Your adrenal glands are endocrine glands located on top of your kidneys. They produce many important hormones, including cortisol, aldosterone and adrenaline. The adrenal hormones help regulate several bodily functions including metabolism, blood pressure and especially your body’s response to chronic stress. There is perhaps no more chronically stressful job than midwifery, especially if you are a self-employed midwife.

Cortisol is a stress hormone – It increases during stress. Being afraid, startled, exhausted, hearing loud noises, not eating all increase cortisol. It is a catabolic hormone mobilizing fuel sources to regulate blood sugar. It does this through 4 main functions.

1. Protein Catabolism – breaking down protein

2. Gluconeogenisis – Glucose creation from protein breakdown

3. Lipolysis – breaking down fats

4. Immune suppression – decreases WBC production

Aldosterone is a steroid hormone made by the adrenal cortex (the outer layer of the adrenal gland). It helps control the balance of water and salts in the kidney by keeping sodium in and releasing potassium from the body. Too much aldosterone can cause high blood pressure and a build-up of fluid in body tissues.

High levels of serum potassium directly stimulate aldosterone secretion from the zona glomerulosa. An increase in dietary potassium induces an increase in aldosterone secretion, whereas potassium depletion causes a decrease.

Adrenaline, also called epinephrine, is a hormone released by your adrenal glands and some neurons during emergency or dangers. It is secreted directly into the blood and is transported to different parts of the body. It speeds up the heartbeat and hence supplies more oxygen to the muscles for fight or flight. It dilates the pupil to increase the area of vision and dilates the bronchus. This results in increasing breathing rate and blood pressure which enable them to fight with such urgent situation.

This stress response works fast (within seconds) for immediate physical danger, but for people with post-traumatic stress disorder (PTSD), memories of the trauma or a flashback may elevate adrenaline levels months or years after the original incident.

If you are a community-based midwife in the United States, even if you are in counseling, you likely suffer from complex or singular PTSD or CPTSD. The difference being one event or multiple compounding events of trauma.

After months or years of stress and trauma and constant need to over decrease adrenaline and cortisol, the adrenal glands become fatigued. This has been called adrenal fatigue, its more accurately called HPA Axis dysfunction.

The Hypothalamus/ Pituitary/ Adrenal Axis all work together to control and respond to stress. There are three stages of HPA Axis Dysfunction.

Stage 1: Alarm Phase (Hyper-Cortisol).

Individuals in this stage usually report feeling restless, irritated, or “wired”. Immediate stressful situations are causing high cortisol production, but there is inadequate signaling within the HPA axis to shut-off excessive cortisol production. An inadequate diurnal rhythm may also appear in this stage, manifesting in higher levels of cortisol at night. This HPA axis imbalance, if left unchecked, can eventually affect other systems in the body, such as weakening immune response, as well as contribute to loss of sleep, anxiety, weight gain, insulin, resistance and blood sugar fluctuations.

Stage 2: Resistance Phase (Cortisol-Dominant).

This stage may be the result of ongoing acute adrenal dysfunction or the accumulation of years of mild stress without adequate relaxation and recuperation. Lab testing may indicate erratic patterns of cortisol production, inadequate diurnal rhythm, as well as reduced levels of DHEA.

Stage 3: Exhaustion Phase (Hypo-Cortisol).

This later stage of HPA dysfunction is typically associated with a multitude of issues, including fatigue, sever insomnia, depression, hormonal imbalances, or an increase in pain and inflammatory conditions. Test results in stage three will show depleted levels of cortisol and DHEA (Addison’s disease is the complete loss of cortisol production). Individuals in this stage may find even the simplest tasks have become difficult to complete.

By stage three, the adrenal glands have essentially burned out from too many years of over production. If you would like a real world example of what actual ‘burn out’ looks like, please interview any of the ‘retired’ midwives you know, myself included. We are a sad and sorry bunch who kept burning the candle at both ends while often single-handedly holding our home lives together and defending ourselves from repeated political attacks. We spend a lot of time in bed and have a multitude of diagnosis like autoimmune diseases, chronic fatigue, IBS, Lupus, Fibromyalgia, MCAS, Breast cancer, and Diabetes.

Recovery is possible

It takes a huge lifestyle change including WORKING TOGETHER in group practice (a post for another day), taking regular vacations, and having clear boundaries and a working ‘Holy No” to heal. But here are a few of the first and most healing things you can do to nourish your adrenal glands.

1. Drink an adrenal mocktail every evening. Seriously skip the alcohol and give your body what it needs. This simple and delicious tonic is a part of my every evening routine. Your adrenals want a little glucose, salt and potassium and all the trace minerals you can find. And added benefit of immune boosting and antioxidant Vit C.
   So I start with a cup of coconut water base and add fresh squeeze OJ in equal parts and then stir in a 1/4 tsp of Celtic or Himalayan sea salt and 1/4 tsp cream of tartar (potassium). You can add aloe Vera juice for more potassium and minerals and you could also add powered absorbic acid to increase the vit C. Put it in a fancy glass and sip on your way to an early bedtime.

    

2. Take magnesium – seriously! Almost everyone is deficient in magnesium, especially if you’re a midwife – skipping meals, eating at three am, junk food, and excess cortisol all contribute to deficiencies. Most of the symptoms of deficiency are mild, but very noticeable symptoms include: PMS, depression, anxiety, bloating, unexplained fatigue, insomnia, muscle cramps or facial ticks, headaches or migraines. A lack of magnesium is also one of the culprits behind chronically low sex drive. 400-600mg of magnesium malate, theonate or sulfate at bedtime are good choices.
   
   
3. Meditate, breath deeply, and take baths especially with Epson’s salts and aromatherapy- this simple evening ritual can do wonders at reducing stress and anxiety and reminding you to take care of yourself in lots of little ways.
   
   
4. The fourth healing habit when youre working to heal your adrenals or recover from HPA Axis dysfunction is to not get hungry. And I know because years of cortisol over secretion, causes an uptick in glucose, which also triggers weight gain, many of us trying to heal are also overweight and trying to lose weight. However, being hungry is a trigger to secrete more cortisol, so try eating a protein rich breakfast within one hour of walking, to experince a calmer day.

As always, please take as good care of yourself as you take of your clients, the world needs you!

Love,

Augustine, The Midwives Midwife