6 Ways to Reflect on Trauma-Informed Care in Birth Work

Let’s face it: trauma is everywhere. Most of us have experienced trauma in one way or another, and so have our clients. Despite the ubiquity of trauma, practices for providing trauma-informed care are not always clear, as they often go against the grain of dominant culture.

What is trauma? For years, I had only heard the psychiatric definition, which frames trauma as an ongoing psychological disturbance due to an event, experienced or witnessed, that threatened one’s life. However, there has been an ongoing expansion of our understanding of trauma to make more space for the variety of experiences that people have. 

At its core, trauma is a physical, emotional, and embodied response to an experience that is too much, too fast, or too overwhelming for us to cope given the resources we have available. The memories, both of the experience itself and our reaction to it in the moment, live in our bodies. 

We hold our lived experiences in our minds and in our bodies. Our bodies, alive, breathing, remembering, experiencing, are shaped by these events. We all have conditioned tendencies, which are embodied ways of responding to experiences to maintain our safety and security. These are learned responses based on what has protected us in the past. We also have protective reactions (think fight, flight, freeze, and fawn), that are automatic responses based in evolutionary biology. 

When we show up to a birth space, we are bringing all of these elements with us. So are our clients. 

Exploring Trauma-Informed Care

When we provide trauma-informed care, we allow the whole self to arrive in the space. We understand that trauma might be a part of the client’s story, and we keep in mind that we may never know. We intentionally co-create a space with the client so that they can explore and reflect at their own pace, while being able to transition back into their lives at the end of the session. We don’t push folks to share, disclose, reflect, or heal faster than feels comfortable and safe for them. 

We can turn to curiosity and facilitate reflection with our clients, rather than prescribing answers. For example, we cannot define another person’s safety, but we can ask them what they need to feel safer in the space. We can’t define trauma for another person, but we can ask how they felt about an experience. We can’t decide what healing modality will be best for our client, but we can provide them with multiple referral options. When our clients share their thoughts and reflections, we can respond with neutrality and non-judgement to what they have shared. Throughout our time with them, we can celebrate the tools and strengths they are using.

Our bodies feel safer when we understand our options and are told what will happen in a given time frame. As birth workers, we can share (with permission) about the variety of options a client may have in their birth, as well as the risks, benefits, and alternatives of those options. We can also always provide an overview of what we’ll discuss in a given session, and when birth time arrives, we can walk folks through the next few things that are likely to happen. For example, when we’re on the way to triage, we can provide an overview of the check in process and the questions they will likely ask. Understanding options and knowing what likely lies ahead are significant factors in calming the body’s fear responses and decreasing the likelihood that an experience will be processed as a trauma.  

In the spirit of trauma-informed care, instead of providing further firm definitions of what trauma-informed care is and isn’t, I’m going to leave you with some reflective questions. These questions are organized along BADT’s six principles of trauma-informed care, principles I feel are highly effective in capturing the nature of trauma-informed care. For my first couple years of practice, I wrote these principles on a post-it note so I could refer to them while sharing space with clients. 

Reflection Questions for Facilitating Trauma-Informed Care with Clients

1. Safety:

   1. While we can’t define safety for others, what steps are we taking to reduce potential harm?

   2. How are we supporting physical and psychological safety in the birth space? In our client sessions? How can we position ourselves in the space we are sharing with the client to support them in feeling physically safe? (example: do they feel more comfortable if they are facing the door?)

   3. What questions can we ask to open the door for clients to share with us what will help them feel safer? 

   4. Are we working at a pace that matches our clients needs and energy? 

   5. When we talk about hard things with clients, are we making space for intentional transition back to their day? Are we ensuring that they have other avenues of support, other than us, to process?

   6. Are we working within our areas of competency?

   7. Are we using gender-expansive and culturally competent language?

2. Trustworthiness and Transparency:

   1. What does it mean to build trust?

   2. How are we maintaining the confidentiality of our clients and communicating with them about confidentiality?

   3. What experiences, positive and negative, with other providers might our client have? How are these experiences shaping your relationship?

   4. How can we communicate with clients about our own boundaries and maintain those boundaries?

   5. If a rupture occurs, how do we navigate repair?

3. Peer Support:

   1. What is the value in having a shared experience with another person and getting support from that person?

   2. How do we value lived experience? 

   3. How are we connecting clients to peers with shared experiences?

   4. How are we explaining who we are, and who we aren’t, to clients so they understand our social location, positionality, and experiences?

4. Collaboration:

   1. How are we co-creating the experience with our clients?

   2. What are we doing to build relationships with other providers, birth workers, and peer support networks in our community?

   3. What joy, growth, and expansion comes from community that cannot be accomplished on our own?

   4. How can we facilitate collaboration between our clients and other support systems they may have?

   5. How can we see ourselves as equals walking alongside our clients? How can we uproot savior mentalities that we may hold?

5. Empowerment & Choice:

   1. How are we highlighting and focusing on the strengths our clients already have? How are we encouraging the use of the tools already in their toolbox, rather than asking them to create new tools and strengths?

   2. How do we facilitate opportunities for client choice while balancing that birth is unpredictable?

   3. How can we create space for clients to pick what they take away from each session, how the structure of our time together might unfold, and what they do and don’t want to share?

   4. Do we create space for clients to choose how we and others interact with their bodies every time? Are we modeling for other providers how to do this?

6. Cultural, Historical, and Identity-based Humility:

   1. Where are we in the ongoing practice of uprooting our implicit and explicit bias?

   2. Are we creating space for clients to share about their identities and experiences?

   3. How are we valuing traditional Indigenous and cultural practices?

   4. How are we connecting our clients to culturally relevant care practices? Do we have relationships with these providers?

   5. Are we the right birth worker for a given client, based on where we are in the ongoing journey of providing care with cultural humility?

   6. Who are we learning from/following/engaging with? How are we actively unlearning systems of oppression?

Let’s Talk About It

Take some time to sit with these questions and consider revisiting them regularly. These reflections will steer us towards providing care that is more consent-based and expansive, and care that builds on the strengths and resources our clients already have. 

Engaging with trauma is an ongoing practice of learning, reflection, and implementation. If you are looking for additional support around healing trauma or providing trauma-informed care, let’s talk about it. I teach doulas about providing trauma-informed care through my course with The Educated Birth, as well as privately. I’m also in training as a Somatic Trauma Therapist and provide one-on-one sessions. Additionally, JB teaches an incredible lesson on trauma-informed care as part of BADT’s Full-Spectrum Doula Course. We’d love to support you on our journey to becoming more trauma-informed. 

Ama Warnock (they/them) is a full-spectrum birth worker, somatic practitioner, childbirth educator, and peer counselor. They live and work in Chicago. They specialize in working with QT families, fat folks, and survivors of trauma and violence, all from a place of lived experience. Ama co-founded the Redwoods Birthworkers Collective and founded the Embodied Reproductive Care Center in Chicago. They work as part of the BADT team and as an educator with The Educated Birth. They hold an MPH focused on non-carceral mental health crisis responses and obstetric violence. In their free time, Ama is constantly doing crafts. You can connect with them over Instagram (@embodiedreprocare) or email (amathedoula@gmail.com).