Trauma, Pregnancy and Postpartum
I credit my adrenal glands with keeping me alive the day my daughter was born; when I needed them, they stepped in to keep my vital signs up, keeping blood pumping to my brain until I could get medical care.
Because they’re EVERYTHING when it comes to truly supporting adrenal health, let’s outline the essential factors of health and wellness.
And know this: while POST focuses on pregnancy and postpartum self-care, this information will serve you your whole life. Now is the time to start looking at your essential self-care, including diet, exercise, stress reduction, and sleep. These naturally support your health and build your adrenal resilience, bolstering them for when you need them most.
It all starts with becoming aware of how past trauma may have wired your nervous system for chronic stress, how those loops get reactivated over time, and how they can be deactivated.
Trauma is the after-effect of a deeply disturbing or life-threatening experience. It is subjective: some experiences are traumatic for all people, and others may traumatize some people but not others. One major event can be traumatic, such as a car accident, and repeated events can be traumatic, such as being ridiculed, abused, or ignored by your caregivers as a child. Trauma is a deeply personal experience, but one that has lasting mental, emotional, social, and physical effects, and it can keep you feeling alone and isolated from others.
Trauma can be physical, sexual, mental, and/or emotional. When it happens in childhood, it lays down powerful neurological wiring that drives your behavior and your physiology. Trauma affects everything from digestion, sleep, blood sugar, and cardiometabolic health, to fertility and hormone balance.
Trauma gets wired into the survival centers of your brain even as an infant. For example, repeated perceived threats to your survival in childhood—from a violent, depressed, or absent parent, for example—get wired into your brain where they powerfully direct your behavior and physiology into adulthood. This happens because as a child you knew that your survival depended on your caregiver. If your caregiver created an emotionally or physically unsafe environment, you learned to focus on and over-value their needs and under-value your own.
While a childhood fear of abandonment shifts how your brain is hard-wired, it also programs a corresponding belief into your subconscious mind, usually:
“I’m not good enough for/not worthy of____________.”
If you got the message in infancy that love was conditional, you learned to prioritize the needs of your caregiver(s) and ensured your survival by doing, or not doing, the things that were most likely to draw attention from your caregiver(s). In adulthood, this pattern manifests in your relationships with others and in your relationship with work. It reveals itself whenever you make something in the outside world more important than your authentic needs, hopes, and desires. This is chronic stress.
A history of trauma drives you right into chronic stress, which hijacks your autonomic system and robs you of the behavioral control, digestion, sleep, cardiometabolic health, and hormone balance you need. Chronic stress also has major negative effects on your pregnancy and your long-term health outcomes.
Pregnancy is the best time to take stock of your stress levels and explore whether old patterns may be subconsciously driving you into chronic stress. Later, we’ll cover specific stress hormones and how they affect you in pregnancy. I’ll also give you some tools to begin to work with chronic stress, and these will be built into your Postpartum Self-Care Plan.
First, let’s understand how this pattern settles into your brain in childhood, and how it ends up directing your brain and body as an adult.
CO-REGULATION AS BABIES
As a baby you learned about the safety of your environment, people, and the world from your caregivers. You were always looking for ways to connect with your caregivers so they could mirror back to you a sense of safety, warmth, and love. This is coregulation.
If you didn’t get enough reassurance or connection with a warm and loving caregiver as a baby, you likely developed a pattern of emotional fear and distrust that got programmed into your nervous system by over-activation of your survival centers. What does this sound like? Yup—chronic stress.
Coregulation in a baby becomes self-regulation in an adult. In these early relational experiences, you learned how to regulate your body in response to your environment: did you learn in childhood that people and the world are safe, or did you learn to be hyper-vigilant and distrustful? Whichever one your environment taught you, you take it with you into your adult life. It guides you as you make your way through the world, for better or worse. If you learned to be mistrustful, it’s usually for worse. You can be living with chronic stress and not even know it, because it’s just the way your body got programmed.
Let’s look at how these patterns get programmed, so that we can start to understand how to reprogram them for a healthier pregnancy, postpartum experience, and life afterwards (we’ll dive into specific tools to reprogram your nervous system in the Stress Reduction chapter).
THE ANS
Your autonomic nervous system, or ANS, houses your survival centers and is involved in reproduction, digestion, temperature regulation, acid/base balance, sleep and wake cycles, and brain function. It also sounds the alarm when you’re confronted with an acute threat to your survival (like a car speeding toward you, or a hungry sabretooth tiger).
YOUR SYMPATHETIC NERVOUS SYSTEM
Your ANS is made up of two main branches that act like on/off switches for your stress response: the sympathetic and parasympathetic nervous branches. Your sympathetic branch is responsible for your fight or flight response. It gets activated in response to a perceived threat to your survival, and sends a signal to your adrenal glands to secrete stress hormones. The whole purpose of your sympathetic nervous system is to get your adrenals to secrete these hormones, which mobilize energy to fight or flee. This was great in the days of an acute stressor like that hungry sabretooth tiger, but chronic over-activation of this system (like running late, being in traffic, your kid screaming at you, your purse spilling when you’re running out the door, not being able to find a parking spot…all before your work day even starts) has major negative health effects.
When it’s activated by a perceived threat, your sympathetic nervous system is responsible for orchestrating a body-wide stress response to prepare you to fight or flee. This response includes:
Shallow, rapid breathing to get more oxygen in quickly (to power your muscles)
Rapid heartbeat and rising blood pressure (to get blood and oxygen to muscles quickly)
Rising blood sugar to feed hungry muscles for fight or flight
Narrowed vision (you become acutely, intently focused on the threat before you, and forget about anything else in your surroundings)
Muscle tension (your muscles become activated to prepare to fight or flee. Today that looks a lot like chronic neck and shoulder tension, tension headaches, and back, pelvic, and knee pain)
Diversion of energy from nonessential functions like digestion, immunity, reproduction, and higher thought to provide more energy to fight or flee
Brain function shifting to your most primitive survival centers (focus on me)
The main stress hormones that activate the stress response are adrenaline, noradrenaline, and cortisol, although many other chemicals are released to help orchestrate this massive chain of events inside your body.
YOUR PARASYMPATHETIC NERVOUS SYSTEM
Your parasympathetic branch supports “rest and digest,” where you focus on healing, repair, digestion, fertility, sleep, etc. The parasympathetic nervous system response promotes:
Proper digestion
Fertility and reproduction
Rest, sleep, detoxification, and cellular repair
Deep breaths
Slowed heart rate and lower blood pressure
Higher thought, planning, contemplating, dreaming, and goal-setting
Connecting with others, social interactions, and relationships
Brain function shifts to newest center, frontal cortex, and relational centers (focus on we)
When your sympathetic nervous system is not over-activated, your body strikes a healthy balance between activation of sympathetic and parasympathetic systems.
In addition to the fight or flight response, humans have two more responses to extreme stress. These patterns demonstrate the importance of the ANS in regulating not just your physical state but also your emotional state. The ANS sends many messages via the vagus nerve. Vagus is Latin for “wanderer,” because it wanders from your brain all the way down to your pelvis (it’s also my favorite cranial nerve!). The vagus nerve uses distinct pathways called the dorsal vagus and ventral vagus, and they link your emotional and physical states.
In my research, I’ve relied on the work of Dr. Steven Porges. Dr. Porges developed Polyvagal theory, which is critical to our understanding ANS functions. I have also leaned on the research of Pete Walker, whose work on complex PTSD brings a whole new level of awareness to the development of the stress response in babies and how as adults it subconsciously directs our thoughts, feelings, and behaviors.
This book is by no means exhaustive, and if you want to engage more deeply with this work, I strongly encourage you to seek out a mental health professional who is well-versed in Polyvagal theory and complex PTSD. Remember, there is no time like the present to take charge of your health and your life. Let your pregnancy be a calling from these deeper parts of yourself to treat your body and mind with greater care, so you can show up for your child—and most importantly, as always, for yourself.
Polyvagal Theory of ANS Activation
When you’re feeling safe and social, or living with an optimal balance of sympathetic and parasympathetic activation, you are operating from what’s called the ventral vagal state. Here you are at ease and naturally connect with others. In a ventral vagal state, stress hormones and inflammatory chemicals decrease.
Below that is a state of chronic fight or flight activation, where you are in constant sympathetic overstimulation. Stress hormone levels rise and chronic muscle tension and pain develops, along with digestive issues, hormonal imbalance, development of sleep problems, depression and anxiety, etc. This state can also manifest as another response to threats, called the fawn response. We’re going to learn about that in the next section.
Finally, there is the dorsal vagal response, which happens when your sympathetic nervous system is over-activated. The result is a shutdown of the sympathetic response, which manifests as the freeze response to threats (again, more on that in the next section). It is characterized by extreme fatigue unrelieved by sleep, an inability to connect with others and worsening social isolation, immobilization or shutting down, decreased muscle tone, and depression. You still see digestive issues, hormonal imbalance, and sleep problems, although they begin to appear differently in this state.
FIGHT, FLIGHT, FREEZE, OR FAWN
We’ve learned about fight and flight already, but what about the other two? Freeze and fawn responses occur as responses to early childhood trauma. Many women play out these patterns in adulthood because of trauma they experienced in childhood.
If you have people pleasing tendencies, you may be unconsciously acting out a fawn ANS response. This is a maladaptive ventral vagal response that leads to people-pleasing and codependence. When you fall into the fawn mode, you abandon your own needs to meet someone else’s. For instance, a child might learn to placate their parents to get positive attention. They’ll go out of their way to make the parents’ lives easier instead of tending to their own needs. Later in life, many driven women find that they have been acting out a fawn response with a boss, older colleague, partner, or authority figure, creating a relationship in which they compulsively put the other person’s needs above their own (you can see how engaging in self-care would go right out the window).
The freeze ANS response is a maladaptive dorsal vagal stress response in which you freeze or “play dead.” People who fall into a freeze response pattern experience muscle and vocal inhibition, so they suddenly feel unable to move away from danger or use their voice effectively. It developed in animals that couldn’t hope to win fights or flee successfully. For those animals, it was easier to play dead and try fooling the predator into seeking other live prey. This response has been noted in survivors of sexual assault.
It is now believed that these patterns can get programmed into your ANS even if you inherited trauma from your ancestors rather than experiencing it directly; consider the violence suffered by the ancestors of BIPOC women in the United States (which also raises the question of whether this inherited trauma is a correlating factor in the disproportionate number of maternal deaths of BIPOC women). These trauma responses can also be reinforced later in life if you experience traumatic or triggering events. These experiences combine to further reinforce a sympathetic, or chronic stress, response. Underlying that sympathetic response is often a low-level anxiety that pops up the moment you stop doing, making it difficult to get any real rest. This cycle of chronic stress and anxiety can continue for years until you become completely burned out, at which point you will also see symptoms like weight gain, cardiovascular disease, digestive issues, hormone imbalance, depression, and fatigue unrelieved by sleep.
This is not what you want for your pregnancy, or your postpartum. Let’s talk about how to change it.
RECLAIMING YOUR BIRTHRIGHT OF EMOTIONAL HEALTH
Pregnancy is an amazing time to explore your emotional state and see what lingers below the surface. You won’t always like what you find, but emotionally cleaning house will make it so much easier to make room for your child and the postpartum struggles you will face.
You are not responsible for what you learned as a child, but as an adult you are responsible for your emotional regulation. It’s worth it to explore negative emotional patterns that block your self-care, especially because they can also block your relationship with your new baby. These patterns are chronic stressors, and they leave clues. If you spend a lot of time grappling with emotions like shame, guilt, fear, jealousy, resentment, or judgment, I encourage you to find the time and space to process and release these negative feelings. They harm you, and they may also harm your child.
In the Stress Reduction section, there are tools to help you begin unlearning the emotional patterns that no longer serve you. You’ll also have the chance to include some of these tools in your Postpartum Self-Care Plan.
During pregnancy, your relationship with your body will change and you may feel like your body is being hijacked. That presents a great opportunity to examine the way you relate to your body. How you feel about your body can be a source of chronic stress, so healing this relationship can move you from chronic stress to a greater sense of peace.