Trauma and Perception of Pain in Labour
The following is a response to a recent email I received (with her consent).
Based on the limited information provided I understood that this mother is pregnant with her 4th child, has a history of satisfied births and deliveries. However, during her third pregnancy she experienced an emotional trauma that impacted her early labor experience, resulting in increased pain with contractions.
She reached out because she is noticing that she is a. reliving this emotional trauma and b. afraid of the onset of labor because of a perceived notion that it will be painful or perhaps, more painful.
The questions were as follows:
I'm looking for information on the connection between experiencing OTHER trauma and going into labour / giving birthand the effect it can have on your pain perception / pain threshold DURING labour.
I found out that going through trauma can in fact lower your pain threshold (with other pain, not the pain from the trauma) and cause the pain you experience to be more intense. Is there any information on thisthat will help to prepare myself and to help myself be less scared of what is to come?
I also feel like I'm going through the same trauma again- just not as intense as when it happened. Is there anything I can do to work through this?
First Theme: History of previous trauma not related to birth and the impact it can have on labor and delivery
Trauma is pervasive, period. The symptoms of a traumatic stress response can yield its ugly head at any point, especially if we are engaged in stressful or vulnerable events. That said, I want to highlight the resilience and grit factors that humans demonstrate over and over again– bottom line is that we can tolerate an enormous amount of adversity and continue to thrive. Truly, this is amazing.
Let’s unpack trauma for a moment.
A traumatic event is an experience that threatenedyour sense of safety, was horrific, and you felt powerlessto change the circumstance. This threat could have been perceived or actual. Meaning, the risk of harm was present, regardless if the event resulted in actual harm.
Trauma equates toxic stress load and most often, remains trapped within the nervous system and the psyche. It is akin to the engine on your car running full throttle, but the car is in neutral (it is not going anywhere). All that energy but nothing is moving.
We can experience Big T traumas (abuse, rape, war, accidents, NDE, severe injury, environmental catastrophe, adverse childhood experiences, childbirth, terminal illness, historical oppression, racism) or little t traumas (divorce, loss of job, relocation, childhood bullying, loss of friendships, financial insecurity) to name a few. The key is to focus on any event or experience that results in the accumulation of toxic stress.
We all have a tipping point. As humans we can tolerate a lot, however, all of a sudden one adverse experience can tip the scale and we present with symptoms of posttraumatic stress response (notice the change in language – response vs disorder). Although the above list is incomplete it highlights some examples of the kinds of experiences that can result in ‘mental injury’ i.e., trauma.
Unresolved historical trauma can increase the risk of childbirth trauma. However, there are so many variable factors to consider. Each mother has vulnerabilities and strengths, and in any given moment, anything can change. Our perception of the event is as powerful as the event itself.
This is why two people can experience the same traumatic event and one may develop posttraumatic stress symptoms while the other, returns to a state of health after a debrief and a good cry/shake/laugh/roar.
What does ‘resolving’ trauma mean?
Simply put, has the emotional debris been felt and integrated – has it been grieved? Has your brain stored the event properly so that it is no longer flooding your system with unprocessed emotional material? Has your nervous system been restored to homeostasis, in such that it no longer perceives your current reality as threatening? Has your body released the trauma through movement, sound, expression, and felt sensations? Have you made sense out of the situation? Have you applied meaning to the event? Do you feel safe in your body and in your environment?
These are all questions to consider when trying to resolve or heal from trauma. We do know that healing from one adverse event is less complicated than healing from a history of multiple traumatic events. That said, the process is similar regardless and contemplating these questions, and receiving necessary support to facilitate movement through the process, is helpful.
What can happen during labor and delivery?
Labour and delivery is a physiological and emotionally stressful event for any mother. During this experience mothers are vulnerable; albeit powerful. This vulnerability can result in the triggering of a ‘trauma’ response (a.k.a. a toxic stress response) in such that the mother does not feel safe, perceives the situation as harmful to baby or herself, does not trust the caregivers, and perceives an utter lack of control.
If the historical traumatic event or episodes has not been processed, integrated, and healed, it is possible that the mother’s system can become activated, as above, and become flooded with adrenaline (gas) and cortisol (breaks). Both of which are counterproductive to the progression of labor. These hormones can halt or prolong the labouring experience, which lends to the second theme on perceived pain.
Second Theme: Pain perception and tolerating labor pain
Frederick Leboyer, a grandfather obstetrician, who wrote ‘Birth Without Violence’ spoke about the pain-perception cycle being connected to an increase in perceived fear.
The cycle is as such: Fear = Tension = Pain//Pain = Fear = Tension.
As such, if the mother perceives her environment as unsafe or out of control for any reason, or if she feels something in her body that links to a memory of past violation or pain, her autonomic nervous system will move into high gear and flood her system with adrenaline (the hormone associated with fight or flight hormone).
Cortisol is a secondary hormone that comes online in attempt to counterbalance the rush of adrenaline – akin to putting on the breaks. With both cortisol and adrenaline flooding the system, the body constricts and retracts in an attempt to protect itself from perceived harm. This constriction results in tension. And, tension increases pain.
When we are constricting, in attempt to avoid pain, we are resisting the natural pain of labour, thus intensifying the experience of labour pain.
The antidote is counterintuitive – to move towards the pain, not away from it. And to challenge the intrusive fearful thoughts. In other words, is the fear rational or perceived?
The battle with labour is often the dance between moving towards pain yet wanting to run away and resist it.
So, what is a mother to do?
Sometimes knowing too much complicates matters.
Fearing the ‘potential’ triggers during labour and birth because we know that unresolved trauma may contribute to more painful or complicated labour, only adds fuel to the fire.
I remember one of my teachers, Dr. Michel Odent, saying that mothers just need to get out of their thinking brain. And caregivers need to do whatever it takes to reduce potential stressors.
Much of what we say and do during the antenatal period adds stress. And although I am a trauma informed advocate and therapist, I question if learning about the implications of historical trauma or childbirth trauma is adding unnecessary stress?
There is much that a mother can do in preparation:
Receive trauma informed counselling to process emotions
Speak to your caregivers openly about your fears and history
Question, challenge, and flow the fears
Ensure that you trust your caregivers
Seek out practitioners who believe in informed consent
Educate yourself about the holistic stages of labour and birth as an altered state experience
Engage in transparent communication between caregiver, family, friends
Move your body – yoga, dance, walk, play
Resourcing - Learn how to support your nervous system when it is activated
Engage in creative activities
Write in a journal
Develop a spiritual practice or meditative practice
Do what you can to build trust in your body and the process of birth
Foster loving supportive relationships
Is there a silver lining?
Yes. Human beings and mothers are resilient.
We can heal, and we can heal during labour and birth.
If the pain is unbearable, do what is most compassionate in that moment. Sometimes the most compassionate choice is pain medication. Love and self-compassion is powerful medicine and it is the antidote to trauma. Human beings are wired for love (read Stan Tatkin or Stephen Porges). Giving birth is an act of selfless courageous love, regardless of how we deliver.