After the Resuscitation: Provider Integration & Support
Karen Strange, CPM
A difficult resuscitation can affect you profoundly
As birth professionals, we are accustomed to being the ones who remain present, make decisions, care for others, and keep going. There can be an unspoken expectation that because this is our work, we should somehow be able to withstand whatever happens.
But being skilled, experienced, or responsible for others does not make us untouched by what we witness.
Holding life and death is profound.
You may have watched a baby struggle to live. You may have worked for what felt like an eternity without knowing what the outcome would be. You may have heard a parent's fear, felt the weight of decisions you had to make, or found yourself doing things you had practiced many times under circumstances unlike anything you had imagined.
And afterward, everyone else may have gone home.
You may be left carrying it.
Sometimes you know you have been traumatized
Sometimes we know immediately that an experience has traumatized us. Sometimes it shows up later—in replaying the birth, not wanting to think or talk about it, questioning ourselves over and over, feeling unusually emotional or numb, having difficulty sleeping, feeling anxious before another birth, or discovering that some part of us still feels as though the event isn't quite over.
There can also be an unspoken belief:
I am a midwife. I should be able to handle this.
I don't believe that.
Being deeply affected by something profound does not diminish your competence or your ability to care for others. It means you are human and that something deeply consequential happened while you were responsible for caring for others.
Time alone does not necessarily heal what happened
We can put an experience away. We can return to work. We can attend many more births. We can tell ourselves that the baby survived, that we did the best we could, or that there is nothing to be gained from continuing to think about it.
And still, years later, we may discover that the experience remains very much alive in us.
Healing and integration usually require more than simply waiting for enough time to pass.
That does not mean endlessly analyzing the birth or repeatedly reliving everything that happened. It means finding a way for what happened to become something you can remember, learn from, grieve if necessary, and carry differently.
Healing happens in relationship
When you are completely inside an experience, it can be almost impossible to simply decide to "focus on something else."
Suggestions to take a walk, notice something beautiful, rest, distract yourself, or think positively can feel ridiculous when the experience has taken up all the available space.
Sometimes we need another person to be with us in what feels unbearable before we can begin to experience anything beyond it.
I know this personally.
After my husband Patrick died by suicide, I did a tremendous amount of trauma work. I remember sessions with my trauma therapist when we would walk outside while talking with her on FaceTime, often with my dog Clover running around having fun.
I could notice the beautiful trees. I could feel the fresh spring air. I noticed the beautiful blue sky. I remember those moments even now, in the chaos of what had happened.
But I wasn't simply taking a walk and trying to appreciate nature.
My therapist was there with me.
She wasn't trying to take me away from what had happened. She was helping me be with something enormous while also helping me experience that something else existed in that moment.
Over time, those experiences helped me learn that I could be with what was painful without being completely consumed by it.
We don't always heal by ourselves. Sometimes another person's presence is part of how we find our way back to ourselves.
Healing doesn't have to mean living inside the trauma
The frightening thing happened.
It matters.
You do not have to minimize it, make peace with it before you're ready, or convince yourself that everything is okay.
And at the same time, something else is happening now.
At first, that "something else" may be very small:
Feeling your feet on the ground while someone sits with you. Wiggle your toes.
Walking while you talk.
Feeling the air on your skin. Simply notice it too.
Noticing your dog beside you. Do you feel yourself smile when you notice them?
Having one moment in which your attention lands somewhere other than what happened.
These experiences aren't meant to distract you from the trauma or make it less important.
They can gradually help your nervous system recognize that the traumatic event, is over, that it is no longer the only thing happening.
Eventually, it may become possible to remember what happened, grieve what happened, learn from what happened—and also experience the rest of your life.
Healing doesn't require forgetting.
The experience can remain important without continuing to occupy everything.
There are many ways to get support
There is no single approach that is right for everyone.
Some people benefit from working directly with particular memories or moments that remain highly charged. Others benefit more from body-based or nervous-system approaches. Some simply need a good therapist and a relationship in which they feel safe enough to begin talking. Often it is some combination.
Approaches you may want to explore include:
EMDR (Eye Movement Desensitization and Reprocessing): Often used when particular memories, images, sounds, sensations, or moments continue to feel highly charged or "stuck."
Somatic Experiencing (SE): A body-oriented approach that works with nervous-system activation, sensation, and the body's responses to overwhelming experiences.
Havening Techniques: Uses touch, attention, and other techniques intended to help reduce the emotional intensity associated with distressing experiences.
Trauma-informed psychotherapy: Sometimes the modality matters less than having a skilled person with whom you feel safe, understood, and able to explore what happened.
There are also approaches that focus more broadly on nervous-system capacity, resilience, and learning to move flexibly between difficult experiences and the resources available in the present. These are not necessarily trauma treatments, but this kind of work has been very meaningful in my own life.
You do not have to know which approach you need before asking for help.
If you would like more information about any of these approaches, or help finding resources or practitioners, you are welcome to contact me. I am happy to point you toward places to begin. I have done a great deal of this work myself.
And don't forget the clinical piece
Emotional integration does not replace learning from what happened.
After a complication—whether the outcome was good or bad—and particularly after a difficult or unexpected outcome, I believe it is important to go back and look carefully at the event.
What happened?
What went well?
What might have been missed?
What information was available at the time?
What did you understand differently then than you do now?
What do you want to practice or do differently in the future?
We cannot know with certainty how a different decision might have changed an outcome. But we can gather more information, look honestly at what happened, and allow what we learn to shape our future practice.
This is not about blame.
It is about becoming more skillful, more aware, and better prepared for the next baby who needs us.
A note from me
If you are struggling after a birth or resuscitation, you do not have to prove that it was "bad enough" to deserve support.
This work can ask an enormous amount of us.
Holding life and death is profound.
Allow yourself to take seriously what it has asked of you.
Karen Strange, CPM, AAP/NRP Instructor