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A Look at Pregnancy and Birth Trauma and Polyvagal Theory from the Perspective of Prenatal and Perinatal Psychology

by Sally Dear-Healey, CCE(BWI), CD(BWI)

Prenatal and perinatal psychology (PPP) provides a unique and critical awareness of the process of conception, pregnancy, and birth that is lacking from most childbirth education programs, doula trainings, and provider’s educations. One of the main benefits of pre- and perinatal psychology is that it recognizes the need to consider not only the mother and her experience, but also the baby and their experience.

Polyvagal Theory, developed by Stephen Porges (1994) provides us with a dynamic understanding of how and why mammals shift between a calm states that promote intimacy and optimize health, growth, connectedness and restoration to flight, flight, or freeze states, which are normal autonomic nervous system (ANS) responses to threat, fear, and lack of safety. Individuals with a history of trauma are especially vulnerable as their “neural reactions have been retuned towards a defensive bias and they (have) lost the resilience to return to a state of safety” (Porges, S.W. and Dana, D., 2018). The goal of Polyvagal Theory is to keep an individual within their “window of tolerance” in their sympathetic nervous system (SNS) (fight or flight –aggressive defense system) and parasympathetic dorsal vagal complex (DVC) (freeze – passive defense system) and focus on feelings of connection, safety, and orientation to the environment which are part of their parasympathetic ventral vagal complex (VVC), otherwise known as the social engagement system (SNS).

“An estimated 70 percent of adults in the U.S. have experienced a traumatic event at least once in their lives” (https://www.sidran.org). This estimate may be low. According to a Journal of Trauma and Stress article, “Most respondents (89.7%/N = 2,953) reported exposure to at least once DSM-5 Criterion A (trauma) event” (Kilpatrick et al., 2013). Specific to birth, a study investigating the prevalence of Post-Traumatic Stress Disorder (PTSD) following childbirth found that 17.2% of women had symptoms of PTSD following childbirth (Shaban et al, 2013). Again, these statistics may be low as PATTCh (Prevention and Treatment of Traumatic Childbirth) reports “Between 25 and 34 per cent (sic) of women report that their births were traumatic” (http://pattch.org/resource-guide/traumatic-births-and-ptsd-definition-and-statistics).

Returning to pre- and perinatal psychology, Thomas Very, M.D. and David Chamberlain, Ph.D., both pioneers in birth psychology and founders of what is now APPPAH, the Association for Prenatal and Perinatal Psychology and Health, realized “There is a growing body of empirical studies showing significant relationships between birth trauma and a number of specific difficulties; violence, criminal behavior, learning disabilities, epilepsy, hyperactivity and child, alcohol and drug abuse” (Verny, 1981). For mothers and babies birth trauma often results from birth-related difficulties including but not limited to premature and postmature births, breech births, inductions, anesthesia, forceps deliveries, and cesareans. Trauma may also result from a mother’s feeling a lack of safety and support, which is transposed directly to her baby.

This is where Polyvagal Theory provides us with a method of understanding how trauma manifests during conception, pregnancy, and birth and how we can actively create feelings of safety, thereby facilitating increased social engagement, improving bonding and attachment, and increasing the overall short- and long-term health and wellness for mothers and their babies/children.

Polyvagal Theory proposes that cues of safety are an efficient and profound antidote for trauma. According to Porges, “The theory emphasizes that safety is defined by feeling safe and not simply by the removal of threat… and is dependent on three conditions: 1) the autonomic nervous system cannot be in a state that supports defense, 2) the social engagement system needs to be activated to down regulate sympathetic activation and functionally contain the sympathetic nervous system and the dorsal vagal circuit within an optimal range (homeostasis) …; and 3) cues of safety … need to be available and detected via neuroception (2018, p. 62 & 62).

Birth is an intimate event, and according to Porges “Intimacy is a state-dependent behavior.” He goes on to say that “For mammals, immobilization is a vulnerable state” (2018, p. 63). To help women achieve the state of intimacy necessary for conscious conception, pregnancy and birth we need to work with women prior to conception and throughout their pregnancy so that they – and subsequently their babies – are able to regulate and change previously disruptive autonomic states by accessing the social engagement system and ventral vagus so they are not re-activated by previous or current trauma. The social engagement system is recruited through “cues of safety such as a quiet environment, positive and compassionate … interactions, prosodic quality (e.g., melodic intonation) of … vocalizations, and music modulated across frequency bands that overlap with vocal signals of safety… (Porges, 2018, p. 66). In other words attitudes and behaviors, what people say but how they say it, as well as their facial expressions.

The primal perspective is one of the foundations of prenatal and perinatal psychology. As David Chamberlain is often quoted as saying, “Newborn babies have been trying for centuries to convince us that they are, like the rest of us, sensing, feeling, thinking human beings.” To be clear, this research is not meant to induce guilt since parents often get caught up in the type and hype of birth practices that are prevalent at the time and even the normal pressures of life can contribute to a stressful pregnancy or lead to a traumatic birth. Instead, its purpose is to increase awareness and effect changes in policies and procedures that might otherwise cause or contribute to trauma and subsequent short- and long-term harm in mothers and their babies/children. For those that have already been affected, help is available. Play therapy, womb surrounds, craniosacral therapy, birth simulating massage and various other forms of therapy and bodywork have been found to be highly effective. For more information on prenatal and perinatal psychology and polyvagal therapy, as well as opportunities for healing and working with these individuals please go to https://birthpsychology.com.