ABEs at APPPAH Conference 2019 – Prenatal and Perinatal Trauma Increases Risk for Disease (& Worldwide Efforts for Prevention and Healing)

I gave my first talk on ABEs at APPPAH – my first conference and my first talk in 15 years. This was an international conference in Denver with the Association for Prenatal Perinatal Psychology and Health (APPPAH 2019). As as post on my chronic illness trauma blog I’ll tell you a little about my personal process about getting there despite my chronic fatigue, share a little about my talk introducing Chronic Illness and ABEs at APPPAH, and give you some of the highlights from the conference. As I often do, I’ve made some updates since first posting.

Working with My Chronic Illness to “Get There”

The fact that I could go to a 4-day conference – and talk – are signs of ongoing healing for me, even as moving towards what I want more of in my life – career and connection – triggered huge flare ups.

I worked with the two old patterns I mention above through Family Constellations in Germany in September.

The experience helped me see more clearly how getting immobilized when trying to move forward in my life is linked to multigenerational trauma.

It also has origins and contributions from my own prenatal and birth experiences, among other types of adversity.

This old trauma pattern is an underlying contributor to my symptoms of chronic fatigue syndrome (ME/CFS) and freeze.

Since getting home from Germany, my symptoms of fatigue have gotten more severe than they’ve been in a few years then continued to intensify as I prepared my talk. Being aware that my flares were triggered by following my heart helped me keep going.

It also helped me relate to my symptoms with some compassion and not just fear and frustration.

My fatigue, food sensitivities, anxiety, grief and other symptoms kicked into even higher gear as I got closer and closer to the date of my talk.

So I used a lot of my tools, including reminding myself this was a pattern rather than “the truth,” cleaning up my diet in the days before heading to the conference, doing yoga even if it was 11 pm at night, etc.

It also helped that I got support from others, including friends and especially my husband, who is also a trauma therapist and gets these patterns. David listened to a run through of my talk and gave me input, polished my blackened silver jewelry I wished I could wear :-), cleaned and gassed up my car, and did it all with love.

My body took these resources and “worked with me.”

I was well enough to show up, attend presentations every day, make new friends and connections, deliver my own talk AND enjoy it. Woohoo!

This is all huge progress for me (you can learn more about my story here).

My Talk on Chronic Illness and Adverse Babyhood Experiences aka ABEs at APPPAH

About 30 people came to my presentation on ABEs at APPPAH. It was fun and energizing to have a conversation with such a terrific group of engaged professionals who already “get it,” and who are planting their own seeds all around the world.

I also got to meet a few of you who are readers of my blog or who I’ve met online because of it – what a total treat!!

What was also encouraging to note was that my flare started to decrease significantly as soon as the conference ended. I had hoped and suspected this might happen, but didn’t know for sure. The context from understanding trauma continues to be a huge help.

My presentation was about Adverse Babyhood Experiences (ABEs) and Risk for Chronic Illness. I shared research that supports the protective resources that doulas, midwives, doctors, nurses, parents and others provide because of their understanding of the consciousness of babies, interpersonal biology, bonding, adversity and more.

I also chose this topic because knowledge about the effects of ABEs and other types of trauma needs to be part of our general education, starting in childhood, and also in training for health care professionals of all kinds.

This is especially true for physicians involved in obstetrical, newborn and pediatric care as well as professionals who care for parents and parents-to-be. This is because most doctors still don’t know about the science of trauma, ABEs, or ACEs (adverse childhood experiences), nor that it affects our biology rather than being “all in our heads.”

It’s also something that helps us as patients on our own journeys of healing. Knowing how many already understand it is another way of realizing that we are not alone.

You can read more about ABEs in my detailed post, download articles from my talk, or get my free ebook on ABEs (100 pages with 100 references) and a short version in fact sheets below. The APPPAH journal also published my journal article on ABEs in July 2020.

The forms will appear momentarily.

The rest of this post shares conference highlights from this dedicated, big-hearted group of people doing ground-breaking work around the world.

APPPAH 2019 International Conference

There were 180 attendees from 26 states here in the US and from 12 other countries, including Canada, Australia, England, Brazil, Japan, China, India and more. APPPAH has enrolled over 400 students in their pre and perinatal training program from over 40 + countries.

There were teachers, doulas, midwives, psychologists, trauma therapists, naturopaths, film directors, researchers, nurses, family doctors, obstetricians, neonatologists, sociologists and all kinds of other attendees.

This is a group that recognizes that babies are conscious, aware beings and that events from conception, pregnancy, birth and our first years influence all of us, as well as our long term physical and emotional health and well being.

10 Golden Rules for Future Parents, Distributed World Wide

This free downloadable booklet is called Ten Golden Rules for Future Parents. It presents the tools – validated by the science – explaining how to best support health through prenatal, birth and other early experiences.

The Rules were initiated in Greece by a supreme court judge who realized how important it was for parents and parents-to-be to understand all that we know so they have the tools to help babies grow with a sense of safety and happiness.This is also how we create a peaceful world through our future generations.

This booklet is now distributed by the World Organization of Prenatal Education Associations (OMAEP, for the French name of Organisation Mondiale des Associations pour l’Education Prénatale). National Associations for Prenatal Education (ANEPs) also spread this booklet and education about just how much we know.These organizations have special Consultative Status at ECOSOC (United Nations Economic and Social Committee). Imagine having it available at every hospital and clinic and as part of routine education for parents around the world!

Prenatal Memories (Japan and the US)

One of the most inspiring speakers for me was Dr. Akira Ikegawa, an obstetrician (OB) who was part of a team of about 15 people from Japan (and also 2 obstetricians and a prenatal educator from China).

He has spent the past 20 years studying prenatal memories, which includes talking to children and parents and 10,000 surveys ⁽¹⁾Ikegawa, A. Parenting Begins From a Baby’s Time in the Womb: What we Know From Prenatal Memories. Japan: Art print Co., Ltd. 2006. This changed his obstetrical practice. It all started when he realized that we interrupt child development by how we work with women, babies and families through pregnancy and birth.

Until realizing [how mother-infant bonding and child rearing begins with prenatal experiences], all I could focus on was a successful delivery and there was no room for me to worry about anything else. I would feel relieved after a delivery, but I seldom felt delighted. I was so preoccupied trying to avoid any complications that I overlooked the fact that a delivery had an immeasurable meaning for a baby’s life (from “I Remember When I was in Mommy’s Tummy,” p. 65)

Dr. Ikegawa learned how to help mothers and fathers bond better with their babies. This includes explaining that babies watch from within the womb and do better if a mother can stay calm. Doing such things as explaining that her feelings of anxiety or stress are her own and hers to take care of, rather than her baby’s also helps moms and babies. Mothers even have success helping their breech babies change to a vertex position by explaining that birth is easier if they point their heads down.

Dr. Ikegawa’s research of over 1500 children finds that up to 30% of children, and even 50% in one study, remembered something from their experiences in the womb or during birth, especially until the age of about 3 years (p. 69). He was also inspired by psychologist David Chamberlain, PhD, co-founding president of APPPAH who also discovered that many of us remember our birth (see “Babies Remember Birth“).

He has also discovered that babies choose their parents, come with a clear purpose, and have much more awareness – even prenatally – than we’ve realized. He and his team are therefore developing a way to work with children through early education practices to support what they already know and bring, and that helps them better communicate with us.

What I was most excited about was that Dr. Ikegawa sees this form of practice as a way to begin to Unite the World, which was in the title of his talk: The Prenatal Memory Global Project.

They’ve created a documentary called Prenatal Memories of Children with interviews of children and mothers. You can rent it for $10 on vimeo. The picture at the above is from the documentary.

Find more about their project Unite the World, where you can get more information and download free PDFs about their work, including Dr. Ikegawa’s free 100 page ebook. Or download it by clicking the button below:

If you’d like to get another “feel” for what I see as the tremendous potential in their work, watch Arrival. It’s a gentle sci fi movie about a university professor who helps the military overcame fear when facing something new and potentially threatening. She uses her skills and curiosity and what she learns helps change the world (for the better).

American Circumcision

I performed circumcisions when I was a family doctor and always felt I was doing something wrong. I was taught the common procedure that included strapping a baby down to a plastic board and using local anesthetic only if I wanted to, since the injections themselves can be painful and some doctors believe that ” it is quicker to just get it over with.” Even though it was common and accepted, something didn’t feel right about performing surgery on a baby within a few days after birth and in this manner.

I decided from day one that if I had to do this, I would try to minimize the effects by learning how use local anesthesia effectively, since this wasn’t used by every doctor and didn’t always work. Everything I’ve since learned about trauma explains why it felt so wrong.

Trauma and Circumcision

Performing circumcisions and practicing obstetrical care with the only tools I had from my medical training were reasons I felt I was causing harm and part of why I left medicine 20 years ago. I didn’t realize then that part of my discomfort came from the trauma I was unwittingly causing and witnessing.

Neurologist and traumatologist Dr. Robert Scaer defines trauma as “any negative event that occurs in a state of relative helplessness —a car accident, the sudden death of a loved one, a frightening medical procedure, a significant experience of rejection—can produce the same neurophysiological changes in the brain as do combat, rape, or abuse.

What makes a negative life event traumatizing isn’t the life-threatening nature of the event, but rather the degree of helplessness it engenders and one’s history of prior trauma.

A procedure like circumcision inherently stimulates fear as well as pain. Risk of trauma from this type of procedure is especially high in a baby, who is entirely helpless, locked into an especially vulnerable position, and assaulted without the capacity for defensive behaviors or objections to be honored.

Furthermore, the vast majority of parents do not fully realize what the procedure involves, nor the extent of potential side effects (which are not measured or tracked here in the US). They are not asked to be present to hold or comfort their baby. In my day, this was at least in part because parents would be too horrified at what was being done to their babies if they actually knew.

The argument to “let parents decide” without giving them full disclosure is still used today as it was in my time, and overlooks the lack of understanding parents actually have.

As I describe throughout my blog, trauma and adversity of all kinds are much more subtle than we realize. They are also risk factors for inflammation ⁽²⁾Rasmussen LJH, et al. Cumulative childhood risk is associated with a new measure of chronic inflammation in adulthood. J Child Psychol Psychiatry 2019;60(2):199-208. doi: 10.1111/jcpp.12928 [published Online First: 2018/05/10], autoimmune and other chronic illnesses ⁽³⁾Dube SR, Fairweather D, Pearson WS, et al. Cumulative Childhood Stress and Autoimmune Diseases in Adults. Psychosom Med 2009;71(2):243-50, mental health conditions, a heightened stress response to later non traumatic events such as routine immunizations ⁽⁴⁾Taddio A, Katz J, Ilersich A, et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349(9052):599-603, and more.

I learned at the APPPAH conference and from the new documentary by Brendon Marotta that circumcision is the most common surgery in the US and that “no other industrialized country routinely practices non religious routine circumcision.”

The documentary is called American Circumcision and is available on Netflix. The following is additional information I’ve gathered as a result of what I learned at the conference. Some of it was from the movie, some from conversations, some from looking at the research, and some from articles others have sent me.

Circumcision is an ACE

The American Academies of Pediatricians (AAP), Family Physicians (AAFP) and Obstetricians (ACOG) all still support the procedure in their policy statements, even as the evidence is not strong enough to recommend it or make it universal. One reason the AAP raises for not changing their policy is concern that advocating against circumcision discriminates against people of Jewish and Muslin faiths, for whom this is part of their religion.

The important information to note here is that we need to start by recognizing the effects of trauma on all babies. This enables us to all make informed decisions so that we can prevent harm, or mitigate harm and heal the effects of trauma when we do conduct circumcisions.

One argument to advocate to the AAP and others against circumcisions is about the increasingly recognized effects of trauma – from any source – and how effects accumulate to add up over time.

Dr. Robert Block, former president of the American Academy of Pediatrics, has emphasized the need for more awareness and prevention of trauma. He cites the adverse childhood experiences (ACE) studies in a report to Congress in 2011 and in a recent article in May 2018.

Intact America, a leading voice in the movement against circumcision, also writes about circumcision as an ACE.

When doctors understand what trauma really is, it helps them understand how circumcision and other medical procedures and practices we routinely use can contribute to ACEs and ABEs.

California is advocating that all physicians become trauma-informed, citing Dr. Robert Block on ACEs, among others. They use the same wording as in the article below about the importance of screening for trauma needing to become a “Universal Precaution.”

JAMA Article “Trauma-Informed Care Should Become a Universal Precaution”

This November 2019 article in the Journal of the American Medical Association (JAMA Pediatrics) was written by 2 Canadians.

It may be helpful for anyone wanting to speak to a doctor about the need to think of circumcisions as a form of trauma.

It may also be helpful for anyone working to change policy.

Email me if you want a copy since it is not available for free download.

The article is called ” Trauma-Informed Care as a Universal Precaution: Beyond the Adverse Childhood Experiences Questionnaire.” ⁽⁵⁾Racine N, Killam T, Madigan S. Trauma-Informed Care as a Universal Precaution: Beyond the Adverse Childhood Experiences Questionnaire. JAMA Pediatr 2019:1-2. doi: 10.1001/jamapediatrics.2019.3866 [published Online First: 2019/11/05]

Given this widespread adoption [of the ACEs questionnaire], which likely cannot be halted altogether, we encourage practitioners to adopt a trauma-informed approach to patient care, which extends well beyond the use of a single ACEs questionnaire.

Trauma-informed care is rooted in the assumption that any child or adult could have a trauma history, and this approach should be used across medical settings with all patients whether an ACEs questionnaire is administered or not. Given the high rates of adversity in the lives of children and families, TIC should be a universal precaution.

Learn more about circumcision in this thorough review article and at DOC (Doctors Opposing Circumcision).

Supporting Fathers and Dads-To-Be

I attended a breakout session by chiropractor and podcaster Dr. Jay Warren, who developed a special interest in supporting fathers after becoming a Dad himself. He took a Pre and Perinatal Training (PPNE) offered by APPPAH that now has graduates in over 50 counties and then changed his practice to include support for moms, dads and babies during pregnancy and birth and beyond. Bonding is one of the factors he focuses on now.

Jay described how we now expect fathers to be involved but have little to no education, support or information. These days, dads and fathers-to-be often feel bewildered, lost or overwhelmed.

He is a team member at The CAP Wellness Center in Encinitas, California where they offer prenatal classes in person and online, support groups, the podcast and more. Their team includes an obstetrician and they provide a host of services.

I loved hearing just how many resources and tools are available. It starts with “getting” just how valuable and important it is to have an understanding of the intelligence within birth, pregnancy, trauma, bonding and more. And that we don’t have to wait for our medical system to get it to make powerful changes in our own lives.

The above picture is from his podcast 79 On How Becoming a Father Changed Me

Documentary in Brazil