Beyond "the body keeps the score": what we now understand about birth trauma
Birth trauma is increasingly understood as something that happens in the nervous system, not simply in the mind, and you can’t think or talk your way out of it.
Much of the support available for people after a difficult birth involves talking: recounting events, seeking explanations, making cognitive sense of what occurred. Of course, understanding what happened, and why, can bring genuine relief, and it is a central part of birth reflection work.
But for many people, the story is already well-known; they can tell it clearly, chronologically, over and over, and yet something persists.
This is where attending to the body alongside the story becomes important. Not instead of talking, but noticing what happens in the body as the story is told. Tracking where activation lives, where breath catches, where something shifts, is the territory that Somatic Experiencing, developed by trauma therapist and biophysicist Peter Levine, helps to navigate.
What Somatic Experiencing understands about trauma
Somatic Experiencing is a body-based approach to trauma, developed by Dr Peter Levine. It is not a talking method, though there is talking in it. The practitioner pays attention to the body while the story is told, slowly, a little at a time, watching for where the body tightens and where it eases. The work goes at a pace the nervous system can bear, building a felt sense of safety before approaching the hardest material. The aim is not to relive what happened, but to let the body learn that the danger is over.
Levine's central insight was that trauma is not the story of what happened, but an incomplete biological response to perceived threat. When a living organism faces danger, its nervous system mobilises enormous amounts of energy to support survival: fight, flee, or if neither is possible, freeze. In many animals, this cycle completes naturally after the threat has passed. The gazelle that escapes the lion shakes violently, discharges the residual survival energy, and returns to grazing; so the threat is metabolised. It is a compelling picture, and for years it was the one this work was built on.
In human mammals, this completion is almost always interrupted, particularly in a frightening birth experience. On the ward, there is nowhere for the response to go; you can’t flee a bed, much as you might want to; you can’t fight off the people who are helping you. So the body does the only thing left and freezes, or complies, or leaves. Then the danger passes and still there is no space to finish what started because there is a baby to feed within the hour, and a body to recover from, while caring for someone who needs you through the night. You are discharged, sent home, expected to be grateful that everyone is alive. On Levine's account, the survival energy that was mobilised and never released stays held in the body, and the nervous system stays on alert long after the room has emptied.
To fight, flee and freeze, we can add a fourth response particularly relevant to birth: fawn. Fawning involves appeasing, complying, becoming accommodating in order to maintain safety and connection with those who hold power. In maternity settings, where institutional authority, fear for the baby, exhaustion and the desire to be seen as cooperative all converge, the conditions for fawning are almost structural. Someone may smile, agree, thank the midwife, sign the form, while internally feeling terrified, overridden or absent from their own body. They may not recognise what happened until much later, when the compliance they performed sits uneasily alongside the distress they felt, and continue to feel.
This is why outward cooperation during birth can never be taken as evidence that everything was fine, meanwhile the body registers what the voice did not (could not) say.
Does the body keep the score?
A recent paper in Frontiers in Systems Neuroscience by Kotler, Mannino, Fox and Friston offers a serious challenge to the now-familiar idea, popularised by Bessel van der Kolk, that the body literally stores trauma. Their argument, grounded in predictive coding, is that trauma is better understood as a disorder of prediction rather than of storage. Predictive coding is the idea that the brain is constantly guessing what comes next, building expectations from past experience and correcting them only when reality proves them wrong. Most of the time this is invisible and useful in that it is how you cross a road or catch a cup before it falls. After trauma, though, the guessing goes awry and what persists is not a memory lodged in bodily tissue, but a loss of metastability: the brain's capacity to fluidly move between states becomes rigid, locked into self-confirming predictions of threat.
In their framing, the brain learns to expect danger and then trusts that expectation too much. It holds to the prediction of threat so firmly that no amount of present safety can correct it. A knock at the door could drop you into dread, the sight of a blood pressure cuff sets the whole body bracing, a baby’s cry or a certain turn in conversation floods you before you have the chance to decide anything. The original danger is long over, but the body cannot tell, because the forecast has been turned up too high to notice the quiet and safety present. This is what the paper means by hypervigilance, flashbacks and avoidance: a system caught in its own predictions, unable to update. The body participates in this, not as archive, but as messenger. Unattenuated interoceptive signals, a racing heart, a tight chest, are read as confirmation of danger rather than as ordinary noise. And so the prediction proves itself: the body produces the very alarm the brain then takes as evidence the alarm is justified and the trauma loop has no way out from the inside.
It is tempting to hear all this as moving trauma from one place to another, out of the body and into the brain, but the brain is body. The nervous system is not separate wiring laid over the flesh; it runs through the gut, the chest, the skin, the whole of you. There is no line where the body ends and the nervous system begins.
Kotler et al’s paper present a nuanced and important challenge, which does not diminish the somatic dimension of trauma, but reframes it. The goal of healing, on this account, is not to release what is stored, but to restore flexibility: to expand the brain's capacity for adaptive variability, to allow new information in, to update the predictions that have calcified.
This reframing does not leave Somatic Experiencing behind, though it does ask something of it. SE attends to the body because the body is the interface through which the nervous system communicates its state, and because careful, paced attention to bodily sensation offers one route toward restoring the flexibility that trauma has eroded. Where the predictive coding model asks how we restore metastability, SE offers a practical, relational approach to doing so: through titration, pendulation, the gradual expansion of the window of tolerance.
Kotler et al’s paper does not take aim at Somatic Experiencing, or at Levine directly, rather it targets the storage model in general, however their argument does implicate SE as Levine's language is of held energy, of survival charge that was mobilised and never discharged, while the predictive coding model suggests there may be nothing stored to release. None of this suggests the work fails, the relief is real and palpable when people undoubtedly soften, settle, find their breath again through this work . What I am less sure of now is why. Somatic Experiencing offers the opportunity to pay paced attention to the body, rehearsing safety whilst visiting or talking about challenging memories, as if we are feeding the nervous system new evidence: that we are safe now, in the present, and the body can stop bracing as though the danger were still here.
Birth as a rite of passage
There is another dimension to birth trauma that clinical frameworks, however sophisticated, do not fully reach.
Midwife and researcher Rachel Reed, in her book Reclaiming Childbirth as a Rite of Passage, argues that birth has always been, across cultures and throughout history, a threshold experience. It involves separation from a previous self, a period of liminality, and emergence into a new identity. The stages she identifies, Preparation, Separation, Liminality, Emergence and Integration, map not just a physiological process but an existential one.
When birth goes well, this rite of passage can be profoundly integrating. When it does not, when the threshold is crossed in fear, without support, in conditions that override rather than honour the body's process, the disruption is not simply clinical. It touches identity, selfhood, the sense of what one is capable of and what the world can be trusted to provide.
This is why people sometimes describe difficult births in terms that go beyond distress: a sense of betrayal, of something fundamental having been violated, of a story that should have been one thing and became another. Reed's framework helps name this. The rite of passage was interrupted or distorted. Something that should have moved did not move. The integration that birth, when held well, supports, did not occur.
Healing, on this account, is not simply about symptom reduction. It is about completing what was interrupted: not by rewriting what happened, but by creating the conditions in which the experience can be met, witnessed and, over time, integrated into the larger story of who someone is.
What this looks like in a birth reflection session
In practice, working somatically with birth trauma means paying attention to more than the words being spoken.
When someone describes the moment they were told they needed an emergency caesarean, or when their pain was not attended, or they were not believed or listened to, I am watching for what happens in their body as they tell it: the held breath, the forward lean, the hands that grip. I am tracking whether they are in the memory or in the room. I am noticing whether their window of tolerance is narrowing, and if so, slowing down, orienting to the present, finding resource before continuing.
I am also tracking what happens as the story moves through: the moments when something shifts, when a breath releases, when eyes soften, when a person sits back in their chair instead of forward. These are not incidental, but rather signs of the nervous system updating, of the predictions beginning to revise, of metastability quietly restoring.
This work does not require a full course of SE treatment to be meaningful. Even a single session that attends carefully to the body's responses, that moves at a pace the nervous system can tolerate, that builds resource before approaching difficult material, can offer something that purely cognitive or narrative approaches do not.
A note on what this work is not
I am currently in training as a Somatic Experiencing practitioner with the School of Somatic Experiencing International. My work with birth reflection sessions draws on SE principles alongside my background in midwifery, yoga and yoga nidrā, and my clinical understanding of birth physiology and the maternity system. I do not offer SE as a standalone therapeutic modality; if that is what someone needs, I will say so and support them to find an appropriate referral.
What I do offer is birth debrief or reflection work that takes the body seriously, that moves at a pace the nervous system can manage. I hold space not only for the clinical questions, but for the rite of passage that was disrupted, and for the possibility that completion, integration and peace are still available, in their own time and at their own pace.
References
Kotler S, Mannino M, Fox G and Friston K (2026) The body does not keep the score: trauma, predictive coding, and the restoration of metastability. Front. Syst. Neurosci. 20:1812957. doi: 10.3389/fnsys.2026.1812957
Levine, P. (2010). In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.
van der Kolk, B. (2014). The body keeps the score: brain, mind, and body in the healing of trauma. Penguin Press
Wong, A. (2020). Why you can't think your way out of trauma: the importance of the body's wisdom in the treatment of trauma. Psychology Today.
Kuhfuß, M., Maldei, T., Hetmanek, A., & Baumann, N. (2021). Somatic experiencing: effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. European Journal of Psychotraumatology, 12(1), 1929023.
