 Okay, thank you for that. So Leanne Schwartz is a practicing midwife for over 16 years, and she also has a master's degree in health. She's also a mother, an educator, and an intuitive healer. Her passion is to empower people to live their full potential. Along with her birthwork, Leanne offers one-to-one healing sessions, leads workshops, and works for Griffith University, researching writing curriculum and teaching in the master's level midwifery programs. She runs advanced skills and self-care workshops and retreats for midwives, and I think this session leads on beautifully from the last session, which was also a little bit about burnout and self-care. So that is introducing Leanne. I'm just going to put Leanne on speaker and make her the presenter, and you can unmute yourself now, Leanne. Great, thanks Hazel, and hi everyone. It's great to be here. This is definitely a passionate subject of mine, so I'm really happy to be speaking with midwives and researchers and women about this topic. So as I'm flicking through, please feel free. If something's not working right, or you need to ask a question, please feel free to ask a question anytime, and let me know if you can't hear me. Thanks, Leanne. So a lot could be said about preventing stress and burnout. The way our maternity system is organized has a long way to go in this area. The key really that's vital to explore is that bigger picture stuff, but we can't really deal with that in a session like this. So what we're going to focus on today is dealing with our own stress, our own trauma, and burnout in our practice and daily life. So this is really about empowering ourselves with the tools and understanding to cope with the demands of this amazing but potentially traumatic and stressful vocation that we've chosen. So I am also going to do a little poll, and I'll write it in the chat as well. And what I'm wondering is this, have you or another health professional that you know ever experienced symptoms or feelings of burnout? So you can use the poll there that you see and I'll write it in the chat as well. So just as that's going, I'm going to just keep going and have a look at what the research is saying as you're replying to that poll. So in Australia, small study almost 30% of midwives are experiencing moderate to high levels of burnout. Another study over 50% and 20% experiencing anxiety stress and depression as a result of their work. It's not just Australia, studies in Turkey, Denmark, Canada, Sweden, all over the world, the research agrees. Midwifery is a high risk profession for experiencing burnout. In fact, research that says that student midwives are burning out. So it's happening that quickly. So let's have a little look at what our poll says. So 96% of you here have experienced or no someone who's experienced burnout in a health profession. It really is a high risk profession. So recent study that looked at the Australian arm of the Wellm data, the work health and emotional life of midwives found that almost half of the study had considered leaving the profession in the preceding six months. Now that's huge. And they were saying things like dissatisfaction. In fact, one of the themes that emerged was that their working life was a nightmare. So imagine that living every day feeling like your work is a nightmare. So the question is, what can be done? Now, just as a side note, another analysis of that same data found that continuity of care is consistently beneficial for midwives. So this Wellm data is found about others as well. Midwives working in shift-based models providing fragmented care are always at greater risk of psychological distress when we look at the research overall. So we're not going to talk about that today, but I wanted to throw that in there in terms of the research and what we're seeing. So we know that the way the maternity system is set up is a large part of why midwives are stressed and burning out. And as I said, we can't do a lot about that today. We can't look at how midwives practice workload issues, but there's still a lot that we can do. Now we're told as health professionals that it's our responsibility to cope with the emotional demands of our job. So what happens is that minimum midwife doesn't cope. She'll tend to internalize those feelings. She'll blame herself, her own lack of resilience. And I apologize that I'm using she. It just comes naturally if you're a male midwife, you can hear he. So these emotional, these issues of emotional sustainability, they're really just starting to be talked about as a profession-wide problem rather than an individual failing. So a lot of midwives don't know that many of their colleagues are struggling. And I find that both in the retreats and when I'm doing mentoring with people, often midwives have this feeling that for some reason, they're experiencing something worse. They aren't able to cope. So we tend to assume it's a personal issue rather than this profession-wide problem. Now the emotional demands of midwifery are huge. And one of the keys to coping with these demands is cultivating tools and practices. And that's what we're going to talk about soon. But first, I want to look a little deeper at where all this stress is coming from for midwives and what can be done about it. Now we hear a lot these days about birth trauma and the huge impact that has on women and families. And this subject is an absolute passion of mine. It is so important. But we also need to look at our own trauma as health professionals. And where is this coming from? So there's one study that looked at 420 UK midwives who had experienced a perinatal event where there was a perceived serious risk to mother or baby. Now, I think I would argue that that is virtually every midwife. I don't know anyone who has an experience to perinatal event where there was a serious risk, a perceived serious risk to mother or baby. Of that study, one third of those midwives had PTSD, post-traumatic stress syndrome. Griffith University that I work with published a paper. And in their study, almost a fifth of all midwives met the criteria for probable PTSD. So we're going to look at this a little bit deeper. So we could say that stress is inevitable. No matter where we live, how we live, even here in Bali, there is always some degree of stress. And stress is actually good for, you know, some really interesting research on how stress is beneficial for our body to a degree. So that activation of our nervous system, it helps cognitive abilities, it sharpens our perception, it strengthens our body. So we've got all sorts of positive things about small amounts of stress. And what we call simple stress, humans are designed for this. So that's where you see a tiger. It activates the fight, flight, freeze, the sympathetic nervous system. It's temporary. So as soon as the threat is over, the stress drops and we go back into the parasympathetic mode. Rest, digest, heal. And, you know, we use these analogies all the time with women. In the natural world, we could say there's only simple stress. You see that tiger, you're either going to die, or you're going to run away, or you're going to be injured. Something's going to happen and the threat is going to be over. But complex stress, it never really goes away. The problem is, is the body doesn't know the difference between a credit card payment that's way overdue and you don't know how to pay it, and that tiger. But we're not designed for complex stress. So our bodies are designed for this kind of stress where the sympathetic nervous system gets activated and then it goes away. Now we can't eliminate stress. You know, I've got death taxes. We could add stress to that. But even though stress is inevitable, our responses and even our physiological reactions to it are not inevitable. And that's what I want to talk a little bit about. First, I'm going to go through a little bit more about traumatic stress and what happens. And then we're going to look at a specific practice that we can do and some other practices that we won't be able to cover here, but just some ideas to get you started in looking into this area. Now trauma is a very specific kind of stress. And I want to talk a little bit about what happens to our brain in traumatic stress, because this is the kind of stress that I see midwives dealing with all the time, day in, day out. Partly because of the nature of our work, vicarious stress, where we're exposed, vicarious trauma, where we're exposed secondarily to someone else's trauma, that has a traumatic effect on us, day in, day out, to be exposed to that trauma. We also have our own organizational challenges in our work life and just the stress of being on call, of being a midwife, of going into work every day, whatever your version of mood of free is, it's huge and traumatic stress is one of the big challenges that we face. So you can see a brain here on the screen and a very, very basic view of the brain divided into three parts. So the reptilian, instinctual brain, primal brain, the limbic system, which is our emotions, our feeling brain, and the prefrontal cortex. And that regulates our rational thought, and it helps regulate emotions. Now what happens during a traumatic event is the amygdala in the brainstem gets turned on. It's like emergency systems are all go. We all know that feeling, the sympathetic nervous system ramps up. And what happens is that with the prefrontal cortex, which is the part that regulates emotions, our rational brain, is it basically gets switched off during a traumatic event because we need to respond with a speed that's much faster than a neocortex. We need to respond directly from that instinctual brain. So we need that. It's a healthy function. But that prefrontal cortex is the part that helps us analyze and give meaning to experience. So what trauma does is it puts us into survival mode. Our brain gets flooded. And in this state, we don't process events. We actually remember them as pure experience. So what that means is that when we're faced with another similar event, because our brains have remembered it, our bodies have remembered it as pure experience, our brain actually goes automatically into sympathetic mode, fight, fight, freeze, because it thinks another stress is here. That same trauma is about to happen. So that might be from a smell, an event, it could be from anything that sets off because we haven't, in trauma, unresolved trauma, we haven't been able to process, rationalize, or move through that experience. Our bodies and our brains have remembered it as pure experience. So we have very little ability to think rationally in that state, but often it's actually quite hard to know when you slip into that state. Sometimes people notice the increased heartbeat or they notice that everything looks a bit clearer or they're very tense, but often you don't even notice when you've moved into that traumatic stress state. So with traumatic stress, long-term traumatic stress, the brain goes into that activated sympathetic mode, but it never fully turns off. Now that sort of next thing that makes the brain flood again, it could be the next birth that seems to be unfolding how that last traumatic birth went. It might even be when we empathically relate to a woman whose birth is similar to our own, but what can happen is little things are happening, so we're constantly in this activated state, and that means in that activated state it's like looking at the world through a filter of a sympathetically activated nervous system, and a sympathetically activated nervous system sees everything as a threat. Even small things, there's an overreaction or a sense of irritability, even it might show up on when it's quite mild, or it could look more like anger or aggression, because through a sympathetically active nervous system, everything looks like a threat. So this is really helpful, right? We want that when you're running from a tiger or if you're living in constant danger, you want to have that activation, but in day-to-day life, when there's no immediate danger, it's debilitating. So I see midwives all the time who are living in this state just a little bit, all the time, and it might not look like they're having PTSD. They might not be experiencing flashbacks all the time, because it's traumatic stress. It's that they're a little bit hypervigilant all the time. Now what do you imagine the impact on the women and families that we care for is when we're in that state, particularly during labor and birth, when women are so hormonally sensitive, the other challenge that we face of course is that what makes Midwifery unique is our women-centeredness, our empathy, our caring, and actually cultivating caring and empathy within our work, it's protective for burnout and stress. There's really powerful research and ways to use caring and empathy to prevent and actually resolve burnout and stress. You can see this quote here on the screen, midwives are at risk of experiencing secondary traumatic stress. This has harmful consequences for midwives' own mental health and for their capacity to provide care in their relationship to women, threatening the distinct nature of midwifery care. So being stressed, burned out, caring trauma, it threatens that distinctive nature of midwifery care. And the answer is not to stop caring. The answer is to learn ways to cope powerfully with what's being experienced, and that starts with acknowledging it. So we're just going to look at very briefly at what happens to the body under stress. So you might have noticed in yourself your creative thinking might be impaired. Maybe you have trouble sleeping, your immune system, every part of the body is impaired. It doesn't work as well when you're under a state of stress. So one of the things that's actually happening is the body goes into what we call an incoherent state. So we could use an analogy of a car that's not running well. So if something's out, smart plugs aren't firing, the car is not going to be as efficient. It might not go as quickly. It's probably still going to function, but it's not going to go as well. Though our cognitive functions or immune system, they're all exactly the same. But that incoherent state can be measured as the balance between your sympathetic and your parasympathetic nervous systems, and how well your heart and your brain are synchronizing. So is that rhythmic activity of your heart, is it coherent or incoherent? And that has a huge impact on cognitive functions, attention, perception, memory, problem solving. And I'm going to talk about those in a moment in terms of our work as midwives. So just take a moment to think of a recent stressful experience you've had. What do you notice about your own body in your mind when you're under stress? What kind of body sensations happen when you think about a stressful situation? And you might even think about what kinds of decisions you make, how clear is your thinking during times of high stress? What we know is that a brain that's in a state of traumatic stress cannot access its full capacity. Now, this really matters. I've already said we know that even apart from the normal stresses of life, midwives who've been exposed to traumatic events, and I think that's all of us have high rates of vicarious trauma. A brain that's operating with unresolved trauma is not operating at full capacity, especially when the current event is in any way similar to what caused that initial trauma. So think of the midwife who has an maternal emergency go wrong. What happens next time she's exposed to a similar thing? Where is her brain? It's not going to be fully available to her. Because so many of us are living in that sympathetically activated state, a lot of the time, we might not be in an optimal decision-making state either. So if you think about the last, say, bad decision you made, for me, often mismanaged emotions play a part, overwhelm a strong reaction, overreaction. When I think of the last really powerful positive decisions I've made, usually I'm feeling balanced and positive, even if it's stressful, I feel calm, I feel clear. So why do we make such poorer decisions when we're stressed? So one big part of it is we're not actually present to what's happening in front of us. We're in that incoherent state. So when we're experiencing positive emotions, gratitude, love, joy, compassion, we're in that state of coherence, the coherent heart rhythm. It looks smooth. I'm going to show you some graphs in a moment where you can actually see what it looks like. So all our bodies synchronize, work better, and we have a better ability to think. So that state of coherence, we call it an efficient state, because everything works together harmoniously. It's a level of optimal performance. I want to show you just a little slide of two different states. Oh, Hazel and Lorraine, I am no longer presenter, so I can't move the slides forward. So if someone's done something, if you could move the slides, that would be great. Thank you. Okay, so here we've got a slide of the heart rhythm pattern of somebody at the top there under frustration and in the state of appreciation. So you could imagine how much better all of those systems in your body would work in that state of appreciation. Now, of course, it's easy to say that. It's easy to say, oh, well, of course, it's going to work better when you're in that state of appreciation. The great news is there are so many ways that we can work with ourselves to move into this coherence state, which is not necessarily appreciation. It could look like many things. This is just two states of being, but it's moving from a state of incoherence to a state of coherence. And some of you may have heard of the Heart Math Institute. They do incredible work and they've done amazing research on a very simple technique called the quick coherence technique or heart-focused breathing that we're going to do together in a moment. And the results have been amazing with education, health professionals, decision making, physical health, mental health on this very, very simple technique. And I'm going to show you another slide with, so on the left hand part of the screen there, you can see somebody in their normal state, so you can see their respiration, their heart rate variability, and their blood pressure. And you can see it's in an incoherence state. Then they applied this small technique and moved into a coherent state. So this is a very powerful, very simple little exercise that we're going to do right now. So I just invite you wherever you are to simply relax if you feel comfortable. You may want to close your eyes and just focus on the area around your heart. Just notice where your heart is in the center of your chest. Just notice that area around your heart. Bring your awareness and your attention to the area around your heart. Now, as you focus on that area around your heart, just imagine your breath is flowing in and out through that area. Almost like your heart itself could gently breathe, breathe in and breathe out. Like your breath just gently goes in and out through the area of your heart. Now, as you continue to breathe through the area of your heart, let you to remember a positive feeling, a time when you felt good inside. It might be just simple appreciation for something that's happened recently. It might be the love or the care that you feel for someone. It could be a person, an experience, a recent or an old memory. See if you can re-experience it as fully as possible. If you're picturing a person, really picture them. If you're remembering it and experienced, remember the smells, how you felt, time when you felt something positive, love, joy, excitement. Let that one go and find another memory or thought. It might simply be gratitude for a beautiful sun or life-giving water that we have. It could be something very simple that you appreciate or love. Just remember that as much as you can, as fully as possible, allow yourself to experience that. When you're ready, you may want to even put your hand on your heart and say thank you to yourself for taking a moment, for taking a moment to be still, to be present and to find appreciation and love inside of yourself. I'd love to hear in the chat just how your experience was, how that was for you. This quick coherence technique, you'll see on the screen there, I've put in the very simple way to do it. You can do this in a much longer technique or you can do it as a 30 second technique. It's quite amazing if you're feeling at a balance to just stop and spend 30 seconds doing heart focus, heart breathing, heart feeling. Once you practice this more and more, what happens is the body goes more and more quickly into that state of coherence. I'm bringing this to you today as a very small, very simple technique that anybody can do to help move their body into a state of coherence. This is also something that you can teach to children and certainly you can teach to the women and the families that you work with as a really powerful way to come back, to come back into the present moment and to help the body move into that coherence state. One of the most powerful ways that I've found to work with stress and trauma is a very specific form of tapping. Now on this screen, you'll see some information about tapping modalities for trauma specifically. Very powerful, very easy to teach so people can treat themselves. There's no evidence of harm. It's something that you don't, you don't have to talk a lot about what happened. Sometimes that's really helpful, you know, so if I'm working with midwives on a traumatic event, sometimes they need to talk about what happened. But in other times, it's not, for whatever reason, particularly in different kinds of trauma. It's not appropriate to talk about it. They don't want to talk about it. Or for example, when I used to use it with my teenage daughter, she did not necessarily want to talk about her trauma. But she wanted to have a space where she could feel it inducing tapping and have it shift. I've had incredibly profound experiences with tapping professionally, personally, and in my family. And that's both in my work with women with babies, but also my work with midwives and other birth keepers. So I teach a program called tapping for birth that has a very specific way of tapping that really allows those underlying feelings to emerge and resolve. We don't have time in this session today, of course, to teach tapping or to go into it, but I bring it here because there are a lot of resources online that you can find. And it's something, one of those really powerful ways that I encourage you to start looking for because we need ways to be working with the trauma and the stress that's there in our profession. So every year, Georgina Kelly, Ibu Robin, Lim, and I run Deepening the Journey, an advanced skills retreat for midwives. I teach the tapping for birth program here, alongside other tools and practices for midwives to upskill, not just in that toolbox that we need for practice, but really to be able to self-nurture, to have the skills in dealing with our own stress and trauma, and to be nourished, to really fill that cup. Because the biggest thing I see is that you can't, whether this is women or midwives or educators, you can't give from an empty cup. And we're often modeling as midwives ways of being that are not sustainable for the women that we're working with. And what we need to be really modeling is how do we care for ourselves so that we can care for others? So the midwives that come to our retreat and our ongoing mentoring programs, one of the most common things we hear is, I'm rejuvenated, I'm reinspired. I remember why I wanted to be a midwife in the first place. I have the skills to deal whatever happens in my work in space, stay inspired. I have passion again. And these words are so powerful, because when we're inspired, when we're passionate, when we're feeling powerful, we can deal with almost anything. And as midwives, we need to give ourselves the time and the space to reconnect with what, why we came to this calling of working with women in birth in the first place. So if you're interested in our retreat, you can find us at deepeningthejourney.com. And I really encourage you, if it's not coming to this retreat, it's doing something because it's time to fill our own cup. Our profession is at a breaking point. We need to be addressing this in many different ways. And this is one powerful one. Okay, I would love to hear any questions. Thank you so much, Leanne. That was a lovely presentation and I really enjoyed doing that quick meditation. I've been keeping an eye on the questions on the side. And I did find, I looked at that survey, 96% of attendees said yes to experiencing symptoms of feelings of burnout. And that included new grads on there, somebody said. So I've got a question for you. How can we best prepare our future midwives during their course without scaring them? Yeah, I think that's a great question. I actually used to add Griff that I used to do tapping with all the Bachelor of Midwifery students because I found it was a way, it was like having something in their back pocket they could just take away with them. Again, the biggest thing is it's all, you know, there I see in the chat there, there are many comments around the environment, around practice, all of these other there's a lot that we, if we teach that to midwifery students, they're getting that, they hear that. What I see is the most important thing that's missing in what we're teaching is how do you cope with this? How do you actually work with this? Or first that it is a thing so that we don't have new graduates that are leaving within a year because they're so burnt out in stress because they aren't being taught the tools to work with that stress. And the very first tool that needs to be there is an understanding. You know, for example, when I talk about traumatic stress and that state of hypervigilance, mid student midwives, I see often they're walking out already in that hypervigilance state in terms of their work. And so there needs to be that first, that understanding that that is an issue, that's something that can happen and you need to be aware as student midwives, as midwives, as any human being really that this is what can happen and particularly it's going to happen if you don't, if there aren't tools and you're not taking the time to really resolve trauma. And in our society, I would say it's just so new in the last few years that it's even okay to talk about trauma. It's okay to admit to it. You know, we're starting to see more around war veterans, that kind of thing, military PTSD, you know, it's starting to be talked about, but just barely. So that's what student midwives need to learn, both the tools and the understanding of what might happen and what is happening. Excellent. Thank you. There was one comment about, does it mean that we practice a kind of toxic profession? Or are we in a toxic profession because of the amounts of burnout? Did you think about that? Well, I would say the way that midwifery is in many places in the world, possibly most places in the world, where it's fragmented care or, you know, it might be continuity of care, but within a very rigid system, it's unsupported. There's a disparity between what the medical profession and what midwifery professions are saying rather than a collaboration. That is a toxic environment. Midwifery itself, I don't believe is toxic, but I believe that the way it's being practiced around the world at the moment is toxic in many places. Yeah. Yeah, and Cecilia mentioned that too. She said, you know, the environment is a contributor, such as time spent writing and reading, online hospital documentation, the required continue education courses you have to do, the student teaching requirements, as all those add to it being toxic and contributing to rates of burnout. Exactly. And that's why I said at the beginning, you know, the key is the entire medical system, the entire way that birth and maternity is set up, everything from the actual practice to, yeah, all of those things that you said. I mean, all of that, the requirements on midwives are huge. And I guess what we need is to be able to address this from many different ways. So we need to address it from the self-care perspective, but it's not just self-care. You know, it's not just that massage kind of self-care. It's that really deep self-care where we value ourselves. But what I see in the reason that I do this work, particularly mentoring with midwives, is that midwives that are burnt out and in that traumatic stress state, they aren't the ones that are going to be able to be powerfully making a difference in the medical paradigm or the maternity system paradigm. So we need to start with us so that we can actually make a difference because in that state, no one's out there making a difference. The midwives that are out there making a difference are passionate, they're inspired, they might be angry, that's okay. You know, there might be some deep emotion behind that, but they are not the ones that are broken. They're the ones that have the power and that's what we need as a profession is we need to pull back that power within each of us so that we can have that collective making a difference happen. Yeah, and that echoes what Irene is really saying that, you know, it should be a happy environment and sometimes women or colleagues can be very cool to each other. If we embrace and nurture each other, if we had that collective sense, then that would definitely help as well. And Eleanor was saying that, you know, we need to address the paradigm, the environment, the self-care isn't enough to keep going in the same toxic setup. So again, if that was from the collective making, I wouldn't change that. Yeah, I absolutely agree with that, Eleanor. And whatever one's saying, you know, self-care is never going to be enough. And particularly what you don't want to do is just sort of self-care enough that you keep going back in. The interesting thing that I see with the midwives that come to our retreat is they tend to go back in their lives change because once you when you're in that state of being passionate and inspired, you actually can make changes in your own life. Maybe you can't change the whole system, but you might be able to change the way you work or where you work or who you work with or what you're doing that was contributing to those first things. And that's, I think, the most personally inspiring for me thing that I see when midwives make a big change within themselves is that that's when their work environments can start to change. And we need that everywhere. I just saw a comment there, do we need to be more resilient or self-caring? I have challenges with the word resilient. I think midwifery needs to be more sustainable because if we start talking about being resilient, often we're really good at being resilient. You know, we can push through, we can stay up later, we can do more, we can somehow be rubbing the wounds back and getting our paperwork done at the same time. We are good at that. But what we need to be is sustainable. So being sustainable does mean being self-caring. And that sort of idea of resilience, I think, needs to fade away and move into a model of sustainability. Excellent. Thank you so much. I don't think we've got any more. Oh, there's another question there. We have to give a lot, but does it mean that we have to empty ourselves, thinking in an organic mentality in our life as a garden? Yeah, I like that. I mean, we definitely don't. If we keep filling up that bottle, then we're not going to be empty. You know, if you think of a, say, a permaculture perspective when the garden metaphor was used, I mean, an ultimate garden is self-sustaining. So it gets enough nourishment from sun and wind and water that it's a self-sustaining thing. It gives and gives and gives, but more still comes because the seeds go. So we can be an organic permaculture garden if we're in a good environment and we've got rain and sun. That's the way I would see it. Absolutely. And also, there are many different gardens all around the world, which says it rule very different. And what is self-care for one person doesn't mean that self-care for another. And I saw a beautiful picture online, I think it was just yesterday, about all the different types of self-care there could be from, you know, just organising your, you know, your household to having a massage. It can be many different facets to self-care. Exactly. Saying no can be our biggest self-care moment being able to say no. I'm just going to take back the presenter status so I can just go through. Thank you again so much. I think that was such an interesting presentation and a great discussion at the end. Thank you everyone for taking part in that.