There is a relationship between birth and trauma. Some people are traumatized through their birth experience while others begin the birth process in a traumatized state. Past trauma can have a significant impact in the birth room, including presenting additional challenges and the possibility of being retraumatized. This article presents practical tips for being more empowered and minimizing trauma during pregnancy and birth. 

Before we go further, I would like to acknowledge there are many obstetrical care workers who treat their patients respectfully and kindly while doing the important work of providing medical care. They are aware of the vulnerability of birthing families and treat them in a way that leaves them feeling safe, happy and whole. However, that is not the case everywhere or with everyone; there’s still work to do.

For most people birth in and of itself is not traumatic. In most cases, trauma stems from how they were treated through their birth. There are too many birth stories that include coercion, disrespect, disempowerment, fears that aren’t addressed, being left alone, feeling unsafe and unsupported, and lack of choices. Birthing people don’t know what their options are and therefore they have none. They don’t know how to prepare and what to do. They are told what’s going to be done to them rather than being part of the decision making process. Many women report feeling like they were stuck on a runaway train.

Women need to feel safe while giving birth. In fact, birth is shorter, more comfortable, and usually uncomplicated when that’s the case. There are things we can do to decrease or negate the impact of some common practices in the North American medical model of birth that may lead to feelings of vulnerability or trauma. In many cases it’s just how things are done and set-up. 

Globally, 1 in 3 women have been subjected to physical and/or sexual violence. Every birthing person should be treated as a survivor but that is not the case yet. Fortunately in some hospitals, including ours, staff have special training in this area and provide extra respectful, sensitive and compassionate care to survivors.

Practises that may add to trauma in some people include…

• Being exposed, naked, uncovered in front of others.
• People who are fully clothed (and highly educated or seemingly “in charge”) standing over someone who is partially or wholly undressed, usually on their back, and possibly with their legs open, in a vulnerable state.
• Being touched, especially from behind, without consent or even being told first. 
• Language such as “good girl” and “honey” and “dear”.
• Cervical checks in general. Exasperated by being told, “I’m going to check your cervix now,” without a conversion to explain reasons, options, and waiting for consent. Painful cervical checks. Staff not stopping when being told “No!” or “Stop!” or any of the many other ways women say no or stop. 
• Being put into positions, often presented as, “You have to…”. Lack of choice.
• Not being “allowed” to move freely.
• Legs being held or put into leg rests / stirrups
• “Put on this gown.” Being told what to wear, especially when that garment does not offer full coverage and is open in the back.
• A room set up that results in “private parts” facing the door.
• Technical language used in medical settings can be confusing and scary for some people.
• Epidurals and the numbness that may result.
• Not having timely access to pain medications, including epidurals.
• Language related to failure or “not doing it right”, e.g. lack of progress, making too much noise, breathing wrong, being too stiff, reacting too much to pain, stop crying.
• Lack of choice in birthplace and/or medical care provider.

Things you can consider doing to feel more in control, more empowered, and lessen the chances of being traumatized:

• Expect excellent and compassionate care but be prepared in case not everyone you meet feels that way to you.
• Remember you have the same rights in the birth room as you do in the coffee shop or anywhere else! No one is allowed to touch you or do anything without your consent. You have the right to say “yes”, “no”, “wait”, “stop” to any test and intervention. 
• Be an active participant in your care. Consider your care providers as part of your team. 
• Ask enough questions to make informed choices.
• Pause. Normally things don’t have to happen right away. Ask your questions, gather your wits, get grounded and then proceed.  
• Bring a companion who can help you find your voice and help advocate for you. Doulas play an important role in this. 
• Ask for a few minutes alone or with your support person(s) before making decisions. You might regroup, realize you have more questions, find the strength or means to say no to something you don’t want, or yes to something you don’t want but feels like the best choice. 
• Maintain control over cervical checks and other procedures that might feel invasive. Don’t proceed until the care provider has an understanding of how to help you feel as safe as possible.  
• Share that you are coming into this experience with past trauma. No need to share details.
• Hire a doula who is trauma-informed.
• Say no. Use the word consent.
• Wear clothing that feels safe and offers the level of modesty you need.
• If you want touch comfort measures and also modesty, massage and touch can be done over a sheet or your clothing.
• Consider how you might react to the intense sensations of birthing – pressure as the baby descends, pain and/or power of contractions, your body stretching. 
• Tools to deal with the aforementioned sensations – meditation, hypnobirthing, comfort measures, pain medications including epidurals. Some people opt for cesarean. Discuss these options with your midwife/doctor if you are concerned. Your mental and emotional health are just as important as your obstetrical health.
• Think about how it might feel to have an epidural that might cause legs to feel heavy or numbed. This can be a welcome relief or it might be frightening.
• If you have a counselor or psychiatrist, have a meeting to help you prepare for birth and postpartum.
• If it’s not possible to be covered or positioned in a way that offers privacy from the door, then a companion can hold up a sheet or stand between you and the door, acting like a visual block as people enter & exit the room.
• Wear headphones.
• Wear a sheet or blanket like a fort or super-hero cape.
• All the other things that bring comfort and security during birth.
• Stick a sign on the door if there’s a single point you wish everyone to know. It might be, “Please read my birth plan before meeting me.”
• Consider warm compresses on the perineum during crowning if you’re on your back. This can offer warm comfort and a greater sense of privacy. On the other hand, some people would find this scary and like too much touch. 
• Assume birthing positions other than being on your back, such as being upright, leaning forward, and hands & knees.  
• If you normally wear glasses, consider the impact of leaving them on or off through labour. Seeing more or less detail may be helpful.

Things You Can Put on Your Birth Plan

You can create a nice Birth Preferences Document that builds bridges of communication and understanding with your medical care team. If you are a survivor or are vulnerable, then you may wish to include additional points related to trauma, which are listed below. It can be helpful to the staff if your document includes, “Due to past trauma, …..”.  You don’t have to disclose and won’t be asked to explain what that trauma was. 

• Wait for verbal consent before touching me in any way.
• I need to have complete control over cervical checks, including when they’re done, by whom, and the pace. I may say “yes”, “no”, “wait”, and “stop”
• Please assume I have not consented to anything until I expressly say yes. 
• Before we discuss options, procedures and next steps, ensure I… (options include: am fully clothed or covered, am sitting, am standing, have my partner/companion/doula nearby. Use any or all of those things in any combination). 
• If I’m on the bed I will face the foot of the bed until the moment of birth. 
• I will need a few minutes (alone?) to process information before making choices.
• Please limit the team to essential staff only. No observers or students practicing on me.
• Minimal cervical checks and only by experienced staff who will proceed only after obtaining my expressed verbal consent. 
• Please use my name when addressing me; no terms of endearment such as honey or good-girl.
• Please ensure I am covered as much as possible throughout my birth.
• I would like warm compresses during crowning.
• Hands off my bottom during crowning.
• I would like to hear the baby heart monitor if it is being used.
• Please silence the baby heart monitor if it is being used.

Preparing for your birth can include…

• Getting as prepared as possible before giving birth. Learn about local practises and your options. Knowledge is power! My prenatal classes are designed with this in mind.
• Work with a midwife or doctor with whom you feel safe and comfortable.
• Hiring a doula. Most communities have a professional association with bios for a variety of doulas.
• Practising saying no to things you don’t want and yes to those you want. Ask for what you want.
• Taking steps to learn your options – prenatal classes, appointments with your medical care provider, counsellors, local birth-workers – and prepare a plan for your specific concerns.
• Practising the things you might want to do in labour, such as a variety of positions, comfort measures, grounding practises, moving freely in clothing you wish to wear in birth.
• A hospital tour. The fewer surprises the better.
• Pack a birth bag that includes choices of clothing, things you can use for comfort, and even a couple of things that bring you peace.
• Asking lots of questions along the way. Practise having discussions with your team in order to have shared decision making. When you say “no” that should be respected and when you say “yes” you’ll feel better about your decision. You will likely be pleasantly surprised.