ACEs and Childbirth: Why I Ask My Clients to Share Their ACEs

I know this may feel like a lot to some people, but having my clients share their ACE scores and a bit about their Adverse Childhood Experiences helps me understand how trauma may show up in their childbirth experience.

Trauma and childbirth cannot be separated. We cannot truly support people through pregnancy and birth without understanding how trauma lives in the body and nervous system. Birth is an inherently vulnerable experience. It involves pain, uncertainty, exposure, and loss of control—conditions that mirror many early traumatic environments. For first-time parents, birth can awaken trauma that has never been activated in such a physical way. For second- or third-time parents, trauma from previous births can resurface and shape expectations and fear.

As part of my onboarding process, I ask clients to complete an ACE questionnaire. This is not something we deep dive into, and I do not require details. What matters to me is understanding how trauma might influence their stress responses, sense of safety, and ability to remain present during labor. There are also other trauma-related questions that are important to me and to my practice, because trauma-informed care is not optional in birth work—it is foundational.

What Are ACEs?

ACEs stands for Adverse Childhood Experiences, a term that comes from a large public health study conducted by the CDC and Kaiser Permanente. This research identified categories of early life adversity that significantly influence long-term physical and mental health. These experiences include various forms of abuse, neglect, and household instability, such as parental substance use, domestic violence, or incarceration.

An ACE score reflects how many categories of adversity someone experienced before age eighteen. Higher ACE scores are associated with increased risks of chronic illness, depression, anxiety, and difficulty regulating stress. But ACEs are not a prediction of failure or dysfunction. They are a framework for understanding how someone’s nervous system learned to survive.

When someone grows up in unpredictable or unsafe environments, their body adapts. It becomes alert to danger. It learns to scan for threat. It develops strategies to stay safe. Those strategies may be invisible in everyday life, but pregnancy and childbirth can reactivate them in powerful ways.

Why ACEs Matter in Pregnancy and Childbirth

Pregnancy and childbirth place extraordinary demands on the nervous system. Hormones shift rapidly, the body becomes the focus of constant monitoring, and medical authority becomes part of daily life. For people with trauma histories, this can replicate earlier experiences of powerlessness, fear, or lack of bodily autonomy—even when care is respectful and well-intentioned.

Birth may trigger trauma through physical exposure, pain, medical procedures, or feeling unheard. It can also activate memories of earlier violations of consent or safety. Even when someone intellectually knows they are safe, their nervous system may respond as though they are not.

For first-time parents, childbirth may be the first time their body enters a state of such vulnerability. For those who have already given birth, trauma from a previous labor or medical emergency can strongly shape how their body prepares for the next one. Trauma is not erased between pregnancies. It accumulates.

This is why trauma and childbirth must be considered together. Ignoring trauma does not make it disappear—it simply leaves providers unprepared for how it will show up.

Trauma Is Not Always Obvious

One of the most harmful misconceptions about trauma is that it only looks like panic attacks or emotional breakdowns. In reality, trauma often shows up quietly.

Some people become overly compliant in medical settings. Others dissociate and feel disconnected from their bodies. Some struggle to make decisions, while others become rigidly attached to plans. Some shut down emotionally, while others feel flooded with fear. These are not personality traits. They are nervous system responses shaped by early survival.

Without understanding trauma, these behaviors can be misread as difficult, anxious, or uncooperative. With trauma-informed awareness, they become signals that someone needs more safety, more time, and more control.

Birth Is a Nervous System Event

Birth is often framed as a medical or physical process, but it is also fundamentally a nervous system event. Labor requires the body to relax deeply while tolerating intense sensation. This only happens when the nervous system feels safe.

For people with trauma histories, safety is not assumed. Their bodies learned that vulnerability can be dangerous. During labor, this may show up as muscle tension, fear of losing control, difficulty surrendering to contractions, or sudden emotional shutdown.

These reactions are not failures. They are protective responses that once served an important purpose. Knowing a client’s ACE score allows me to anticipate how their nervous system may respond under stress and adjust my support accordingly. It helps me slow down, explain more, and prioritize emotional safety alongside physical comfort.

Why I Include ACEs in My Onboarding Process

I include ACEs in my onboarding process because trauma shapes how people experience care. I do not need details. I do not analyze or diagnose. What I need is context.

Knowing someone has a higher ACE score helps me understand that they may need more predictability, more explanation, and more reassurance. It reminds me to avoid assuming that calm equals comfort or that silence means consent. It encourages me to create space for questions and to offer choices rather than directives.

Trauma-informed care is not about uncovering stories. It is about adjusting how we show up.

Trauma-Informed Birth Support

Trauma-informed birth support centers emotional safety as much as physical care. It prioritizes consent, collaboration, and respect. It recognizes that many people enter birth carrying invisible histories of harm.

In practice, this means explaining what is happening before it happens. It means asking permission before touching. It means offering options instead of issuing commands. It means respecting boundaries even when they seem inconvenient. It means understanding that fear is not irrational when viewed through the lens of lived experience.

Trauma-informed care does not remove medical intervention when it is needed. It changes how those interventions are delivered.

ACEs and Pain Perception in Labor

Trauma affects how the brain processes pain. Chronic stress can heighten pain sensitivity or cause the body to disconnect from sensation entirely. For some people, labor pain may feel overwhelming. For others, it may feel unreal or distant.

People with higher ACE scores may struggle to use coping strategies when stress escalates because their nervous systems are already operating near capacity. They may panic when sensations become unpredictable or feel afraid of their own bodies.

Understanding this allows for gentler pacing, more grounding techniques, and reassurance that these reactions are not failures of strength.

Trauma and Medical Systems

Many ACEs involve unsafe caregivers or authority figures. Hospitals and medical systems can unconsciously recreate those dynamics. Bright lights, multiple strangers touching the body, unfamiliar language, and loss of privacy can activate survival responses even in well-run settings.

Trauma-informed birth support helps clients navigate these environments without becoming overwhelmed. It provides continuity and advocacy in systems that can feel impersonal.

Trauma From Previous Births

Birth itself can be traumatic. Emergency procedures, separation from a newborn, unmanaged pain, or feeling coerced can leave lasting psychological impact.

For parents returning to birth after a difficult experience, fear may be woven into their expectations. Their bodies remember what happened even if their minds struggle to articulate it.

This is why I ask about trauma in onboarding. Childhood history matters, but so does birth history.

ACEs Are About Patterns, Not Labels

An ACE score is not a diagnosis. It does not define who someone is. It provides insight into how their nervous system learned to survive.

A higher score does not mean someone is weak or fragile. It means their body developed strategies to endure adversity. My role is not to judge those strategies but to work with them.

Why Trauma-Informed Questions Matter

Beyond the ACE score, I ask questions about past medical experiences, fear, and what helps clients feel safe. These questions are not about uncovering trauma. They are about preventing it.

They help me know how to communicate, how to touch, and how to support decision-making. They help me avoid repeating harm.

Why This Matters for Outcomes

When trauma is ignored, people are more likely to dissociate, panic, or feel powerless. They are more likely to leave birth feeling unseen or violated. They are more likely to struggle emotionally afterward.

When trauma is acknowledged, people are more likely to feel respected and heard. They are more likely to integrate their birth experience rather than feel fragmented by it.

Trauma-informed care is preventative mental health care.

Birth as a Healing Opportunity

For some people, birth becomes a moment of repair. A time when their voice is honored, their body is trusted, and their boundaries are respected.

This does not erase past trauma, but it can reshape how the nervous system understands vulnerability. Healing is not guaranteed, but safety makes it possible.

Why I Ask My Clients to Share Their ACEs

I ask because trauma shows up in birth. Because birth activates childhood survival patterns. Because previous births create new trauma. Because nervous systems need safety to function.

I do not need the stories. I need the map.

This allows me to provide care that is slower, gentler, and more responsive. It allows me to meet clients where they are rather than where I assume they should be.

Final Thoughts

We cannot separate trauma from childbirth. Birth does not begin in labor. It begins in the nervous system’s history of safety and threat.

When clients share their ACE scores with me, they are offering a framework for understanding their needs. Not their pain, but their resilience.

My role is not to fix what happened to them. My role is to support them as they bring new life into the world with dignity, agency, and care.

Trauma-informed birth work is not optional. It is essential.