Holding Space for Trauma

Pregnancy, birth, and new parenthood are high-risk times for people to encounter new trauma — or for past trauma to resurface. Those who work with birthing and lactating families must understand how to recognize the signs of trauma and know how to help.

Below, we share advice from Dr. Melody Jackson, GP, IBCLC, the instructor of LER’s course, “When Developmental Trauma & Breastfeeding Collide: Is Breast Still Best?” We’ll cover basic facts, and add some tools to your toolbox for discussing and navigating the complex topic of trauma with the families you serve.

FOUNDATIONAL FACTS
Trauma is a complex topic. But a few key concepts can get you started in understanding how this critical topic may impact your client’s lactation experience.

And while you’re asking, be specific about what you intend to do; “examine your newborn” may mean different things to different people.

Fact 1: Trauma is common. Research shows that trauma impacts a large portion of the population. That’s obviously not good news, but it does help in one way: It can make it easier to talk about. “It should give comfort in talking with a client about these experiences — it isn’t just them. It’s a lot of us,” says Jackson.

Fact 2: There are different types of trauma. Three primary types to be aware of are single incident trauma, multiple incident or repeated trauma, and childhood/developmental trauma (also known as complex trauma).

Fact 3: Developmental trauma has unique effects. Trauma that occurs in childhood can disrupt a person's future attachment experiences, cause loss of ability to differentiate real from perceived threats, and leave them stuck in survival mode. All of this affects relationships and emotional regulation in adulthood — which can lead to big challenges during the transition to new parenthood.

Fact 4: Previous trauma makes new trauma more likely. Unfortunately, when someone has already been exposed to a traumatic event, their risk of experiencing further traumas is substantially higher. This has important implications for birthing parents with past trauma, as their risk of experiencing new trauma during pregnancy, birth, and postpartum are elevated.

Fact 5: Pregnancy, birth, and breastfeeding are high-risk times for new trauma to occur and/or for old trauma to resurface. Whether someone has past trauma or not, the vast physical, emotional, psychological, and social changes during the perinatal period all introduce risks for trauma.

TIPS FOR TALKING ABOUT TRAUMA
When you suspect trauma may be impacting a client’s experience, how do you bring it up? Trauma is a sensitive topic, but you can learn to navigate it with clarity, compassion, and calm. Consider these tips.

Notice the signs. How do you know if trauma might be playing a role in your client’s experience? Jackson has two pieces of advice.

First: Consider it for everyone. Given the widespread nature of trauma and the high-risk nature of the perinatal period, encountering new parents with trauma as a lactation care provider is almost a certainty.

Second: Pay attention when you sense something is going on, but you can’t put your finger on it. You’ve evaluated the situation from every angle and still feel like you’re missing a piece of the puzzle? That’s a key time to consider the possibility that trauma is present.

Choose your words. Making a practice of including trauma-related questions during all initial assessments is one way to gather information without making your client feel singled out or exposed.

“Try something like, ‘We know that many people experience trauma, and that it can make breastfeeding more challenging, so I like to check in with all the parents I see. Is there anything you’d like me to know so that I can help you better?’” Jackson recommends.

Including questions about trauma history on your intake forms is another option to consider.

You don’t need the full story Your client does not need to tell you exactly what happened to them in order for you to support them. Simply knowing that they experienced a traumatic event and acknowledging that it is making breastfeeding and new parenthood challenging is often enough.

Exercise empathy. If a client shares their story, truly validate their experience and honor their trust. Acknowledge what they’ve said, empathize, and open up a discussion if they want to share more. Don’t worry if you don’t know exactly the “right” thing to say, Jackson notes — sometimes a caring, connected silence can be just what the person needs.

Focus on their goals. When breastfeeding is a struggle and trauma is adding to the difficulty, one step is absolutely key: Clarify and honor your client’s breastfeeding goals and focus on those. Trauma can often make a new parent hyper-focused on “doing everything right” and especially worried about “getting it wrong.” One of the most helpful things you can do, says Jackson, is to focus on “good enough parenting.” Urge them to let go of perfectionism. In a parent who is really struggling, that might mean setting a different lactation goal and accepting a middle ground, if that allows them to feel healthy emotionally.

Know when to call in support. What if a client brings up trauma that is out of your depth, or is struggling with a situation that can’t be addressed within the time constraints of a consult? Three steps are key, according to Jackson: Acknowledge their experience, acknowledge your limitations, and connect them with a mental health professional who can help.

A CHANCE FOR HEALING
While it’s true that past trauma can cause unique challenges for a lactating parent, there’s also good news: Lactation can offer an unprecedented opportunity for healing.

The regular doses of oxytocin and bonding can down-regulate the hyperarousal response, reduce cortisol, facilitate sleep, and reduce anger, irritability, and perinatal depression and anxiety.

Perhaps the most incredible part: Research shows that breastfeeding reduces the risk of intergenerational abuse and trauma, helping to break cycles and create a healthier future.

With the right support, “Breastfeeding can be a real moment for improving mum’s reflective capacity and can contribute to her healing,” Jackson says.

With the right information and tools, you can be that support!

READY FOR MORE?
Jackson’s course, “When Developmental Trauma & Breastfeeding Collide: Is Breast Still Best?” is included in our new online conference, “Hope & Healing: Lactation Support in the Context of Trauma.” This two-part conference also includes Trauma Informed Care, a full course on how to care for clients from a trauma-informed perspective.