Recovering Emotionally from your Client’s Difficult Birth 

Have you felt the lasting impact of a client’s difficult birth?

Working with birthing women is no ordinary job. No birth is the same. There is high stress, exhaustion, high responsibility and massive consequences as a result of your decisions and actions. When your client has a difficult birth, it’s hard on you too.

Because midwives constantly work under high-stress circumstances, your experiences may seem commonplace to others. Those around you, and even you yourself, may dismiss or normalise the trauma you are so often exposed to.

When you disregard the emotional impact a client’s difficult birth has on you as a midwife and as a woman, it can be difficult to process your experiences and traumas and so they pile up like layers.

 

Types of Trauma in Difficult Births

There are levels of trauma – there are the clearly tragic ones, being with a mum birthing a stillborn.

However, there are also trickier ones to recognise. Birthing women can bring their own historic traumas into the birthing room, and it becomes high anxiety that you as their midwife end up holding for them.

Or that birth that almost went awry, but all ended up ok, but just by a hair’s breadth.

Or a decision you made that you later doubted and were left wondering whether your actions could have contributed to a birth turning into a medical emergency or damage. Could you have done something differently and there would have been a better outcome?

Sometimes, you carry a birth on the edge, on high alert with a higher-risk mother, or once a baby has shown meconium or lowered/higher heart rate etc.

The situations are endless, and sometimes in multiple rooms all at once, when you are already over-tired, overstretched, and often whilst you feel inadequately supported.

I have also heard about an underbelly of toxicity in many delivery suites where power dynamics between obstetricians – medical – nursing staff – juniors results in bullying and undermining.

 

What Can You Do To Manage The Impact of The Trauma of a Difficult Birth?

 

It’s important to check in with yourself after difficult births to make sure you have tended to yourself. Feelings and emotions affect our physiology and vice versa – so to ensure you’re being the best midwife you can be, it’s important to check in on this and to take care of yourself.

Chinese medicine is essentially all about balance and keeping ourselves in check so as to be in harmony and in good health.

I asked Naomi Abeshouse what she had to say on this topic, as she has worked with survivors of trauma and torture over a seven-year period.

 

Naomi, you’ve worked with survivors of trauma and torture when you were working with refugees using Chinese medicine. Can you tell us about your experience with that, and how it might relate to midwives recovering from supporting a traumatic birth at work?

 

When I worked with survivors of torture and trauma, their stories were heartbreaking and tragic. What many of them witnessed or experienced left them with severe challenges in life. Simply functioning – sleeping, eating, dealing with everyday situations was near impossible.

However, I was also struck by their resilience and commitment to their recovery. All of them had severe PTSD and yet with some intervention from acupuncture and a safe environment to heal, so many of them experienced major change – sleep was the biggest game changer. Once able to sleep better, their energy improved, their mental state improved and they felt capable of taking more positive action in their lives, including exercise. Possibly most importantly, hope was renewed.

 

Emotional Trauma in Midwifery

I believe that at some point, all experienced midwives encounter a serious traumatic event in the hospital. Along the way there are many trauma-filled, high-stress experiences in each shift.

I understand that midwives are offered debriefing, but what is the culture around that in your hospital? Amongst yourself and your friends, colleagues and family? How many of you lack a warm, open, non-judgemental and patient ear when you need it? Do you even recognise when you need it?

Debriefing is only one way, albeit a very important way, to recover from trauma.

But trauma is not just held in the mind, and so words are not the only way to recover from stress and trauma.

We know that the hormones adrenalin and cortisol are involved when we are under stress. At some point during even the most natural peaceful birth, the adrenalin flows a little higher. So as a midwife, your adrenalin is getting a workout each shift. Couple that with a night shift, and being on your feet for hours, missing sleep and the Kidney energy gets really affected.

 

Trauma in Chinese Medicine: The Kidneys and The Heart

 

Kidneys

Kidneys are related to the emotion of fear. They also get called upon when you have used up all the Qi allocated to you for the day, and you have to dig deeper. It’s the well of the Kidney Qi that gets drawn upon.

So as a midwife, you are more susceptible to Kidney depletion. The Kidney energy also is damaged by shock.

Heart

The heart/Shen (spirit) is also affected by shock, pain and trauma.

 

How to Nurture Kidneys and Heart

During a shift, you can take care of your Kidney and Heart energy by:

• Breathing – do what you can to bring mindfulness into your work. If you feel your adrenalin kicking in, try draw out your exhalation. If you are in delivery with a labouring woman, breathe her through her contractions. Take a few moments to breathe consciously throughout your day.
• Work on developing better boundaries – the more you understand and respect your boundaries, the less other people in the ward can have an impact on your state. This includes colleagues. You can develop a thicker skin even with a big heart. When working with a birthing woman, she is in such a vulnerable and raw state that it’s easy to overly empathise and allow boundaries to become more blurred. When the boundaries are blurred you will be more impacted by her experiences. There is a way to maintain your sense of connection to her, and yet remain entirely in your own body and experience.
• Recognise and respond when you have been affected by stress and trauma – your body will tell you if you listen. So take the time to stop and listen. It matters.
• Acupressure yourself – HT-7 & KI-1 calming points, settles the Shen.
• Keep wholesome snacks going – e.g. bone broth in a thermos.
• In your breaks – put your legs up the wall, hands over lower abdomen and do some conscious breathing meditation.
• Try debriefing with caring colleagues or dial-a-friend.
• Counselling.
• Acupuncture & herbs – to restore your Kidney & Heart energy, settle the Shen.
• Moxa on BL-23 – home self-care.
• Make time for the things you know work for you & chuck the guilt  – walks, cuppas with friends, singing, dancing etc.

 

Have you experienced the trauma of a difficult birth? Let us know in the comments how you recover from this challenging aspect of midwife life.