Ecstatic Birth - Nature's Hormonal Blueprint for Labor (part 2)

[christinamarie]

*Part 2

Epidural Drugs

Epidural drugs are administered over several hours via a tube into the space
around the spinal cord. Such drugs include local anaesthetics (all cocaine
derivatives, eg. bupivicaine/marcaine), more recently combined with low-dose
opiates. Spinal pain relief involves a single dose of the same drugs
injected through the coverings of the spinal cord, and is usuallyshort
acting unless given as a combined spinal-epidural (CSE).

Epidural pain relief has major effects on all of the above-mentioned
hormones of labor. Epidurals inhibit beta-endorphin production,15 and
therefore also inhibit the shift in consciousness that is part of a normal
labor. This may be one reason why epidurals are so acceptable to hospital
birth attendants, who are not prepared or trained to deal with the
irrationality, directness, and physicality of a woman laboring on her own
terms.

When an epidural is in place, the oxytocin peak that occurs at birth is also
inhibited because the stretch receptors of a birthing woman's lower vagina,
which trigger this peak, are numbed.58 This effect probably persists even
when the epidural has worn off and sensation has returned, because the nerve
fibers involved are smaller than the sensory nerves and therefore more
sensitive to drug effects.58

A woman giving birth with an epidural will therefore miss out on the fetal
ejection reflex, with its strong final contractions designed to birth her
baby quickly and safely. She must then use her own effort, often against
gravity, to compensate. This explains the increased length of the second
stage of labor and the extra need for forceps when an epidural is used.59
Use of epidurals also inhibits catecholamine release,60 which may be
advantageous in the first stage of labor; close to the time of birth,
however, a reduction in CA levels will, as with oxytocin, inhibit the fetal
ejection reflex and prolong the second stage.

Another hormone also appears to be adversely affected by epidurals.
Prostaglandin F2 alpha helps to make a laboring woman's uterus contractible,
and levels increase when women labor without epidurals. In one study, women
with epidurals actually experienced a decrease in PGF2 alpha, and average
labor times were increased from 4.7 to 7.8 hours.61

Drugs administered by epidural enter the mother's bloodstream immediately
and go straight to the baby at equal, and sometimes effectively greater,
levels.62 Some drugs may be preferentially taken up into the baby's brain,63
and almost all will take longer to be eliminated from the baby's immature
system after the cord is cut. For example, the half-life of bupivacaine --
the time it takes to reduce blood level by 50% -- is 2.7 hours in the adult,
but around 8 hours in a newborn baby.

Another indication of the effects of epidurals on mother and baby comes from
French researchers who gave epidurals to laboring sheep.65 The ewes failed
to display their normal mothering behavior; this effect was especially
marked for the ewes in their first lambing that were given epidurals early
in labor. Seven out of eight of these mothers showed no interest in their
offspring for at least 30 minutes.

Some studies indicate that this disturbance may apply to humans also.
Mothers given epidurals in one study spent less time with their babies in
hospital, in inverse proportion to the dose of drugs they received and the
length of the second stage of labor.66 In another study, mothers who had
epidurals described their babies as more difficult to care for one month
later.67

Such subtle shifts in relationship and reciprocity may reflect hormonal
dysfunctions and/or drug toxicity and/or the less-than-optimal circumstances
that often accompany epidural births--long labors, forceps, and cesareans.

Incredibly, there have been no large studies of the effects of epidurals on
breastfeeding, although there is evidence that babies born after epidural
have a diminished suckling reflexes and capacity consistent with
drug-related effects.68 One study showed that healthy full-term babies
exposed to epidurals during labor were less likely to be fully and
successfully breastfed on hospital discharge.69

Caesarean Surgery

Cesarean surgery can be a life-saving operation for mothers and babies, but
it is often overlooked that it involves major abdominal surgery. Cesarean
delivery increases the risk of maternal death by about four times,70 71 and
can significantlyaffect the mother and baby's health in subsequent
pregnancies.72 Cesarean rates are currently 27 percent in Australia,73 and
27.6 percent--the highest level on record--in the U.S.74

Obviously there is a shorter or absent labor with cesarean birth, and the
peaks of oxytocin, endorphins, catecholamines, and prolactin are reduced or
absent. Furthermore, mothers and babies are usually separated for some hours
after birth, so the first breastfeed is usually delayed. Both will also be
affected to some extent by the drugs used in the procedure (epidural,
spinal, or general anaesthetic) and for post-operative pain relief.

The consequences of such radical departures from our hormonal blueprint are
suggested in the work of Australian researchers who interviewed 242 women in
late pregnancy and again after birth. The 50 percent of women who had given
spontaneous vaginal birth were the most likely to experience a marked
improvement in mood and an elevation of self-esteem after delivery. In
comparison, the 17 percent who had caesarean surgery were more likely to
experience a decline in mood and self-esteem. The remaining women had
forceps or vacuum assistance, and their mood and self-esteem were, on
average, unaltered.75

Another study looked at the breastfeeding hormones prolactin and oxytocin on
day two, comparing women who had given birth vaginally with women who had
undergone emergency cesarean surgery. In the cesarean group, prolactin
levels did not rise as expected with breastfeeding, and the oxytocin pulses
were reduced or absent. In this study, first suckling had been at 240
minutes average for cesarean babies, and 75 minutes average for babies
vaginally born. The authors comment

These data indicate that early breastfeeding and physical closeness may be
associated not only with more interaction between mother and child, but also
with endocrine [hormonal] changes in the mother.76

Other research has shown that early and frequent suckling positively
influences milk production and the duration of breastfeeding.77 The authors
of the hormonal study above found that duration of breastfeeding was not
affected, and conclude, '.other factors.can compensate for deficient
hormonal release.'78

These studies not only indicate important links between birth and
breastfeeding, but also show how an optimal birth experience can influence
the long-term health of mother and baby. For example, successful
breastfeeding confers advantages such as reduced risk of breast cancer and
osteoporosis for the mother and reduced risk of diabetes and obesity
long-term for the child.79 And enhanced self-esteem after a natural birth -
which can be a life-long effect, in my experience and observbation -- is a
solid base from which to begin our mothering.

The connections between events at birth and long-term health certainly
deserve more study.80 But we cannot afford to wait for years for researchers
to prove the benefits of an undisturbed birth. Perhaps the best we can do is
trust our instincts and vote with our birthing bodies, choosing models of
care that increase our chances of undisturbed- and ecstatic- birthing.

Early Separation

Even in non-interventionist settings, it is uncommon for the baby to remain
in the mother's arms for the first one to two hours. And yet nature's
blueprint for this time includes a specific and genetically encoded
activation of the brain and nervous system for both mother and baby. For
example, when the newborn baby is in skin-to-skin contact, at the mother's
left breast (which is where new mothers in all cultures instinctively cradle
their babies) and in contact with her heart rhythm, according to Joseph
Chilton Pearce, 'a cascade of supportive confirmative information activates
every sense, instinct and intelligence needed for the radical change of
environment . thus intelligent learning begins at birth.'81

For the mother also, 'A major block of dormant intelligences is
activated.the mother then knows exactly what to do and can communicate with
her baby on an intuitive level.' 82This awakening of maternal capabilities
is well known among animal researchers, who link it to the action of
pregnancy and birth hormones on the brain of newly delivered mothers. Such
intuitive capacities are sorely needed in our human culture, where we rely
so heavily on outside advice from books and experts to tell us how to care
for our babies.

When these activations do not occur within about 45 minutes of birth,

.cut off from his mother's nurturing and with none of the encoded
expectancies met, the newborn's adrenals continue to release steroids in the
face of maximum fear and abandonment. The infant screams for a short time
and then silence falls.83

The damage caused by separation, Pearce writes, is '.massive and past the
point of repair.' 84Like Odent, he believes that our current birth practices
are psychologically crippling to babies, mothers, and society as a whole,
and the evidence in his book is compelling.

Optimizing the Ecstasy

The following suggestions will help a woman to use her hormonal blueprint
and so optimize the experience and safety for herself and her baby. Remember
that birth is 'orgasmic in its essence'85 so that conditions for birth are
ideally as close as possible to conditions for lovemaking.

* Take responsibility for your health, healing, and wholeness
throughout the child-bearing years
* Choose a model of care that enhances the chance of a natural and
undisturbed birth (eg home birth, birth center, one-on-one midwifery care).
* Arrange support according to individual needs; trust, a loving
relationship, and continuity of care with support people are important.
* Consider having an advocate at a hospital birth- a private midwife
or doula is ideal.
* Ensure an atmosphere where the laboring woman feels safe,
unobserved, and free to follow her own instincts
* Reduce stimulation of the neocortex (rational mind) by keeping
lighting and noises soft, and reducing words to a minimum.
* Cover the clock and any other technical equipment.
* Avoid drugs unless absolutely necessary.
* Avoid procedures (including obvious observations) unless absolutely
necessary.
* Avoid caesarean surgery unless absolutely necessary.
* Don't separate mother and baby for any reason, including
resuscitation, which can be done with the cord still attached.
* Breastfeed and enjoy it!

Giving birth is an act of love, and each birth is unique to the mother and
her baby. Yet we also share the same womanly physiology, and the same
exquisite orchestration of our birthing hormones. Our capacity for ecstasy
in birth is also both unique and universal, a necessary blessing that is
hard-wired into our bodies, yet that requires, especially in these times,
that we each trust, honor, and protect the act of giving birth according to
our own instincts and needs.

Dutch professor of obstetrics G. Kloosterman offers a succinct summary,
which would be well placed on the door of every birth room:

Spontaneous labour in a normal woman is an event marked by a number of
processes so complicated and so perfectly attuned to each other that any
interference will only detract from the optimal character. The only thing
required from the bystanders is that they show respect for this
awe-inspiring process by complying with the first rule of medicine--nil
nocere [Do no harm].86

References

1. Odent M. The Scientification of Love. Revised ed. London: Free
Association Books, 2001.

2. Odent M. The fetus ejection reflex. The Nature of Birth and
Breastfeeding. Sydney: Ace Graphics, 1992:29-43.

3. Chapman M. Oxytocin has big role in maternal behaviour: interview with
Professor K Uvnas-Moberg. Australian Doctor 1998, 7 August:38.

4. Dawood MY, et al. Oxytocin in human pregnancy and parturition. Obstet
Gynecol 1978;51(2):138-43.

5. Nissen E, et al. Elevation of oxytocin levels early post partum in women.
Acta Obstet Gynecol Scand 1995;74(7):530-3.

6. Fuchs AR, Fuchs F. Endocrinology of human parturition: a review. Br J
Obstet Gynaecol 1984;91(10):948-67.

7. Malek A, et al. Human placental transport of oxytocin. J Matern Fetal Med
1996;5(5):245-55.

8. Matthiesen AS, et al. Postpartum maternal oxytocin release by newborns:
effects of infant hand massage and sucking. Birth 2001;28(1):13-9.

9. Verbalis JG, et al. Oxytocin secretion in response to cholecystokinin and
food: differentiation of nausea from satiety. Science 1986;232(4756):1417-9.

10. Feifel D, Reza T. Oxytocin modulates psychotomimetic-induced deficits in
sensorimotor gating. Psychopharmacology (Berl) 1999;141(1):93-8.

11. Insel TR, et al. Oxytocin, vasopressin, and autism: is there a
connection? Biol Psychiatry 1999;45(2):145-57.

12. Knox SS, Uvnas-Moberg K. Social isolation and cardiovascular disease: an
atherosclerotic pathway? Psychoneuroendocrinology 1998;23(8):877-90.

13. Sarnyai Z, Kovacs GL. Role of oxytocin in the neuroadaptation to drugs
of abuse. Psychoneuroendocrinology 1994;19(1):85-117.

14. Uvnas-Moberg K, et al. Oxytocin as a possible mediator of SSRI-induced
antidepressant effects. Psychopharmacology (Berl) 1999;142(1):95-101.

15. Brinsmead M, et al. Peripartum concentrations of beta endorphin and
cortisol and maternal mood states. Aust N Z J Obstet Gynaecol
1985;25(3):194-7.

16. Goland RS, et al. Biologically active corticotropin-

releasing hormone in
maternal and fetal plasma during pregnancy. Am J Obstet Gynecol
1988;159(4):884-90.

17. Laatikainen TJ. Corticotropin-releasing hormone and opioid peptides in
reproduction and stress. Ann Med 1991;23(5):489-96.

18. Jowitt M. Beta-endorphin and stress in pregnancy and labour. Midwifery
Matters 1993;56:3-4.

19. Rivier C, et al. Stimulation in vivo of the secretion of prolactin and
growth hormone by beta-endorphin. Endocrinology 1977;100(1):238-41.

20. Mendelson CR, Boggaram V. Hormonal control of the surfactant system in
fetal lung. Annu Rev Physiol 1991;53:415-40.

21. Heasman L, et al. Plasma prolactin concentrations after caesarean
section or vaginal delivery. Arch Dis Child Fetal Neonatal Ed
1997;77(3):F237-8.

22. Franceschini R, et al. Plasma beta-endorphin concentrations during
suckling in lactating women. Br J Obstet Gynaecol 1989;96(6):711-3.

23. Zanardo V, et al. Beta endorphin concentrations in human milk. J Pediatr
Gastroenterol Nutr 2001;33(2):160-4.

24. Lederman RP, et al. Anxiety and epinephrine in multiparous women in
labor: relationship to duration of labor and fetal heart rate pattern. Am J
Obstet Gynecol 1985;153(8):870-7.

25. Odent M. Position in delivery (letter). Lancet 1990.

26. Saito M, et al. Plasma catecholamines and microvibration as labour
progresses. Shinshin-Thaku 1991;31:381-89.

27. Thomas SA, Palmiter RD. Impaired maternal behavior in mice lacking
norepinephrine and epinephrine. Cell 1997;91(5):583-92.

28. Lagercrantz H, Bistoletti P. Catecholamine release in the newborn infant
at birth. Pediatr Res 1977;11(8):889-93.

29. Odent M. The Nature of Birth and Breastfeeding. Sydney: Ace Graphics,
1992.

30. Schradin C, Anzenberger G. Prolactin, the Hormone of Paternity. News
Physiol Sci 1999;14:223-231.

31. Fleming AS, et al. Testosterone and prolactin are associated with
emotional responses to infant cries in new fathers. Horm Behav
2002;42(4):399-413.

32. Soltis J, et al. Urinary prolactin is correlated with mothering and
allo-mothering in squirrel monkeys. Physiol Behav 2005;84(2):295-301.

33. Maaskant RA, et al. The human prolactin receptor in the fetal membranes,
decidua, and placenta. J Clin Endocrinol Metab 1996;81(1):396-405.

34. Grosvenor CE, Whitworth NS. Accumulation of prolactin by maternal milk
and its transfer to circulation of neonatal rat--a review. Endocrinol Exp
1983;17(3-4):271-82.

35. Grattan DR. The actions of prolactin in the brain during pregnancy and
lactation. Prog Brain Res 2001;133:153-71, p 165.

36. Declercq E, et al. Listening to Mothers: Report of the First U.S.
National Survey of Women's Childbearing Experiences. New York: Maternity
Center Association, October 2002.

37. Freidman EA, Sachtleben MR. Effect of oxytocin and oral prostaglandin E2
on uterine contractility and fetal heart rate patterns. Am J Obstet Gynecol
1978;130(4):403-7.

38. Stubbs TM. Oxytocin for labor induction. Clin Obstet Gynecol
2000;43(3):489-94.

39. Haire D. FDA Approved Obstetric Drugs: Their Effects on Mother and
Baby., 2001 www.aimsusa.org/obstetricdrugs.htm.

40. Theobald GW. Letter: Dangers of oxytocin-induced labour to fetuses. Br
Med J 1974;4(5936):102.

41. Fuchs AR, et al. Oxytocin and initiation of human parturition. III.
Plasma concentrations of oxytocin and 13,14-dihydro-15-keto-prostaglandin F2
alpha in spontaneous and oxytocin-induced labor at term. Am J Obstet Gynecol
1983;147(5):497-502.

42. Randolph GW, Fuchs AR. Pulsatile administration enhances the effect and
reduces the dose of oxytocin required for induction of labor. Am J Perinatol
1989;6(2):159-66.

43. Phillip H, et al. The impact of induced labour on postpartum blood loss.
J Obstet Gynaecol 2004;24(1):12-5.

44. Stones RW, et al. Risk factors for major obstetric haemorrhage. Eur J
Obstet Gynecol Reprod Biol 1993;48(1):15-8.

45. Phaneuf S, et al. Loss of myometrial oxytocin receptors during
oxytocin-induced and oxytocin-augmented labour. J Reprod Fertil
2000;120(1):91-7.

46. Queensland Health. Perinatal data collection, Queensland 2002. Brisbane:
Queensland Health, 2001.

47. American College of Obstetricians and Gynecologists. Obstetric Analgesia
and Anesthesia. ACOG Technical Bulletin 1996;225(July).

48. Thomas TA, et al. Influence of medication, pain and progress in labour
on plasma beta-endorphin-like immunoreactivity. Br J Anaesth
1982;54(4):401-8.

49. Thomson AM, Hillier VF. A re-evaluation of the effect of pethidine on
the length of labour. J Adv Nurs 1994;19(3):448-56.

50. Kimball CD. Do endorphin residues of beta lipotropin in hormone
reinforce reproductive functions? Am J Obstet Gynecol 1979;134(2):127-32.

51. Jacobson B, et al. Opiate addiction in adult offspring through possible
imprinting after obstetric treatment. Br Med J 1990;301(6760):1067-70.

52. Nyberg K, et al. Perinatal medication as a potential risk factor for
adult drug abuse in a North American cohort. Epidemiology 2000;11(6):715-6.

53. Kellogg CK, et al. Sexually dimorphic influence of prenatal exposure to
diazepam on behavioral responses to environmental challenge and on
gamma-aminobutyric acid (GABA)-stimulated chloride uptake in the brain. J
Pharmacol Exp Ther 1991;256(1):259-65.

54. Livezey GT, et al. Prenatal exposure to phenobarbital and quantifiable
alterations in the electroencephalogram of adult rat offspring. Am J Obstet
Gynecol 1992;167(6):1611-5.

55. Mirmiran M, Swaab D. Effects of perinatal medication on the developing
brain. In: Nijhuis J, editor. Fetal behaviour. Oxford: Oxford University
Press, 1992.

56. Meyerson BJ. Influence of early beta-endorphin treatment on the behavior
and reaction to beta-endorphin in the adult male rat.
Psychoneuroendocrinology 1985;10(2):135-47.

57. Livezey GT, et al. Prenatal exposure to phenobarbital and quantifiable
alterations in the electroencephalogram of adult rat offspring. Am J Obstet
Gynecol 1992;167(6):1611-5, p 1614.

58. Goodfellow CF, et al. Oxytocin deficiency at delivery with epidural
analgesia. Br J Obstet Gynaecol 1983;90(3):214-9.

59. Lieberman E, O'Donoghue C. Unintended effects of epidural analgesia
during labor: a systematic review. Am J Obstet Gynecol 2002;186(5 Suppl
Nature):S31-68.

60. Falconer AD, Powles AB. Plasma noradrenaline levels during labour.
Influence of electric lumbar epidural blockade. Anaesthesia
1982;37(4):416-20.

61. Behrens O, et al. Effects of lumbar epidural analgesia on prostaglandin
F2 alpha release and oxytocin secretion during labor. Prostaglandins
1993;45(3):285-96.

62. Fernando R, et al. Neonatal welfare and placental transfer of fentanyl
and bupivacaine during ambulatory combined spinal epidural analgesia for
labour. Anaesthesia 1997;52(6):517-24.

63. Hale, T. The effects on breastfeeding women of anaesthetic medications
used during labour. The Passage to Motherhood Conference; 1998; Brisbane
Australia. CAPERS.

64. Hale T. Medications and Mother's Milk. Amarillo TX: Pharmasoft, 1997.

65. Krehbiel D, et al. Peridural anesthesia disturbs maternal behavior in
primiparous and multiparous parturient ewes. Physiol Behav
1987;40(4):463-72.

66. Sepkoski CM, et al. The effects of maternal epidural anesthesia on
neonatal behavior during the first month. Dev Med Child Neurol
1992;34(12):1072-80.

67. Murray AD, et al. Effects of epidural anesthesia on newborns and their
mothers. Child Dev 1981;52(1):71-82.

68. Riordan J, et al. The effect of labor pain relief medication on neonatal
suckling and breastfeeding duration. J Hum Lact 2000;16(1):7-12.

69. Baumgarder DJ, et al. Effect of labor epidural anesthesia on
breast-feeding of healthy full-term newborns delivered vaginally. J Am Board
Fam Pract 2003;16(1):7-13.

70. Harper MA, et al. Pregnancy-related death and health care services.
Obstet Gynecol 2003;102(2):273-8.

71. Enkin M, et al. Effective Care in Pregnancy and Childbirth. 3rd ed.
Oxford: Oxford University Press, 2000, p 409.

72. Hemminki E, Merilainen J. Long-term effects of cesarean sections:
ectopic pregnancies and placental problems. Am J Obstet Gynecol
1996;174(5):1569-74.

73. Laws P, Sullivan E. Australia's mothers and babies 2002. Sydney: AIHW
National Perinatal Statistics Unit, 2004.

74. Hamilton B, et al. Births: Preliminary data for 2003. National vital
statistics reports 2004;53(9).

75. Fisher J, et al. Adverse psychological impact of operative obstetric
interventions: a prospective longitudinal study. Aust N Z J Psychiatry
1997;31(5):728-38.

76. Nissen E, et al. Different patterns of oxytocin, prolactin but not
cortisol release during breastfeeding in women delivered by caesarean
section or by the vaginal route. Early Hum Dev 1996;45(1-2):103-18.

77. de Chateau P, Wiberg B. Long-term effect on mother-infant behaviour of
extra contact during the first hour post partum. II. A follow-up at three
months. Acta Paediatr Scand 1977;66(2):145-51.

78. Nissen E, et al. Different patterns of oxytocin, prolactin but not
cortisol release during breastfeeding in women delivered by caesarean
section or by the vaginal route. Early Hum Dev 1996;45(1-2):103-18, p 116.

79. Burby L. 101 Reasons to Breastfeed Your Child: Promotion of Mothers'
Milk Inc, 2001 http://www.promom.org/101/.

80. Odent M. Primal Health Database: Birthworks, 2003
http://www.birthworks.org/primalhealth/.

81. Pearce JC. Evolution's End: Claiming the Potential of Our Intelligence.
San Francisco: Harper San Francisco, 1992 p 114.

82. Pearce JC. Evolution's End: Claiming the Potential of Our Intelligence.
San Francisco: Harper San Francisco, 1992 p 115.

83. Pearce JC. Evolution's End: Claiming the Potential of Our Intelligence.
San Francisco: Harper San Francisco, 1992, p 122.

84. Pearce JC. Evolution's End: Claiming the Potential of Our Intelligence.
San Francisco: Harper San Francisco, 1992 p 125.

85. Baker JP. Prenatal Yoga and Natural Childbirth. 3rd ed. Berkley: North
Atlantic Books, 2001 p 90.

86. Kloosterman G. The universal aspects of childbirth: Human birth as a
socio-psychosomatic paradigm. J Psychosom Obstet Gynaecol 1982;1(1):35-41, p
40.

Sarah J Buckley MD is a family physician, internationally-acclaimed writer
on pregnancy, birth, and mothering, and mother of 4 children, all born
gently at home. Her book Gentle Birth, Gentle Mothering is due for
publication in late November 2005. See www.sarahjbuckley.com
<http://www.sarahjbuckley.com/> for more of her writing