Polyvagal Principles For Birth and Postpartum
Optimizing the birth process to minimize the trauma experience and foster connection and co-regulation.
Birth coaching through a Polyvagal lens has deepened and informed my practice, providing insights that enable me to actively cue signals of felt safety for my clients and effectively offer safe support enhancing my clients pregnancy and birthing experience.
Polyvagal Theory informs us that during the birthing process all participants need to feel safe, supported and connected to optimize birth and minimize trauma. Polyvagal Theory, created by Dr. Stephen Porges, offers a scientific framework for examining feelings of safety by integrating insights from neuroscience.
Originating from his inquiries into the dual role of the Vagus nerve—a singular nerve—as both an indicator of resilience and a potential risk factor for newborns, Polyvagal Theory delves into the intricate dynamics of our physiological responses. Dr. Porges explains that from the moment of our birth, we are inherently wired for connection. Rooted in a primal urge for survival, there exists within us a profound yearning to connect. Polyvagal Theory proposes that the survival-related suck-swallow-breathe-vocalize circuit matures to form the social engagement system that supports homeostasis and co-regulation.
The Vagus nerve forms a network of nerves originating in the brainstem, “wandering” down to the gut. This nerve acts as a vital conduit for transmitting signals related to feelings of safety and threat, thereby influencing both our emotional state and physical sensations. The ventral pathway, positioned in the front, affects organs situated above the diaphragm, whereas the dorsal pathway, situated in the back, impacts organs located below the diaphragm.
When I guide a birth, I sense that I am harmonizing the collective energy in the room: the birthing individual, their partner, and the medical team. It’s a dance of mutual support. Through subtle cues of safety, calmness, and connection, I facilitate an atmosphere of reciprocity.
Our nervous system operates based on three foundational components arranged in a specific autonomic hierarchy, each with predefined pathways.
Parasympathetic—Ventral Vagus Complex: This state embodies safety and social connection. Here, feelings of curiosity, tranquility, connection, and comfort prevail, accompanied by positive thoughts and narratives of healing and hope. Even amidst painful contractions or discomfort, the sensations are temporary and there’s a sense of being on the right path.
Sympathetic System: Governed by spinal nerves, this system propels us into fight or flight mode. Urgency, panic, fear, anger, and irritation dominate this state, often giving rise to thoughts tinged with negativity and apprehension, leading to narratives of fear, anger, or catastrophe.
Parasympathetic —Dorsal Vagus Complex: This state manifests when we feel immobilized by fear or experience a sense of collapse or shutdown. It signifies the perception of extreme danger or life-threatening situations, eliciting narratives of feeling stuck, hopeless, helpless, or enveloped in darkness.
As a New York City birth educator and doula with over two decades in practice, I hold Polyvagal Theory in high esteem as it aligns seamlessly with my intuitive approach. When I guide a birth, I sense that I am harmonizing the collective energy in the room: the birthing individual, their partner, and the medical team. It’s a dance of mutual support. Through subtle cues of safety, calmness, and connection, I facilitate an atmosphere of reciprocity.
One common question posed by my clients is how to get the baby out. While I aim to empathize with their perspective, listening to their narratives, addressing their fears, and validating their concerns, I also seek to reframe their inquiry. It’s not solely about ‘getting’ the baby out; rather, it’s about feeling safe enough to let the baby out. Allowing the baby out is a natural process of welcoming. “Getting” the baby out implies a mechanical extraction, a medical intervention. Instead, consider the baby as our biobehavioral choreographer, listening to their cues throughout the birthing journey. The baby isn’t merely the outcome of birth; they are integral to the entire process.
Reframing this huge, fear-based question is an essential step in creating a sense of safety for the birthing parent, throughout pregnancy and into labor. When the laboring parent feels safe, the hormones of birth can function optimally. This is critical. Because feelings of threat, anxiety, and uncertainty have profound autonomic signatures that interfere with “nature’s mechanisms” that facilitate the birthing process. Feeling safe is a clue to the body’s natural birthing mechanisms.
However, as emphasized earlier, the focus extends beyond just the birthing person. Cultivating a feeling of safety within the labor support team, encompassing both the partner and the medical professionals, is equally crucial. When all individuals involved in the birthing journey experience a sense of safety, genuine support, and authentic connection, we can enhance childbirth physiology and reduce the likelihood of overwhelming experiences that may lead to negativity.
When the team can work together, and stay calm and connected, the baby has the time and support to do what it needs to do. The results can be wonderful. Here’s one example:
I was assisting a client in labor, and as she was beginning to push, I noticed that her doctor was getting uncomfortable. She turned to my client and said, “If this baby is not born in the next few pushes, I’m going to have to cut you. I know that you don’t want an episiotomy, but this baby really needs to be born now.” My client shot me a distressed look. We had been working for weeks preparing her pelvic floor, and I knew she didn’t want an episiotomy. I asked the obstetrician, “May I make a suggestion for a position change?”
Her doctor responded, “Yes, of course, how can I help? We don’t have much time.”
I asked my client if she was able to turn over onto her side; I wanted to get her off her back to give her baby a break. She said, “I can’t move.” I told her, “I’m right here with you, and I’ll help you if you want.” She nodded. Her OB and I helped shift her onto her left side. This freed her sacrum. I offered, “I can help you lift your right leg up and over to provide more space.” My hope was that this change would allow her baby to move. It did!
They are able to communicate cues of safety through their tone of voice, their facial expressions and posture to everyone in the room, and the atmosphere becomes calm rather than panicked.
On the next contraction, the baby rotated. Then, on the contraction after that, the baby rotated a bit more and began to crown. On the following contraction, the baby’s head birthed, followed by the shoulders, and then the whole baby slipped out, without the mom needing a cut. An intact perineum!
My client was relieved and thrilled. Her OB said, “Good call!”
In the birthing room, relationships built on mutual trust and respect promote connection and coregulation among everyone. When the doula is anchored in their ventral vagal complex, they can become more curious and can make quick decisions based on intuition, creativity and experience. They are able to communicate cues of safety through their tone of voice, their facial expressions and posture to everyone in the room, and the atmosphere becomes calm rather than panicked.
I aim to encourage a sense of safety among my clients through the application of what Deb Dana terms the “three essentials of safety”: Context, Choice, and Connection. By proactively providing the necessary information and context to soothe their nervous system, I preempt the need for them to vocalize their concerns. It’s important to articulate why this approach is beneficial.
When individuals feel constrained or trapped with limited choices, their autonomic nervous system perceives danger, triggering a survival response. Offering choices empowers individuals with a sense of autonomy and self-control, although an excessive array of options can become overwhelming. Thus, it’s important to discern the appropriate level of choice tailored to each client’s needs at the moment.
As professionals, it’s essential to take a moment to settle into and anchor ourselves in the ventral vagal state, inviting others to join us in connection. We must actively signal feelings of felt-safety for our clients, working to help them feel secure and at ease.
Individuals with a more regulated autonomic nervous system support others in regulating theirs, nurturing feelings of safety and tranquility. During the birthing process, co-regulation serves as a tool that engages the nervous systems of both the labor support person and the client.
Co-regulation serves as the language of our nervous systems, facilitating the dynamic interaction necessary for regulating our autonomic nervous systems, particularly the ventral vagal system. In this process, individuals with a more regulated autonomic nervous system support others in regulating theirs, nurturing feelings of safety and tranquility. During the birthing process, co-regulation serves as a tool that engages the nervous systems of both the labor support person and the client. When the doula and the mother have their ventral vagal circuits synchronized…not only is the mother calm and glowing, but so is the doula.
Deb Dana emphasizes the concept that “story follows state,” which suggests that neuroception, our nervous system’s subconscious detection of safety or danger cues, precedes our conscious perception and cognitive understanding of the world. In other words, the narratives we construct about our experiences align with the state of our nervous system at any given moment.
Our nervous system serves as the origin of our narratives. Therefore, it is imperative to familiarize ourselves with its workings, particularly before labor and delivery. Identifying the cues that reliably trigger feelings of safety or threat is essential.
We may find ourselves in blended states, such as entering labor with energy or mobilized to care for a newborn. Insufficient anchoring in ventral vagal energy can result in burnout, anxiety, or overwhelm.
Therefore, despite the unfamiliarity of childbirth and the unpredictability of the postpartum period, prioritizing cues of safety over danger is key. The cues of safety don’t have to outnumber the cues of danger, although they have to outweigh them.
During a recent encounter with a laboring client, she expressed dissatisfaction with the nurse’s presence, attributing it to “negative energy that was affecting her vibe.” Upon further exploration, she revealed her disappointment that her husband was asleep on the other side of the room while she endured the labor process alone. Showing me a TikTok video of a partner providing loving support during labor, she voiced her unmet expectations. In response, I encouraged her to communicate her needs to her husband. When he awoke, I suggested he move closer to her, but he hesitated, feeling inadequate in her eyes. I reassured him that her frustrations were not personal but rather a common occurrence during labor, indicating a need for increased emotional connection.
Redirecting his attention to supporting her, I guided him to fetch ice chips and encouraged him to return closer. Meanwhile, I approached the nurse, suggesting she introduce herself and review the client’s preferences since we were nearing the pushing stage. She acknowledged her unintentional aloofness and agreed to be more engaged.
As the husband returned with ice chips, I seized the opportunity to introduce a helpful technique for pushing. I demonstrated the sheet pull method, and they embraced the idea. They successfully applied it during pushing, leading to the baby crowning in just a few attempts. The nurses, astonished, called the doctor.
With the client’s consent, I captured photos of the couple working together, creating cherished memories. After the birth, as she held her baby with her husband by her side, she praised his invaluable support during labor, highlighting how wonderfully he had assisted her.
The underlying state of our nervous system influences the narrative unfolding in our minds. Altering the nervous system can subsequently shift the storyline of our internal narrative.
Reestablishing connection is significant, especially in instances where there has been a rupture or break in connection. It’s essential to commit to the process of reconnecting. Even minor instances of misattunement are subconsciously perceived and, if left unaddressed, can evolve into narratives, without reaching conscious awareness.
Understanding the nervous system is vital for birth preparation and parenting. Increasing regulation during pregnancy enhances the ability to recognize safety cues during labor. Developing intuition and interoception aids in connecting with the baby and discerning needs during labor, reducing stress. Recognizing automatic stress responses is major, as adverse early experiences shape survival instincts. Positive experiences reshape the nervous system for regulation and connection. Becoming curious and practicing compassionate awareness initiates discernment and new connection pathways. Discover strategies to guide our nervous system towards a state of safety and connection. Identifying micro moments of felt safety shifts from protection to openness and connection during challenges like labor or parenting a newborn.
We are always engaging with the nervous system, our own and other people’s. Our nervous system is at the center of our experience.
By cultivating a harmonious blend of physiological and emotional well-being, we enhance the overall birthing experience. Numerous activities can be embraced to anchor the body in a sense of safety, incorporating movement, sound, breathwork, and positive social interactions into your day.
To optimize relaxation, consider the utilization of both bottom-up and top-down techniques. Implement bottom-up procedures, such as the deliberate practice of slow exhalation, effectively recruiting the ventral vagal circuit. This induces a state of calm, openness, and an overall sense of safety and trust. On the other hand, top-down approaches, such as revisiting positive memories or visualizing beloved individuals and joyful experiences, offer complementary avenues to relaxation.
Here are specific exercises tailored to your holistic approach:
Breathing Exercises: Emphasize slow exhalations over short inhalations. The vagal influence during exhalation suppresses sympathetic nervous system activity, strengthening states of calmness, openness, and trust. During labor, moms aim to harness their breath to navigate contraction waves or delve beneath surges, allowing them to surrender to the experience. I often suggest clients try slow exhalations while reflecting on a positive memory or visualizing a loved one.
Movement during pregnancy helps to nurture bodily regulation and inner trust. Encouraging mobility and changing positions during labor facilitates the baby’s journey through the pelvis. Additionally, movement in labor raises pain thresholds, enhances confidence, and contributes to positive emotional experiences.
Sound practice during pregnancy, such as singing, chanting, gargling, or humming integrated into daily routines, carries into labor as a grounding technique. Offering a cup of water and a spit-bowl for gargling helps reestablish equilibrium.
Positive Connections: Reach out to a trusted friend, family member, or supportive community for assistance. Sharing experiences and receiving encouragement can foster a sense of connection and support throughout your parenting journey.
We are always engaging with the nervous system, our own and other peoples. Our nervous system is at the center of our experience. Creating a sense of felt-safety lays the groundwork for maximizing the birthing experience. As a birth coach, it’s my responsibility to attune to my own nervous system, acknowledging its responses. Additionally, I must remain curious about the nervous systems of others, serving as a regulating presence to support their neuroception.
Safety is an embodied experience. A safe and supported birth and postpartum period sets both mom and baby up for the rest of their life.
