The Sad Moms Club

30. The Impact of Birth Trauma and How to Start Healing with Amy-Rose White, LCSW

• Joni Lybbert • Season 2 • Episode 30

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We are so lucky to learn from Amy-Rose White today. She is an LCSW who has worked in the perinatal community for decades, and started PSI Utah. Amy-Rose shares some of her personal experience with birth trauma and then teaches us about what birth trauma is, symptoms you may experience, and some treatment options. She also shares some of how the medical system could change to prevent birth trauma. If you are feeling anxious, her voice alone will help you feel more calm. 

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Follow along on The Sad Moms Club's Instagram: @the.sad.moms.club

Follow along on The Sad Moms Club's Instagram: @the.sad.moms.club

Joni:

Hey, welcome back to the sad moms club podcast. I'm Jenny Liberte. And today we're talking to Amy Rose White. Let me tell you, I've heard so much about Amy Rose over the last couple of years, being involved in this community. Because she's kind of like the mother of. PSI. In Utah, the mother of maternal mental health and Utah. And she's been working in this field for a couple of decades. She's very knowledgeable. And she has this calming presence. That was just good for me in general. You may have heard me talk about Karen Kleiman before, she's also a social worker. Who's. Really big in this space. But she wrote this book called the art of holding in therapy and She talks about the therapist mothering. Their client mothering the mother because. The client is mothering, their children. And who is mothering the mother, hopefully the therapist. And I just feel like. That wording, the art of holding is something that Amy Rose has mastered. And I felt like cared for and. Respected and almost like a mother during this hour long discussion i had with her so really uniquely wonderful person and i'm excited you get to learn from her So today we talked about birth trauma. What is birth trauma? Symptoms you might be experiencing What leads up to experiencing a birth trauma We talk about some prevention and treatment she does with her clients, how healthcare can change to prevent women from experiencing birth trauma. So. There's a lot of information in here. She's just a wealth of knowledge and she's so well-spoken. She's really great. So let's get started talking to amy rose So today we have Amy Rose White. Thank you so much for being here, Amy Rose. I appreciate it.

Amy-Rose:

It's my pleasure. Thanks for having me.

Joni:

perinatal and integrative psychotherapist in private practice, and you've created some amazing programs both here in Utah and in Oregon. You're the founder of Utah Maternal Mental Health Collaborative, which turned into PSI Utah, if I'm understanding the history correctly. So you've done so much. So thank you for spending an hour with us so we can learn from you. Can you just start by introducing yourself and share however much of your story you feel comfortable sharing that led you to working in the perinatal community?

Amy-Rose:

Of course. The short version is I had a traumatic birth with my first child who recently turned 20 years old. Like I, that's how long I've been in this. part of the field, which I can't believe. And I had no idea what was going on. I was three weeks from graduating my MSW program. I'd been pregnant my whole last year of graduate school, and my peers would come over, told the baby, and I would just cry and cry and cry. And I had no idea. That you could have PTSD after delivery. I had no idea how high risk I was. So basically within the years that followed that and having a second child and really having to face my PTSD once I was pregnant with him I'll tell that story as we go along. I became so passionate about providing services that I really couldn't find for myself and working as an advocate in healthcare, medicine, mental health care, and. As just an advocate in the general community of families and parents to help us just better understand how common these illnesses and conditions can be. What are the risk factors and how to address them really effectively because I probably suffered a lot longer than I needed to.

Joni:

When did you find out it was PTSD or that maybe it was any kind of perinatal mental health disorder?

Amy-Rose:

Yeah, I honestly did not really recognize what it was till the week I discovered we were pregnant with my second. And that was about a year and a half. When my son was a little over a year, because my kids are 27 months apart and I had not been sleeping for 14 months. I had one of those babies that woke up every single hour on the hour and started his day at 4 a. m. High needs spirited baby um, who had. Very significant injuries during the birth. And so I was always catching up with what he needed and had no clue how anxious I was about his needs and over functioning in that way, insisting that I be the one to nurse him to sleep, even though my husband was very supportive and helpful. I just had all those things that I didn't really notice. And... Although I didn't want to go through it again, I knew we wanted two children, so I had a kind of a let's get this over with attitude. And as soon as I was pregnant with a second, one night in bed my husband turned to me and said, are you thinking about Max's birth? And I said, yeah, how do you, how did you know? And he said, you're breathing really fast. that's when I knew that I was having some symptoms that were resurfacing, which is an element of birth trauma we'll get to talk about today, simply because there were reminders. Obviously, my nervous system was acknowledging it was going to have to go through this again, potentially. And so then I got into therapy specifically for it. I did EMDR, had a great response to that, had a very healing and reparative pregnancy and birth.

Joni:

Oh, I'm so glad.

Amy-Rose:

Yeah, me too. So at a certain point, I really decided I wanted to start support groups for moms and I happened to run into a flyer in this little town in Oregon that I lived in, where another therapist was already doing this. And she and I founded an organization there. I started a private practice when my little guy was two. And the rest is history on that sense. The other piece that I did want to share, which is a little more personal that I typically don't speak about, but I feel like this is just a right time for me in my life to speak about it is I think the more deep psychodynamic, if you will, the root. of why I've always worked with mothers and children. That's been true for me since I was 16 years old. Is that I had a mom who really struggled and had pretty severe untreated mental health issues, really severe anxiety, probably had a traumatic delivery herself. And I think on an unconscious level, I've always been trying to help her through other women in ways that obviously as a child. I wasn't able to. So ultimately for me, perinatal mental health work is the greatest tool we have against child abuse. It's prevention and it's designed to support women having the motherhood experience they really want. Because I know my mom didn't and I, still feel sad about that for her.

Joni:

Yeah. Thank you for sharing that personal part of your life. I do feel like this is... Most people get into psychiatry or therapy for some personal reason. We don't always know the full reason until we start doing our work and working with other moms. But yeah, thank you for sharing that. Can you, I guess to start talking about some Birth trauma. That's the topic for the day. Can you define birth trauma and maybe even like the larger definition of reproductive trauma?

Amy-Rose:

Of course. So birth trauma really refers to any experience that the woman or birthing person experiences as she perceives it. as a threat to her or the baby's physical, emotional, psychological, or spiritual integrity. So it is a matter of perception. Birth trauma is in the eye of the beholder, as Beck and Driscoll say.

Joni:

Yeah, that seems like that could encompass a lot more than I've even thought. I've brought this up a couple of times over the course of the podcast episodes, but I was pretty surprised when I first started working in this space and I was at the University of Utah and I could read all about their birth. And it just, it didn't seem traumatic the way they wrote it, but their perception was very different or their experience was very different. And it just really opened my eyes to just how much pain women are going through, sometimes we're causing the pain through like lack of communication. The PSI website says like 9 percent of women experience birth trauma or postpartum PTSD. I'm curious if it's more because it just seems like. Maybe I'm just in this space and I hear about it a lot, but it just seems really common.

Amy-Rose:

I'll tell you that the studies are few and far between, as you probably know. We don't have excellent research that is ongoing and really keeps us up to date and reflects. What you and I see in practice, so that is true. It's roughly 9 percent in the literature for full blown PTSD. That means you meet all the criteria that folks like us use in the DSM, but roughly 18 to 34 percent of women report that their birth was traumatic for them. And I think that reflects a little more accurately what we see when working with women. And you make an excellent point that we can, view a birth or read about a birth that does not look particularly traumatic, and yet the woman experiences really severe kind of whiplash from the event. And we can also view births that look very traumatic that a woman does not develop PTSD or partial criteria. And I think we have a lot of people walking around with partial criteria. Or are they, they have complex interpersonal trauma from childhood, so they're at risk and they have a lot of symptoms that impact their quality of life, but they might not recognize it because they're not having true flashbacks in the middle of the day the way we think of veterans having them or, some of the more classic symptoms that get overlooked.

Joni:

Yeah, I think you make a great point. It can be overlooked and, sorry, my phone just went off when I put on do not disturb. I just lost my train of thought. I think that's a great point though. Can we, before we talk about like some symptoms and either full blown PTSD or partial PTSD, what types of experiences have women reported to you that they found traumatic?

Amy-Rose:

empirically all over the map. I have anything from anesthesia that didn't work during a cesarean section and the woman felt the entire operation, which is really obvious. I've worked with a number of women who've experienced that all the way to someone who had what looked like Outsiders has a beautiful home birth with a supportive partner and a doula and her children nearby, but who was a survivor of sexual abuse and this particular birth and the way it unfolded and the way she experienced herself in her body brought up so much trauma from the past that she felt pretty debilitated for the months that followed. So in terms of what I hear, it really varies. I would say the most common story is a hospital birth during which medical care providers don't look the person in the eye, don't ask for permission or consent before performing procedures, don't explain to the family why certain things are needed. Any experience where a woman feels coerced, manipulated Not collaborated with when it comes to what's happening next, a lot of planned inductions that maybe aren't medically necessary in the literature. We see things like medical complications, NICU stays hemorrhage, kind of obvious things. Any medical problem in the baby or the mom, a bed rest, prolonged labor or very short labor, really intense experiences, prolonged pain, long prodromal labor that's stuck and very painful. Those are some of the more common ones we see in the literature, but in terms of what I hear in my office, it's all over the place.

Joni:

Yeah,

Amy-Rose:

How about you?

Joni:

I feel like the number one, I think maybe it's just the most surprising one when I was first getting into the space was hearing about C sections, unplanned C sections and maybe it's because they're kind of normalized, which is great in some ways, but I'm just used to hearing about them, that I was surprised how many women really struggled with their c section and that I feel like I was pressured into this choice. I didn't feel like I had a choice. I feel like if I didn't make this choice, my baby was gonna die. And then I later learned that I really did have more options. I just didn't know about it. I don't know what the percentages of people who end up having a cesarean birth, but it seems like it happens pretty often. And not that everyone has a traumatic experience. Some people, it was very communicated and they felt very powerful in their decision. Other people have different experiences and more traumatic experience.

Amy-Rose:

Absolutely. And in answer to your question, it really varies across hospital systems, but in the United States, it's increasingly becoming the norm. In fact, maybe so much so that it didn't occur to me to say it just now. Because the vast majority of people I see that's just part of their birth experience. And In some hospital systems, like a low rate would be a quarter and a high rate would be like 60 to 75. I just worked for the hospital system in another state this summer where I think it was upwards, it was over 65%. Almost everyone there is having a cesarean.

Joni:

Wow. So interesting. Yeah. And I don't know all of that side of it, but yeah, for some people that can be really upsetting and painful and hurtful and traumatic.

Amy-Rose:

Absolutely. It's a Major unplanned surgery.

Joni:

Yeah. And then there's like a whole nother conversation about the lack of support that women have after having a major surgery. And so what are some symptoms that you commonly see people are coming in with if. Maybe this is two questions, common symptoms and then common symptoms that maybe you didn't know that trauma was the root or other people have missed that in the past and they're still having this trauma symptoms long after they have given birth. Does that question make sense?

Amy-Rose:

Yes. Great question. So the symptoms that I see typically fall into three categories. Intrusion, avoidance. And hyper arousal, and I'll explain what I mean by that for your listeners. So intrusion symptoms mean I can't stop thinking about it. I can't stop picturing it. There might be unwanted intrusive thoughts, images, sensations in the body that are a reminder of the birth. And again, we have three primary causes or themes, and that is one that's related to the birth, something that happened before, like a prior event, like I mentioned, this woman who had a home birth, and the neonatal complications. So those are the three. greatest risk factors or themes associated with birth trauma PTSD, but then the symptoms will be intrusive feeling sensations and images, avoiding thinking about the birth, avoiding the hospital, and of course, one of the biggest potential, really devastating implications for birth PTSD is that we avoid the major trigger of the traumatic delivery, which is the baby. So it can influence attachment and bonding and then hyper arousal, not being able to sleep, feeling anxious all the time, having loud noises, crying, older children making noise, all the things that the nervous system is usually going to be challenged by. anyway, are just on steroids with someone that has some or all the criteria for birth trauma PTSD.

Joni:

I feel like it could be missed. It could look like anxiety. So how do you make sure you're treating the root? And like, how do you catch the root? Is there anything that they're saying that is concerning for trauma? I guess it could just be a really good intake.

Amy-Rose:

Really good intakes are essential, and I think that's why so much is missed at the six week checkup or the pediatrician's visit, because those more nuanced questions typically are not asked. And we honestly do not have, as I'm sure you're well aware, really great screening or questionnaires specific to birth trauma. We have some narrative forms that people can fill out that give us a lot of great information, but the standard medical provider doesn't have quote unquote the time to invite a patient or client to do that and then go over it. So using the EPDS will catch anxiety typically, and anxiety as a symptom is almost always part of PTSD. I would say postpartum depression can be the imposter for PTSD because constantly feeling overwhelmed, feeling those intrusions and symptoms, feeling on edge and hyper aroused, wanting to avoid driving past the birth clinic, for example, or the doctor's office or the road that you took to the hospital. The billboard that reminds you of the hemorrhage that you had. It can be so many things that can lead to depression. So the EPDS is a great starting point because most people that have full bone PTSD will fail it in the sense that they will answer 10 to 12 or Much higher than that. And then it really is up to the clinician to ask the good questions. And when I meet with someone who has recently had a baby, I always say the most important thing that I understand today is one, how bad do you feel? And what does that look like? And two, if we can get to your pregnancy and birth story, because just that alone, those things alone will tell me so much about how she's coping now, how she perceived. The pregnancy, how she perceived the birth, and most people will tear up or disassociate. You know, It takes an astute clinician to really be watching and paying attention. Someone might disassociate when you ask them that question. So it's a subtle and not so subtle process of elimination, but I think making sure that we are checking for those three categories. Do you have any intrusion symptoms? Do you have any avoidance symptoms? Do you have any hyperarousal symptoms? And that doesn't take long to get an immediate assessment on.

Joni:

I think you explained this, but can you give me like specifics of things that someone might have as an intrusion symptom? What might be coming to their mind?

Amy-Rose:

Yeah, they're just replaying what happened and why over and over again. Elements, an image of riding the elevator and holding the nurse's hand is just constantly in their mind. A feeling of having a pit in their stomach, but not knowing why. Things of that nature, they can be quite diverse, but it's basically unwanted sensations, thoughts, feelings.

Joni:

Different than like an intrusive thought that we talk about with postpartum OCD or postpartum anxiety. They're like intrusive thoughts, but to the birth or to the trauma, the reproductive trauma.

Amy-Rose:

Exactly. They're specific to that trauma or oppressed trauma. So you had the baby and the birth went quote unquote well, but now you're having intrusive images of an earlier sexual abuse or an assault. So it is about the specific traumatic elements and images, thoughts, feelings, and memories.

Joni:

And I imagine with the larger umbrella of reproductive trauma that could come up with like people who do infertility treatments, maybe a really hard pregnancy. It's doesn't have to happen during the birth. It could be your postpartum stay. It could be a lot of things.

Amy-Rose:

Absolutely. Abortion, miscarriage, neonatal loss, neonatal complication. Yes, fertility treatments. Absolutely. And as the unconscious mind does a brilliant job for us of sequestering these things quite far away from our conscious awareness until Things settle down a little bit. So sometimes people are in, total survival mode and the social worker goes to talk to a parent who's almost lost their twins in the NICU. And they're not reporting symptoms yet because they are fueled with cortisol and norepinephrine and adrenaline that is getting them through that moment. But nine months later, when they're home with baby and their two other older kids, now we start to see symptoms pile up. And that's why it can also be hard to catch because we're way out of that six week window. You know, It's considered a victory that the baby or babies are home. No one's really checking on that parent anymore and their partner. The well child visits aren't that frequent and they're really focused on baby. So can be delayed onset.

Joni:

Yeah, that's a good point. And we're very forgetful once someone brings baby, home, and they're healthy, it's so easy to forget the person who experienced that. And the parent too, the other parent, the non birthing partner, also can be very traumatic for them.

Amy-Rose:

Oh, absolutely.

Joni:

I hope this doesn't like, scare people too much. This topic was requested because people said, I'm afraid of having a traumatic birth. And I guess what I really want to get to is, how can someone prevent this? And can they even prevent it? Do you have control in this?

Amy-Rose:

I think to a degree forewarned, forearmed, as they say, and I think that's why I shared a little bit of my personal story is that I just had no idea I was at risk for that. I was told I was at risk for depression and that basically that was it. I was like, Oh, okay I'll just, I'll cross my fingers. So personal history, Okay. is really important. In my case, I had a personal history of really severe adolescent depression. I had been hospitalized twice. I've been on an SSRI for 12 years before getting pregnant. That was my greatest fear in life was having a relapse. I've been in remission for over a decade. I was doing great, but I took myself off that medication before getting pregnant without. Anyone giving me wisdom or feedback about that? Cause I just had this idea that was better. I mean that particular medication that might've been a good decision because it's no longer on the market because it gives people liver damage, but yeah, it was called Sarah's own, but it worked great, but it had some side effects. But recognizing that if you have Any early attachment injuries in your life, if there's any form of abuse or neglect, if you've had chronic stress, poverty, violence, really on any end of the continuum, you are at higher risk. You might not ever have received a PTSD diagnosis. I know I didn't. I had been living with that my whole life, but it was so normal to me. I didn't think anything about it. And the older I got, the fewer the nightmares and the more regulated my nervous system got. And so it's just not something that I think a lot of people are even aware of. We've got a lot of really chronically stressed, adrenal fatigued, partial criteria, PTSD people like myself walking the earth, having no clue that feeling out of control, feeling like You don't have power and decision making over your own body, pain any boundary violations, and obviously you've got a lot of hands on your often naked body when you're giving birth, and so that brings up any past boundary intrusion you might have experienced in your life, and I'm not trying to scare people either, but it's really important to be aware that does a increase the need for you to feel empowered and have good communication with your health care providers. That doesn't mean that we're in charge, of making a birth plan and making sure all those things go according to plan. In fact, The more control we tend to need in our lives, the higher risk we are for all kinds of perinatal mental health conditions, because probably the most uncontrollable thing in our lives is a child, the birth process, and then the child that comes after it. One thing is to really focus on Brain health because those of us that do have lots of big t's and little t's as we refer to trauma in the trauma treatment world We have to spend extra time nurturing our sleep. We have to spend extra time nourishing our brain Omega 3 fatty acids from things like cod liver oil nuts Fish, eggs, meat, if you eat those things. And if you don't, you've got to get supplements from somewhere else. Because you're not typically going to get enough of those to support your brain. If you have a history of anxiety or depression or trauma in your life, just by a vegan diet alone, that is my personal opinion, having been a long time vegetarian and vegan, and now I'm, I eat meat. I eat meat to support my brain and eggs and all the things. I go in and out. But the basics of nutrition. sleep and counseling to really talk about what fears do you have? Because before my birth, I definitely wanted a certain kind of birth. I had very specific ideas in my mind about what was best for the baby and best for me. And in retrospect, a cesarean section actually would have been much better for my child. But in my viewpoint from all the Books that I'd read by Ina May Gaskin, who's a famous midwife. I was like, I'm not having a cesarean. My child really suffered and his heart rate never went down. So it was never even really offered to me except for pure exhaustion because I had pushed for almost four hours. But in the end. If I'd been more educated about the impact of vacuum extraction on infants, I would not have elected to do it. I wish I would have been more open to all ideas, and I think that's an important part of prevention. You want to have rehearsed yourself, through the major scenarios that could happen, and understand your choices in each scenario, rather than set your sights just on one outcome. You want to have an advocate. For yourself in the birth. And sometimes that can be the partner and sometimes it's not. Partners are just as scared as we are and overwhelmed. They go into their own birth zone. I've noticed because there, there's a fear response that comes up for partners. It wasn't that long ago that women very commonly died in childbirth and did infants. It really is not that far back in our history, and I think there's a implicit evolutionary fear that comes up for everyone involved around that. So it's not always Easy for the partner to be the advocate. And I bring that up because I can't tell you how many times I hear people feel betrayed by the partner. They didn't stand up for me. They didn't hold the line. They didn't ask enough questions. I couldn't speak what I was feeling because I was so focused on the contractions, or I was in pain, And there's a lot of, relationship issues that can come up after a traumatic birth related to that. So I'm a huge fan of doulas. I love doula care. It's very statistically shown in the literature to improve birth outcomes when a doula is present, if only to be the voice for the patient and or the support for the partner. That person is obviously more impartial than someone who is partnered to you perhaps for life. And doesn't do, 100 births a year. You know, This is kind of a life and death situation in the sense that there's this very sacred portal that we join into when we're Literally bringing a child through the veil, so to speak, into the world. And a doula that's like their bread and butter. That's what they like, this might be our only time or only living child. stakes prenatally and postnatally that sleep and nutrition must be the focus. Ideally, if you have any risk factors, meaning a history of any mental health issue, personally. If you have immediate family members that suffer from mental health, just having a plan with your care provider, whether that is even an acupuncturist or a functional medicine physician, or a therapist or psychiatrist, even if it's mainly focused on nutrition and not medication um, But you have a backup plan. Hey if some of these old symptoms pop up or if the thing that happened to my mom happens to happen to me, meaning, you know, I have a night where I don't feel like I need to sleep or I can't sleep or I start to feel so anxious, I'm terrified to take the baby home. You know, These are things that if we talked about them openly wouldn't seem scary because they'd be so normalized. So if you have a plan going in. And you get as much social support as you can afterwards. This goes for everybody across the board because PTSD rarely sits by itself. It's usually partnered with anxiety and or depression, or even some other things like OCD. So we can minimize the risk of all those things by trying to get four to six hours in a row of sleep as soon as possible, which is a challenge. I always encourage people to talk to lactation folks if they plan on nursing or chest feeding. And if there's any pain with that, or You have a baby like mine that just simply doesn't sleep for whatever reason that you do not muscle through that alone and think, Oh, in six months, I'll be through this and I'll be okay, because those of us that have a little bit of a higher risk load in our brains, they don't like that and you can muscle through for a long time, but the consequences are usually pretty significant.

Joni:

Yeah, the hope is that eventually you'll end up at our door if that's the case, but it's so much better if you know beforehand and you can just do more prevention instead of trying to play catch up months after you've had your baby. I love the doula point. I feel like just being in this space the last couple years, I've learned the value of doulas. My mom had three births. At a birth center to at home. I like was very comfortable with duals and midwives, but I didn't really understand their their value if you don't have a birth at home or at a birthing center. And as I've talked to more moms and I've realized like, wow, if they just had someone that can. Educate them in the moment. Hey, these are your options. This is why they're talking about this. And advocate for you and educate you in the moment beforehand is it's great too. It just makes such a huge difference.

Amy-Rose:

Absolutely. And you hit on a really key point, which is That person can act as a translator for what's happening because unfortunately, and that's a real flaw in our medical system, and it can happen in a birth center environment or even a home birth. No one's perfect. Oftentimes important information just isn't conveyed and people don't understand why. But when they're given That narration of why and what's happening next and what likely might be the reasons for those. Even if they just get a little more information, they feel so much more a sense of personal agency and control.

Joni:

Absolutely. Even as a nurse, I found how often a doctor would come in, explain something to the patient or the family, and then I'd come in later and they'd ask me a question based on something they heard. It's just like new language. And so I feel like most people, I expect them to get like 20 percent of what was said. You're not going to get a lot of it. And then add you're in pain, emotions are high. You're worried about your life, your baby's life. It totally makes sense. So it's helpful if you can be educated before, and then you have someone who can educate you throughout or just advocate for you. I love doulas. They're so great.

Amy-Rose:

They are. Let's make more of them.

Joni:

That's all really helpful. Are there educational resources you recommend if someone is currently pregnant or hopeful to be pregnant to look into now, like maybe a book or I don't know, a podcast, someone you recommend learning from?

Amy-Rose:

I have in my mind more resources. Once you're already in that space. Unfortunately, because simply more exist. I think knowing the signs and symptoms going to postpartum. net, which is postpartum support international's website, simply looking at the common signs and symptoms of all of the mental health conditions that can happen and do to roughly a quarter of all women in the United States. Just being familiar with, with that is really helpful. If you are. In a high risk category such as a sexual abuse or assault survivor, I recommend the book, When Survivors Give Birth. It's an excellent book to walk both clients and their providers of various disciplines through things to think about and ways to stay as empowered as possible through the process. The other piece I would add is any nervous system regulating activities like EMDR, somatic experiencing, any type of therapy that works on helping achieve safety in the body. And you can get a lot of these nervous system rewiring programs from people who Specialized in that they don't necessarily have to be therapists or psychiatrists any work like that yoga as a preventative Anything that's down regulating that nervous system that fight flight freeze fawn response will Sure, up your nervous system to handle the really massive fluctuations of not just progesterone and estrogen, but also adrenaline, cortisol, norepinephrine, any woman that's given birth and then found herself shaking violently afterwards, which doesn't happen to Everyone will feel pretty overwhelmed by that. But that's the body's really natural response to a traumatic experience, which I would argue most birth is a trauma to the body, at least, even if it's not perceived psychologically as one. It is a massive event not just in terms of what's happening the pelvis, the uterus, the baby goes through a big trauma, but also just physiologically, hormonally, so much is changing. And the thing about risk is people who have hormone sensitive brains. are the folks who are more likely to have had more adverse childhood experiences. And that's one thing that you can take. You could go to the ACES, I think it's aces. com, A C E S. com and actually take the ACES quiz, which is a really quick and easy way to get a score in terms of your risk for all kinds of health issues. But it gives your birth care team, if you were to say, Hey, I took this ACES questionnaire, I scored a six. I don't really know what that means. Hopefully you and I are doing our part to build a system that knows exactly what that means and says, okay, let's. Talk about how that shows up in your life now and think of some tools and it could be really simple Slow breathing exercises that you practice during a pregnancy or during the adoption process If you're not a gestational carrier, that is also something that comes up. You can absolutely have from the adoption surrogacy process. So there's a lot that we can do, but there's fewer preventative birth trauma resources than I have in terms of intervention ones. And I can send you an email link to some of those. A lot of them are in New Zealand, Australia. There is some work in the United States. I believe it's betterbirth. org that are working to advocate for policies and procedures that are more supportive and. Patient centered and therefore result in better outcomes.

Joni:

That's hopeful. I hope. They are able to achieve that. Yeah, thank you. That's a great place to start. The only one I've learned about recently is birth smarter. Have you heard of their company?

Amy-Rose:

No

Joni:

I believe she was a doula beforehand, but she lived in New York city. She had her first baby and she realized like, wow, I was prepared for this and I still wasn't prepared for this. And so they have online courses, but also they're in salt lake now as well. In person courses where they walk through that maybe if you can't afford a doula, you can afford like a 200 course that tells you what could happen and what this means and what options you might have. And I just recently learned about it and I'm interviewing them soon, so I'll learn more.

Amy-Rose:

wonderful. Thank you for educating me about it. That is fantastic. And I think that because of consumer demand, more and more people will be developing programs like that and have access to it. And ultimately, hopefully that will impact the system.

Joni:

yeah, definitely. I've learned over just the year of doing this podcast, it takes so many people to create change, definitely at a system level, but at individual level, there's plenty of people who are struggling and we need like therapists and medication providers and doulas and educators and policy people like so many people to actually make the changes that we hope for. Collaboration is so key here because we can't do it all and typically it's more than one person on your care team that you need more than just a therapist or more than just a medication. You need like a whole team to surround you and support you. Treatment wise, so let's say you had a traumatic birth, what are some things you do with clients first, and then things you recommend if people can't see you for some reason?

Amy-Rose:

I would say the first thing is for anyone that's had a baby recently adopted a baby find the EPDS online if your care provider is not giving that to you and self score it. It's not hard to do. You can find ones where you can see what the numbers mean. Try to be as honest as possible. That's a little bit of a mhm. of a hard thing when you see the score next to the numbers because everyone wants to say zero. Most of us don't want to have something going on, which is why I like when we use the words emotional health conditions rather than disorders. No one loves to be disordered, right? So taking that, knowing your score. Understanding that it means that you need more support. If you're over 10 to 12, you need more support. Finding a perinatal specialist, whether that's a psychiatrist or a therapist, via the maternal mental health website in the state of Utah, where you and I happen to live, or postpartum. net, which has the world's largest database of providers and peer support options, is a great start. Support groups can be helpful, but for birth trauma PTSD, if you noticing that intrusion avoidance arousal system, oftentimes going into a group of new moms is way too overwhelming. You're not quite there yet. You need to have some recovery under your belt before you're ready for those situations and scenarios. So finding a provider interviewing a couple on the phone. If someone won't talk to you for 10 or 15 minutes on the phone for free, I wouldn't see them. And I say that as someone who's privileged to be very busy in their practice. I think if that's important to someone, hearing someone's voice on the phone, getting a sense of how they work, asking them some questions about, how long have you been doing this? What would you do if I do have birth trauma, PTSD? How do you approach it? Thank you. These are fair questions that don't take more than 10 or 15 minutes to answer. And then really listening to your intuitive sense around if that's a connection that you have with that person. Definitely focusing on sleep and like the fish oil piece, knowing that you have lots of options. Magnesium is excellent and it's totally compatible with nursing. Magnesium glycinate really helps with those hyper arousal symptoms and sleep fish oils absolutely are supportive for mood anxiety and PTSD symptoms and are compatible with nursing. or chest feeding. And then in terms of once you're in treatment with someone that you connect with, getting to tell the story in a supportive way with a practitioner who teaches you something, what we call containment strategies. So you're telling the story, but in a way that doesn't leave you at the end of the session, feeling re traumatized. So a good therapist will be using somatic. And energy psychology techniques like EMDR, somatic experiencing, breathing techniques, mindfulness, and they're really going to be solution focused on tell me exactly what your sleep looks like and what's challenging about it. Tell me how much you eat each day and what does that look like? And who gets that to you? Tell me about the pain. that you're in or not. And how is nursing going? I'm not a lactation consultant, but I'm close with those who are, and I know a thing or two about breastfeeding. So if there's any nipple degradation, pain, swelling, bleeding, We want to address that first. You don't want to start doing EMDR on birth when someone is not sleeping and has bleeding nipples, sorry to be graphic for your audience, but it's

Joni:

it's great.

Amy-Rose:

not in good shape physically or maybe has like interpersonal violence going on at home. So you want someone who's. going at the pace that you and your body can handle with ultimately the goal using a variety of techniques. There isn't a one size fits all for anyone to basically help your brain have a reparative experience of that trauma. So that may be EMDR, where we use bilateral eye movement or sounds or lights to retell the story at the. Most strenuous part of the story that is Continuing basically because PTSD being an eye the beholder It's basically the brain thinks the past is still present right now so all these techniques help the brain understand that is not happening right now and Ideally gets the memory to neutral. So sometimes we're working right on that exact memory of the birth. Sometimes we're working on In EMDR we use first, worst, and most recent memories around feeling out of control. Feeling helpless, feeling like choices were taken from us. That could be something that seems pretty benign, but to the person, they have a memory of their parent not picking them up from school at five, and that's what they keep thinking about. Who knows? It could be anything. So we might use EMDR therapy or somatic experiencing, which is about how the body contracts around trauma. We might use narrative therapy. I am really big in using the physical body. To do the kind of work where we actually redo the whole birth in vivo. So have people actually stand up, get in the posture. I'm not in my office anymore, so I have to get really creative like this. I only do telehealth, saying the thing that they couldn't say when they were in pain to the doctor sometime, not an art therapist, but I do have people do art or writing or drawing I've used the voice quite a bit. So a lot of things for women in particular in our culture get stuck in our throats. There's a lot of things we don't say. I have a teacher. Who has us teach clients, and I use this in my own personal life on a daily basis, a no practice of literally just saying no, no, no, no, no, no, no, no, no, no, over and over again as a way to open up, to get esoteric of the throat chakra, but to really reclaim the power that we often feel is lost in a traumatic delivery. So it could be so many things. I could obviously talk for an hour more just about treatment, but you want someone who is solution focused. You don't want to go in there and just talk about the birth every time you go in for a month. That it can actually be re-traumatizing. You want someone that has a plan of action and then ultimately has you redo it, rewrite it the way you wanted it to happen, re-experience it in a positive, empowered way, create a belief. And this is a big thing in endurance medic experiencing. We wanna look at the belief that came out of the trauma, and then we're rewriting that belief into something that's more functional once we get that memory to neutral. So I do have a voice I can trust myself. I do trust my partner. There are safe people in the world. This is the kind of thing that we want to help people reinforce in very concrete ways using what we know about neurobiology and neuroplasticity.

Joni:

It can be so powerful to go from this powerless state to this empowering. belief. It takes time, unfortunately, all things do. But yeah, thank you for explaining that. can you explain a little bit about somatic experiencing and how does that even come up? Are you just doing somatic experiencing ever, or is it usually along with EMDR or narrative therapy or some other kind of therapy?

Amy-Rose:

So I personally am a really eclectic therapist. There are colleagues of mine who are certified in somatic experiencing, which is a very long and rigorous academic and in vivo experience. Developed by Peter Levine that almost exclusively do SE, and I'm not one of them, but I think it's fantastic. So I incorporate them a little self taught at this point because I've gone down the EMDR route before SE, which they often go together. I really enjoy both. So Levine's work. I watch a lot of SC practitioners and I steal some of their techniques, and then I embed them in my own EMDR training. So somatic experiencing is really based on the idea that as. mammals, we have an innate capacity for healing. We have an innate capacity for transmuting, I would say, trauma through the body and all traumatic experiences are absorbed, so to speak. By the body. So a wonderful book on trauma. That's very popular now. It's been around for quite some time the body keeps the score by Bessel van der Kolk who's been doing that research for decades. Having started my very early social work in domestic violence and child abuse. I was familiar with FOA and van der Kolk's work for quite a while before I became a therapist. I was a social worker from basically 16 to 27 and then became a therapist around 30. So his Peter Levine, who really developed the whole package of SC observed animals in the wild because it's confusing to think about what animals. Go through on a day to day survival basis, including if you just look at like at a domestic animal like a cat can Freaking out jumping to the ceiling one moment and then on its back in the Sun on the carpet acting like nothing ever happened Literally five seconds later and he was really curious about how that was because that's not how we are We're almost getting a car accident and we're shaking up all day Maybe for three days, and it depends on that window of tolerance for stress. In our own nervous system, it is often based on our own history of different kinds of trauma. So what he did was he really discovered in watching animals and he wrote a wonderful book called an unspoken voice, which describes this in more detail. The animals literally go into a dark corner and shake. Trauma off when it happens, their bodies literally shake, they self groom, they do all sorts of things. And I've noticed that I've been a lifelong animal lover, especially cats. And I've noticed that if a cat feels embarrassed, you'll immediately see it groom itself a little bit. And I interpret that as a little bit of just like shaking off that sense of Oh, I just fell off that table. But don't mind me over here. I'm just kind of like myself and they do physical things. They do compression and stroking and shaking and things that move the energy of that kind of assault of one kind or another through the nervous system. So it doesn't get stuck, but we don't do that for us. Someone says a mean thing. We get a nasty email. We have someone cut us off in traffic. Those are kind of minor things. I wouldn't call them traumas, but the things our nervous system might perceive. If we do have histories of trauma, which is just a part of life, it really is inescapable. You're going to experience some kind of loss throughout the course of your life, if not abuse, unfortunately. And we know that one in three women by the age of 18 will experience sexual abuse or assault. In one in four boys. So our bodies are primed to need to release the energy of these challenging experiences where our brain perceives a threat to our survival, and we can learn a lot from animals by actually shaking on purpose. I use a rebounder, a mini trampoline on a daily basis to move things through my own nervous system. I do a lot of shaking with clients and SC at its core, and you can look at this on YouTube and watch Peter Levine do this. We look at where trauma has gotten stuck in the body in terms of what we call contraction. So when you talk to someone about something difficult for them, they often will physically get small. And I know you can't see me, your listeners, but I'm actually like curling my body forward, like a little hedgehog, we tend to get small and our voice gets really little and it might get high. And when you see and hear a client do that, it's a sign that a contraction is happening. So part of SE is actually about opening through that contraction. So we might have a belief such as I'm powerless, and I would actually have the client, perhaps in this situation, slightly elevate their chin, slightly open their chest, maybe even put their hands out and say, I'm powerless. I'm powerless. I'm powerless. I'm power. Well, That doesn't feel true anymore. You start to say I'm powerless against the contraction. People start to laugh. We open through shame using somatic experiencing. We open through powerlessness using S. E. Techniques. Simple things like doing a butterfly tap and bilaterally tapping your shoulders while breathing in deeply and breathing out long stimulate something called the vagus nerve. That's an S E technique. Lots of things that we do to basically signal to the brain. You are not about to die.

Joni:

Thank you for that education. That was very helpful for me. Seems like I need to learn a little bit more. I recently just heard that term for the first time like two months ago from Leisha Nelson. Do you know

Amy-Rose:

I do. She's a colleague.

Joni:

Okay, yeah. And I was like, I don't actually know what that means at all. And she started explaining it and so this helped a lot. Thank you. What do you feel like you've been involved in policy and education in nonprofits? What do you feel like needs to change if anything in healthcare to reduce the prevalence of traumatic birth?

Amy-Rose:

I'm smiling as you're asking me this question because I want to be really respectful to my colleagues in health care. They have an incredible burden in terms of numbers of patients, the cost of health care, the hours that they work, the intensity. Of what they work with and the system around birth care, health care has so much paternalistic patriarchal conditioning as part of it, meaning power over instead of power together that I feel like That's very fundamental pedagogy and paradigm really has to change because having been a medical social worker who's worked hospital for a couple years, we tend to not have a strength based way of looking at patients and clients in general. We tend to think that we know what's best for them. We know what would be the better choice in emergency or rush situations. To your point, we use a lot of acronyms and fancy language and lingo that we know they don't understand. And I think it's an unconscious way of holding that power over, which no one goes into these spaces intentionally, consciously wanting to do. I don't believe people, you know, most people have power. And it's so institutionalized that it bleeds through the way we communicate to patients. And until we become mindful of that and increase our self awareness of how that looks in patient interactions and we learn things like motivational interviewing, which is a core technique taught in social work, usually Which is about collaborating with the client or patient to increase the likelihood that they'll follow through with the plan that we do think would be best for them and their baby. It's about asking questions like, what do you think of that plan? What are your concerns? How likely are you to do this thing that I'd like you to do? And if it's really unlikely, why is that? And what are the barriers to doing what I'd like you to do? Now in an emergency situation, we might not be able. to explain all that. But we can set the foundation in the relationship that the expectation is, I don't know what's right for you. I have my own opinion and you have a whole story about why you feel the way you do and what you personally need. As a birth trauma survivor myself, I needed to have a lot of agency around my own pain and feeling like I had some options, not just medication. When I had my second child and that I had someone who really understood what I'd been through before. I went to a midwifery practice with a bunch of midwives. It's not all of them could know my personal history. So that's why a doula was so important for me with my second child, even though my husband was very supportive. We need to first understand that piece is just a fundamentally broken area of medicine, in my opinion, and I realize that's offensive to a lot of people and we need to be willing to be offended and get over it because

Joni:

I

Amy-Rose:

we're not going to change anything. If we're protecting our Egos, you know, I gave what I was really proud of in terms of some educational presentations to a bunch of nurses and providers who work with women's health care this summer. And they tentatively had me work with them in hopes of me delivering the same presentation on trauma informed care and obstetrics and prevention of birth trauma, PTSD to their OBGYNs. But after I talked about VBACs being. very correlated with reparative experiences around birth trauma and unplanned C sections being highly correlated to birth trauma. They decided that would be too offensive to the doctors. So they didn't get that education. That happens all the time because that hospital, it's too bad. It's too bad. So that piece has to change. I think we need to normalize mental health as part of healthcare. That has to change. And it is. I'm proud to say that people like you and I have been doing a lot of work to spread the word in health care that we need to educate prenatally and during pregnancy and during experiences around fertility, adoption, miscarriage, abortion, loss, that mental health concerns are very prevalent and there is a way to prevent them to a degree and they can be And very well treated if caught early. So those two things are what I would say. I could talk for hours about my personal opinion about this, but I think people need to have a lot more agency. I guess that's the last thing I would say is if it's normal for patients to have babies because of the physician's schedule, that is not okay. If people are getting planned inductions and cesareans because someone needs to go on vacation at a certain time or they want to go home and be with their family or go to sleep, I understand that, but that is fundamentally disempowering to the patient. We cannot normalize that as being okay. And when a woman is told, Oh, this baby's too big, you'll never be able to birth this baby. Unless there is a very true medical reason why that can be clearly established as true. Those kinds of messages have. Got to stop

Joni:

Yeah, because they bring them up to you later on when they're struggling.

Amy-Rose:

oh my gosh, yeah, well it takes their power away and that's the main thing we see with birth trauma is a feeling of disempowerment and lack of agency and control. Our bodies are meant to do this. Do we need medical intervention from time to time? Absolutely. Is it an incredible gift that we have medicine for emergencies? For sure. It's an incredible blessing. Can most of the time our bodies do this without it? I believe. The answer is yes, and I think when we program women to think that their bodies are a problem, they are not meant to do this. This is a medical condition that is borderline in a crisis and emergency all the time. That sends the signal to the limbic brain that they are in danger, they can't do it, and it fosters a dependency, and I think that really needs to change.

Joni:

I appreciate you sharing all that. I think that's a really. Good way to zoom out on this and talk about a system problem that over time will hopefully change. But it is hard when egos are, egos are hard. I worked as a nurse for a while, so

Amy-Rose:

I take my hat off to you. There's no way I could do it.

Joni:

Yeah, me neither. That's why I'm not doing it anymore.

Amy-Rose:

And if I could add one more thing to that, we need to have culturally appropriate practice. And if a woman comes in and says, in my culture, the first person who touches this baby is sacred. It sets the energy tone for the rest of this person's life, which is true in many indigenous American cultures, or what happens in our culture is that people come in and we perform a blessing in a ceremony in the first 24 hours. And that's very important. If you just have a blanket policy in your hospital or birth clinic that's not allowed, you are being culturally insensitive. And to me, that's unethical practice and you're setting people up for traumatic delivery. Like we need to really think about the language, the culture, the rich history that people come to birthing with and not superimpose the dominant culture, whatever that is in your locale onto patients universally. That's another really important piece I see missing.

Joni:

yeah. Thank you for bringing that up. So many good points. Thank you so much for your time, Amy Rose. This has been fantastic. You just have like a calming voice. I feel so calm. I was a little nervous before. No nerves. So thank you for sharing yourself for the last hour. If someone wants to work with you, how should they contact you?

Amy-Rose:

They can find my number on my website, which is amyrosewhite. com.

Joni:

Awesome. And you have a bit of a wait list right now, but they could get on the wait list and still see you in time.

Amy-Rose:

Yeah, absolutely. And I always refer people to folks that I trust as well. If they need someone immediately, I do have some ancient YouTube videos. I'm getting back to making those this fall. I'm going to try to expand my presence in YouTube land to serve more people. So that might be another option. If you look me up on YouTube, I am there and they're a couple of years old, but I'll be back in that space soon.

Joni:

Oh, that's awesome. Yeah, that's why I do this podcast is because at least it's a free way to get some information, even if it's not the same as having a real conversation with a real person about your specific experience, at least you can start somewhere. So totally get that. And that's cool that you're putting time into that. Okay. Thank you so much. Thanks

Amy-Rose:

Thank you for what you're doing. Thank you for creating space for this important information. I really, really admire you.

Joni:

Amorose. Okay. So I'll be sure to link a lot of things that she mentioned throughout. The podcast episode, like the ACEs quiz, the EPDs, screening questionnaire that might look familiar to you, postpartum.net. The book when survivors give birth, the body keeps the score. And actually her website as well. So if you want to have her be your therapist, you can reach out to her there. And I don't think I have a lot to add personally. I guess the biggest thing, and I've been saying this a lot recently, but if you can leave a review, if you can share a podcast episode that impacted you, that you think may help someone else. If you can subscribe to it. Yeah. Just any way you can help this podcast grow would be so appreciated just because. I want more women to know about it and preferably before they even have children or while they're pregnant so that they can find these resources, but for our hands. So. That's all I got and hope y'all have a great week.

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Joni Lybbert

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