in this time and place around what it is to have a baby?
Mel:
[53:59] And that we're still not, safe in birth just like we're not as women safe all the time in life we can't expect to be kept safe thank you athena for being here if anybody's resonated with the things that you're sharing and they want to look deeper what else is on offer from you out in the universe there at
Athena:
[54:23] The moment there's been a range of things but at the moment i'm just continuing to work in private practice So people can come and see me for sessions if they're interested in doing that. I also do workshops and education stuff with midwives and obstetricians. I have run online groups for midwives and midwifery students. And at the moment, I'm in the process of translating some of those into filmed online course content. And we've agreed that we'll have the first one of those ready to launch in February.
Mel:
[54:53] Excited.
Athena:
[54:53] Yeah. So you can tuck that in your back pocket and that'll actually be focused on, not specifically around birth trauma, but it's focused on ways to help settle your nervous system in your day-to-day life.
Mel:
[55:09] And that was one of the major skills, the muscles that were... You're encouraging us to exercise is nervous system, reducing the overwhelm. And I think you work at the Birth Council.
Athena:
[55:23] Yeah. So the name of my practice is the Birth Council. So I actually, like as a practitioner, I work with all sorts of people. But when I started, I really had this very clear idea that I was going to work in that nexus of therapy and birth. So I created this name for the practice. Now I'm kind of like, oh, I possibly should have considered that that needed to be a little bit broader because I do work with all sorts of people in all sorts of circumstances, but we're still there. The Birth Council, you can find me online. There's a website. Feel free to get in touch with me and have a chat.
Mel:
[55:59] Yeah. And I'll put all those details in the show notes, including the resource folder on the papers that we spoke about and the books. I've been making little notes the whole way to make sure that they're in the resource folder for anything who wants to keep looking. Thanks again, Nina.
Athena:
[56:15] Thank you, Mel. It's been a real pleasure, as always, to talk with you.
Mel:
[56:19] We will see you all in the next episode of The Great Birth Rebellion. 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.
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