Written by Stefanie Antunes, originally published as a Featured Story in the International Doula, Volume 17, Issue 2 (2010)
Every year, thousands of doulas, childbirth educators and midwives leave the profession. While many may leave for family or financial reasons, a great number leave due to a feeling of unease. Some describe it as feeling overwhelmed, while others call it feeling frustrated. I have come to call it the Three-Year Itch.
Many of us come to the birth profession with a great sense of excitement in a great new career journey that will allow us to touch other people at such a special time in their lives. It often begins in a very magical way — a birth that leaves a mother feeling exhilarated and a
partner feeling proud of his involvement and thankful for our impact. Over the years, perhaps some negative experiences occur — the ones where women’s choices fall on deaf ears or where a mother or baby may have been harmed, even though there were options to avoid
it. We may find ourselves supporting the mother whose birth experience went very wrong and who is feeling like her life is falling apart.
For many, what begins to happen is the formation of a gloomy cloud overhead; which may bring about a feeling of unease, a feeling that something just isn’t right, speaking in an “us versus them” tone, a feeling that there is no need for these things to happen and believing it’s not fair. What they may be experiencing is called Vicarious Trauma (VT). The technical definition of VT is: “A permanent transformation in the helper’s inner experience resulting from empathetic engagement with the client’s traumatic material” (Pearlman & Saakvitne, 1995).
Most people do not realize they are suffering from VT. They may simply think it is time for a career change; that perhaps they were not meant to be in the field after all. Signs and symptoms can include intrusive imagery, cynicism, poor memory, volatile moods, lack of spiritedness and/or physical problems. Basically VT is a set of cognitive, emotional, physical and spiritual disturbances that result from helping trauma survivors. So, what does birth have to do with trauma? Although we all wish every birth was an amazing transformative
experience, the truth is current systems do not always support this possibility. Sometimes women’s choices and preferences are not respected. Sometimes women make choices that are not informed, which may ultimately lead to interventions they had hoped they could
avoid. Trauma is really stress gone haywire. It is not the event itself that determines whether something is traumatic to an individual but the perception of the event. What this means is that one person’s happy birth story can be another’s traumatic event. The issue for those of us in the birth profession is what we witness or hear. When a helping person is listening to shocking, sad or awful stories, it may look like s/he is calmly listening, but the activity going on in the brain is not calm. The helper is using something called “controlled empathy.” Not only is the helper absorbing the shocking story, but s/he must respond to the content in a constrained manner. Controlled empathy
is a vigorous neurological activity, which can actually cause damage to one’s brain.
Dr. Ellie Izzo and Vicki Carpel Miller, authors of Day After Day The Price You Pay: Managing Your Second-Hand Shock™ estimate there are over 100,000,000 helping professionals worldwide. They describe in remarkable detail the toll of VT and what can be done to help resolve it. They also discuss how hard work and dedication can take a heavy toll on the helper. Since this heavy toll cannot be seen by the naked eye, it may explain why so little has been written about it. The toll for many can be high and the recovery resources low. According to a study by Pearlman and Saakvitne (1995), at least 53 percent of those in helping fi elds are trauma/abuse survivors. The estimated percentage is actually higher to account for those who have blocked their trauma from memory and those unwilling or unable to discuss it.
The toll of VT
These feelings begin to cloud our judgment. They may impact the kinds of clients we accept. They may create a strong dislike for a particular hospital or care provider in our area. We begin to feel, act and speak in a very jaded way. Voilà, we are officially in the Three-Year Itch. It can also be described as “compassion fatigue.” Whatever the term, when we are in it, it feels awful. It can change the way
we look at the world, the way we sleep, the way we interact in our community and with our family. This may cause many of us to leave
the profession within a couple of years (generally years four or fi ve); but for those of us who want to stay the course, there are some very important things to help us work through this treacherous period.
The Three As
Awareness. Think of how helpful it would be if you knew heading into your career that you may hit a point where things felt overwhelming, but that you could move past it with some strategies. You might even be able to avoid it with some pre-planning.
• Know that VT and Second Hand Shock™ are very real.
• Each person will perceive and react differently to VT.
• Be aware that these feelings of frustration are common.
• Symptoms will not always be associated with the precipitating trauma.
• These feelings do not mean you chose the wrong fi eld of work.
• Be prepared that your clients’ birth experiences won’t always be great.
• Know that at some point you will face a bad situation that you just may not know how to deal with.
• You can get past this.
Never forget that these feelings can affect your relationships (both personal and professional), impact your credibility in your field and community, lead to lost wages and/or affect your clients who are caught in the middle.
Acceptance. If you identify yourself with the description above, you are already halfway to the resolution. Acknowledging and accepting this stage of your journey is a large step toward moving past this phase. The biggest danger for most of us is when we have entered this field to relive our own great birth experience or to help other women avoid the negative. When we are in it, it feels terrible experience we may have had. These reasons are almost certain to have us dealing with VT and to feel defeated when what we are striving for does not
materialize. We must remember to accept the good work that we do, even if the outcome is not good. Otherwise we are at risk for only feeling good when we perceive ourselves as miracle workers making huge impacts all the time.
Here are some things to do to move forward:
• Create realistic expectations for yourself. We can all change the world but only one family at a time. Focus on small goals not fixing the system. Keep in mind that much advancement has been made in maternity services and together we will continue making them.
• Plan a period of readjustment and development. Ask yourself what help you need. How can you benefit from someone in your community with years of experience who has weathered these storms? What further education might help you feel more confident in advocating for change?
• Surround yourself with the right support network. Do not try to do it alone. It is absolutely imperative that you have someone to debrief with. Within the confines of confidentiality, speak with someone about negative situations that have impacted you emotionally. Discuss
what happened, what was involved, what you can take and learn from this experience. At a later date, you can consider advocacy work to remedy situations that repeat themselves.
• Create a plan. Once you can begin to accept things for what they are (a complicated system of interrelated people, processes, procedures, organizations) you can begin to formulate how you might affect change at the level intended — personal, local, regional, national, international.
• Rejuvenate. Keep yourself at the top of your priority list. It is not just a cliché. If you are to be an effective professional in this fi eld, you must be able to keep yourself healthy, both physically and emotionally. Take time for yourself on a regular basis.
Action. When we describe the phase of transition in labor, we often say things like, “It’s the toughest but the shortest,” “It’s right before you get to meet your baby,” “It will be over before you know it.” The Three-Year Itch is something of a transition phase and it can become a thing of the past for you, steering you towards a fulfilling and rewarding career as a doula/childbirth educator/midwife if you can just make it over the hump in order to see the rainbow following the storm.
Those who can overcome these feelings will feel invigorated and reenergized in their roles, create action items allowing them to continue working at affecting change in their community, see their accomplishments rather than what is still left to do, see gaps in maternity care as areas for improvement and will be able to take action. The only difference between those who accomplish a lot and those who accomplish little is tenacity and determination.
There is no better world than one where we work to help others. The doula profession is a noble one. We all have a collective goal to see a world with peaceful birth, an experience that is empowering and transformative for the new family. We will only see this future if we can learn from our experiences, stay the course and help others on their paths. Leaving the fi eld due to burnout will serve no one. Even those
who leave often feel forever drawn to what could have been. Let us work together to get past our Three-Year Itch, whether it truly happens for us in that three to five year mark, or before or after.