Tuesday, November 12, 2013

Birth Trauma May Be Subtle, But Addressing It Can Be Powerful

Our girl - two days old.
So much I didn't know back then.   
Without having given it all that much thought, when I heard the term "birth trauma" I had always assumed it always meant something such as when birth had to be induced prematurely because of an umbilical cord wrapped around the baby's neck, or  where the baby struggled to get through the birth canal but then had to be pulled back up for a c-section. To me, I pictured birth trauma as...well...really traumatic. What I hadn't fully considered, until recently, is how traumatic birth can be for some babies, even without additional complications.  

Given that I was carrying twins, I would say that their birth was essentially uneventful except that our daughter was born an hour and 10 minutes after our son. Most people react to this with the realization that 1) I didn't have a c-section with twins and 2) that I had to wait an hour and 10 minutes to push out the second baby. There was nothing wrong, the doctor had said to us, the second baby just wasn't ready to move down yet. So we waited. I think I passed out because I don't really remember that hour. I have always told this story with the punchline being that once our son came out, our daughter realized how much room there was and didn't want to leave. "She was doing things in her own way, on her own schedule...just like always" I would say, laughing. 

But, maybe I had that wrong.

I find all of Peter Levine's work immensely
inspiring. Check out his site here
As Peter Levine and Maggie Klein show in their groundbreaking book Trauma Through a Child's Eyes,
"...trauma resides not in the external event but in how the child's nervous system processes that event. Based on Dr. Levine's decades of pioneering work, they make clear that it's in the storage and freezing of unresolved emotions triggered by adverse events that create the long-term negative impact."
The event doesn't need to fit into our idea of what is traumatic. It can be as simple as falling off a bike, or having someone laugh at something you said. What matters is the way your child processes it and then copes with it.

Our daughter has had issues separating from me for a number of years. Not just your average separation anxiety, but behavior that had me seriously stressed out for her. She would clutch at me and wail when I left her at preschool (even with teachers and children she had known for years). She would do the same when I stayed home and her father was taking the kids out for the afternoon. Bedtime could be an enormously long, drawn out affair. Basically, it was becoming a nightmare - as much for her as it was for us. 

When things are good, there is so much love between them.
On top of this, although she loved her twin brother dearly and and always thought of him first when it came time to give a gift or share a treat, she would fight tooth and nail for alone time with me. When I showed him attention and asked her to be with someone else, she would dissolve into tears or erupt into a rage. Again, basically age-appropriate behavior, but as I learned from my interview with the author of The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, the differences,
"...involve frequency, severity, intensity and duration. These are typically the hallmarks that make something diagnosable as opposed to something more typical. However, this is not the most important question for people who are concerned about their children’s behavior. The truth is, what is concerning to one parent may not be as concerning to another. Some people have a higher tolerance to certain behaviors and may respond less reactively, thus adding less fuel to the fire. What needs to be asked is, 'is my child’s behavior negatively impacting him or her and our family?'" 
This upset didn't happen all the time, but my overall sense of our daughter - starting from around the age of 3 - was that, more often than not, she clung to me like a barnacle, seemed excessively fearful about being separated from me and wasn't rational when it came to my spending time with her brother. Sometimes it was only one of the three, other times all of them combined with a dash of rage thrown in for good measure. There were other issues, but that's a discussion for another day. 

Last weekend I had spent a long time alone with her while dad had her brother at soccer and then out for dinner. She and I had a wonderful afternoon spent drawing, making rubber band bracelets, having a "spa day" together and just being together. At the end of the day we curled into my bed and lay, under the covers, reading her new favorite book The Snow Queen. She was peaceful, relaxed and at ease. We turned out the lights and talked quietly.
Sometimes I marvel at how capable and sophisticated
she can be. At other times I worry deeply for her.  

Then her brother came home - late. Dad went out to walk the dog and, telling her I would be right back, I jumped up to get his teeth brushed and get him ready for bed. She remained in the dark, in my room. Alone. She called to me over and over to come back. I kept answering that I would be there in a minute, that I had to get her brother's pajamas out, brush his teeth and so on. She was getting more and more hysterical. When he tried to join us in my room for a snuggle, she wouldn't let him into the bed and became completely overwrought. Our son began to wail that he needed mommy time, too, and my triggers started flashing. I felt pulled in too many directions, I felt I couldn't make everyone happy. I lost my temper with her. 

Screaming and crying, she ran into her bedroom and pulled the covers over her head. Wailing and sobbing, she screamed "get away from me!" over and over again as dad tried to comfort her. Eventually it switched to a more plaintive cry for mommy. With a deep breath to calm myself I went in to her room to try and help. 

As I curled up behind her and put my hand on her back, I began to put light pressure on her body, which usually helps calm her down. She struggled to catch her breath and cried more softly. I began to narrate...

"You didn't want me to be with him. You wanted me all to yourself, didn't you?"

Somewhat angry voice: "Yes! You are always with him!"

"I wasn't paying attention to you. I was focused on him. Did you feel like I had forgotten all about you? Did it feel as though I wasn't thinking about you?"

Her crying opened up again and it got harder (generally a good clue that I've hit on something she feels deeply). I increased the pressure on her back as she pushed into me. 

Suddenly, something popped into my head and almost without thinking I said to her, "baby...you know how I always tell the story of when you were born and we laugh and say how when your brother came out you weren't ready and you wanted to do it your own way?"

Quiet crying.

"Maybe I got it wrong. Maybe to you it didn't feel that way? Maybe to you it felt more like suddenly the person who had been right next to you your whole life had left and you were all alone and didn't know how to get out. Maybe you were scared."

The crying opened up again and she shook with sobs. 

"Did you think we were only paying attention to your brother and that we had forgotten you?"

Through her tears she said, "I was calling and calling you and you didn't come!" 

Crying, crying, crying.

Hugging her from behind, "I never forgot you, baby. We were waiting for you. Everyone was waiting for you! You were never in danger, but I understand it must have been scary. I'm sorry you felt that way...you don't have to feel that way any more. I am always thinking of you and you never have to be afraid that I will forget you even when you are not with me. Even when I am with your brother. You are in my heart always."

Her crying got heavier and she turned to face me and curled up with her face buried in my hair and sobbed for a while. Eventually, her cries became softer. As her emotions regulated she took in a big, broken, deep breath and quieted down. I kissed her tear-stained face and whispered, "I love you"

Breathing softly, she said, "I love you, too, mommy." And she pulled the cover over her shoulders and fell asleep.

In the days since this episode she has been very different. Where she used to insist that I keep my eyes on her at all times in the yard before school, or would forcibly drag me to drop her at her classroom and throw a tantrum when I stopped to talk to a friend - now she's running off to play with her friends and heading to class on her own. It's not as though she won't have setbacks here and there, but the change is remarkable. And this story seems to resonate for both of us - to her it feels as if it fits and to me I feel as though I've opened a small window into understanding some of her behaviors. 
My beautiful girl. This is a smile worth
fighting for. This makes it all worthwhile. 

We've been down a long road with her. This fear and anxiety is only part of what is going on for her. I am still working through the puzzle that makes up my sweet girl, but I am sharing this part of her story in the hope that those of you reading this will consider the idea that the answer isn't always so black and white. A child acting out can't always be explained by the standard child behavior expert answers. Sometimes you have to try on a different pair of glasses, or look at things from another angle, to really crack open what may be going on. 

It can be so tempting to punish a child for "bad" behavior and insist that they are manipulating us to get what they want. But the reality is, children are using every skill they have in their attempt to be loved and accepted. They need our help - not to fix them, but to scaffold them in understanding how to help themselves. 
"Because the capacity to heal is innate, your role as an adult is simple: it is to help the little ones access this capacity. Your task is similar in many ways to the function of a band-aid or a splint. The band-aid or splint doesn't heal the wound, but protects and supports the body as it restores itself." - Trauma Through A Child's Eyes 
Your child will stumble and make mistakes and act in ways that may feel like an incredible nuisance to us adults. But this is when they need us the most. For a moment, imagine yourself at your very worst: needy, angry, lashing out, not able to get people to understand what you need. Would you want the person you love and depend on the most to turn their back on you, or would you want them to open their arms and let you know they love you, no matter what?

I am far from a perfect mother, but one thing I know is that my daughter chose me for a reason. There is so much about her that I relate to and can connect with on a very deep level. At times, that can make our relationship painful and overwhelming, but at other times I can see that my ability to resonate with her is beginning to heal her and in doing that, I know I am healing myself, too. 
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