Birthworker Self-regulation: Adding Solutions, Not Problems

Birth professionals, no matter the title they go by or where they might work, have the potential to dramatically affect the experience of birth for a birthing family.  Not necessarily by what they do or not do, but more by the quality of their presence and way of be-ing.                                                                                                                                                                                                                                                                                                                                                                                  Birthing new life onto our planet can be seen to be among the most pivotal moments in the life of the person doing the birthing.  It is a huge opening and opportunity on all levels. The tsunami-like primordial current of birth has the power to bring up much of our unresolved trauma, as well as to transmute it.  The less that birth is tampered with, the greater the likelihood that it will empower and heal.                                                                                                                                                                                                                                                                                                                                            However, birth in 2019 more than ever is laced with a hefty dose of fear-mongering and intervention, often unnecessarily.  The statistic of one in three births said to be traumatic is to my way of thinking simply the tip of the iceberg. If one embraced a broader definition of trauma as something that was “too much, too fast, and too soon” – too much for our capacity to cope, moving at too fast a pace for us to integrate the experience, and being sudden or unexpected – then the figures would tell an even more compelling story.                                                                                                                                                                                                                                                                                                        Trauma can also be defined as an ongoing response to a threat that is no longer present in time. Through a neuro-biological lens, it is seen as a consequence of the amygdala or threat detector in our brain failing to switch off long after the original danger has subsided.  Stress chemicals flood our system indefinitely and perpetuate the highly charged state of fear which is inherent in the Fight, Flight, Freeze and Appease protective survival responses.                                                                                                                                                                                                                                           Our species of social mammals is hard-wired for safety and connection. These are the basic pre-requisites for moving forward from trauma, and perhaps even preventing it in the first place.  The reading of danger signals happens in three main ways:  taking in information from our internal (body) environment, our external environment, and from the people around us. This is a biological imperative and happens constantly and multi-dimensionally, below our conscious awareness.  And so, the ability of the people around us to influence the state of our autonomic nervous system is very real. This is known as co-regulation.                                                                                                                                                                                                                                                                                                                                                  French obstetrician and birth advocate, Michel Odent, alluded to this idea in his declaration that a midwife should be able to sit in a corner of the birthing room and knit – in other words, their presence and behavior would signal to the birthing person’s brain, without words, that all is well; in fact so well that the midwife can afford to knit.                                                                                                                                                                                                                                                      On a primal level that underlies all other human functioning, the quality of presence that the birthworker brings refers to the state of their autonomic nervous system:  how regulated or dysregulated is it?

Nervous system regulation is not something that can be feigned.  It is the ability of the system to return to balance naturally over a short period of time, without having to employ strategies such particular ways of breathing or moving one’s body, or less desirable attempts at regulation such as smoking, drinking alcohol or eating sugary foods. Regulation at this level is a marker of resilience on a fundamental level.  And it requires that we don’t suppress our uncomfortable feelings and sensations but learn to metabolize them in healthy ways.
 

So, when a midwife, obstetrician, doula, partner or other member of a birth team bring their unprocessed stress and trauma to the birthing room, there is likely to be a direct impact on the birthing person. And this is especially the case when it relates in some way to their own birth or birthing of their babies, sexual experiences, and medical or surgical interventions. 

If they do not commit to their inner work on an ongoing basis, their nervous system is more likely to become triggered by events in the birth room, which may in turn affect the quality of their presence, their decision-making and their behaviour.

Triggers may come in the form of smells, sounds, visual, situational and other reminders where the brain associates these with past traumatic events in the person’s life, and the nervous system automatically responds in protective survival mode. This may be subtle, or it may not.

The birth professional may attempt to cover up their feelings of being triggered and ‘act professionally.’  However, the birthing person in their highly sensitive state are, like other mammals,  primed to sniff out threats to their safety and fear in those around them.  They may pick up the birthworker’s subtly raised eyebrow, high-pitched voice of anxiety, and the overly cheery demeanour as signals of dissonance.  This is then likely to be interpreted by them as “It’s so bad that they’re having to withhold the full story”, or worse still, “I’m being manipulated and controlled with lies.”  And so, the birthing person’s own fear intensifies.
 

Many are subconsciously drawn to working in birth as ‘wounded healers,’ where they will have opportunities to re-visit their own trauma vicariously through their clients or patients in attempts to make sense of it and heal more fully.

In that situation it is even more imperative that they dedicate to this awareness and to growing their resilience.  This is never a once-off affair as life will continue to throw them curved balls.

What can you as a birthworker do to bring a cleaner slate to the birth room so that the birthing family can rely on you for co-regulation?

Can you hold a strong and safe container for the family without overriding or ignoring your own level of regulation?

And can you ‘join’ with the birthing person in that space but not become ‘merged’ with them?

 

With a foot in each of the trauma and birthing fields, some of my personal recommendations for achieving these are:
 
               1.  Become attuned to your stress physiology and nervous system states, triggers and ways of managing.

              2.  Commit to your own trauma healing, ongoing stress management and hence, your longevity in                                   your chosen vocation.  With the alarmingly high levels of trauma among birth professionals  –                                       vicarious, secondary or whichever label it may go by  –  this cannot be emphasized enough!

             3.  Keep challenging yourself around your boundaries with clients, colleagues and the system under which                    you practice  – physical, psycho-emotional, intellectual, energetic, and spiritual boundaries. Learn to                          tune in to your instinctual Yes and No.  Get clearer about “theirs” and “mine.”

            4.  Learn to differentiate the client’s experience from your reaction. Ask yourself honestly, “In what way, if                       any, are these events touching into my own story?” If in fact your own trauma surfaces, remind yourself                   of the place you are in, the date, and “That was then, and this is now.”

            5.  Bring your awareness to your own body every now and again. Assess your own nervous system                                   responses and how you are being affected on a felt-sense level if there is a difficult situation playing out                   in the birthing room. Is your heart beating more quickly? Is your breathing becoming shallower?  Have                     you become numb to feelings or checked out of your body, despite physically going through the                                 motions of all that is required in your job?

           6.   Learn a variety of grounding techniques to bring down the charge in your nervous system in the                                  moments when you find yourself in the midst of a fight, flight, freeze or appease response in the birth                      room.  A simple one is to take your focus to your feet and sense the support of gravity. Wiggle your toes,                  and imagine roots extending deep into the earth through the soles of your feet.

          7.   Ways of self-soothing or self-stimulating during stressful moments include extending the exhale part of                   your breath cycle, moving in some way, speak, connecting  verbally or non-verbally with colleagues,                           sipping water, massaging around your jaw, opening and clenching your hands, taking some brief time                       away from the situation if possible, or drinking in the warmth of your hands placed over your kidneys                         and adrenals.

        8.   Remember that it is okay to feel elated or moved by your client’s situation without collapsing into                              emotion yourself. However, it would serve your client if you let go of any agenda, attachment to outcomes                or attempts to ‘rescue.’  Too much empathy can promote pity, disempower your client and blind them to                  their own unique ways of coping.


When you are regulated, you stand to offer birthing families an experience of safety, help calm their nervous system, normalise and validate their responses, support them in setting boundaries, soothe their attachment wounds, reflect their coping skills, add a sense of coherence to their experience, and transmit the possibility of healing and resilience.  And that is 
huge.

 

Without your authentic nervous system regulation on board, all of these would be less likely for your clients. The situation can then spiral downwards, with one person’s nervous system setting off the other’s, and trauma upon trauma being perpetuated for all concerned. 

 

Your regulation and the resonance that you bring to birth as a professional cannot be under-estimated.  It can profoundly improve the experience of the birthing families you seek to support, and reduce their likelihood of developing entrenched trauma responses.  And all of this can come into effect before you even begin to do something actively to counter the potential for trauma.  

References: 

–  Rice, H et al. (2013)   Bearing Witness:  midwives’ experiences of witnessing traumatic birth. Midwifery. Vol. 29, Issue        9, pp 1056 – 1063   https://www.midwiferyjournal.com/article/S0266-6138(12)00244-6/pdf 

–  Toohill J. et al.  (2019)  Trauma and fear in Australian midwives. J Aust Coll Midwives. Vol. 32, Issue 1, pp 64 to 71                 https://www.sciencedirect.com/science/article/pii/S187151921730269X?via%3Dihub

Nisha Gill works at the intersection of trauma, birth, bodywork and women’s sexuality. She is trained in Somatic Experiencing and Somatic Practice, two neuro-physiological approaches to trauma resolution which are underpinned by the Polyvagal Theory and are gathering momentum worldwide. Nisha offers 1:1 therapy in person and online, and facilitates workshops on trauma-informed care for birth professionals and other body-oriented practitioners.

Link here to more information on Trauma Healing.

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