Wednesday, 2 January 2013

Let your hormones be in the driving seat in labour

Ok, hormones. Giving birth is regulated by the autonomic nervous system. This is controlled by the most primitive part of our brain, sometimes called ‘the reptilian brain’. The autonomic nervous system controls our basic functions: breathing, heart rate, body temperature, digestion, excretion – and giving birth. The autonomic nervous system has two modes of function – the sympathetic and the parasympathetic systems.

In normal daily life, especially when at rest, the parasympathetic system is to the fore and our heart rate is normal, breathing is normal, digestive functions and all the rest are normal. When we encounter stress the sympathetic system takes over as our body prepares for fight or flight. Our heart rate increases, we start to sweat, blood is diverted to our muscles and non-essential processes such as digestion and excretion shut or slow down. I am sure we can all think of times when we were under stress which made it difficult to eat or go to the loo - for example being in a strange place or insanitary conditions such as a festival.  Or becoming relaxed and everythings suddenly working: for example, arriving home from holiday the body relaxes and suddenly we need a poo!

Giving birth, because it is also controlled by the autonomic nervous system is similarly affected. We see this in wild animals – if they are disturbed or feel threatened in labour, labour stops until they feel safe again. Biologically this makes sense as it ensures both mother and baby survive. Interestingly, with animals in advanced labour who are threatened labour speeds up to get the baby out quickly so they can then get to safety.

You can reduce the effect of the sympathetic system by relaxing and breathing calmly and the body returns to normal state with parasympathetic system in the fore.

Birth is affected by three main hormones associated with the autonomic nervous system: oxytocin, endorphins and adrenaline. Oxytocin is like the accelerator of labour. The more oxytocin your body releases the stronger and closer the contractions become. Oxytocin causes the muscles to contract. It is also known as the love hormone as it is released during cuddles, stroking, kissing, nipple stimulation and sex. During climax it is oxytocin that causes ejaculation and vaginal contractions. The release of oxytocin is inhibited by the activation of the sympathetic system due to fear or embarrassment, and also by bright lights.

Endorphins are the body’s natural pain relief, a natural opiate. They are released when we are happy and feel loved, when we are massaged or we rub a part of our body to ease a pain. They are also released when we laugh. Their release is inhibited in the same ways as oxytocin. Where oxytocin was the accelerator, endorphins are the clutch. As oxytocin is released and contractions increase, the body releases endorphins which help you cope with the contractions. This then leads to more oxytocin being released, contractions increases in strength and length as labour goes up a gear. So it goes on: oxytocin is released, contractions increase, endorphins are released, the body copes, more oxytocin is released, contractions increase, endorphins are released, the body copes etc. By the end of labour the cocktail of oxytocin and endorphins creates a natural high. Davina McColl, the presenter, who confesses to using drugs in her past, described the high at the point of birth as the biggest high she had ever experienced. Both mother and baby’s brains are flooded which aids bonding, the contraction of the uterus and breastfeeding.

By contrast, the third hormone, adrenaline is released when the sympathetic system is to the fore. Adrenaline is the brake in this analogy. It is the release of adrenaline that causes labour to slow down or stop. Adrenaline is released when we are afraid, embarrassed, feel lack of control. Remember what happens to other mammals in labour? This happens to women too. It is very common for women who have been labouring well at home to find that their contractions slow or stop when they go to hospital as the adrenaline released by the excitement and anxiety.

Just to complete the analogy: the handbrake in labour is stimulation on the neocortex. The neocortex or fore brain is the most recent part of the brain and controls language and reason. In labour the more primitive part of the brain is in control and there is little activity in the neocortex. Stimulation of the neocortex by talking, or making decisions, wakes up the neocortex which then takes over control of the body resulting in stalled labour. Left undisturbed, women are in ‘labour land’, barely able to talk by the end, or understand speech.

The last hormone to be involved in labour is prolactin. This is released at birth and encourages the placenta to come away and milk to be made.

To put this knowledge into practise think about the following situations you might find yourself in.  What could you, or your birth partner do to restore or protect the flow of positive hormones, keep the parasympathetic system to the fore and reduce the impact on interference?

1. Labouring at home, sunlight streaming in, phone ringing, workmen drilling in the road.

2. Labouring well at home, go into hospital and contractions slow down, you’re told you’re not in proper labour and to go home.

3. You are worried about childbirth, about the baby being okay, about coping with the pain. Your partner has lots of worries about childbirth, about the baby being okay, about you being okay.

4. You are in a hospital room. The lights are bright, the sun is streaming in, you can hear the midwives’ phone ringing at their desk, there are workmen drilling in the car park.

5. Labouring well but every time you have a contraction midwife approaches and puts her hand on your belly and the contractions stops.

6. Labour has been going well and contractions were getting closer and stronger but now are slowing down. Your heart rate is up. You start to worry that everything is going to go wrong.

7. Labour has been going well and contractions were getting closer and stronger. You haven’t seen a midwife in ages and partner is getting anxious. You are picking up on his anxiety.

8. Midwives are talking to you about the time, about when you last went to the loo, or what time the consultant will be around, they are asking you to make decisions about colour of cord clamp or asking you about when you are going back to work.

9. You are on an electronic fetal monitor. Everything is fine but just hearing the beeps is making you anxious. You listen out for every one to check if baby is okay.

Drop me an email and I will discuss this further.  See the next blog post to get ideas too.