Hormones of labour: What are they and how to promote them PT 1



"Natural childbirth allows the hormones that have been working for women for thousands of years to fulfill their functions. This is more important than just helping a woman through labour and delivery. Birth-related hormones also affect well-being much later in life."

- Janet Schwegel, Author





Hormones are driving labour, birth, and breastfeeding experiences, after also changing and adapting throughout pregnancy. By understanding the hormones involved, we can better understand their role, how to promote and support them and how to potentially fill in the gap where they are absent or augmented. I hope to do so throughout this post!


Oxytocin


As many know it, the hormone of love. This hormone is present and active in experiences of sexual intimacy, loving, sensual touch, hugs, birth, and breastfeeding, and also promotes calm, connection, healing, and growth.


During the prelabour phase, oxytocin activates the receptors in the uterus, brain and mammary glands to maximise its impact. During labour, it is the most powerful hormone to stimulate contractions. It also reduces stress as it centrally activates the parasympathetic nervous system, which creates a sense of calm and analgesic effects (pain relief) in mothers and babies. As the labour intensifies, so does the production of oxytocin, unlike a synthetic oxytocin drip (also known as Syntocinon in Australia), the natural oxytocin is released in pulses, which allows the steady incline of the labour intensity. Postpartum, oxytocin plays a key role in activating the reward and pleasure centre in the mother, to bond to the baby and promote long-term survival for the infant. In the hour following birth, it will aid in starting up the contractions again for placenta delivery and reducing the risk of a postpartum haemorrhage. At this time it also provides natural warming for the newborn via the mother's chest and facilitates breastfeeding initiation.


It is also important to note that the father, or partner of the mother, also experiences higher levels of oxytocin in this period, studies showing the same baseline as the mothers' experience. Though this happens through a different pathway than for mothers, fathers can promote this through skin to skin, eye contact, joint exploration and play. Read more about these studies here.


It is also shown that epidural analgesia reduces maternal oxytocin in labour. This can impact the postpartum processes of breastfeeding, healing, bonding, and complications. When we are looking at applying synthetic oxytocin (syntocinon), it is important to note that this does not cross into the maternal brain in biologically significant amounts, therefore it may not provide the benefits described above.


Ways to promote Oxytocin:

- Ensure birth space is calm, familiar, and safe for the birthing person

- Partners role can promote oxytocin (touch, eye gazing, verbal encouragement and words of affirmation)

- Nipple stimulation or other physical touches, especially if between mother and partner

- Having a birth altar

- If you already have kids, having these present or around the birth space. If unavailable, pictures of them hanging up may promote oxytocin

- Massage, light touch

- Warm water

- Food


Beta-endorphins


These are the hormones of pleasure and transcendence. They are endogenous opioids that give analgesic effects and dictate responses to stress and pain. This hormone is a part of activating the pleasure and reward centre I mentioned in the oxytocin hormone paragraph (vital for bonding and infant survival).



It is said that our beta-endorphins, acting as our natural pain relief, are 20 to 40 times stronger than morphine, and the prelabour phase is important in increasing our body's receptors for this hormone. Therefore, if induction or planned caesarean occurs before spontaneous onset of labour, this process will be neglected and there will be a gap with this hormone.

During labour, if pharmaceutical drugs are used, the natural release of the beta-endorphins is reduced, as they directly respond to messages from the body (if we are not perceived to be in pain, there is no need to produce the hormone). If no pharmaceutical drugs are used, the endorphin release will steadily increase as so does the labour. Prolactin will also be produced in response to this hormone in labour.


You know when women say they were there, but they were also somewhere entirely else during their labour? Yeah, you can thank beta-endorphins for that! They play a role in the feeling and state of altered consciousness. This can help with the potential stress and pain of labour. In the postpartum period, these delicious hormones aid in the euphoric feeling many women experience from a physiological birth and tend to the imprinting on the infant.


When we are looking at promoting beta-endorphins, there is a fine line as too much can inhibit oxytocin and slow down labour, and too little won't give adequate pain relief and stress reduction. This will differ from woman to woman.


Ways to promote Beta-endorphins:

- Ensure woman is feeling calm, relaxed and supported

- Woman must feel safe in her birthing space (this will be different for each woman)

- Light touch massage (the goosebumps we get from this helps!)

- Eat dark chocolate

- Use music, affirmations, meditations or hypnobirthing tracks to promote calmness


Epinephrine and Norepinephrine:


As we know them, these are our flight or fight hormones: Adrenaline and noradrenaline. It is important for the birthing woman to switch off their neocortex (what differentiates us from other animals) and go into their primal brain (what we share with all other animals). In saying that, let's look at the way domestic, or wild, animals experience birth. Most often, dogs and cats will hide in a closet at home, cocoon themselves in a stuffy, darkroom, away from all their human companions. Wild animals will hide when they are giving birth to avoid the attraction of predators when they are in their most vulnerable state. If an animal feels threatened, or that a predator is near, they are able to stall their labour until in a safer environment.



These are great examples of how we should organise our birthing space and environment for women. If a woman feels unsupported or fearful during labour, too much adrenaline will be released which can cause the labour to slow down. If they are within the medical system, this can be seen as 'failure to progress', and intervention often occurs. When we are in fight, flight or freeze, our body becomes tense, pain increases and it causes more distress. This cycle is known as the fear tension pain cycle, which is hard to crack once in it. Women begin to feel fear, they tense their body, their pain sensitivity increases. Following that, they fear the oncoming pain, so they tense up even more, and pain increases again. She is now fighting the surges, rather than working with them.


During labour, a late influx of adrenaline occurs to help push the baby out - how perfect is this all designed?! This adrenaline then aids in the baby's ability to transition to the world outside of the womb and makes them alert enough to initiate breastfeeding.


How to avoid excessive stress responses:

- All about the environment! Lights, smells, voices, people, terminology will all play a huge part in this

- Special attention needs to be given to the woman's emotional wellbeing - this will be different for each woman

- What will make her feel safe? Words, physical touch, medical knowledge, no talking, lots of talking, no unnecessary bodies in the room... etc



 

I will wrap up part 1 of the hormones of labour here. I hope all that I have provided give you some understanding of the hormones and why they are so important. A part of the education that is severely lacking in the hospital birth education classes, but is well incorporated into independent childbirth classes. To be able to support the physiology of labour, we must first understand what we are supporting, and how each best to receive that support.


Stay tuned for part 2!



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