I was delighted to present at the recent North American Registry of Midwives (NARM) student seminar of the NARM African Pilot Project here in Cape Town. We began by sharing the difficulties we encounter when learning at the interface between the medical model of care and the midwifery model of care. The opening discussion focused on how we could act differently so that we could maintain our own authenticity within the midwifery model of care while at the same time meeting the needs and demands of clients within the maternal care system. There is nothing like the discussion that ensues when midwives (or aspirant midwives) get together and we agreed, after tea and biscuits, that the subject matter I wished to tackle may shed some light on our questions.
I presented a schematic summary of the neurophysiological foundations of the autonomic nervous system function, which is the part of the nervous system most strongly involved in the labour and birth process. A diagram of the different levels of brain function and how traumatic events affect and are stored in the autonomic nervous system as well as the limbic system of the brain. How a traumatic imprint may affect a woman’s anticipation and experience of labour was explained. We also discussed the sympathetic and parasympathetic responses, now joined by a third response, that of the attachment and social communication response according to the polyvagal theory.
This theory helps us to understand why it is imperative to create a safe environment in order for a woman to labour effectively and give birth spontaneously, and why stressful interactions and circumstances will alter her ‘polyvagal‘ autonomic nervous system response, leading to tension and fear. Tension and fear during labour tend to impede and slow down the process of labour, increasing sensations of pain. It is often helpful to explain to clients how this works as they are then able to release and share their fears and calm themselves.
After more tea and biscuits, we did a birth simulation exercise to show the connections between how we are born and how we respond to being with women during labour and birth. The seminar ended promptly at 6pm and we returned to meeting the respective needs of our own families, as midwives should!