Functioning of the primal brain and the neocortex during the birthing process
During the birthing process a delicately balanced cascade of interrelated hormones flood the body and brain. These various hormones – the catecholamines, endorphins, oxytocin, ACTH, prolactin, and so on – rise and fall in a complex interplay that is attuned to the needs of the unfolding birth. Blomme (2000) calls this 'The Chemical Symphony of Birth'. These all-important chemicals are secreted and controlled directly from the primal brain. When the primal brain is unimpeded in its work, labour is able to proceed naturally. It is therefore important that the birth attendant support the woman in a manner that reduces neocortical stimulation and thus enhances the work of the primal brain.
When a birthing woman’s primal brain is dictating her labour the birthing achieves an optimum state. The woman in this state acts and appears as if she is ‘… on another planet’ (Odent, 1999, p.29). This ‘other worldly’ state of woman during natural birthing is easy to understand. It is simply that the conventions of modern cultural practices, those ways of conducting oneself in society, no longer have meaning to her. These influences, designed for social control, are constructed logically in the neocortex as each individual grows; learning that such activities as screaming, moving naked around the room and opening the bowels are not done in company. These social rules become deeply imprinted and hence the labouring woman whose neocortex is alert will be most reluctant to go against the socio-cultural rules of her lifetime and this will inhibit her labour. However, if the social controls of the neocortex are removed, the labouring woman is not bound by her modern conditioning and is able to enter a ‘primal’ state that overrides the ‘niceties’ of socio-cultural conditioning. The woman in natural birth responds instinctively to her body’s needs and is able to do anything that is required in the birthing process.
An understanding of two broad principles concerning the primal brain and neocortex provides the foundation of good midwifery practice when supporting the woman during the natural birthing process. The first principle is based on understanding that the primal brain completed its development before the linguistically able human being evolved and hence does not respond to language in the way that the neocortex does. The labouring woman cannot ‘tune in’ to her primal instincts if the people with her talk, question her or make comments. It is especially harmful if the midwife engages the woman in logical talk or tries to direct her actions. A good example of this is the midwife who asks the woman about addresses or phone numbers because factual recall is highly stimulating to the neocortex. (Who does not have to think hard to remember their doctor’s phone number?)
I frequently see midwives interfering with women’s natural birthing by directing the woman to adopt a position or action: some midwives still direct women to push! This directing not only stimulates the neocortex by the use of language but it also belies the woman’s instinct by changing her instinctive actions. This reinforces the socially constructed belief that the birthing process is inherently dangerous and requires experts to control it.
The primal brain functions best to facilitate a natural birth when the woman feels unafraid. This not only provides us with the second principle of natural birthing, but it also explains why women birth better in their home environment. A reduction of fear is achieved when the woman not only feels secure and supported by her care providers but when she is convinced that her care providers will protect and guide her during her labour. With this knowledge the woman is able to release neocortical control. Of course, for this understanding to occur, the woman needs to have built a relationship with her midwife and other care providers throughout her pregnancy.
It is also helpful if the midwife has guided the woman in visualisations and labour role play during the pregnancy. When facilitating the natural birth process it is also important to realise the primal brain of the human being is like that of any mammal. It is reassured when the birthing process is unobserved and when the birthing environment is quiet, warm, darkened and the sounds and smells of the environment are comforting and safe. From this second principle the importance of protecting the woman’s environment is clear.
If a woman is unable to birth in the safety of her home environment the midwife needs to ensure that the most home-like environment possible is reproduced in the birthing room. This means that besides ensuring that the room is warm, darkened, quiet and that the odours in the room are non-threatening, the midwife should ensure that everyone who enters the woman’s birth room enters as if they were a visitor attending a solemn occasion.
Any visitor to the room should also understand the dangers of entering the room with an attitude, of speaking or making loud noises and of making sudden movements. Strange and sudden actions, noises and odours in the birth room are a threat to the primal brain. They disturb the birthing process by both stimulating the neocortex and creating a potential danger signal to the primal brain which promotes the production of adrenalin and reduces the hormones necessary for natural labour. It follows from this that the woman in natural labour needs to be protected from this kind of interference.
In the final analysis it is clear that the birthing woman is best supported by people she trusts in a safe, protected environment that both enhances primal brain functioning and reduces neocortical interference. The midwife supporting natural birthing will not give directions but will monitor the condition of the woman, the condition of the baby and the progress of the labour in as unobtrusive a manner as possible. This means that explanations regarding all possible midwifery actions should be discussed and perhaps role-played with the woman during the antenatal period.
During the labour the midwife should then be able to undertake the necessary actions without talking. This is far easier than people think. It is simply a matter of using a reassuring touch and making gentle reassuring noises that communicate to the mother without stimulating the neocortex. Of course, if this kind of touch and reassuring noise has been practised in the antenatal period then the woman knows its meaning without having to actively interpret the meaning with her neocortex. The vastly superior outcomes of natural birth are never doubted by the women who have experienced it.
I believe that all midwives should take on board the principles of care that arise from an understanding of the role of the primal brain in labour so that all women, no matter what their choice of birthing, are able to benefit. I am convinced that an understanding of the primal nature of natural birth will benefit all birthing women and, as midwives, it is our duty to rediscover and promote the natural birthing process.
Bloome, P. (2000) The Chemical Symphony of Birth.
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Lamde, E &. Schwatz, J.H. (1981) Principles of neural science. N.Y: North Holland/Elsevier
Le Doux, J.E. The emotional brain: The mysterious underpinnings of emotional life. New York: Simon & Schuster, 1996.
MacLean, P.D. (1973) ‘The triun brain’ evolution of the human brain through ages. In T. Boag & D. Campbell (Eds.), The Hincks Memorial Lectures, Toronto: University of Toronto Press.
Odent, M. (1999) The scientification of Love. London: Oxford University Press.
Schnidt, R.F. (Ed). (1985) Fundamentals of neurophysiology. N.Y. Springer-Verlag.
We welcome Dr Chris Vose to our team and give thanks to her
for presenting this paper on behalf of the Natural Birth training &
research centre at the NSW State Midwives Conference 1st November 2002
in Byron Bay. Chris was awarded ‘best speaker’ at the conference.
With thanks to the Training & Research Centre for Natural Birth Inc.
Published in byronchild/Kindred, Issue 4