“In these challenging times,” “we’re all in this together,” “stay at home.” If no one has given you permission to scream or curse from hearing these phrases, allow me to do that. Being exasperated does not diminish the value of these statements that are 1) acknowledging what is happening, 2) normalizing the experience and 3) making a plan to be well – that is all perfectly sound messaging. However, it is also perfectly human to be frustrated, angry, exhausted, triggered, sad, and overwhelmed by this world health crisis.
If you are also pregnant or postpartum, it’s okay to express disappointment that you feel robbed of your planned birth experience, or that you are scared to navigate having a new baby with fewer supports in place due to social distancing, or that it’s terrifying to walk into a hospital where you know so many people are ill and dying.
If you are also one of many people in this world that has experienced trauma or Adverse Childhood Experiences, you may be feeling particularly vulnerable and overcome by this trifecta of events. While many of our healthcare systems have been working to become trauma-informed, this is not yet a universal approach. Trauma-informed care seeks to minimize healthcare’s potentially negative effects on those who have experienced trauma, and to provide opportunities for healing.
Before sharing strategies to minimize trauma and improve health, let’s review some of the information that led to the practice of trauma-informed care. In 1998 the CDC and Kaiser Permanente completed a study on ACES or Adverse Childhood Experiences. The study’s co-lead investigators, Robert Anda and Vincent Felliti interviewed over 17,000 patients about their childhoods to find 10 different types of adverse childhood events including sexual, physical or emotional abuse; neglect, loss of a parent due to death, domestic violence, divorce or incarceration; mental illness in a parent and drug or alcohol abuse by a parent.
Anda and Felliti wanted to find out the effects on long-term health from exposure to these difficult experiences. They created a questionnaire, and any one of these experiences would add one point to a person’s ACE score. Although they were only getting a general sense of the patients’ history, when they analyzed the data, they were astounded at the results. Two out of 10 patients had experienced sexual abuse; three out of 10 had been physically abused.
“Just the sheer scale of the suffering — it was really disturbing to me… I remember being in my study and I wept,” said Anda. Almost two-thirds of the study participants reported at least 1 ACE, and one in five reported 3 or more.
When they looked further at the patients and their adult health, they found significant relationships between ACES scores and “pretty much every one of the major public health problems” that were included for study, he says.
While not everyone with high ACES scores became ill, adults who had ACES scores of 4 or more were twice as likely to have heart disease, compared to people whose ACE score was zero. Women with five or more ACES were at least four times as likely to have depression as those with no ACE points.
How is it that some people overcome these histories, when others have lifelong struggles such as addiction or depression? Dr Bruce Perry, a psychiatrist and neuroscientist specializing in childhood trauma answers this way: “Really it boils down to something pretty simple. And its relationships,” explained Perry. Some type of meaningful relationship, a helping hand, a trusted person can provide the opportunity to mitigate the effects of ACES, according to Dr Perry.
A helping hand. A healing process. It’s more than an opportunity, it’s an imperative. Knowing that 70% of the population has been exposed to something that causes major health problems must move us to action in implementing trauma-informed care throughout our systems of education, healthcare and government. Unfortunately, many systems were either not yet or just getting started with this process when the pandemic arrived, and certainly, for most systems the focus has shifted into crisis mode, possibly putting any strides towards trauma-informed care onto the backburner. Thus, the strategies offered here can hopefully provide some guidance while hospitals, schools and communities are themselves wading through the ordeal of COVID-19.
As adults, learning that past traumatic events may contribute to our current health status can, at first glance, seem disheartening. However, for so many people, hearing this information often affords them some insight into the “why is this happening to me” question, and perhaps more importantly, can start to provide the correct tools for healing. These tools can range from evidence-based therapies to journaling, to, as Perry stated, healthy relationships. The goal is to grow and develop resilience: the ability to positively adapt and thrive within the face of adversity. The more that adults take care of their own trauma responses, the more likely they are to effectively respond to children in a way that fosters resilience.
Some tools to help manage the experience of being pregnant or postpartum during a pandemic from a trauma-informed perspective include:
For babies, toddlers and children, trauma intervention strategies include educating and supporting parents in understanding and coping with trauma. Some evidence-based therapeutic interventions include Attachment and Behavioral Catch-Up (ABC) and Parent-Child Interaction Therapy (PCIT).
Finally, remember that the list above is not meant as a “to do” list, but as helpful suggestions. Pick one, pick three or create your own healthy tools to manage, and feel free to share them in the comments. One thing I can promise from my clinical practice is that the people who engage in finding coping tools and/or treatment are the people who get well. You deserve it.
Lita Simanis, MSW, LCSW, PMH-C is the Coordinator of the Pregnancy & Postpartum Mood & Anxiety Disorder Program at AMITA Health/Alexian Brothers. Here, she developed the first perinatal intensive outpatient program in the state of Illinois that opened its doors in August, 2015.
She is also a Perinatal Crisis Counselor for the NorthShore Mom’s Line, is Secretary on the Board of Directors for Postpartum Support International and a Board Member of the International Marce Society for Perinatal Mental Health. She is the co-coordinator of the Postpartum Depression Illinois Alliance.
Lita started a quarterly Perinatal Mental Health Provider breakfast and is a member of the Illinois Department of Public Health Maternal Mortality Review Committee.