“I believe that women don’t realize how abuse/trauma can affect their pregnancy, birth and postpartum. I didn’t. Thank goodness I had [doula’s name] with me for my first baby … I may never have gotten over my own rape that had happened years earlier. I thought it was dealt with … it wasn’t, and birth brought it all to the front again. [Baby’s name] was 13 days overdue (from an accurate due date) and I know that it was my subconscious that held him in. No one asked me… I never said anything and it wasn’t until postpartum that the realization came to be.” – email correspondence
I’d like to share a story with you. It’s about how I came to develop a training program that teaches caregivers (doulas, midwives, doctors, social workers) how to support Survivors of Abuse through pregnancy, childbirth, and the transition to parenting. The training is called A Safe Passage.
Several seemingly isolated experiences have informed and led to its development, including my own survivorship and subsequent mothering journey. However, one memory remains particularly vivid as a catalyst to the formal “beginning” of this work.
I‘d been attending births as a doula for years before the intersection of childbearing and abuse really sank into my awareness. Despite taking Penny Simkin’s workshop years prior (When Survivors Give Birth, which focused on the impacts of early childhood sexual abuse on childbearing), it wasn’t until I was confronted with my own double role in one woman’s life that I finally “woke up.”
It was in the context of a domestic violence counseling program. I had worked with pregnant women in this context before, so the notion that a pregnant person could experience abuse wasn’t new. But my awareness of the abuse had always been in my capacity as a counselor/advocate rather than a birth worker. It had not yet dawned on me that these two worlds that I moved between (Birth work and Violence Against Women work), were not as distinct from one another as I had imagined.
I naively believed that my birth work “bliss” balanced out the “heaviness” of my work in the Violence Against Women community. I should mention that prior to this moment I’d attended several introductory and advanced doula trainings offered by all the major “players” in the field. Not once had the topic of supporting pregnant survivors of domestic abuse been touched upon—and remember: at this time, the one topic that did receive some coverage (supporting survivors of childhood sexual abuse) was (and still remains) an “advanced” topic that does not make it into most doula training curricula.
So, here I am sitting in my counseling office. I’m speaking with this new client—we’ll call her Lisa (not her real name), a pregnant woman whose partner has been mandated to attend 16 group sessions for men charged with woman abuse. During these sessions, the participants learn to identify the ways they use power and control in their relationships, how to safety plan, and ways of taking responsibility for their behaviors and abusive choices.
So Lisa is now answering the question I’ve posed regarding sources of support for her during the pregnancy. She answers: “ … I’ve just met with Krista [a doula, not her real name], and I think she’s going to be great – a really good fit”.
My worlds collide.
In that moment it occurred to me that the doula she is referring to is someone I’d arranged to have work, free of charge, with “a woman in need” – a request I had received from the local health unit, as I had many times before through my doula services website. Due to privacy issues, this was the extent of the information I received before making the referral.
With the realization that I was unwittingly playing a double role in Lisa’s life, the illusion of a boundary between birth work and Violence Against Women work evaporated, and the limits of my birth worker skill-set became obvious—as did those of my doula colleagues.
A wave of panic washed over me. The doula, we’ll call her Krista, I had arranged for Lisa was inexperienced, a novice, fresh from her weekend training course (still to this day the predominant model through which most prospective doulas will receive their training). I felt strongly this doula would not be prepared, and having reviewed the court records I was given as the assigned counselor, I knew Lisa needed something that would exceed having a caring and compassionate person to attend her birth.
Krista, like any doula, would have received introductory information enabling her to attend births in a non-clinical capacity. Although this would be helpful to some degree, Lisa would really benefit from someone who could understand so much more: how abuse impacts the experience of pregnancy and childbirth; how abuse comes to shape the way one sees oneself in the world; and how it often erodes women’s abilities to see their own capacities, their self-worth, and their right to be treated with dignity and respect.
I felt strongly that this pregnant client would need someone who could not only “hold space” for the emergent and unscripted nature of birth, but also handle the unanticipated and sometimes very scary dynamics of working as a care-provider in an environment of woman abuse. A doula who would know how to become as “big” or as “small” as the woman needed (as my dear friend Christy Hall would say), in what could become an unsafe space within moments. A skilled advocate, someone who could assist her to navigate what might be coming up for her as a pregnant person experiencing abuse. For instance, the possible involvement of child protection and the court process, and the grief that can arise from being unable to experience the transition to mothering in the way one might have imagined.
Lisa needed her doula to be someone who could understand what it might feel like to so desperately want to experience all the “normal” parts of becoming pregnant and planning for motherhood, while on the other hand coping with the deep seated fears that nothing was going to change – the abuse was not going to stop once the baby arrived.
This collision between my work as an abuse counselor and my work as a birth worker who had indirectly referred a “woman in need” to an inexperienced doula, is what changed everything for me, laying the foundation for A Safe Passage.
Founded in 2004, A Safe Passage has provided information via workshops, public speaking engagements, and private consultation to more than 1500 care providers around the world looking for information and training to better meet the needs of survivors of abuse in their care. From South Africa to the Arctic, from birth attendants in incarcerated settings to midwifery education training programs and Public Health Units, the training provided to workshop participants is grounded within the strongly held belief that everyone in the childbearing year, regardless of circumstance, has the right to trauma informed care.
Trauma informed care is:
… a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma… that emphasizes physical, psychological, and emotional safety for both providers and survivors… and, that creates opportunities for survivors to rebuild a sense of control and empowerment.
– Hopper, Bassuk & Olivet, 2010, p. 82
Advocating for a trauma informed approach recognizes that not all care providers are in a position to routinely screen for violence in the lives of clients; however all people attending to any experience related to reproduction can become trauma informed.
Practicing from a trauma informed lens allows us to appreciate not only the impact trauma can have on pregnant survivors’ lives, but to see strength and resilience where others see deficits. It helps us recognize the difference between facilitating healthier options and holding people individually responsible for what is a collective responsibility to nurture safer communities. It leads us to focus our attention on working to widen the path of possibilities—so that pregnant survivors, regardless of circumstance, may be treated with dignity and respect in their transition to parenting.*
During two full days of training, we begin by unpacking the assumptions we bring to our work with pregnant people which may inadvertently be creating hurt. For instance, a commonly held belief about abuse is that “once you know better, you do better.” This notion (myth) becomes particularly heightened when working with pregnant people, as the health of the developing fetus is often given priority over responding appropriately and humanely to the pregnant person.
Here is what past participants have had to say:
“Those of us lucky enough to have attended one of Jodi’s workshops know that she brings a calm and grounded presence. Her heartfelt and genuine way of sharing her wealth of knowledge about caring for people who have experienced trauma engages everyone in a thought-provoking way. Jodi’s work changes you, personally and professionally, at a deep level, provoking a new way of thinking when interacting with all clients. As a Public Health Nurse with a reproductive health focus, attending Jodi’s workshops has fundamentally challenged how I think about and interact with my clients, community partners and in my broader advocacy work. Her workshops would be valuable to anyone that works in public health. The capacity to supportively work with people who have experienced trauma is one of the most fundamental and important skills necessary for effectively caring for people who are undertaking ‘the unrelenting work of just trying to survive’.”
– Deanna Stirling, B.Sc.N, R.N., PHN Middlesex-London Health Unit
“Because I attended ‘A Safe Passage,’ I have been able to check my own behaviour and birth bias. If it wasn’t for ‘A Safe Passage’ I would still be enveloped in the hegemony of the ‘natural birth’ culture/movement. I am especially thankful of this because it allows me to be truly objective but yet connected to my client’s birth experience. I am now truly a Full-Spectrum Doula because of this experience and I am so very, very thankful as I am now able to experience the full spectrum of birth.”
– Erich Otten, certified Perinatal Support Practitioner, Full Spectrum Doula The Doula Dude
“I was profoundly affected by the aspects of A Safe Passage that brought me into touch with my own preconceived notions and judgments about abuse, addiction etc. Those raw, uncomfortable aspects of the workshops left me more able to accept situations as they are. More able to meet women where they are. More able to understand the link between abuse and substance use etc. It was humbling and left me questioning how I was supporting women during the perinatal time. That theme is crucial to the workshop in my opinion. The self-examination portion. It changed how I practice.”
– Sarah Baughman – CD(DONA), CPD(CAPPA) Expectations Certified Doula Services
We begin with ourselves, because our birth practices are an extension of our own values, beliefs and experiences. We then walk slowly through the possible ways childhood sexual abuse, sexual violence, and domestic violence shape the conceptional and reproductive experiences. We adopt the lens of trauma to consider the way “informed choice” is problematized. We explore how to establish and maintain necessary boundaries, how to nurture safer spaces for disclosure, how to implement safety planning for clients and for ourselves, and how to manage our own vicarious trauma.
The impact of abuse on the transition to parenting should not be considered an “optional,” “special,” or “continuing education” topic—although it is generally treated as such. This gap in most foundational training programs is a gross injustice. Not only are the impacts of abuse on the lives of pregnant people missing from our practice base, but so too is a deep and genuine understanding of how survivors of abuse negotiate the transition to parenting against the odds. We also thereby lack an understanding of the wide range of “normal” responses to the fantastically unimaginable situations of pain, betrayal and terror our clients have endured.
Furthermore, we miss opportunities to learn how to keep ourselves safer in our relationships with clients, what to watch for, signs that risk is escalating, and ways to advocate that amplify, not replace, the voice of the pregnant survivor.
In closing, I would like to honor each and every person who has nurtured me to become a better birth worker and advocate. It’s your strength and our stories that I bring into learning spaces with others. I hold dearly the patience and willingness to continue to dialogue, so we may all learn and grow together in our understanding of what makes safe(r) spaces possible in the lives of those who have survived. A special thank you to my local birth worker community, Without Distinction. You’re remarkable humans.
Share your knowledge #traumainformedbirth
*Not all survivors who become pregnant will carry a pregnancy to term. I respect each individual’s right to make choices that are best for their current circumstances, including the choice to not become pregnant, or to continue to carry a pregnancy.
Jodi has a PhD in Health and Rehabilitation Sciences – Health Professional Education from The University of Western Ontario. Jodi worked as a DONA certified doula and childbirth educator for 10 years, with a focus on the intersections between trauma histories and the experiences during the childbearing years. Jodi was employed in both residential and clinical settings as a full-time woman abuse counsellor, providing counselling to individuals who have been abused, as well as facilitating groups for women whose children have been exposed to their abuse.
Jodi’s unique combination of skills from both the birthing community and the Violence Against Women sector has spurred a high demand internationally for her workshops aimed at informing other medical and allied health and social service professionals around the complex issue of trauma and the childbearing years. She was featured on CBC’s radio program UpNorth, discussing Mental Health and Pregnancy.
Jodi resides with her family in London, where she co-runs a private counseling practice with Amanda Saunders, MSW, RSW and Holly Gibson, MSW, RSW, who are also skilled birth workers, called Sharing Spaces.