The birth process for mammals is a hormonally driven process.
Having a good understanding of this process can help pregnant mothers work with their body in labour, as the 'cocktail' of hormones that can flow through a women’s body during labour can either ‘support’ labour or cause the uterus to work less effectively and cause pain to increase.
This wonderful hormonal cocktail mix is responsible for starting labour, strengthening contractions, providing pain relief and even slowing or stopping labour - but how do we stimulate the hormones that support labour and manage the ones that cause the uterus to work less effectively and cause pain to increase?
Michel Odent - long-time French obstetrician and Mick-Jagger-style elder ‘Rock God’ of the birth world (Michel is now well into his 80s) - is well known for his work on the role of hormones in birth.
I had the pleasure of going to see Michel Odent speak when he was in Australia a few years ago, and he clarified something for me - he explained that birth is an involuntary process that is ‘inhibited’ by the neo-cortex portion of our mammalian brains. (The neo-cortex is the large outer ‘shell’ portion of our brain. In humans it’s the part of our brain that’s responsible for sensory perception, motor commands, spacial reasoning, conscious thought and language; it’s often referred to as the ‘thinking part’ of the brain.)
Being an involuntary process, giving birth isn’t a logical, rational, ‘thinking’ process, though!
Michel Odent explains that for a labouring woman to be in the mental state needed for releasing ‘optimal’ birth hormones she needs to be in the primal, non-thinking part of her brain. Because of this, it’s beneficial for a woman to ‘disengage’ the neo-cortex part of her brain during labour. Some people call this labour land.
Now it’s been found that a labouring woman can get to the optimal birthing ‘place’ more easily if she feels calm, confident and trusting in her own ability to birth her baby. She needs to feel safe, warm and well supported to be able to disengage the neo-cortex and surrender to the process.
So, with that background, lets take a closer look at the roles in the birthing process of four of the hormones in the ‘cocktail’ - oxytocin, endorphins, adrenalin and melatonin.
Oxytocin is produced by the hypothalamus and is stored and secreted by the posterior pituitary gland and acts primarily as a neuromodulator in the brain ... actually that definition activates my neo-cortex a little too much! I prefer Michel Odent’s description of oxytocin as (imagine my best, not racist/stereotypical French accent) “ze hormone of lerve”.
Oxytocin is the main hormone needed to be released to get the uterus contracting, to thin and open the cervix, to move the baby down the birth canal, and to release the placenta. The higher the levels of oxytocin in a labouring woman’s body, the stronger and closer together the contractions.
It is known as the “lerve” hormone because it is released during cuddles (with your partner or your baby), stroking, kissing, nipple stimulation (which can be a handy tool for a stalled labour), laughing and sex. It also facilitates bonding and stimulates lactation. It is a feel-good hormone. When you’re close with your baby, intimate with your partner or having a great dinner with friends that you love, you’ll have high levels of oxytocin in your brain (and so will those you are with).
Not only does oxytocin get labour working effectively but it has a calming and de-stressing effect. Low light, a low level of activity and loving touch are all conducive to producing oxytocin.
I’ve observed from going to births and from talking to women about their birth experiences that women who have the ability to go to that place deep inside themselves, ‘switching off’ their neo-cortex, seem to manage really well in labour and birth. Some women seem to go there instinctively; some women work really hard to get there. Unfortunately, many women don’t even realise that it’s an option - meaning that many of us are, unknowingly, essentially fighting the birth process.
Please note that some people assume that going to that deep place within takes them to a silent, still place - for some women it is, but the reality is that it takes many forms, and although some birthing women may appear calm and silent externally, their feelings internally can be intense, challenging and joyous.
Other women may become wild and noisy primal creatures. When we ‘switch off’ our neo-cortex we lose our inhibitions and let go. This is vital to the process. Birth is a powerful experience.
Endorphins are your body’s natural pain relief. When you have high levels of endorphins in your body, they act like a natural opiate, protecting you from pain.
Endorphins are released in labour in response to oxytocin when a woman feels calm and safe. The rising levels of oxytocin are met with rising levels of endorphins, contractions strengthen, and the cycle continues. When a labouring women is able to maintain this, she can feel quite ecstatic at the end of her birth, which puts her in a state that’s perfect for meeting her baby and falling in love. Practicing meditation/relaxation techniques - particularly in early labour - can help elevate endorphin levels. Breathing calmly, having a warm bath, and light touch massage are all conducive to producing endorphins.
You are probably already familiar with adrenalin - it triggers the fight-or-flight response to stress and fear. If a labouring woman feels afraid, embarrassed, observed, out of control or in pain, adrenalin is released. Adrenalin is a hormone that is antagonistic to oxytocin and inhibits the release of endorphins. If adrenalin is released in the first stage of labour it can cause labour to slow down or even stop, and make the labour feel more painful.
However, it’s the surge of adrenalin that comes towards the end of first stage labour (transition) that is necessary to facilitate the almighty strong second stage contractions that will bring your baby into your arms.
So whilst adrenalin is definitely powerfully beneficial for the second stage of the labour, it’s production in the first stage of labour actually makes early labour more challenging.
There is perhaps less written about melatonin than the other three hormones.
Melatonin is a hormone associated with sleep and sleep cycles. Light affects how much melatonin your body produces - when the sun goes down your melatonin levels rise.
Raised melatonin levels have been shown to ‘shut down’ the neocortex - the thinking part of your brain - causing drowsiness, and helping you prepare for sleep.
It’s well known that the vast majority of labours begin at night - I know I get called to births more often than not during the night, or in the morning after Mum has been labouring at home all night.
A 2009 study (Smooth Muscle Cells Melatonin Synergizes with Oxytocin in labour to Enhance Contractility of Human Myometrial Smooth Muscle Cells - by Sharkey, Puttaramu, Word and Olcese) looked at the way melatonin synergises with oxytocin to promote contractions in labour. So it makes sense to be labouring in a dark, quiet place. If you are labouring during the day turn off the lights, draw the curtains (even if you are in hospital) and try to relax your mind and body to stimulate your body to release melatonin, synergising with oxytocin to strengthen your contractions.
Practicing relaxation/meditation/breathing techniques during pregnancy can be very valuable to prepare you for labour and birth. Learning these techniques will help you stay in the present moment, calm your nervous system, and boost your ability to ‘disengage’ the neo-cortex; this releases the oxytocin and melatonin to increase labour contractions, while at the same time boosting your body’s natural endorphin pain modifiers.
These techniques put you in the best possible place keep adrenalin levels down during first stage and to manage the intensity of labour and birth - and get you to ‘labour land’ more easily.
With thanks to Lindsay from http://newcastledoulasupport.com.au for these images