Home Birth and Midwifery Care

In the past year there has been an increasing awareness of the importance of finding balance between our work and personal lives. Finding a way to balance the stress of our everyday lives and find moments of calm and feelings of connection with people around us. I don’t think there are any of us who have come this far through the pandemic without realizing the role stress can play in our lives, or felt the loneliness, and isolation that came from the Covid lockdowns. In my own life finding myself abruptly without childcare for my two children last year and the disconnection from my greater circle of friends was a wake up call. There is only so much trauma that the body can tolerate whether that be emotional, mental or physical traumas. For many of us this last year that sense of isolation lead to increases in anxiety, and depression. The stress of this experience has left many people stuck in a hypervigilant state.

Hypervigilance is an important physiologic response. No one wants to be eaten by a bear or sickened by Covid-19. As a species we have evolved to enter into what is called a sympathetic state when we sense a threat to our survival. But what happens when the threat to our survival is gone? What happens when our body is constantly assaulted day after day with news of a threat to our survival? Our physiology can shift over time and get stuck in a pattern of hypervigilence. So even though the bear is gone or the lockdown is over the fear and anxiety remains embedded in our physiologic reactions to the world around us.

Imagine you are a deer on the edge of a corn field at dusk. It’s the best time of day to eat your leafy greens. So slowly… cautiously… you look around before you cross the road. You feel the evening dew under your hooves and feel the gentle breeze across your back. You are relaxed and happy to be about to eat your dinner. Maybe you have young fawns with you nuzzling your leg to show they love you. It is a peaceful moment with a deep sense of contentment with your place in the world.

VRRRROOOOMMMM… Suddenly you hear a sound on the road.

Have you ever stopped to think about what is actually happening in your body in those moments?Maybe you have. You may have learned about the autonomic nervous system prior to this. The autonomic nervous system has classically been thought of as split into two pathways the sympathetic the fight or flight, and the parasympathetic rest and digest.

Dr. Stephen Porges, PhD, who pioneered the groundbreaking Polyvagal t heory, presents a more complex way of looking at our neurological responses to stress. According to Dr. Porges, the parasympathetic nerve pathway which consists of the vagal nerve, is split into a ventral nerve pathway (SAFE AND SOCIAL) and a dorsal nerve pathway (FREEZE/COLLAPSE).

In this freeze collapse state your blood pressure drops, your breathing slows, you feel chilled, your limbs may feel heavy or hard to move, eye contact becomes uncomfortable. Your brain becomes foggy and you feel yourself as separate or dissociated from the present moment. In this foggy head you can’t seem to make decisions and your thoughts are slowed. You may feel depressed or hopelessness setting in.

The Polyvagal Theory:

So if you are that deer in the forest and you hear a noise you actually have another primate survival mechanism. You can fight or flee. Or as is most often with deer, you can freeze. After all that is why we say “like a deer in the headlights”, right? Or like many small mammals that “play dead” so the predator will leave them alone.

Now imagine this is how you move through the world everyday. What can we do when we find ourselves stuck in this hyperaware, hypervigilent state? For some people with chronic anxiety, PTSD, TBIs, or those who are neurodiverse or on the autism spectrum this may be a familiar state of being. In fact it may be so familiar that you don’t know how to move out of that state and any attempts to do so may seem scary or anxiety inducing in and of themselves. So how do we get to a calm place that feels safe and where we can connect with our world and the people around us. In other words, how do we get to a parasympathetic safe and social ventral vagal state. A state where we can sleep restfully, digest our food fully, and connect with people around us.

So once we find ourselves in this pattern whether it be because we have come the last 18 months of trauma or because we are autistic or fall somewhere else in the neurodiversity spectrum, or are neurótico al but have experienced some of trauma in the past either physical or emotional, what do we do about it?? How can we make it feel safe to enter a ventral vagal safe and connected space in our have it actually feel safe and comfortable. How do we stay there? OR if we move down the autonomic ladder, how do we develop resiliency to bounce back up the ladder into a safe state again.

There are many different techniques that I have used to help both myself and my patients to move through their trauma and anxieties. Overtime through working with patients it becomes easier to find and stay in a relax safe and connected state within ourselves. So when we are confronted with a stressful situation we can navigate our way through it instead of its navigating us. I use bodywork, mindfulness coaching, Integrated listening systems (ILS), and hyperbaric oxygen treatments to help patients become more aware of the patterns they are in and how to move through them.

ILS in particular was developed as a direct result of Dr. Porges neurophysiological research into the Polyvagal theory. It uses music to stimulate neurons in our autonomic nervous system and cranial nerves in order to reroute our neurological responses so that we can change our trauma and anxiety responses and live a more balanced life.

This pandemic has challenged all of our nervous systems and continues to do so but there is a light at the end of this. You don’t have to be that deer moving through the world stuck in a hypervigilant state.

If you want more information about Dr Stephen Porges and the Polyvagal Theory here are some more resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108032/

https://www.stephenporges.com/

Https://www.polyvagalinstitute.org

Polyvagal Theory and Regulating our Bodily State

Https://integratedlistening.com

For more information on the connection between stress, illness, and trauma with Dr Gabor Mate here are several great talks:

For more information about neurodiversity:

And if you want a more scholarly article about the role of anxiety in autistic here is a recent one from 2020. The Sensory Abnormalities and Neuropsychopathology of Autism and Anxiety https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290113/

Dr Rebekah’s Philosophy on Home Birth:

As a naturopath and doula, it is the belief of Dr. Rebekah that the childbearing year of pregnancy, birth, and motherhood is sacred journey. This is a very emotional time for many women and an intimate experience for both the parents as they expand their family. This is one of the most vulnerable times in a woman’s life and it is important that she is in a comfortable place surrounded by people, who make her feel safe and empowered. Following the midwifery model of care Dr. Rebekah combines the highest standards of maternity care by balancing the elements of traditional wise woman’s wisdom and modern medicine. Doulas and Midwives trust that birth is a normal, natural process and attempt to minimize the level of medical interventions, invasive testing and procedures. As a naturopath and doula with training in midwifery as well, Dr Rebekah takes the time to listen to each expectant mother, making sure she feels heard and her individual autonomy is respected. She also believes in the importance of educating the whole family so that they can make clear decisions about any treatments that may be recommended.

Pros and Cons to Out-of-Hospital Birth:

Whether, at a hospital, birth center, or at home, there is always some level of risk associated with giving birth. Statistics have shown that planned out of hospital home births or birth center births attended by a trained midwife are not only proven to be safer but have better outcomes and lower rates of interventions. It has been shown through studies that when a laboring woman is in a familiar, intimate environment she feels safer and is more likely to birth naturally. When a woman feels safe and comfortable she is more likely to feel in control of how she moves through the labor and to trust her body’s natural instincts. When a woman in labor feels safe and in control it is a very empowering experience and she is less likely to be overwhelmed by stressful emotions or fear which can cause complications for the laboring mom. The main risks to home birth primarily exist in regard to the unavailability of immediate high level intervention should serious complications arise. However, there are not many emergencies in a healthy, low risk pregnancy and birth. Midwives are trained to manage most complications of labor including postpartum hemorrhages and neonatal resuscitations. Some women do have a little extra bleeding after the baby is born and this is generally easily managed at home by the midwife with no need to transfer. Likewise sometimes baby is born needing just a couple puffs of air or suction to help clear their breathing after the birth and midwives always carry oxygen and other necessary supplies to births with them should this be necessary. When those rare complications do arise that require transfer, they usually do so with sufficient time to transfer mother and baby safely and without stress. If the emergency develops rapidly the midwife is trained to initiate emergency procedures until the EMT service arrives. The chances of mother or baby dying during birth are very low no matter where the birth occurs. Part of the role of the midwife and a naturopathic doula, throughout the pregnancy, is to make sure the parents are fully informed of these risks and benefits. The parents must be willing to except the risk and responsibility that sometimes unpreventable emergencies do occur in or out of hospital. If you are interested in learning more about the benefits and risks of Home Birth, the Midwives Alliance of North America has a great Fact sheet.