Pregnant women across the globe practice in their own way of preparing for their births. with their hearts set on the best outcome for their babies. Such is the pure, dedicated heart of a mother that she easily forgets about her own needs, and often fails to appreciate the fact that taking care of her needs, in reality, helps to create the positive and safe birth that she rightfully desires. Although two separate individuals, a mother and baby are linked as one (also referred to as mother-baby dyad), therefore any stressful event affecting the laboring mother directly influences the baby and hence puts the birth in a compromised situation. As discussed in her childbirth education course, Aisha al Hajjar names this phenomenon as "birth being an orchestra of hormones", which implies the critical role hormones play during birth. Many hormones are involved in facilitating normal birth such as Oxytocin, Beta-endorphin, Prolactin, and the fight or flight hormones--adrenaline and noradrenaline. Adrenaline and noradrenaline are part of the group of hormones known as Catecholomines, and are produced by the body in responses to stresses such as hunger, fear, cold, and even excitement. Researchers argue that an overload of catecholomines can severely interfere with the orchestrations of the more relaxing, pleasurable hormones that are meant to progress labor smoothly, facilitate bonding, and reduce pain. Most medical professionals do not have a proper understanding of physiological birth, and more often than not their invasive protocols and interventions put the mother’s body in a heightened state of fight or flight, which prevents the other hormones from becoming established enough to facilitate normal birth. Physiological birth is dependent on this balanced release of neuro-chemicals and hormones, and since stress hinders this process, a woman must be free to labor in an environment where she feels empowered, safe and supported.
In the average hospital setting, laboring women are held to a standard called the Friedman’s Curve. In 1955, a study was published by Dr. Emanuel Friedman that was based on his assessment of the average amount of time it took laboring women to dilate, the progress being measured in centimetres during labor. While recommended standards have been changed by the American College of Obstetrics and Gynecology, Friedman’s curve is still widely used in hospitals today, and is a major source of stress for women wanting to avoid the dreaded “failure to progress” diagnosis, which is a leading cause of unplanned cesarean sections. When a woman enters a hospital in labor, she is being timed based on this method. It is stress, however, that can slow down dilation in labor, or even stop labor from progressing. Imagine trying to relax your body enough to allow a simple physiological function to occur, such as a bowel movement. Picture yourself in a brightly lit room full of loud machines, with various strangers coming and going. Just as you find the ability to breathe out and relax your sphincter muscles, another strange person flies into the room and roughly examines your anus, while making comments about your time and performance. Would you believe that you were to blame? Recently, Friedman’s curve has been reevaluated and is considered outdated, when Dr. Zhang’s research showed a significant difference in average labor curve compared to Friedman’s original study (Zhang J, et al. Am J Obstat Gynecol. 2002).
A woman may enter the hospital with the belief that it is the safest place for them to give birth, but her body responds to the environment as a place of danger. Mammals release adrenaline in situations where they feel observed when they are vulnerable, scared, or cold. Consistent levels of adrenaline impede the release of oxytocin. This hormone is the catalyst for the natural contractions needed for a woman to birth her baby easily, and has been shown to decrease labor pains in animal studies. Hormonal disruptions can be amplified when one intervention necessitates and leads to another that is used to monitor, prevent, or treat its side effects. When intervention induced stress negates the natural balance and timing of hormone release, both mother and baby are at a drastically increased risk of a myriad of birth and postpartum complications. Medical interventions, when used appropriately can be life saving procedures that have their place. However, since physiological birth is inherently safe for healthy women, most medical interventions are excessive and unnecessary. In reference to Pitocin induction, even the World Health Organization advises that “Induction of labor should be performed with caution since the procedure carries the risk of uterine hyper-stimulation, rupture and fetal distress” (WHO recommendations for induction of labor 2011). Additionally, a recent study showed that being induced via receiving Pitocin, which is a synthetic form of Oxytocin, is linked to a 36% increase in postpartum depression for women with a history of depression or anxiety prior to pregnancy, while there is a 32% increase observed for women with no prior history of depression or anxiety (Kroll-Desrosiers AR, el al. 2017). Interventions have taken the place of certain natural hormone processes, while increasing stress hormones. The aforementioned drugs are routinely used on healthy women, they serve no beneficial purpose and inhibit the natural hormones needed for physiological birth to occur.
What is the natural and physiological purpose of stress hormones? In early labor, stress hormones are likely to slow down labor, or stop labor completely. For animals giving birth in the wild, this response serves to keep mothers and babies out of harm‘s way. If there is a sudden fear of predators in early labor, catecholamines are released to stop labor, so that the animal has time to move out of danger before labor begins again (Lothian 2004). Once the animal finds a safe, secluded area, labor will initiate again. The effect is different, however, in late labor when birth is drawing closer, and a surge of catecholamines occurs to initiate a fetal-ejection reflex since by this point, getting the baby out quickly is better to allow the mother to move to safety. The baby experiences a surge in noradrenaline close to the time of birth, which plays an important role in the baby’s adaptation to life outside the womb. It also ensures that the baby is wide-eyed and alert at first contact with the mother to facilitate the early processes of bonding. Stress hormones have their place, but consistent elevated levels lead to complications in otherwise healthy mothers and babies.
What can be done to help reduce stressful situations during birth? Above all else, women need to know they have options. Every woman has different needs and beliefs, and it is not possible for all needs to be met by the medical system. Research has shown that women who choose a planned home-birth under the care of trusted midwives and doulas have lower stress due to enhanced emotional support, and are less likely to experience complications such as postpartum hemorrhage. Within hospitals there are measures that can be taken to allow a more private, hands off birth. Privacy does not mean the woman is alone either, but that she is allowed to have a more respected hands off experience, where she is left to follow her body’s cues. In fact, for many care providers it's not about what can be done, rather learning to do less. Dimmer lighting, less people in the room at any given time, less examinations, allowing the laboring woman food and water as she feels hungry or thirsty, and allowing her to move and take any position her body desires intuitively. Mother and baby needs are very simple. Too much stress, usually caused by environmental influences and perceived threats from outside of a woman’s body, interferes with an uncomplicated physiological birth taking place. Women must be free to labor in an environment where they feel empowered to do what their body is made to do, they must feel safe and warm, and must feel supported by those who have the privilege of being in their birthing space.