 Now, we are just going to start our presentation. So we have Leanne Swarch, she's going to talk about midwives, trauma and sustainability. Leanne has been a midwife for more than 20 years in clinical practice as well as teaching midwives in a postgraduate university program for over 12 years. She also runs retreats programs and workshops for midwives and families aiming to facilitate profound transformation as well as sharing practical skills and knowledge that make the difference. Her master's degree is in health research and this has helped her to balance evidence-based care with intuitive knowing in her work and teaching. Leanne is passionate about working with midwives and other bird workers because midwives are the gatekeepers at the beginning of the life. Knowing how transformational the moments around bird are and how much it impacts the woman, her baby and family and the community around her means that our role is crucial. Midwives don't just make a difference through clinical skills and saving lives. We need to pay attention to who we are deep inside and yet there's still not enough support and attention given to supporting sustainability in midwifery. Leanne's passion is sharing the skills and tools needed to navigate the midwifery calling and well-being and balance. If you want more information about Leanne, you can visit the website ConsciousBirdCommunity.com. I'm pleased to present Leanne and the mic is you, yours whenever you're ready. I'm just going to make your presenter. All right. Thank you. Thanks, Paola. That's great. I'm just looking at where everyone's from and it's fantastic because I was born in New Zealand, grew up in Canada and lived in Australia for eight and a half years and now live in Indonesia the last 11 years. So you're all my people, it's so beautiful. We've got all my countries there. So nice to see you all. You know, in this slide, I decided to keep this beautiful ocean background of the first slide here was actually just part of the theme of that PowerPoint. But I decided to keep it on there because it just gives me that sense of softness, relaxation, all the things that we need to have this sustainability inside. Not that we need a beach, but what it gives me is that inner sense of calm and ease and relaxation. So there you go. Instead of I was going to put a beautiful birth picture in the back, but instead I stayed with the ocean. So I know a lot of this conference is about cognitive information, you know, clinical updates, fantastic information. This next hour, a little under an hour, we're going to be together is a little bit different. I'm going to share some information, but I want this to be experiential as well. So I'll be guiding us through some very short practices through our time together as well. So I'm going to do a little talk. I'm going to have us do a little check in, a bit of a research overview, another short process, and then we'll have a little bit of time for questions at the end. So I hope that you can stay awake enough, all of you who are up so late, 9pm, 10pm, and enjoy this little process. So one of the things that I think everybody knows here is midwifery is absolutely unique. And I believe that our personal nourishment is essential to our longevity in this work. In order for midwifery to be sustainable, we need to keep ourselves well nourished. I'm using the word nourished, but not just physically, mentally, emotionally, maybe even spiritually. And I really believe there are particular aspects about being midwife that mean we need to take extra care of ourselves. It could be sleep schedules for some people being on call for others shift work, the life and death nature of being at a birth as much as we're there in this beautiful empathic capacity, we're also there really to be that gatekeeper as well. And I think this juxtaposition of caring, empathy, being with women in partnership, you know, we're connected, we're loving at the same time as being completely grounded in medical understanding, evidence-based practice, this is really different from most other jobs, most work. And this means that we need to go about our self care in a very different way. We can't just take the occasional vacation and expect to be in peak form to be a midwife. And I'm going to keep coming back to this understanding as we go through this talk, this uniqueness of midwifery that means we really need to look after ourselves in a different way. So I've made this short talk experiential to give you a little taste of small practices you can come back to again and again when you need them. Because this is what I do, I nourish midwives, birthkeepers and mamas like all of us. I don't think I need to say too much here because Paula said it so beautifully. I like all of us that are here, I'm sure, very passionate about my work as a midwife and in working with midwives, both in private sessions, in workshops and postgraduate university programs. And I'm also passionate about my family. I have two beautiful children, two daughters, and somehow that didn't make it on the slide. So I'm really happy to be here with all of you today. And I want to start by just giving us a moment in the middle of this online conference, our special international midwives day, just to take a moment to be present. So if you're somewhere safe and you feel comfortable right now, just start by closing your eyes. Take a moment to bring awareness to your breath. Notice where you feel it moving into your body and where you move out. You might notice your mind starting to want to think about a whole bunch of things. And just bring your attention back to the breath. Just for a moment, being here now. Notice if there's a slight coolness as the air moves in, maybe you'll warmth as it moves out, just bringing all your awareness to the breath. Now allow your awareness to drop into the area of your heart. Take a moment to notice what's there in your heart. Notice how you are right in this moment. Just listen and be aware of yourself. Gently with curiosity. Notice how your body feels right now. Scan through, notice. Observe what's happening in your mind, where your thoughts are jumping. Feel how your emotions are doing right now. Just gently observing and noticing. If you feel comfortable, you may want to place a hand on your heart to deeply connect with yourself just for a moment, saying hi to you. As you're ready, take a breath or two into your hand. Say thank you to yourself for taking this quiet moment and bring yourself back to the room that you're in. I'd like you to check in with yourself right now. When was the last time that you really stopped and checked in with yourself? For us to be nourished as midwives, this needs to be a regular practice. We need this. It doesn't take hours of your day. A lot of people feel like, well, mindfulness, it's these hours of meditation. No, it means taking the time to do a little check-in, a check-up with yourself regularly. We're so good at check-ups with women and families that we work with. We are so good at it. We're always checking in. We want to know how she is, how she's doing, and we want to know that because if we know how she's doing, then we can help her adjust what's needed or it helps us to actually know what is needed in that situation. But how often are you checking in with you? Now, that quick check-in isn't going to solve any problems, but it starts to bring awareness to what's really going on for you. Being able to care for ourselves to make midwifery sustainable starts by knowing what's going on inside of me. And I'm going to talk a little later about why this is specifically important for midwives, to know how we're doing, and to be able to do something about it. And Celine, you said last hour, day, week. That's great. So that's what we all need is to be doing this check-in really regularly. How am I doing? What do I need? Just stopping and being present. So yes, it needs to be last hour, last day, and last week. That's fantastic. And I would say one of the big reasons that we need this, now somehow my slides have jumped all over the place. Where are we? There we go. So is because rates of stress, of anxiety, of burnout in midwives are at an all-time high. It's quite shocking when you look at the data. And when you speak to midwives, I mean, I speak with students regularly who are saying, I feel burnt out. I'm tired of this. And they're students. The WELM study, Work, Health, and Emotional Life of Midwives recent data found that almost half of midwives studied and considered leaving the profession in the last six months. That's huge. And the reasons, of course, they're familiar to all of us, dissatisfaction with the organization, the system, the model of care, dissatisfaction with their role, feeling unable to be the kind of midwife they want to be, all of those things that are so familiar to so many people. But all the research shows the same thing. Their midwives have high levels of stress, high levels of anxiety, and so many are burning out. Most studies have shown somewhere between 20 and 50% of midwives are in some degree of burnout or trauma. And I'm going to come back to trauma. Now, I think, you know, midwives, we just care very, very deeply. So I don't know any midwife that's wanting to quit or talking about leaving midwifery because they don't care. It's only ever because the work doesn't feel sustainable. Now, that study that I talked about, the WELM study, that, of course, was completed before COVID and the last two years has brought such a whole new level of challenge. The biggest one that I see is this role change that so many midwives have been faced with. You know, we're so closely connected with the families that we work with, whether it's shift work or on call and continuity, we care. And having to wear masks and PPE, having to tell partners they can't come in for a checkup or a birth, you know, I'm sure this has happened in different ways to so many people here. Having to be this role of this whole new role, a different role for a midwife of sort of being the taskmaster and, you know, doing things like babies being taken away from a COVID positive mama, we're thrust in this role that I think can feel like the antithesis of this caring, empathetic midwives, midwife. And so what I've seen is that those rates of stress and anxiety that were there before, they just shot up through this last two years. And it's really hard when something like that happens, it's often a trauma for a whole, a whole group of people. And it's not that easy to just let go of that trauma and move on. A lot of midwives are saying they still feel this anxiety of, you know, is something going to change again? What's it going to be like? Am I going to be okay? Can I still look after the families that I'm working with the same way? So these things aren't something that we can easily just let go of all the time. I've listed on this slide three main areas that the research has shown are challenging for midwives. System wide issues, you know, workload, models of care, not enough resources, not enough midwives. And I think that is one of the major factors for burnout in midwives. Unfortunately, we're not going to be able to solve that today. But it's still what we're talking about and I'll talk about this why later, but it's still important to look at the individual, even when it's system wide changes. So we also have this unique nature that we already talked about. And of course, the potential for trauma. And that comes through our very close connections with women and with families, and exposure to vicarious or secondary trauma through witnessing traumatic birth. This is something that is, I would say, affecting every midwife that I speak to in some way, this feeling of being at births that are very challenging occasionally, or depending on the context, you know, for some midwives, it's working a system where they don't have control necessarily over what happens to a woman. And so they're witnessing something that they wouldn't do themselves, but they feel powerless to stop it. Or just it's the woman's biology and sometimes births can be traumatic, no matter what, no matter what context, no matter who is there. The problem is, is that we have this high potential for secondary trauma, vicarious trauma. And I think to a degree, you know, some stress and challenging work is inevitable. You know, everyone is vulnerable to traumatic stress. You know, I've said here midwives are. But what the research has shown is that certain professions and midwifery is up there are at a very high risk. And the problem is, is that risk can make our work itself more difficult, more challenging, because we can't be a midwife without this empathetic nature to some degree. So we're always going to have stress, you know, no matter what in stress is good for you to some degree, you know, it helps every part of our body. We need some stress, positive stress, good stress. And I love Kelly McGonagall's work on this. If you want to ever look that up, she has some great TED talks and books from a few years ago on how stress is good for us. So stress is fantastic. However, we all know that stress gone too far is not fantastic. And this is the idea of simple stress. Humans are designed for simple stress. So that's you see a tiger that activates your fight, flight freeze, your sympathetic nervous system, you know, you're either going to run away, you're going to freeze and the tiger is going to lose interest, or you're going to die. It's temporary. So once this threat is over, the stress rates dropped. And then we go back into this parasympathetic nervous system mode of rest, digest, heal. And we use these analogies, I use these analogies all the time with women, you know, the tiger, their birth fears. And in the natural world, there is only simple stress. But complex stress is something different. This never really goes away. So it can start with a traumatic event, like I was talking about before, and that sets the body up in a state of traumatic stress. Or it can be things that pile up lots of smaller stresses. And the problem is the body doesn't know the difference between memories of trauma and traumatic stress are being reactivated. All the little things that are piling up from credit cards to remembering this to forgetting that the body can't tell the difference in all of those. And a current threat, like a tiger, we are designed for stresses that come and go and our body has so many ways of releasing the stress in between. But we aren't designed for complex stress. We can't eliminate stress. But even though it's inevitable, our responses, the way we respond and even our physiological reactions to it are not inevitable. So I mentioned before how much the research and my experience working with midwives around the world is clear on how many midwives have symptoms of post-traumatic stress. So not necessarily ways that they would recognize it. They're not midwives that are necessarily saying, I have post-traumatic stress. But it's clear from the way their bodies are responding and reacting that there is a degree of post-traumatic stress or there are symptoms of post-traumatic stress there. Trauma is a very specific kind of stress. And I want to talk a little bit about what happens in our brain in traumatic stress. So you can see in this slide here a very basic view of the brain divides it into three parts. It's not really like this, but this is the easiest way to understand it. So we have our reptilian brain, primal brain, or we could call that the survival brain. Then we've got our limbic system, which is our emotions and processing emotions. And then of course, our prefrontal or neocortex, and that regulates our rational thought and it also helps us regulate emotions. Now during a traumatic event, the amygdala in the primal brain gets turned right on. So emergency systems are all go. We want that. Nervous system, sympathetic nervous system is on. And the prefrontal cortex, which is thinking rationality regulation, it basically gets switched off during traumatic event. The problem is, is that this is the part that helps us analyze and give meaning to our experience. So we don't want that part when we're in an emergency or a traumatic situation, not as in a birth emergency. We need that. But when we're in a real emergency that's where our life is threatened, we need to be able to react much more quickly than our thinking brain or neocortex can. So this is fantastic. But what happens is that trauma puts us into this survival mode where our brain gets completely flooded. And in that state, we don't process events. We remember them as pure experience because they haven't been filtered through here unless we've done some work on it later. So when we're faced though with another similar event, the brain goes automatically into sympathetic mode fight flight freeze, the survival brain. Now again, we want that the body is thinking, this reminds me of last time I need to straight away go into survival mode. It's like the body gets sensitized. And that actually limits our ability to think rationally. Now, that's not so good for a maternal emergency, for example, or making the right decisions or choices in a difficult event. So with traumatic stress, what happens is that the brain goes into this activated sympathetic mode, and it never quite turns off. Now remember that this part of the brain is only concerned with survival, not our inner well being or the well being of those around us. So I talked about what happens when we're faced with a similar event as previous trauma. Well, this next threat, from our brain's perspective, could be the next birth that seems to be unfolding how that other birth went, or it can even be when we empathically relate to a woman's whose birth is similar to our own. If the mind and the body experience a lot of traumatic stress, then they sometimes go into this constantly activated state. And this means looking through the eyes of a sympathetically activated nervous system that sees everything around us as a potential threat to our well being. Now this is really helpful when you're running from a tiger or you're living in constant danger. This is what we need. We need to be able to say, quick, run, something's wrong, go. But in day to day life, when there isn't any immediate physical danger, it is debilitating. I see midwives and women all the time who are living just a little bit like this all the time. It's like they're on alert. They're never quite fully turning off. They're never absolutely finding a place of deep rest or relaxation. They might sleep deeply, but it's like they'll describe almost like going unconscious when they go to sleep, because their body is trying and their brain is trying to process. But when they're as soon as they're awake, it's like a slightly on alert feeling all the time. So what do you think the impact on the women and the families we care for is when we're in this state during labor birth? I mean, why does it matter how we feel as a midwife more than it would matter for anyone experiencing trauma and burnout? Now I would say there are many, many aspects to midwifery that mean paying attention to our inner state is vital. I'm just going to talk about one of them, I think, today, because we only have a short time together. But I think this is something that you'll all understand. So when we're in a state of stress, whether modally or more strongly, or this slightly activated state that I'm talking about before, what hormones get produced? So it's our catecholamines, like adrenaline, our flight or flight hormones. And what impact do these have? Well, we know they block endorphins, our feel good chemicals 300 times stronger than morphine. And we know the impact that endorphins have, for example, on women in labor and birth. Now, adrenaline is one of the most contagious chemical messengers in humans. And this is really good. This makes absolute sense. We want this because as early humans, or even now, we need to be able to share messages about being in danger in a way that's much quicker than words could ever be. So that'd be the kind of thing where I see a tiger, my hormones need to give messages to everyone around me very quickly, instantly, that something's wrong, be ready to fight or to run away. So those chemical messengers need to be quicker than words. Because by the time I'm saying out loud, okay, you know, I see a tiger, let's run, let's fight, whatever it is. No, my body needs to send these signals out. So our body is very, very efficient because of survival at sending these signals, these adrenaline and other similar hormone signals out to everyone around us. So what happens when a busy, stressed midwife walks in a room with someone in labor? Well, that midwife sends a signal to the birthing body that it's not safe, that there's a tiger in the room, don't have a baby now, stop this process. Now, of course, the woman's body, the baby, they're all sending signals as well. We're not the only equation. And the last thing I want to do is make myself or anyone else feel guilty or badly about their work or being stressed or being busy. It's a reality. We are not the only equation in the birth. And at the same time, a birthing body is so sensitive to these chemical messengers that are being put out on a very deep unconscious level. And what midwives bring into the room and anyone else who's there on a subtle level do impact how our labor and birth goes. We know this from the research and I know it from my own experience. I can feel when I'm a little out of balance, it affects everyone in the room. We're often the one that people are looking to for that sense of safety, both consciously for reassurance is everything okay. Sorry, Viad, we can't hear you. Okay. Do you remember what the last thing you heard was? Okay, great. I seem to be back. So I'm not sure where that cat out. But anyway, you know, Michelle O'Donnell talks about a beautiful French substitution, talks about how the sound of midwives knitting in the background is so soothing unconsciously to women birthing. Because of course, it sends a signal like everything is so okay that I can casually sit here and knit. And I noticed Celine's comment there, can midwives benefit from oxytocins and endorphins at birth? Absolutely. I love all that. Not that many studies in birth itself, but there's so much research of how much benefit there is when you're around high oxytocin, high endorphin people. We benefit. So I mean midwives, I believe get a high from being at a birth where things are going well, hormonally going well. And of course, I think there's a huge benefit to being able to, you know, we're so lucky we get to be in this amazing oxytocin endorphin rich environment all the time so often. So the big message that I want to say here is that we need to be really looking deeply and being honest with ourselves. Are we sending physiological and hormonal signals of safety ease? And everything is wonderful here? Or are we sending unconscious signals that it's not safe? And remember what I'm talking about is happening on a body level, a physiological level. The problem with a lot of us is we go, okay, I'm really stressed about that, but I'm just going to push it down and smile and be here nicely. But for birthing bodies, that doesn't do it, because the birthing body is going to feel what's being pushed down. It's going to feel everything that's there. And I think most midwives I know do have really powerful and beautiful ways of being able to shift their state very quickly before they walk in a room. I think midwives, we are amazing, and we're amazing at bringing that sense of safety. And yet some of this burnout and high levels of stress and anxiety I'm seeing are happening because midwives are doing that day in, day out without really stopping and looking after themselves. Because you can only just shift your state so many times at some point you need to stop. We all need to stop and say, how am I actually doing? What do I actually need here? Am I actually okay? What's still going on from me? So what do we need? We need a shift in paradigm. So I know, I know that when I'm in a bad mood, if I'm stressed out, I'm going to impact the oxytocin levels of the women I'm working with. So I consider an integral part of my job as a midwife to stay in this endorphin-rich state as much as possible, to be in my center, to be able to come back to a place of calm and ease inside. This is something I often, I give homework to families that I'm working with to write their endorphin list. What are all the things that make them feel good deep down? So not just, not that, just getting the massage, things that are great, but what really deep down, well, maybe a massage makes everyone feel good, but those things that are not just the simple self-care-like eating chocolate that people talk about, boost your endorphins with chocolate, but really deep down, what makes you feel good? And I say, this is to help you prepare for birth because birth is an endorphin-rich state. And I think that's true for everyone who's out of birth. We all need to, as much as possible, be going, what do I really need right now in order to deeply feel good inside of myself? And I would argue that training skills, tools, time given to the emotional state of midwives is as important as our clinical skills updates because both have the potential to impact the experience of the families that we're working with on very, very deep levels. And I would say probably a lot more than we know because we're only just really beginning to understand just how important all of this more subtle layer is, and we're only just being able to start to measure that subtle layer. And I'm talking measure physiologically, not just in a sort of a, you know, esoteric sense, but very physiologically. It's also only when we're really present in the moment that we have clarity. And that's when we make the best decisions. And that's also when we can be the most effective change makers. And it's those effective change makers that will actually be able to make the system better. Being in a state of stress, of trauma, it's very hard to make changes in the system. So how do we do this? Now I started with a little check-in with ourselves because that is step one, knowing what's going on. Step two is having skills and tools to be able to quickly and easily come back to center no matter what is going on on the outside. One of the things that I talk about with women is this idea of finding their inner sanctuary within them, this feeling of safety of home and how valuable this can be, this inner sanctuary in birth and parenting and being a mother. And I think for us also, as midwives, we need to be able to have this inner sanctuary, this place of rest and ease inside of us that we can come back to at any time in times of stress or challenge, struggle. And in my experience working with midwives, that sense of inner safety and calm is something that needs to be cultivated. It's not necessarily automatically easy to get in touch with that. I don't think it ever disappears. I think we all have that seed of safety inside, but without regular practice, it can become hard to find it. And that kind of self-care that I'm talking about is about doing what's hard to get to a better place. It's really valuing yourself enough to learn your best ways to regulate your emotions, to regulate your nervous system. And as I said before, we need to value this kind of work, this kind of investment in ourselves as much as we value clinical skills and clinical updates and give the time to do that. Because I think one thing we've all learned over the last couple of years is we have to look after ourselves first if we're going to keep going, you know, we have to fill our own cup. And what we teach mothers to keep motherhood sustainable, keep parenting sustainable is what we need to model. So we're going to, I'm just noticing the time and we've just got a few minutes left. We're going to take a moment to do a very short little process here just to finish off. And this is something that very simple, it's called the coherence technique or heart-focused breathing. And it's something that, oh, Paola, could you just forward the slide or pass me back control of the slides? I've just noticed I can't forward them anymore. Sure. Just give me a moment. Thank you. I'm just looking for your name. So while she's doing that, just take a moment again to bring your awareness in the area of your heart. Close your eyes if you feel comfortable. And you might even just place a hand on your heart. See if you can let your breath go in and out through your heart. Almost as though your heart is breathing in and your heart itself is breathing out. Breathing in through the heart and out through the heart. Now take a moment to think of something or someone you love or appreciate. Maybe it's a memory. Maybe it's the image of a flower or a loved one. And imagine as though that beautiful memory, that beautiful thought, is sitting inside your heart. Bring your breath into your heart and this image you have of what you love or appreciate and breathe out. Almost as though you're breathing light and making this image brighter and brighter. Someone you love, a beautiful memory, something you appreciate. Maybe it's just the image of a beautiful sunset. Breathing light into it and releasing your breath and letting it go. Now you can stay in that state as long as you'd like to. Now that is a very quick version of a technique called as I said heart focused breathing or heart quick coherence technique. And believe it or not, there's so much research behind that particular technique. It's such a simple, can take you 30 seconds or less and all it is is focusing on the area of the heart, breathing through the heart and bringing something you love and appreciate. You can do a few things often I'll do one and then the other. And what it does is it starts to bring coherence to the nervous system, the brain and the heart. And when our heart and our nervous system and brain are in a coherent pattern, then we have this beautiful sense of ease inside and that sense of ease of course gives us the hormones that we need to make midwifery sustainable. And it allows what we need to be able to care in the best way for the women and families that we look after. So I always seem to plan too much. So I'm not going to do the other process, but I did put together a little ebook and a free guided audio meditation for you. So you can go to nourishedmidwife.com to get that. And so I had mentioned the beginning that you know these tools for self care and what you'll find I've called it six powerful steps to bring you back to center. Just a very simple one of them is the quick coherence technique. I also talk about tapping for birth in there, give some of the research around midwives and stress and burn up. So please go and get that if you want some extra, you know, extra things to be able to help this journey. Okay, and we've come to the end. So just a little quick summary midwifery is so unique and we have those absolute unique self care needs that we have to recognize that we are at high risk for stress trauma and burnout and then be part of the paradigm shift by learning the skills, the tools you need to come back to center. So I'd love to open it up for questions and I see some beautiful comments here. Kelly, thank you for saying that, considering myself very lucky to have learned this from you. Thank you. That was my pleasure. All those years ago. And Paloma, there is also the possibility of stress and trauma in the system that is disproportionately focused on clinical skills because of other things liability. Absolutely. It's also the culture of humiliation that goes on in the teaching and peer report modern institutional midwifery that I think needs to be addressed. Yeah, beautifully put Paloma, it's massive. That really important. Oh, thanks for putting the link in there, Lorraine. Thank you, Leanne. We're just going to see if someone has a question. Some people has been reading nice comments that you have already acknowledged and if we have any questions. Well, thank you to everyone who has come along to spend this time because it really tells me and anyone who's listening to this later, but it really is heartwarming to know how many midwives care so deeply to be coming to conferences like this and taking the time to expand themselves. I really appreciate it. All right. So we're just waiting if someone wants to ask anything. All right. So I think everyone is relaxed with your presentation.