The Windshield, Not the Pebbles: Why Perinatal Trauma Lives in the Nervous System
Ask a perinatal clinician what trauma looks like, and you’ll often get a list of events: a loss, a traumatic birth, a NICU stay, a postpartum crisis. Ask Mara Tesler Stein, PsyD, PMH-C, and she’ll point to the nervous system itself.
Mara - a clinical psychologist, EMDR trainer and consultant, and founder of The Touchstone Institute - recently joined Dvora Entin on her Misconceptions podcast to discuss perinatal trauma, the nervous system, and why treatment has to move beyond talk alone. The conversation explored her framework for how clinicians assess, conceptualize, and treat trauma across the reproductive and early parenting years.
The Windshield, Not the Pebbles: A Working Definition of Perinatal Trauma
Mara uses a simple analogy. If you’re driving down a gravel road and pebbles kick up and crack your windshield, someone could argue the pebbles were too small, too slow, or too few to cause that damage.
“I don’t care about the pebbles. Look at the windshield,” she explains. “My windshield is my nervous system.”
The clinical implication is that two people can experience what sounds like the same event on paper and walk away with very different nervous system responses. Trauma, in this framing, is not the event. It is what the event did to the nervous system.
Mara offers a definition broad enough to hold the full range of perinatal experience:
“I define perinatal trauma as any rupture that can happen any time from trying to conceive all the way through the third year of life.”
This window includes infertility, pregnancy complications, birth, loss, NICU experiences, postpartum mood disorders, and the developmental transition into parenthood itself. The definition stays anchored in the person’s nervous system rather than in the traumatic event.
Why the Cracks Keep Spreading
Clinicians often notice that a single event, such as a difficult delivery, a loss, or a frightening postpartum period, seems to generate distress that expands over time, pulling in past experiences and anxiety about the future. Mara explains this through the developmental nature of the perinatal period. The nervous system is a network of associations; everything is interconnected. When a rupture happens in a period saturated with meaning - family-building, identity, the body, a baby - it doesn't stay contained.
"The cracks can go in both directions," she says, pulling on earlier experiences as well as reaching forward. This is why perinatal trauma so often activates earlier attachment wounds, old beliefs about the self, and anticipatory fear about the child's future. It is also why assessment in the perinatal period has to include developmental history, not just the index event.
Guilt Over Helplessness: Why the Mind Chooses the Painful Explanation
Shame and guilt so often accompany perinatal trauma, and Mara offers a clinically useful way to understand them.
“People will unconsciously choose guilt over helplessness every day of the week.”
Guilt implies agency, even if it is painful. Helplessness implies vulnerability, which is harder for many clients to tolerate, especially in a culture that equates good parenting with control. This logic is protective. “Better that it’s my fault,” she explains, “because if it’s my fault, I have an explanation.”
For clinicians, this means guilt is often not the primary target; it is a defense against something more frightening. Listening for the helplessness underneath the guilt can shift the direction of the work.
Digesting Memory: The Case for Bottom-Up Treatment
Our nervous systems are built to digest experiences, including traumatic memories, much like the body digests food. In order for a memory to be integrated, it must be broken down, absorbed, and moved into chronological, long-term memory where it can be reflected upon. But when trauma occurs, the nervous system can lose access to this process. The memory gets stuck in the limbic system.
Because the experience is trapped in the emotional centers of the brain, the Broca’s area, or speech center, often shut down when the trauma is recalled. This is why traumatic events are often almost impossible to put into words and remain in an experiential state.
This is where the distinction between top-down and bottom-up treatments becomes essential.
Top-down therapies, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Acceptance and Commitment Therapy (ACT), recruit the prefrontal cortex to manage and intervene in the emotional centers of the brain. These approaches are vital in the early stages of trauma treatment to build skills, establish safety, and help clients stabilize. But they have limits.
“Cognitive-based therapies are necessary but often not sufficient,” Mara says.
The problem is access. When a client is triggered, the skills learned in a calm state are harder to retrieve in an activated one. Furthermore, repeatedly asking a survivor to talk through a traumatic experience can potentially interfere with healing, because the brain is still reacting as if the trauma is happening in the present.
“Bottom up instead of top down is essential for effective, long-lasting treatment of trauma.”
Bottom-up methods, including Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, and Somatic Experiencing, address the trauma directly at its source. Rather than trying to think their way out of a physiological response, clients are able to actually process the stuck memory. This doesn't replace the need for good psychotherapy or coping skills, but it allows the brain to reset. As the limbic centers stop lighting up in response to trauma cues, the memory can settle into long-term storage.
What “Zero” Actually Means in EMDR
When a memory is reprocessed, the path is rarely linear. The nervous system moves along thematic channels of association, and the clinician's job is to stay out of the way and follow the client's lead. As the brain processes the memory, the distress gradually decreases. This continues until the client returns to the original event and reports zero disturbance.
“Zero doesn’t mean it doesn’t matter,” Mara clarifies. “Zero means it’s in my long-term memory.”
The goal is not erasure. A baby’s death, a traumatic birth, a lost pregnancy, or another painful event remain meaningful. The goal is to move the memory into long-term storage so the client can look at it from a distance rather than reliving it in the present.
“I’m not in it right now,” Mara describes. That distinction, between the memory mattering and the nervous system being captured by it, is central to what clinicians are actually tracking in EMDR treatment.
What This Means for Perinatal Clinicians
These ideas point toward a clinical stance rather than a single technique:
Assess the nervous system, not just the event. Two clients with the same history may have very different trauma loads.
Expect developmental reverberation. Perinatal ruptures pull on the past and reach into the future.
Listen for helplessness beneath guilt. Guilt is often the more tolerable explanation.
Use bottom-up methods when cognitive work is not enough. Skills matter, but access to them matters more when processing trauma.
Track reprocessing, not erasure. “Zero” means integrated, not indifferent.
For clinicians who want to go deeper into this framework, Mara offers trainings built around exactly this perinatal lens, with pathways for both EMDR-trained and non-EMDR-trained professionals:
Foundational EMDR Training for Perinatal & Infant Mental Health Specialists
Gain EMDRIA-approved foundational training with perinatal insights woven into every lesson. Debunk harmful myths, build clinical skills, and join a community committed to expanding access to effective EMDR therapy.
Mara’s Foundational EMDR Training is designed for clinicians who are not yet EMDR trained. This course provides the full EMDRIA-approved basic curriculum with perinatal-specific insights and demonstrations, bridging the gap between standard EMDR protocol and the realities of reproductive mental health.
Perinatal Crisis and Beyond: A Trauma-Focused Comprehensive for EMDR Practitioners
Specialized for EMDR clinicians, this year-long program offers advanced trauma-focused skills for complex perinatal cases.
Perinatal Crisis and Beyond is an advanced course built specifically for EMDR practitioners. Meeting every four weeks over the course of a year, this comprehensive examines the disruptive events that induce ruptures in the developmental path of family-building, with deep dives into the neurobiology of grief and trauma, and trauma-focused interventions across perinatal presentations.
At its core, perinatal mental health is holding space for profound transitions. When these transitions are marked by rupture, the path to healing requires more than insight alone. It requires treating our clients at a nervous system level.
By using treatments that help clients genuinely process their experiences, we can help parents move from a state of survival into the present moment. The goal is not to erase their pain or pretend the cracks in the windshield don’t exist; it’s to guide their nervous systems to do what they are built to do: heal, integrate, and move forward.
Listen to the Full Conversation
This post draws from Mara Tesler Stein’s interview with Dvora Entin on episode 81 of the Misconceptions podcast, “Trauma in the Body: Exploring What We’ve Learned.” Listen to the full discussion below.
References
Entin, D. (Host). (2026, October 9). Trauma in the body: Exploring what we’ve learned (No. 81) [Audio podcast episode]. In Misconceptions. https://www.dvoraentin.com/podcast/episode/24ea64a2/81-trauma-in-the-body-exploring-what-weve-learned
Tesler Stein, M. (2026). Foundational EMDR training manual (4th ed.). The Touchstone Institute. https://touchstone-training.thinkific.com/products/digital_downloads/foundational-emdr-training-manual
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