“In these challenging times,” “we’re all in this together,” “stay at home.” If no one has given you permission to scream from hearing these phrases, allow me to do that. Being exasperated does not diminish the value of these statements that are 1) acknowledging what is happening, 2) normalizing the experience and 3) making a plan to be well – that is all perfectly sound messaging. However, it is also perfectly human to be frustrated, angry, exhausted, triggered, sad, and overwhelmed by this world health crisis.
If you are also pregnant or postpartum, it’s okay to express disappointment that you feel robbed of your planned birth experience, or that you are scared to navigate having a new baby with fewer supports in place due to social distancing, or that it’s terrifying to walk into a hospital where you know so many people are ill and dying.
If you are also one of many people in this world that has experienced trauma or Adverse Childhood Experiences, you may be feeling particularly vulnerable and overcome by this trifecta of events. While many of our healthcare systems have been working to become trauma-informed, this is not yet a universal approach. Trauma-informed care seeks to minimize healthcare’s potentially negative effects on those who have experienced trauma, and to provide opportunities for healing.
Before sharing strategies to minimize trauma and improve health, let’s review some of the information that led to the practice of trauma-informed care. In 1998 the CDC and Kaiser Permanente completed a study on ACES or Adverse Childhood Experiences. The study’s co-lead investigators, Robert Anda and Vincent Felliti interviewed over 17,000 patients about their childhoods to find 10 different types of adverse childhood events including sexual, physical or emotional abuse; neglect, loss of a parent due to death, domestic violence, divorce or incarceration; mental illness in a parent and drug or alcohol abuse by a parent.
Anda and Felliti wanted to find out the effects on long-term health from exposure to these difficult experiences. They created a questionnaire, and any one of these experiences would add one point to a person’s ACE score. Although they were only getting a general sense of the patients’ history, when they analyzed the data, they were astounded at the results. Two out of 10 patients had experienced sexual abuse; three out of 10 had been physically abused.
“Just the sheer scale of the suffering — it was really disturbing to me… I remember being in my study and I wept,” said Anda. Almost two-thirds of the study participants reported at least 1 ACE, and one in five reported 3 or more.
When they looked further at the patients and their adult health, they found significant relationships between ACES scores and “pretty much every one of the major public health problems” that were included for study, he says.
While not everyone with high ACES scores became ill, adults who had ACES scores of 4 or more were twice as likely to have heart disease, compared to people whose ACE score was zero. Women with five or more ACES were at least four times as likely to have depression as those with no ACE points.
How is it that some people overcome these histories, when others have lifelong struggles such as addiction or depression? Dr Bruce Perry, a psychiatrist and neuroscientist specializing in childhood trauma answers this way: “Really it boils down to something pretty simple. And its relationships,” explained Perry. Some type of meaningful relationship, a helping hand, a trusted person can provide the opportunity to mitigate the effects of ACES, according to Dr Perry.
A helping hand. A healing process. It’s more than an opportunity, it’s an imperative. Knowing that 70% of the population has been exposed to something that causes major health problems must move us to action in implementing trauma-informed care throughout our systems of education, healthcare and government. Unfortunately, many systems were either not yet or just getting started with this process when the pandemic arrived, and certainly, for most systems the focus has shifted into crisis mode, possibly putting any strides towards trauma-informed care onto the backburner. Thus, the strategies offered here can hopefully provide some guidance while hospitals, schools and communities are themselves wading through the ordeal of COVID-19.
As adults, learning that past traumatic events may contribute to our current health status can, at first glance, seem disheartening. However, for so many people, hearing this information often affords them some insight into the “why is this happening to me” question, and perhaps more importantly, can start to provide the correct tools for healing. These tools can range from evidence-based therapies to journaling, to, as Perry stated, healthy relationships. The goal is to grow and develop resilience: the ability to positively adapt and thrive within the face of adversity. The more that adults take care of their own trauma responses, the more likely they are to effectively respond to children in a way that fosters resilience.
Some tools to help manage the experience of being pregnant or postpartum during a pandemic from a trauma-informed perspective include:
- Acknowledge: First, recognize what is happening and how you feel. As we say in the mental health field, don’t “Should” all over yourself: meaning don’t say “I should be stronger” or “I shouldn’t feel this way.” Allow feelings to exist without judgement by naming them.
Acknowledgment may include accepting that you have had a traumatic experience or experiences.
- Build healthy relationships: stay connected to those people who support and understand you, including those who are living a shared experience. If you are looking for a support group, try Postpartum Support International’s Virtual Online Support meetings that take place weekly and are also offered for specific populations like military families and NICU parents.
- Commit yourself to doing one meaningful or important task each day. This is not meant to be overwhelming or burdensome, but to provide a sense of purpose. For example: e-mail a teacher you know to thank them for what they have meant to you or to a child; change your toothbrush, schedule an overdue appointment for yourself or a loved one.
- Develop a set of coping tools that truly relax YOU. Yoga is wonderful, but if it’s not for you, that’s okay – try knitting, Tai Chi, progressive muscle relaxation, meditation, Qi Gong, prayer, listening to music, walking in nature, sitting in nature, massage, guided imagery, a bath, a cup of (decaf) tea. For those who have experienced trauma, understand that being quiet and still may feel odd or even jarring to a nervous system that is used to being in flight, fight or freeze mode. Be patient with yourself as you try out different calming tools, and consider these grounding techniques if you tend to dissociate, or feel like you are leaving your body.
- Exercise: Move in a way that allows you to feel good in your body.
- Fun: Find activities that you enjoy and look forward to, and can use as a healthy distraction when needed such as watching movies, sudoku or painting.
- Gratitude: studies show that nurturing gratitude increases happiness and offers a host of health and psychological benefits. One simple way to develop more gratitude is to list or journal about something that you are grateful for each day.
- Help: If you notice that you are not feeling like yourself consistently for more than a week or two, or if you feel like it’s difficult to make it through the day, talk to your healthcare provider or contact PSI’s Helpline to get a referral for professional support. Some evidence-based treatment options include Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and EMDR (Eye Movement Desensitization and Reprocessing).
For babies, toddlers and children, trauma intervention strategies include educating and supporting parents in understanding and coping with trauma. Some evidence-based therapeutic interventions include Attachment and Behavioral Catch-Up (ABC) and Parent-Child Interaction Therapy (PCIT).
Finally, remember that the list above is not meant as a “to do” list, but as helpful suggestions. Pick one, pick three or create your own healthy tools to manage, and feel free to share them in the comments. One thing I can promise from my clinical practice is that the people who engage in finding coping tools and/or treatment are the people who get well. You deserve it.
Lita Simanis, MSW, LCSW, PMH-C is the Coordinator of the Pregnancy & Postpartum Mood & Anxiety Disorder Program at AMITA Health/Alexian Brothers. Here, she developed the first perinatal intensive outpatient program in the state of Illinois that opened its doors in August, 2015.
Reprinted from PSI: Postpartum Support International