Impactful: A Conversation About Trauma-Informed Care with Therapist Sarah Adelmann

In this week's episode, therapist Sarah Adelmann of Resilient Birth shares guidelines about how to mindfully choose our words as part of giving trauma-informed care to survivors of trauma and abuse. Learn more about Resilient Birth at https://www.resilientbirth.com/ TRANSCRIPT: Sara P.: Sarah is an advocate, counselor and educator whose focus is on supporting those with grief and trauma. She specializes in working with survivors of sexual and intimate partner violence in the perinatal period. Sarah has an MA in counseling psychology from Boston College, and a certification in traumatic stress studies from the Justice Resource Institute. She co-founded Resilient Birth, which provides strength-based and trauma-informed care and education for birthing people and providers. Sarah, welcome.   Sarah A: Thank you so much for having me, Sara.   Sara P.: I'm looking forward to chatting with you. And so will you just start by introducing yourself to our listeners? What is your background with birth work and how did you get involved?   Sarah A.: My experience postpartum, actually, is what led me into birth work. And I was an educator and a mental health counselor, but was completely caught off guard by the postpartum period with my first child. There's no support, no check-ins. And I was basically on my own trying to figure things out. And trying to figure out how to take care of a newborn after having a C-section. And I was so sure that as a mental health counselor, I would be able to see the signs, or if I was struggling, advocate for myself, as I did tell my clients to do, but that is not how my experience went at all. And looking back, I realized I was suffering from postpartum anxiety. But I didn't realize how debilitating that was. Until this distinct moment that stands out to me, where this like shift happened, which then sent me on this trajectory of birth work. I was lying in bed and, you know, another sleepless night of a newborn, which I know many birthing people and parents have experienced, and I just wanted to sleep. And I thought at this point that I actually might die if I didn't get sleep. And then the very next thought that was in my head was like, but if you were dead, you'd be sleeping. So. And that's when I had a pausing moment. And I realized that what I was experiencing wasn't normal. And that I needed to take that step back and find the care and support for myself. And I had no intention of wanting to leave my child or leave my family. And I feel like it was my mind’s way of reminding me that I existed, and that I mattered. And that was my catalyst where I saw my own counseling and I saw my own support. And before I had given birth and became a mother, my counseling work was centered around trauma and grief, and I particularly work supporting survivors of violence in my counseling practice. And after this experience, my counseling work shifted to perinatal mental health and wanting to be that advocate, and that supporter that my counselor was to me, and give them a healthy mind and a healthy body and a healthy spirit as they went into this journey. And then I had the blessing of meeting Justine Leach. And she and I came together to create Resilient Birth, which then mirrored both my passions of trauma and grief and supporting survivors with this new identity of being a mom. And our work centers around how do we support survivors who are in birth, pregnancy, postpartum, or anybody who's experienced a trauma in their past lives, because we all have stories, and they all come out to play in this incredible shift that we experience when we give birth. And this company supports people in finding what they need, learning what they might need and learning how the stories may come up in birth. And we also work with providers, and how do you help people who are coming in with stories and give them the most healing, best ideal birth that you can, by being more trauma-informed, and coming at it from the strength-based model. So that's how I got to this work, was through my own needing of healing.   Sara P.: I think… I just love the beauty of your story. Because as you tell it, I can just feel your heart just reaching out to all of these survivors and those who have experienced trauma and new parents trying to figure this all out. And I just love the work that you do and what you do with Justine, having been at your session at the conference, at Evidence Based Birth, and then following you on social Media, I know that you both are just like these huge-hearted women that reach out to people that really have a need for that huge heart to just wrap around them. So I'm so grateful for the work that you're doing and that I get to talk with you tonight about it.   Sarah A.: And thank you for your kind words, it makes my heart feel so full. Because this work is so valuable. You provide this gift of bringing this knowledge like why our words and our language are powerful. So I'm like blessed to be out here to like, express my passion through your work.   Sara P.: Well, awesome. Let's talk about that. So you told us in your background, that you're really passionate about helping birth professionals be informed about caring for birthgivers in a way that is sensitive to the trauma they've faced. You're passionate about supporting parents through that journey as well. Talk to us about why being conscientious about our language is so important in that space.   Sarah A.: Being thoughtful and conscious about the language you're using is just so vitally important to survivors. Research is showing us that the care provider relationship is so impactful for what the birthing person walks away with in the experience of their birth, more so than medical interventions, or what type of birth, the relationship with a provider has the greatest impact on whether or not the person experiences their birth as traumatic. And that's really powerful that these relationships are that important. Survivors who had experienced a traumatic birth as a result of a fractured care provider relationship, describe their birth experience as feeling disconnected, helpless and isolated in their birth, which are really haunting feelings to have because that mirrors a lot of what they've experienced in their trauma. And here now they're coming up again in this birth experience. Probably unexpected. And another big predictor of whether or not birthing person may experience postpartum depression, anxiety or postpartum PTSD is again this, this care provider relationship. And communication is such a huge part of this relationship and the safety of survivors in their experience. I'm gonna be a little vulnerable here and share a bit about my own birth because I think it's a good example of the power of language to both rupture and to both also heal all in the same moment.   I was… I am a survivor myself, and so I brought into my birth anxiety and was blessed with a very easy pregnancy and seemed to be journey down to like the ideal birth center birth you know, that I was looking for. It came in hot on Christmas day thinking I was about to give birth and I had to do a stress test and they noticed that my son had decelerations. And so I was transferred across the road to the hospital. So already my birth had shifted, but I was fine. I just want to be monitored and all that kind of stuff. But the decelerations became greater and his heart rate got lower, and at one point in my birth, we lost his heartbeat all together. And I remember this nurse just coming barreling into the room full of panic and full of anxiety. And I just started to then panic myself, because if she was that scared, and overwhelmed, something must be really wrong. And I remember her moving my body all around, manipulating me trying to find his heartbeat again. And we did we found it on all fours, and it was a blessing to hear this again. But no sooner did we find it, than she asked me to lay back down in my back. And in my head, I'm thinking, I just found my son's heartbeat. I lost it when I was on my back. There's no way that I'm going back on my back right now. And so I, with all I can, you know, muster, I just say “no,” like loudly like, “no.” And she again repeats me, “I want you to lie down on your back, it's the safe… it's the best way we can hear the baby's heartbeat.” And I couldn't voice anything really. After that moment, I was just taken aback. And she started to move me to that position. And here I was, in another moment in my life where someone has dishonored my voice, not listening to my choice or what I want to do with my body, and it's bringing me back to a place where I did not want to have that come into my birth space. And as a survivor, I don't do well with confrontation or conflict. And so the best thing that I've learned to keep me safe is to comply. So I was ready to comply with her ask. The beauty of the story is that I didn't have to comply, because there was another voice in that room. And it was through my midwife Karen's voice, where I regained my birth. She put her hand on my back and said, I believe she just said, No. And then she looked down at me and got at my level, because I'm looking down at the bed because I don't want to make eye contact with someone. Now that there is this contentiousness in the room. So I'm just looking at the bed, just blank white sheet. And she gets down next to me. She's like, “Sarah, would you like to stay in this position? Would that make you feel better?” And I just whispered, “Yes.” And I nodded my head. And she said, “okay, you stay here as long as you are comfortable, and you can move to another position, if you feel necessary, when you're comfortable to do so.” And that restatement of what I wanted, gave me back control of my birth. And it was in that position on all fours that I remember speaking to my son and saying to him, “Are you ready to come now?” And I said, “is a C-section going to be what is the best birth for you?” And we connected in this moment. And I knew, and he knew, and I knew that this was our journey. This was our ideal birth. This is what was meant to be. But because she gave me the path, and she gave me the time to reflect and find out what I really needed, that I had my choice and my agency back. So when I look back on my birth of my son, it's a beautiful one, because that was what our journey was meant to be on. But it was all by giving the gift of communication. When someone honored my words, spoken again, and then followed through with my request, her communication repaired a birth that I've got could have gone very differently. I'll be forever grateful for her gift. She's my angel. I tell her, like, you are my angel.   So I just, I want to share that because that's why I'm… Language is important words can rupture a relationship, but they can also heal. And coming at our communication from on the more trauma-informed approach, we can reduce the risk of re-traumatization of someone else. And we also have a chance to show someone what a healing relationship with communication can look like. Because sometimes you're working with a survivor who's never had someone who communicates with them in a healthy way, who honors their voice, who listens to them, and they can provide that to them. Providers can give them the gift of healing through this trauma-informed communication approach that they would love survivors to take on and as part of their practice, because I think giving survivors agency and their birth and pregnancy postpartum is going to give them the best mental health, overall health and well-being while they transition into the most impactful journey that they're ever going to go on, I believe, in their life.   Sara P.: Thank you. Thank you so much. For being vulnerable and sharing your story, because I think that it will benefit many people. And thank you for sharing it. That was beautiful. So, yeah, so given your feelings you expressed so beautifully about providers, giving that space and honoring with their words, the choice of survivors and the experiences and the voice of survivors, what guidelines would you give for birth professionals working in that space about how to make sure their language honors the choice and the voice of survivors?   Sarah A.: This is a tough question because there's so much that people can do to shift their language, have language that is healing and holds space. And so I wanted to… I just came up with three things… three takeaways that someone could do and implement like tomorrow, if they wanted to, that would have a dramatic shift. And then, if anyone's interested or more, we can connect on that later. But I want someone to walk away with something practical, I guess.   And time and time again, I've heard from working with survivors, how important eye contact can be in a relationship of the care provider. So not looking down at your paper, taking notes, not typing on your computer, while they're answering, having eye contact with them. And there are different reasons why this is so important to them. It helps them know that they're being heard, which is very important, because their voices have been not honored. And so knowing that you're, you're there, and you're present, and you're hearing them is very important. It lets them know that you are engaged because when you're typing or when something else is happening, they're wondering, “have you missed part of my story? Are you really listening?” You know, what… “are they thinking about the next question?” But if you're making that eye contact, they know that you're engaged. But most importantly, eye contact gives them a sense of safety. If you're looking at them, they can read your body language, they can read your facial expressions, they can predict how you might be thinking or feeling, which gives them a feeling of safety. Because then they can have… they can read the situation and tell if it's an emotionally safe one or not. And if they should keep sharing, or not. So that's one of the gifts this eye contact gives them is the ability to like read the other person and understand, Can I still continue to talk about this? Or do I need to shut it down? So that’s one simple shift.   Sara P.: Yeah… communication is so much more than just the words, right? The gestures and the body language and the interpersonal contact.   Sarah A.: Totally, and I think we forget how powerful that nonverbal is. And even if eye contact doesn't feel comfortable to the provider, because—I get it. I'm a clinician and I, you know, don't always feel comfortable, like looking directly or staring at my client, especially when they're staring something emotional, you know—but it's still having that open body language towards them. You know, even if you like, look off for a moment or that sort of thing, just creating that openness with your body that you're listening, you're hearing, you're honoring them. Another simple thing that I think practitioners can implement in their practice is do a brief paraphrase of what is being said after someone finishes sharing, reflecting that back to them and then saying, “is that correct? Is that what you're sharing with me?” And then also asking, “Is there anything else you want to share?” And the reason why this is so important for survivors is that when emotions are triggered, as a result of the trauma, their language shuts down, that part of their brain shuts down. And so they are feeling emotively, they may not be able to find the words in that moment to be able to express their thoughts and feelings fully. So if you give them that chance to rethink, “Is that really what I wanted to say?” that disconnects that from them emotion for a bit, which gives their brain a chance to process and pull back out that language that has been shut off potentially by their trauma experience. I mean, that… there's a clear example of that in my own story that I just shared earlier.   So giving them that break, giving them that chance, but also why this check in of “Is there anything else there? Is that correct?” is so important is because of the power dynamic that in a relationship between a care provider and a survivor. Survivors often want to be the best patient, the good patient, and they might be scared to bring up something that they forgot to say earlier or something that they didn't agree with their, with their providers, if they think something differently. Because of that dynamic, they may worry what that disruption might mean for them. And the number one thing that disruption might mean for them is the chance of reduced safety for their baby or for themselves. So they're more likely going to comply or not voice themselves again, unless it is modeled by the provider by asking for that feedback from them, and giving them that chance to reflect, because that teaches them that their provider honors their feedback, wants to hear it, and appreciates it. So that simple paraphrasing and check-in gives the gifts that they can be this safety in that relationship with them. And one of the other one that I want to share is how information can be really helpful to survivors: it can help them know what to expect--what's gonna come next. And a story I want to share just one more story about An experience of survivor had she, this was not her first pregnancy. And so she's going in for dating ultrasound, to just look at baby heartbeat and that sort of thing. But she also had had previous c-section. So she didn't understand how that might have impacted her ultrasound. And so she's getting the ultrasound and the technician is pushing really hard, and it's causing her pain because it's right on top of her scarring. And she's sitting there in pain. And she's like, well, I don't know if I can say something because they're probably not intending to cause any pain and they might be needing to do this. I'm going to sit here and take it. And as she sat there, she just is processing with pain. And its pain that she had no control over. And she said it was pain that was being inflicted on her by another person. And she found herself being dragged back into her past her pain had been lifted on her before by a partner. And she remembers that the first time she heard her being heartbeat now meshed with this other memory, one that she never wanted to be brought into the room.   Sarah A: And when given a chance to reflect on this moment, later on, she realized all this could have shifted. If the clinician that had said to her, “Because of your previous c-section, there might be scarring that's harder to get through. So we might have to push a little harder. And if it's painful, you can let me know. And we can stop. We can take a break. But I just wanted to make you aware that this may be what you experienced as a result of your previous surgery.” That would have shifted that moment. And she said, if the if the technician had done that, she would have been able to hear her son's heartbeat, without the ghost of her past being brought into the space. A simple gift of communicating what could be the experience and giving her information, but then also giving her the choice on whether or not she could say to stop or to continue” or “Can you take a break?” That could have shifted her whole experiencing that ultrasound? Simple things we can do.   Sara P.: Right? Yes. I love the guidelines that you gave. They're simple, but so powerful. So thank you for sharing them. Well, let's ask the final question. If you had to summarize your feelings on this topic in just one word, what word would it be?   Sarah A.: This was the hardest thing ever. The word I came up with was impactful. Impactful, language is impactful.   Sara P.: Yeah. Especially in the space that were we've been talking about. I really so appreciate, Sarah, you taking the time to share your experiences and your perspectives and your expertise. And I know that our listeners will really benefit from the things that you shared tonight. And I really, like I said at the beginning, so appreciate the heart-driven work that you're doing. And thank you so much for joining me.   Sarah A.: It was a great pleasure. Really honored to. Thank you so much.   Sara P.: I'm so happy to have you. How can our listeners connect with you online on social media?   Sarah A.: Yeah, they can. First, check out our website at resilientbirth.com, if they want to learn more about services and what we can provide to both providers across the country. Or if you have any survivors you're working with, just someone to talk to. They can also follow @resilient.birth on Instagram, and on Facebook (Resilient Birth). And we also have just recently created a private Facebook group called Trauma-Informed Perinatal Professionals. And this is where we dive deep into topics around trauma and birth and postpartum. And it's really a community where members can ask questions, share their own stories, and impart their own wisdom and a community where we collectively come together. The similar mission of helping people have the birth that they want, no matter what their story is.   Sara P.: Yeah, that's a beautiful community. I always appreciate your posts. there and being part of it. Thank you. Thank you again for joining me. I hope you have a great night.   Sarah A.: All right, you too. Take care.   Thank you for joining us on today's episode. As we wrap up, I want to remind you head over to birth words calm. Check out the Classes tab. I now have on there, the recorded webinar that I did for the Evidence Based Birth Virtual Experience following the conference. And that is available now there on the website for you for purchase. Use the promo code PODCAST for 15% off. so head on over there and check it out: birthwords.com/classes   Did words play an important role in your birth experience? If you're interested in sharing your story on the podcast, go to www.birthwords.com. If you're liking what you hear on the podcast, please leave a review on your podcast app. For more resources about harnessing the power of words. to benefit the birth experience, visit birthwords.com   Transcribed by https://otter.ai