When we hear about trauma, most people think about veterans traumatized by combat experiences. In reality, trauma is a more diverse and pervasive condition. Trauma comes from the Greek word for wound. These invisible wounds result from a highly stressful event or series of events leading to emotional or psychological dysfunction.

Experiencing a traumatic event can significantly impact daily function. A person may even feel like they are “going crazy” rather than responding normally to trauma. For example, one may have nightmares, anger, anxiety, or compulsive behaviors following a traumatic event. Untreated trauma can lead to development of a mental health disorder, such as post-traumatic stress disorder (PTSD), major depressive disorder, or generalized anxiety disorder. Repeated trauma, such as that occurring from ongoing domestic violence or childhood abuse/neglect can lead to a subset of PTSD called complex-PTSD.

Pregnant woman - Five Evidence-based Strategies for Managing Trauma in Pregnancy After Loss Labor and Delivery

Shutterstock/zulufoto

Pregnancy loss is a traumatic event for many people. Many loss parents suffer the aftershocks of trauma, some going on to develop a mental health condition such as PTSD. In one study, researchers found that a third of all women assessed at one month post pregnancy loss and 18% of women nine months post pregnancy loss demonstrated post-traumatic stress.

Trauma resulting from pregnancy loss is a real thing – so what do we do about it?

Below I list five evidence-based strategies for managing distress related to trauma that you can use throughout pregnancy and parenting after loss.

1. Regulated Breathing

Sure, this one might be an obvious one. After all, the internet is awash with articles on reducing stress through deep breathing exercises. However, if the stress is resulting from trauma, deep breathing exercises can make it worse! For instance, one response to pregnancy loss is feeling that one’s body has betrayed them and may therefore not feel safe. Consequently, the act of deep breathing to stay present in the moment by connecting to the body can lead to increased anxiety.

Regulated or grounded breathing works better. This can be as simple is breathing towards something, like the floor, or incorporating movement into breathing. For example, one could intentionally move their shoulders up and down in an exaggerated manner while breathing.

Finger breathing - Five Evidence-based Strategies for Managing Trauma in Pregnancy After Loss Labor and Delivery

In finger breathing, you breathe in while tracing up your finger, and breathe out when coming down the other side – Author’s Personal Collection/Melanie Peffer

One of my favorites that I teach to my oldest son and to my students is finger breathing (see photo). In finger breathing, you trace each of your fingers and take an inhale while tracing up one finger, and exhale on the way down.

Another movement based breathing exercise is called owl breathing (see photo). Owl breathing combines movement, breathing, and scanning the room. This strategy can serve not only as a regulated breathing exercise, but also to tune into one’s surroundings to help foster feelings of safety in a stressful or triggering situation. Like any of these techniques, some may work better than others given your unique experiences.

Owl breathing - Five Evidence-based Strategies for Managing Trauma in Pregnancy After Loss Labor and Delivery

Similar to how an owl rotates their head, owl breathing involves head rotations while take deep breaths – Author’s Personal Collection/Melanie Peffer

2. Micromovements

Related to incorporating deep breathing with movements, intentional small movements can help relieve tension and prevent dissociation.

Body tension and muscle aches are one of the subtle hallmarks of PTSD. Muscle tension alongside hypervigilance and increased startle response all fall under the umbrella of hyperarousal. Small micromovements are useful for diffusing tension. For example, gentle rocking, using a fidget device, or swinging your feet can also help dispel tension and help you feel calmer.

Fidget toys - Five Evidence-based Strategies for Managing Trauma in Pregnancy After Loss Labor and Delivery

There are many different kinds of fidget to choose from – Shutterstock/arweatherly

In addition to decreasing arousal state, micromovements can also help with dissociation. Dissociation is when one disconnects from reality. A sign one is dissociating is if they feel checked out or outside of a situation. Although there are a variety of types of dissociative disorders, people who have experienced trauma may also experience dissociation.

For example, during the delivery of my double rainbow, Jasper, the medical team needed me to put my feet up on a chair to help with positioning for epidural placement. At that point, trauma triggers combined with the pain of Pitocin enhanced contractions resulted in me dissociating. The result was I absolutely could not follow the simple command of moving my feet.

Micromovements or strong physical sensations like drinking ice cold water can help keep someone in the moment. In my case, someone handed me a comb and squeezing the tines against the palm of my hand helped bring me back to the present enough to get my epidural placed.

3. Time orientation

Flashbacks are a common hallmark of PTSD. Note that there are two types of flashbacks. They can be based in the body (a somatic flashback) or emotional flashbacks. Emotional flashbacks are less well known and cause us to re-experience emotions felt during a traumatic event. For example, during Jasper’s delivery, the physical sensation of having my water broken and the release of fluids caused me to revisit the terror and grief of my missed miscarriage that completed at home.

Time orientation can help keep you mentally in the present. The goal is to pick events that will ground you in the present to help you distinguish reality from the past. For example, my delivery team knew to ask me what my name was, my age, where I was and why I was there to help with flashbacks. These questions also helped for managing moments of dissociation as well.

4. Bilateral Stimulation

Eye-Movement Desensitization Reprocessing or EMDR is the front-line treatment for people with PTSD. EMDR was introduced as a treatment modality for the treatment of trauma in 1989. In the context of a therapeutic treatment, the therapist stimulates the left and right side of the brain using hand motions (the ‘eye movement’ piece) or buzzers than the patient holds, one in the left and the other in the right hand. Psychologists theorize that the bilateral stimulation triggers the orienting response. The orienting response causes certain regions of the brain to activate. Ultimately, the orienting response allows the patient to reprocess their trauma in a safe environment. After reprocessing, the trauma memory becomes less destressing.

EMDR is a powerful technique – and the principle of bilateral stimulation is easy to do to yourself or have your partner or doula help with. For example, taking a walk is a form of bilateral stimulation. In fact, a therapist I worked with to process one of my miscarriages offered walking sessions for that exact reason.

Butterfly tapping or the butterfly hug is an easy strategy to use. The butterfly hug was originally developed in the late 1990s to help people impacted by Hurricane Pauline. To do the butterfly hug, you cross your arms over your chest and tap alternating on your left and right sides.

Butterfly hug - Five Evidence-based Strategies for Managing Trauma in Pregnancy After Loss Labor and Delivery

Butterfly tapping or butterfly hugging is an easy way to help stay grounded – Author’s Personal Collection/Melanie Peffer

Something that I find particularly fascinating is that there’s support for butterfly tapping to minimize anxiety from both western and eastern traditions. When tapping, the target region is about an inch below the collarbone. This is the location of two acupuncture points of note, KD26 and Lung 1. KD26 is thought to help with grounding and minimize anxiety and fear. Lung 1 or the window of the sky point helps with emotional release.

You can also buy vibrating tappers that you can wear on your wrists or ankles. These are useful to have on during stressful procedures such as ultrasounds or blood draws to help keep you grounded. Your partner or doula can also tap on your shoulders as well.

One word of caution with bilateral stimulation – the speed and intensity of tapping matters. Fast or harder tapping can cause more stress. There are also potential contraindications for people with, for example, traumatic brain injuries. If you have questions, ask an EMDIRA trained therapist.

5. Grounding

An interesting – and accurate – way to think about anxiety is that it is a form of time traveling. One is worrying about something that happened in the past. Or worrying about the future. Either way, anxiety is the opposite of staying in the present moment.

Research suggestions that mindfulness practices or mindfulness-based stress reduction are effective at reducing anxiety. If you don’t have time to learn to meditate to keep your mind in the present moment, fear not there are other strategies that work too!

One we talked about in #3 above is time orientation. Reminding yourself where you are and why. Another excellent strategy for grounding (and one that is easy to personalize) is to use the five senses. The idea is that you ground yourself in the moment through sensation.

For example, in your delivery bag include one item or strategy related to each of the five senses. For smell, essential oils can help bring you back to the moment. Depending on the oil, they can also help with nausea as well.

For touch, I had a soft and stretchy bamboo blanket that I wrapped around myself during delivery. Swaddling isn’t just for babies, after all! And, stuffed animals aren’t just for kids either. My son’s Jellycat came with me to the hospital as well to help with grounding. Taking a hot shower and feeling the water pour over you is also great for grounding and pain relief.

During Jasper’s delivery, I also had my labor necklace made with beads given to me by well-wishers. I ran my fingers over the beads repeatedly to help stay in the moment.

Birthing Necklace - Five Evidence-based Strategies for Managing Trauma in Pregnancy After Loss Labor and Delivery

My birthing necklace. Note the wide variety of beads. Many were gifts from students and friends – Author’s Personal Collection/Melanie Peffer

I packed a picture of my oldest son, Felix, to use for sight. At one point during Jasper’s birth, I was also watching YouTube videos of the ocean.

Taste is tricky in labor…especially if you’re like me and tend to vomit during active labor. I find mints to be helpful for a strong flavor without eating much.

For hearing, I packed a noise machine. My husband also was the D.J. during Jasper’s delivery. He was under strict instructions to not play Johnny Cash’s Ring of Fire! Reminders of the way crowning feels were the opposite of grounding for me.

At one point when active labor was getting to be too much, I remember singing along with Iron and Wine’s Such Great Heights – a song I incidentally used to sing my oldest to sleep with. That, of course, led to the discussion of whether the Postal Service’s rendition of Such Great Heights is better. My husband and I completely disagree about which version is the best (team Iron and Wine, here!). The point is, the song and singing along helped relax me for a while, helped with pain management, and keep me in the moment instead of worrying about the pain, baby, and how close I was to delivery.

Disclaimer: Please note that I am not a mental health professional nor a physician, and the strategies listed in this article should not be construed as medical advice. This article was written based not only on the research literature, but also on my experiences as a Loss Mom and coping strategies I’ve learned to manage my post-traumatic stress disorder.

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