14 Oct Why do people often feel worse after debriefing a traumatic birth experience?
Debriefing (talking about what has happened) does sometimes work but more often it makes people feel worse. It is the advice that is given most often when someone reaches out for help. I was participating in a thread on forum just the other day where a birth professional was seeking support after a witnessing a traumatic birth and the majority of the replies were a loud and hearty ‘Debrief, debrief and then debrief some more!’ The person who posted the question even said that it was making her feel worse but still the response was to debrief.
I liken our default response to birth trauma with debrief to the way in which most people (except birth professionals) think that we need to give birth lying down. This universal misbelief has come about from years of seeing birth depicted this way (mums laying down and pushing) but we know it is not the easiest or best way to give birth. It’s the same with debriefing we have a universal misbelief that it what we must do and is backed up by well known platitudes such as ‘a problem shared is a problem halved’, ‘ get it off your chest’, ‘let it all out’ and many more.
So why is it that so often people come away feeling more upset?
During a traumatic birth the body’s fight or flight centre, the amygdala, is in over drive. It is shouting for us to act. It wants us to fight, fly or freeze. If we could fight or fly then we would better cope with the wash of adrenalin and catecholamine hormones that rinse through the body. However freeze is the only option available to a labouring woman and because labour is often prolonged this is one of the many features that contributes to the trauma. The amygdala under these conditions (prolonged freeze) becomes imprinted with the trauma and the associated aspects of it. This could be the midwife or consultant in the room, it could be penetration, it could be the hospital or the baby or even the father. All of these associations become inextricably linked to the intense fear that the amygdala is responding to.
Each time these details are remembered the link is strengthened. This is why debrief is not recommended as a treatment for traumatic event on the NICE guidelines. Every re-telling of the event drives the trauma deeper into the neural pathways. Consequently the amygdala remains inflamed and hyper sensitive. This is why those recovering from a traumatic birth often feel worse after a debrief.
At the same time in another part of the brain adjacent to the amygdala, the hippocampus, is deciding what do with all of this super charged information; keep it close by or commit to the long term memory? After a traumatic event the hippocampus doesn’t move the event to the long term memory as it would with any other event but keeps it close by, linked to the amygdala causing the person to continually relive their birth either through flashbacks, intrusive and re-occuring thoughts and dreams. The amygdala remains hyper sensitive causing the person to be jumpy, hyper vigilant, irritable and quick to anger. These symptoms keep a person held to that moment unable to move on, almost stuck in time.
Each debrief strengthens the neural connections and prevents the person from processing their memory and moving forward. Of course it’s not always appropriate to move on but that is the subject for another blog.
So a debrief does nothing to address the neurological injury that has occurred but is like picking the scab off a wound. It prevents healing. It is kind of irresistible though, right? And that’s the problem. We are so used to recommending debriefs and to be fair often people will seem keen to debrief and obviously in those cases their story deserves to be sensitively heard and their feelings to be validated. However if they don’t feel better after a debrief it is important to convey the following information:
- It is completely normal to feel the way that they do given what they have been through. It is the brain’s normal response to trauma.
- Often they will naturally heal and begin to feel better if they are given the opportunity to. Rest, sleep and good nutrition are vital. A plan of self care must be put in place to ensure that healing is given the best chance to naturally occur.
- If a person doesn’t feel better after a month of experiencing PTSD symptoms then treatment is available. Although PTSD symptoms are normal after a traumatic birth they do not need to be accepted long term.
To learn more about the symptoms of PTSD or the effective 3 step Rewind treatment then go to www.traumaticbirthrecovery.com