Ecstatic Birth - Nature's Hormonal Blueprint for Labor

[christinamarie]

Ecstatic birth - nature's hormonal blueprint for labor

C Dr Sarah J Buckley 2005 www.sarahjbuckley.com

This article has been previously published in Mothering Magazine, issue 111,
March-April 2002, and in Byron Child, issue 5, March 2003. This version
updated March 2005.

This material has been further expanded as"Undisturbed Birth: Mother
Nature's hormonal blueprint for safety, ease and ecstasy" available in
Sarah's upcoming book, Gentle
<http://www.sarahjbuckley.com/html/gentle-birth-gentle-mothering.htm>
Birth, Gentle Mothering: The wisdom and science of gentle choices in
pregnancy, birth, and parenting.

Giving birth in ecstasy: This is our birthright and our body's intent.
Mother Nature, in her wisdom, prescribes birthing hormones that take us
outside (ec) our usual state (stasis), so that we can be transformed on
every level as we enter motherhood.

This exquisite hormonal orchestration unfolds optimally when birth is
undisturbed, enhancing safety for both mother and baby. Science is also
increasingly discovering what we realise as mothers - that our way of birth
affects us life-long, both mother and baby, and that an ecstatic birth -- a
birth that takes us beyond our self -- is the gift of a life-time.

Four major hormonal systems are active during labor and birth. These involve
oxytocin, the hormone of love; endorphins, hormones of pleasure and
transcendence; adrenaline and noradrenaline (epinephrine and
norepinephrine), hormones of excitement; and prolactin, the mothering
hormone. These systems are common to all mammals and originate deep in our
mammalian or middle brain.

For birth to proceed optimally, this part of the brain must take precedence
over the neocortex, or rational brain. This shift can be helped by an
atmosphere of quiet and privacy with, for example, dim lighting and little
conversation, and no expectation of rationality from the laboring woman.
Under such conditions a woman intuitively will choose the movements, sounds,
breathing, and positions that will birth her baby most easily. This is her
genetic and hormonal blueprint.

All of these systems are adversely affected by current birth practices.
Hospital environments and routines are not generally conducive to the shift
in consciousness that giving birth naturally requires. A woman's hormonal
physiology is further disturbed by practices such as induction, the use of
pain killers and epidurals, cesarean surgery, and separation of mother and
baby after birth.

Hormones in Birth

Oxytocin

Perhaps the best-known birth hormone is oxytocin, the hormone of love, which
is secreted during sexual activity, male and female orgasm, birth, and
breastfeeding. Oxytocin engenders feelings of love and altruism; as Michel
Odent says, "Whatever the facet of love we consider, oxytocin is involved."1

Oxytocin is made in the hypothalamus, deep in our brains, and stored in the
posterior pituitary, the master gland, from where it is released in pulses.
It is a crucial hormone in reproduction and mediates what have been called
the ejection reflexes: the sperm ejection reflex with male orgasm (and the
corresponding sperm introjection reflex with female orgasm); the fetal
ejection reflex at birth (a phrase coined by Odent for the powerful
contractions at the end of an undisturbed labor, which birth the baby
quickly and easily2); and, postpartum, the placental ejection reflex and the
milk ejection, or let-down reflex, in breastfeeding.

As well as reaching peak levels in each of these situations, oxytocin is
secreted in large amounts in pregnancy, when it acts to enhance nutrient
absorption, reduce stress, and conserve energy by making us more sleepy.3
Oxytocin also causes the rhythmic uterine contractions of labor, and levels
peak at birth through stimulation of stretch receptors in a woman's lower
vagina as the baby descends.4The high levels continue after birth,
culminating with the birth of the placenta, and then gradually subside.5

The baby also has been producing increasing amounts of oxytocin during
labor;6 7 so, in the minutes after birth, both mother and baby are bathed in
an ecstatic cocktail of hormones. At this time ongoing oxytocin production
is enhanced by skin-to-skin and eye-to-eye contact and by the baby's first
attempts at suckling.8 Good levels of oxytocin will also protect against
postpartum hemorrhage by ensuring good uterine contractions.

In breastfeeding, oxytocin mediates the let-down reflex and is released in
pulses as the baby suckles. During the months and years of lactation,
oxytocin continues to act to keep the mother relaxed and well nourished.
Oxytocin expert and researcher Professor Kerstin Uvnas Moberg calls it '.a
very efficient anti-stress system, which prevents a lot of disease later
on.'3 In her study, mothers who breastfed for more than seven weeks were
calmer,when their babies were six months old, than mothers who did
notbreastfeed.

Outside its role in reproduction, oxytocin is secreted in other situations
of love and altruism, for example, sharing a meal.9 Researchers have
implicated malfunctions of the oxytocin system in conditions such as
schizophrenia,10 autism,11 cardiovascular disease,12 and drug dependency,13
and have suggested that oxytocin may mediate the antidepressant effect of
drugs such as Prozac.14

Beta-endorphin

As a naturally occurring opiate, beta-endorphin has properties similar to
pethidine (meperidine, Demerol), morphine, and heroin, and has been shown to
work on the same receptors of the brain. Like oxytocin, beta-endorphin is
secreted from the pituitary gland, and high levels are present during sex,
pregnancy, birth, and breastfeeding.

Beta-endorphin is also a stress hormone, released under conditions of duress
and pain, when it acts as an analgesic and, like other stress hormones,
suppresses the immune system. This effect may be important in preventing a
pregnant mother's immune system from acting against her baby, whose genetic
material is foreign to hers.

Like the addictive opiates, beta-endorphin induces feelings of pleasure,
euphoria, and dependency or, with a partner, mutual dependency.
Beta-endorphin levels are high in pregnancy and increase throughout labor,15
when levels of beta-endorphin and corticotrophin (another stress hormone)
reach those found in male endurance athletes during maximal exercise on a
treadmill.16 Such high levels help the laboring woman to transmute pain and
enter the altered state of consciousness that characterizes an undisturbed
birth.

Beta-endorphin has complex and incompletely understood relationships with
other hormonal systems.17 In labor, high levels will inhibit oxytocin
release. It makes sense that when pain or stress levels are very high,
contractions will slow, thus '.rationing labor according to both
physiological and psychological stress.'18

Beta-endorphin also facilitates the release of prolactin during labor;19
prolactin prepares the mother's breasts for lactation and is thought to be
important in preparing the baby's lungs and heat-regulating systems for life
outside the womb.20 21

Beta-endorphin is also important in breastfeeding. Levels peak in the mother
at 20 minutes,22 and beta-endorphin is also present in breast milk,23
inducing a pleasurable mutual dependency for both mother and baby in their
ongoing relationship.

Fight-or-Flight Hormones

The hormones adrenaline and noradrenaline (epinephrine and norepinephrine)
are also known as the fight-or-flight hormones, or, collectively, as
catecholamines (CAs). They are secreted from the adrenal gland above the
kidney in response to stresses such as fright, anxiety, hunger or cold, as
well as excitement, when they activate the sympathetic nervous system for
fight or flight.

In the first stage of labor, high CA levels inhibit oxytocin production,
therefore slowing or inhibiting labor. CAs also act to reduce blood flow to
the uterus and placenta, and therefore to the baby. This makes sense for
mammals birthing in the wild, where the presence of danger would activate
this fight or flight response, inhibiting labor and diverting blood to the
major muscle groups so that the mother can flee to safety. In humans, high
levels of CAs have been associated with longer labor and adverse fetal heart
rate patterns (an indication of stress to the baby).24

After an undisturbed labor, however, when the moment of birth is imminent,
these hormones act in a different way. There is a sudden increase in CA
levels, especially noradrenaline, which activates the fetal ejection reflex.
The mother experiences a sudden rush of energy; she will be upright and
alert, with a dry mouth and shallow breathing and perhaps the urge to grasp
something. She may express fear, anger, or excitement, and the CA rush will
cause several very strong contractions, which will birth the baby quickly
and easily.25

Some birth attendants have made good use of this reflex when a woman is
having difficulties in the second stage of labor. For example, one
anthropologist working with an indigenous Canadian tribe recorded that when
a woman was having difficulty in birth, the young people of the village
would gather together to help. They would suddenly and unexpectedly shout
out close to her, with the shock triggering her fetal ejection reflex and a
quick birth.2

After the birth, the mother's CA levels drop steeply. A warm atmosphere is
important; a new mother is very sensitive to temperature and if she cools
down significantly, the cold stress will keep her CA levels high, inhibiting
her natural oxytocin release and therefore increasing her risk of postpartum
hemorrhage.26

Noradrenaline, as part of the ecstatic cocktail, is also implicated in
instinctive mothering behavior. Mice bred to be deficient in noradrenaline
will not care for their young after birth unless noradrenaline is injected
back into their system.27

For the baby also, birth is an exciting and stressful event, reflected in
high CA levels. These assist the baby during birth by protecting against the
effects of hypoxia (lack of oxygen) and subsequent acidosis.28 High CA
levels at birth ensure that the baby is wide-eyed and alert at first contact
with the mother. The baby's CA levels also drop rapidly after an undisturbed
birth, being soothed by contact with the mother.

Prolactin

Known as the mothering hormone, prolactin is the major hormone of breast
milk synthesis and breastfeeding. Levels of prolactin increase in pregnancy,
although milk production is inhibited hormonally until the placenta is
delivered. Levels decrease during labor but then rise steeply at the end of
labor and peak with birth.

Prolactin is a hormone of submission or surrender--in primate troops, the
dominant male has the lowest prolactin level--and produces some degree of
anxiety. In the breastfeeding relationship these effects activate the
mother's vigilance and help her to put her baby's needs first.29

Prolactin has been associated with nurturance from fathers as well as
mothers, earning the additional label "The hormone of paternity"30. New
fathers with higher prolactin levels more responsive to their babies'
cries.31 Animal studies show that prolactin release is also increased by
carrying infants32.

The baby also produces prolactin in pregnancy, and high levels are found in
amniotic fluid, secreted by the baby's membranes as well as the mother's
uterine lining.33 Prolactin is also secreted into breastmilk, at least in
the rat. 34 According to one researcher,". there is evidence that prolactin
plays an important role in the development and maturation of the neonatal
[newborn] neuroendocrine [brain-hormone] system."35

Undisturbed Birth

Undisturbed birth is exceedingly rare in our culture, which reflects our
ignorance of its importance. Two factors that disturb birth in all mammals
are firstly being in an unfamiliar place and secondly the presence of an
observer. Feelings of safety and privacy thus seem to be fundamental. Yet
the entire system of Western obstetrics is devoted to observing pregnant and
birthing women, by both people and machines, and when birth isn't going
smoothly, obstetricians respond with yet more intense observation. It is
indeed amazing that any woman can give birth under such conditions.

Some writers have observed that, for a laboring woman,having a babyhas a lot
of parallels with making a baby: the same hormones, the same parts of the
body, the same sounds, and the same needs for feelings of safety and
privacy. How would it be to attempt to make love in the conditions under
which we expect women to give birth?

When I gave birth to my fourth baby, Maia Rose, I arranged a situation where
I felt very private, safe and undisturbed, and had my easiest and most
ecstatic labor and birth: one-and-a half hours with an unexpectedly breech
baby. I believe that this birth proceeded optimally because of this lack of
disturbance, and because of my freedom to follow my own instincts.

Undisturbed birth is possible in a variety of settings, but must always
involve a feeling of emotional security for the birthing woman. A familiar
and supportive companion, such as a midwife or doula, can play an important
role in creating and protecting a private space for the laboring woman,
especially in a hospital setting.

Impact of Drugs and Procedures

Induction and Augmentation

In Australia in 2002, approximately 26 percent of women had an induction of
labor, and another 19 percent have an augmentation--stimulation or speeding
up of labor-through either artificial rupture of membranes or with synthetic
oxytocin (Pitocin, Syntocinon).In the US in 2004, 53 percent of women
reported that they had Pitocin administered in labor to strengthen or speed
up contractions.36

Synthetic oxytocin administered in labor does not act like the body's own
oxytocin. First, Pitocin-induced contractions are different from natural
contractions, and these differences can have significant effects on the
baby. For example, waves can occur almost on top of each other when too high
a dose of Pitocin is given, and it also causes the resting tone of the
uterus to increase.37

Such over-stimulation (hyperstimulation) can deprive the baby from the
necessary supplies of blood and oxygen, and so produce abnormal FHR
patterns, fetal distress (leading to caesarean section), and even uterine
rupture.38

Birth activist Doris Haire describes the effects of Pitocin on the baby:

The situation is analogous to holding an infant under the surface of the
water, allowing the infant to come to the surface to gasp for air, but not
to breathe.39

These effects may be partly due to the high blood levels of oxytocin that
are reached when a woman labors with Pitocin. Theobald calculated that, at
average levels used for induction or augmentation/acceleration, a woman's
oxytocin levels will be 130 to 570 times higher than she would naturally
produce in labor.40 Direct measurements do not concur, but blood oxytocin
levels are difficult to measure.41 Other researchers have suggested that
continuous administration of this drug by iv infusion, which is very
different to its natural pulsatile release, may also account for some of
these problems.42

Second, oxytocin, synthetic or not, cannot cross from the body to the brain
through the blood-brain barrier. This means that Pitocin, introduced into
the body by injection or drip, does not act as the hormone of love. However,
it can interfere with oxytocin's natural effects. For example, we know that
women with Pitocin infusions are at higher risk of major bleeding after the
birth43 44 and that, in this situation, the uterus actually loses oxytocin
receptors and so becomes unresponsive to the postpartum oxytocin peak that
prevents bleeding.45 But we do not know the psychological effects of
interference with the natural oxytocin that nature prescribes for all
mammalian species.

As for the baby, 'Many experts believe that through participating in this
initiation of his own birth, the fetus may be training himself to secrete
his own love hormone.'29 Michel Odent speaks passionately about our
society's deficits in our capacity to love self and others, and he traces
these problems back to the time around birth, particularly to interference
with the oxytocin system.

Opiate Painkillers

The most commonly used drug in Australian labor wards today is pethidine
(meperidine, Demerol). In one state, 38 percent of laboring women in 1998
were given this drug.46 In the U.S., several opiate-like drugs have been
traditionally used in labor, including meperidine nalbuphine (Nubain),
butorphanol (Stadol), alphaprodine (Nisentil), hydromorphone (Dilaudid), and
fentanyl citrate (Sublimaze).

The use of simple opiates in the labor room has declined in recent years,47
with many women now opting for epidurals, which may also contain these drugs
(see below) As with oxytocin, use of opiate drugs will reduce a woman's own
hormone production,48 which may be helpful if levels are excessive and
inhibiting labor. The use of pethidine, however, has been shown to slow
labor,more so with higher doses,49 which is consistent with the known
reduction in oxytocin that natural opiates can cause.

Again we must ask: What are the psychological effects for mother and baby of
laboring and birthing without peak levels of these hormones of pleasure and
co-dependency? Some researchers believe that endorphins are the reward we
get for performing reproductive functions such as mating and birthing; that
is, the endorphin fix keeps us having sex and having babies.50 It is
interesting to note that most countries that have adopted Western
obstetrics, which prizes drugs and interventions in birth above pleasure and
empowerment, have experienced steeply declining birth rates in recent years.

Of greater concern is a study that looked at the birth records of 200 opiate
addicts born in Stockholm from 1945 to 1966 and compared them with the birth
records of their non-addicted siblings.51 When the mothers had received
opiates, barbiturates, and/or nitrous oxide gas during labor, especially in
multiple doses, the offspring were more likely to become drug addicted. For
example, when a mother received three doses of opiates, her child was 4.7
times more likely to become addicted to opiate drugs in adulthood.

This study was recently replicated with a U.S. population, with very similar
results.52 The authors of the first study suggest an imprinting mechanism,
but I wonder whether it may be a matter of ecstasy--if we don't get it at
birth, as we expect, we look for it later in life through drugs. Perhaps
this also explains the popularity (and the name) of the drug Ecstasy.

Animal studies suggest a further possibility. It seems that drugs
administered chronically in late pregnancy can cause effects in brain
structure and function (eg chemical and hormonal imbalance) in offspring
that may not be obvious until young adulthood.53-56 Whether such effects
apply to human babies who are exposed for shorter periods around the time of
birth is not known; but one researcher warns, 'During this prenatal period
of neuronal [brain cell] multiplication, migration and interconnection, the
brain is most vulnerable to irreversible damage.'57