Are we trigger happy?

** Trigger warning: this post has no trigger warning. **Trigger Happy

Most of us have heard a newsreader warn about content which “may be distressing for some viewers.” However, as we increasingly turn to online networking sites for ‘news’, the responsibility for such content regulation now befalls users themselves.

As online birth communities have grown and developed, we too found the need for a content warning approach to facilitate the respectful exchange of information; this has manifested in recent times as ‘trigger warnings’ (TWs).

TWs and the online birth community

TWs began creeping into the online community around 2012[i]. In the virtual world of maternity consumers, TWs are often found in special interest groups relating to Vaginal Birth After Caesarean (VBAC); in these spaces, because the experience of unexpected and/or traumatic birth is common, the choice to attach ‘trigger warnings’ to graphic content is a direct reflection of an assumption of shared birth trauma. This TW culture attempts to both acknowledge and validate birth trauma, whilst also protecting individuals from the possible re-triggering of trauma responses.

At first, TWs were rare, attached only to content relating to pregnancy- or birth-related mortality or severe morbidity. However, as this culture has continued to develop, we now see an ever-increasing number of TWs for myriad permutations of birth: elective Caesareans, unplanned repeat Caesareans, assisted vaginal deliveries, long labours, bullying by medical professionals, scalp monitoring, induction, obstetric instruments, manipulative behaviour by medicos, gloved hands… And the list continues.

The problem with this ever-growing list is that, if not kept in check, it slowly censors birth. Whether one moderates a facebook group, writes a blog or regularly shares links to birth videos with friends, if we wish to hold a space in which women can freely exchange information and experiences, it is time for us to think about whether trigger warnings create more harm than they seek to avoid.

Trauma response or strong emotion?

Different to a non-pathological strong emotion which may feel uncomfortable, but is otherwise normal, a post-traumatic response may include flashbacks, disorientation and detachment or hyperarousal[ii]; users who experience such pathological symptoms during online interactions and/or feel the need to debrief their birth experience in any way, should seek the services of trained professional.[iii]

It is important for women who have been ‘triggered’ to know that “although [psychological trauma symptoms] can be distressing, they will settle quickly in most people. They are part of the natural healing process of adjusting to a very powerful event, making some sense out of what happened, and putting it into perspective. With understanding and support from family, friends and colleagues the stress symptoms usually resolve more rapidly.”[iv]

If women need support for psychological trauma symptoms, the online space can prove an invaluable source of community connection – fellow consumers might share information about local professional services and experiences of healing trauma. For this reason alone, it is important to ensure that we don’t, in our desire to protect women from their obstetric history, allow TWs to rob us of the opportunity to have open and honest discussions about trauma responses.

Isn’t it just safer to put warnings on everything?

In a word, no. This trivialises the topic of trauma by perpetuating an assumption that post-traumatic responses and ‘strong but normal’ emotions are synonymous. Not only is this unfair for trauma sufferers (because it downplays their suffering), but it also normalises the idea of traumatic response (which does not promote positive change). This blending of ‘strong but normal’ emotions and pathological trauma responses could, for example, even be dangerous for women with undiagnosed PTSD if they do not realise that their symptoms are pathological.

The overuse of TWs also runs the risk of lost effect. If TWs continue to appear with increasing frequency, when do we stop reading them?

Should we even try to predict what others’ triggers are?

If, as an individual woman, I am in the depths of exploring and healing my own triggers, I am likely already overwhelmed and reading lists of ‘suggested’ triggers is not likely to move me towards healing. In fact, this might do the opposite by: a) creating the idea that there is an insurmountable mountain of triggers to overcome, b) encouraging me to adopt new triggers, or c) making me wonder if there is something wrong with me if I am not ‘triggered’ by the same things as my peers.

It is also a dangerous assumption, particularly in VBAC groups, that because women share a history of traumatic Caesarean birth, they have carbon copy triggers. The trauma response is an intensely personal reaction which might even surprise the affected woman herself – it is folly to expect someone else to accurately predict the nuances of a triggered trauma response.

What happens if we don’t let women identify their own triggers?

Three years ago, Rachel Reed identified that “we have created a culture (and birth culture) that seeks to avoid and minimise extreme emotion and pain, and encourages being in control.”[v] This existing culture now has an online manifestation in the overuse of TWs, and this deliberate numbing of the full spectrum of emotion potentially prevents women from discovering complete healing and full empowerment.

For those with birth-related PTSD, exposure to triggers (with support and coping strategies in hand) is productive and leads to healing. Avoiding triggers ultimately maintains collective trauma symptoms in the long-run and is an unproductive behaviour – this is identified by the National Center for Health as a “maladaptive control strategy… resulting in maintenance of perceived current threat. Prolonged exposure to safe but anxiety-provoking trauma-related stimuli is considered a treatment of choice for PTSD”.[vi]

When does the expectation of a trigger warning inadvertently shame women?

In the case of online VBAC groups, women who share their birth stories encourage each other to be mindful of other members who might still have unhealed trauma; this means that women who plan VBACs and end up with repeat Caesareans invariably (and almost apologetically) precede their stories with TWs. The issue with this approach is that, as the collective increasingly expect TWs from each other, women are taught to err on the side of caution to avoid upsetting others (and any resulting backlash).

What we potentially have here is a new version of our obsessive need to feed mother guilt and shaming. An unmoderated TW culture unfortunately results in (and I have seen this happen) the censorship or removal of birth videos and stories which contain too many group-norm triggers. In this dynamic, calls from the membership for TWs will always be louder than an individual’s right to fully express her birth story. It is conceivable that we will reach a point at which even women who have fabulous, empowered VBACs will eventually feel the need to place TWs on their stories out of the need to respect others less fortunate.

What does an empowering online birth community look like?

There is an irony present when the very women who preach empowered birth to each other also encourage an outsourcing of responsibility for one’s own internet browsing. We cannot expect to question medical professionals and take increased responsibility for our birth choices if we cannot likewise take a similar approach to our own online interactions every day.

What supports empowerment, however, is an online birth community which assumes:

1) We are strong enough to survive reading a confronting blog post or watching a gritty, raw birth video;

2) We are smart enough to scroll past or click away if we notice we are not able to cope with this kind of ‘internetting’ today; and

3) We need to feel all of the strong or confronting emotions inside of us if we are to better understand ourselves and what needs to come next for healing.

At the end of the day, it is better for women to support each other towards healing and resilience – this takes away the need to fear triggers and demand warnings. This is a much more productive and powerful collective goal for the birth community to set.

Conclusion

From a macro perspective, seeking to sanitise or dull strong emotional responses to injustice, the medicalisation of birth and/or the stories of others is not in the long-term best interests of the birth community. Yes, we do need to be mindful of others’ pain and trauma, but robust, uncensored conversation about birth is precisely what is needed in order to fully discuss, validate and troubleshoot the problems of modern-day birth – it is only once consumers and care providers can be honest about the full gravity of the situation in which we find ourselves that we will begin to find solutions.

References:

[i] http://www.stirjournal.com/2014/09/15/trigger-what-why-trigger-warnings-dont-work/

[ii] https://www.psychology.org.au/publications/tip_sheets/trauma/

[iii] http://psychology.org.au/

[iv] https://www.psychology.org.au/publications/tip_sheets/trauma/

 

[v] https://midwifethinking.com/2013/03/27/feel-the-fear-and-birth-anyway/

 

[vi] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925813/