140 million women give birth every year. The Journal of Perinatal Education states, “The experience of childbirth forever shapes women's thoughts of themselves and relationships with other family members.”
Yet, the experience of birthing, from the birther’s point of view, is largely ignored in both public knowledge, and maternity care. The emotions present in the processes of birth, postpartum, and breastfeeding, are massively important, both to the mother and baby’s wellbeing, and to the processes of labour and breastfeeding themselves.
Emotions affect the processes of birth and breastfeeding.
Emotions are interconnected with hormones. Hormones control all aspects of labour, birth and breastfeeding. The lack of knowledge of how emotions affect labour, is a huge gap in maternity care that needs to be filled.
In nature, mammals give birth to their young instead of laying eggs. Mammals birth instinctually, care for, and nurse their young. Guess what? Human beings are mammals too. Human birth is also controlled by instinctual and hormonal processes. Let’s take a look at how that plays out.
Hormones of Birth
Birth begins with the softening of the cervix, caused by prostaglandin hormones. A few days before labour begins, the uterus starts producing oxytocin receptor sites. Oxytocin is the hormone that controls the contractions of the strongest muscle in the human body, the uterus.
Oxytocin
Natural oxytocin is produced in the pituitary of the brain, and in recent years, has garnered it’s 15 minutes of fame for being known as, The Love Hormone. Oxytocin is the hormone of love and bonding that your brain produces when you fall in love, when you make love, even when you have a great conversation with a friend and you feel a sense of connection.
Oxytocin is also produced in breastfeeding and is responsible for helping mammals bond with and care for their infants. Oxytocin is produced in increasing quantities in labour. The peak of oxytocin in the human experience is at the moment before birth. This process in nature ensures mammal mothers bond with and care for their babies.
There are many other hormones involved, such as melatonin, which explains why most labours begin in the middle of the night. There are also beta-endorphins, which can give labouring mothers a feeling of euphoria, a runner’s high. Women have described this feeling as “Labourland”, where time makes no sense, the critical thinking brain shuts down, and a deeper, more expanded sense of self is experienced.
Cortisol hormones, or stress hormones, play a crucial function in stimulating the fetus to produce surfactant, which is the inner lining of the baby’s lungs. The baby doesn’t breathe air in utero, but will need to breathe once it’s born. It is the process of labour which increases the chances that the baby will effectively be able to breathe without problems when it’s born. Some amount of pain is a useful part of the labour process. Pain with a purpose.
There is another hormone that can affect labour - Adrenaline, the fight or flight hormone, produced in moments of acute danger or stress. Think of a mammal in the wild - a deer. If a deer is in labour, and a predator, say a lion, is nearby, what would happen? The deer needs to be able to escape to a safe place. Adrenaline inhibits oxytocin, so that labour contractions stop or slow down. The animal can escape. Only once she can relax in a safe place, will oxytocin begin again.
Humans don’t usually live in wild jungles, so how is this relevant to us? It’s not just a lion that will produce adrenaline in us. Anything that causes stress, anxiety, or worry will produce adrenaline, thus disrupting the normal flow of oxytocin and slowing down labour. Adrenaline sends a danger message to the brain. There’s something wrong! You need to escape! Pain! Danger!
Adrenaline causes the sensation of contractions to feel 10x more painful. Unlike the deer in the wild, human mothers are not going to run and hide. We just think that extreme pain is a normal part of labour, ask for an epidural, and think women who want a natural birth are crazy.
What could cause mothers to experience fear, anxiety and worry in labour?
Some of it is internal - her own thoughts, fears and beliefs about birth, or concern for the wellbeing of her baby. Some of it is external - the stress-inducing environment of hospitals, or people around the birthing mother who may say things that are fear-inducing.
Mammals do not go to an unfamiliar, bright place, with lots of strangers to labour. They labour in dark, private places in familiar surroundings. With modern humans, some feel safe and comfortable in hospitals and should labour there, while some feel safe and comfortable at home, and should labour there. If hospitals were to take into account how important emotions are in affecting birth, they would set up the environment, and treat pregnant mothers, very differently.
Hospitals are usually a place you go when you have an injury or illness. Labour is the only normal, healthy process that humans choose to go to a hospital for. If maternity care staff were to design maternity wards with an understanding of physiological mammalian birth, what would it be like?
Right now the experience goes something like this. A pregnant woman is getting closer to a date society has declared a “due date”, even though, it is only the average date of gestation, and not when the baby’s birth is overdue. People start asking if she has had the baby yet. The doctor might start recommending an induction if pregnancy goes “too far” past an arbitrary date. Maybe there is talk of statistical probabilities of something being wrong with the baby. Maybe there is talk of something being wrong with the mother’s body. The mother starts to feel stressed. Too much stress could inhibit labour from starting, ironically, the opposite of what she wants.
Then eventually, labour begins and she goes to the hospital. There are bright lights and strangers prodding and asking all sorts of questions. Maybe she begins to feel stressed, which causes her contractions to feel more painful, which causes her to fear the next contraction, which causes her to tense her muscles, which causes more pain, which causes more fear. This is the Fear-Tension-Pain Cycle.
Maternity care has had rising rates of epidurals, inductions and cesareans in recent decades, without improving maternal and fetal wellbeing. There are a certain percentage of births where interventions are useful and life saving, but many medical interventions are used far too often. They cost way too much, and when used inappropriately, often leave mothers feeling disappointed, disoriented, and downright traumatized.
Mothers in labour are extremely emotionally vulnerable. When maternity staff treat a labouring mother with care and respect, she can have a beautiful, positive experience, even if medical intervention was needed. This extends into her sense of self and ability to parent, which lasts years.
If she is treated with disrespect, it can make labour a horrendous, frightening experience. Creating safety, support and care is essential to having good outcomes. As many as 45% of mothers have reported having a negative experience of their birth, where a significant factor was the disrespectful way medical staff treated them. Approximately 17% of mothers have PTSD after birth, higher than the rate of PTSD in war veterans.
So if we imagine a future that acknowledges emotions in birth, it might look like this:
A mother and her birth supporters walk into a maternity ward. It is dimly lit, with electric candles and soothing music playing. The triage nurse greets the mother with a smile and a hushed voice, saying how well she is doing.
The mother goes to her room in the hospital, also dimly lit. There is a big bath tub in the corner, as warm water is so soothing for labour. If situations arise that need medical help, doctors, midwives and nurses can discuss the options with the mother, including her in the decision making process.
Eliminating stressful situations will eliminate many of the interventions in birth.
Not only will that improve the experience for families, it will also save the healthcare industry millions of dollars.
If you come across a mother who is upset with her birth experience,
please don’t say, “The only thing that matters is a healthy baby.” Having a healthy baby is important, but having confident, respected mothers matters too.
