Undisturbed Birth: Nature’s Blueprint for Safety, Ease, and Pleasure Mother-Friendly Childbirth Symposium Oct 14, 2015 Los Angeles
Undisturbed Birth: Nature’s Blueprint for Safety, Ease, and
Pleasure Mother-Friendly Childbirth Symposium
Oct 14, 2015
Los Angeles
Slide 2
Family
Physician/GP
Diploma in
Obstetrics
Currently full-
time writer and
mother of four
homeborn
children ages
15 to 24
Live in
Brisbane,
Dr. Sarah J.
Buckley
Slide 3
Dr. Sarah J.
Buckley
Ecstatic Birth: Nature’s hormonal blueprint for labour
www.sarahbuckley.com
Slide 4
http://transform.childbirthconnection.org/reports/physiology
© 2015. National Partnership for Women & Families. All rights
reserved
Slide 5
Welcome! Midwives (students),
Physicians
doulas (students)
Childbirth educators
Nurses, L&D
Breastfeeding professionals,
Other health professionals
Hospital workers
Mothers, fathers
Slide 6
Agenda A birth story
Mammalian birth
The ecstatic hormones of undisturbed birth
Impacts of interventions
What makes birth safe?
Summary and suggestions
Q&A
www.sarahbuckley.com Slide 8
First pregnancy, planned
homebirth
Father ‘Tom’ not involved
Living with a family
Healthy pregnancy
Goes into labour at term
Ruby’s Birth Story
‘Ruby’
www.sarahbuckley.com Slide 9
Ruby’s Birth Story
Moves to ‘birth nest’
Disturbed by children
Moves to smaller room
Disturbed again
Gives birth when house is
quiet, 3 am
Labour begins around 7pm while
in TV room with family
Slide 12
Mammalian Birth Evolution of placental mammal: 65 million years
Evolved for
Survival (safety)
Efficiency (ease)
Reward (pleasure)
= reproductive success
Basis of survival, individually and species
Slide 19
Mammalian Birth“ In all mammalian
species, the course
of delivery can be
influenced by
environmental
disturbances.
Anxiety and fright
inevitably lead to
prolongation of the
duration of labour…
For many animals,
the presence of an
Naaktgeboren 1989
Ch 1, Biology of Childbirth
In: Effective care in pregnancy and
childbirth Vol II
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
Kev
in G
oeb
el
Slide 20
Mammalian Birth
Avoid
environmental
disturbance
Avoid anxiety
and fright
Avoid presence
of observer
Feeling private
Feeling safe
Feeling unobserved
Slide 21
Core Requirements for Mammalian
Birth
Private
Safe
Unobserved
That the
labouring
female feels:
Slide 23
The Ecstatic
HormonesDuring labour and
birth, Mother Nature
provides an ecstatic
hormonal cocktail to
enhance ease,
pleasure and safety
for mothers and
babies of all
Imag
e: W
ikim
edia
Co
mm
on
s
Slide 24
Oxytocin
Hormone of love
Beta-endorphins
Hormones of pleasure and
transcendence
Adrenaline/Noradrenaline
Hormones of excitement
Prolactin
Hormone of breastfeeding
and tender mothering
This ecstatic hormonal cocktail includes:
The Ecstatic
Hormones
Slide 25
Levels of these
hormones build during
labour, orchestrating
some of the actual
processes of labour and
birth as well as
enhancing ease, pleasure
and safety for mother
and baby.
The Ecstatic
Hormones
Slide 26
In the minutes
after birth, both
mother and baby are
suffused, in brain
and body, with this
ecstatic hormonal
cocktail of love,
pleasure, excitement
and tenderness.
The Ecstatic
Hormones
Slide 27
The postnatal peaks of these
ecstatic hormones and the
behaviours that they promote
provide long-term support for
mother and baby with breastfeeding
and attachment.
Imag
e: W
ikim
edia
Co
mm
on
s
The Ecstatic
Hormones
Slide 28
Triangle of Reproductive
Success
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns,
by
eden
pic
ture
s
Birth
Slide 29
The Ecstatic Hormones
Private
Safe
Unobserved
Hormonal release is enhanced
when the labouring mother
feels:
These are the basic
requirements for birth in all
mammalian species.
Slide 30
The Ecstatic Hormones
Oxytocin
Beta-endorphins
Epinephrine/norepinephrine
Adrenaline/Noradrenaline
Fight-or-flight
Catecholamine (CA) hormones
Prolactin
Imag
e re
pri
nte
d w
ith
per
mis
sio
n f
rom
ww
w.jo
you
sbir
th.in
fo
Slide 31
The Ecstatic Hormones
Middle brain
Old mammalian brain
Relational brain
Mostly produced in limbic system
Limbic system (instincts,
emotions) can compete with neo-
cortex (intellect, rational) for
dominance
Slide
33
Oxytocin
Means “fast birth”
Released from
limbic system into
brain and body
Physical and
psycho-emotional
effects during
Sexual
activity/orgasm
Pregnancy, labour
and birth
Breastfeeding
Hormone of love
Slide
34
Also released
during:
Pleasant social
interactions
Skin-to-skin,
eye-to-eye
Cuddle hormone,
ventral contact
Attachment,
maternal
behaviour
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
Go
ldb
erg
Oxytocin
Slide
35
Reduces fear
(amygdala)
Increases trust,
sociability
Activates
parasympathetic,
reduces
sympathetic
nervous system
(SNS)
Calm and connection
Uvnas-Moberg, The Oxytocin Factor (03): Hormone of Closeness (09) ;
Biological Guide to Motherhood (15)
Image: Flickr Creative Commons by achichi
Oxytocin
Slide
36
Pain
relieving,
reward
Short half-
life
(oxytocinase)
Minimal
passage
through blood-
brain barrier
Pheromone
Other
properties:
Oxytocin
Slide
37
Oxytocin in
ReproductionCauses smooth muscle to
contract, e.g. in labour
Causes the ‘ejection
reflexes’
Sperm ejection - male orgasm
Sperm introjection - female
orgasm
Fetus ejection
Milk ejection
HPOC Ch 3.1.1
Slide
39
Oxytocin in Labour
Imag
e: E
ileen
Su
lliva
n
Pulsatile
release
Rhythmic
contractions of
labour
Minimal plasma
oxytocin
increase until
second stage
Increased pulse
frequency HPOC Ch 3.1.3
Slide
41
Oxytocin Blood Levels in
Labour
0
1
2
3
4
5
6
7
pre labour Stage 1 Stage 2/3
OT over 30 minutes pulse frequency (no/30 mins) (after Fuchs 1991_
Slide
42
Oxytocin in Labour
Image: Flickr Creative Commons by goldberg
Increase in
oxytocin
receptor (OTR)
density with
onset of
labour in
women
Increases
uterine
sensitivity to
oxytocin for
efficient
labour and
Before
labour:
HPOC Ch 2
Slide
43
Oxytocin in Labour
1.8711
1140
3550
0
500
1000
1500
2000
2500
3000
3500
4000
non-pregnant 13-17 wks 37-41 wks early labour
fmo
l/m
gDN
A
Myometrial OTR Density in Pregnancy
and Labour
(From Fuchs 1984)
Slide
44
Oxytocin in Labour
Image: Flickr Creative Commons by goldberg
OTRs also
increased in
mammary glands,
brain in the
days and hours
before
physiologic
labor onset in
animals
(Meddle 07, Hayes 07)
Before
labour:
HPOC Ch 2, 3.1.2
Slide
45
Oxytocin in Labour
Maternal oxytocin crosses
placenta
(Tyzio 2006, 2014)
Crosses immature fetal blood-
brain barrier
Inhibits fetal brain activity
Reduces brain requirements
for oxygen and glucose
Neuroprotective
Autism: animal modelsHPOC Ch 3.1.3
Slide
46
Oxytocin
Imag
e:Ei
leen
Su
lliva
n
Stretching of
cervix/lower
vagina as baby
descends causes
oxytocin release
(Ferguson
reflex)
Second stage:
HPOC 3.1.3
Slide
47
Oxytocin
Maternal levels
elevated for 60
minutes after
birth
Elevations related
to newborn
prebreastfeeding
behaviour (Matthiesen
01)
Contracts uterus
Vasodilates chest
wall
Imag
e: W
ikim
edia
Co
mm
on
s
After birth:
HPOC 3.1.4
Slide
48
Oxytocin
Imag
e: W
ikim
edia
Co
mm
on
s
Levels increased
through mother-
baby
interactions
Skin-to-skin and
eye-to-eye
contact enhances
release
Breastfeeding:
mother and baby
receive a dose
of oxytocin
Postnatal:
Slide
49
Oxytocin
Imag
e u
sed
wit
h p
erm
issi
on
Releases
oxytocin in
labour
High levels at
birth
Peak at 30
minutes
Elevated for 4
days
Present in
breastmilk
Baby:
Slide
50
Oxytocin
Anti-stress
hormonal system
for the duration
of breastfeeding
and beyond (Srogren
00)
Calm and
connection
Postnatal:
Slide
51
Oxytocin research Osteoporosis,
obesity
Cancer, prostate
Cardiovascular
disease
Drug and alcohol
abuse
Depression,
anxiety, OCD,
autism, sexual
function
Prozac
HPOC 3.1.1
Slide
54
Maternity Care
Practices….• Maternity care provider and birth
environment (X.2.1)
• Prostaglandins for cervical ripening
and labor induction (X.2.2)
• Synthetic oxytocin for induction,
augmentation and postpartum care
(X.2.3)
• Opiate analgesic drugs (X.2.4)
• Epidural analgesia (X.2.5)
• Cesarean section (X.2.6)
• Early separation of healthy mothers
and newborns (X.2.7)
Slide
55
What Might Impact
Oxytocin?• Maternity care provider and birth
environment (3.2.1)
• Prostaglandins for cervical ripening
and labor induction (3.2.2)
• Synthetic oxytocin for induction,
augmentation and postpartum care
(3.2.3)
• Opiate analgesic drugs (3.2.4)
• Epidural analgesia (3.2.5)
• Cesarean section (3.2.6)
• Early separation of healthy mothers
and newborns (3.2.7)
HPOC 3.2
Slide
56
http://transform.childbirthconnection.org/reports/physiolo
gy
© 2015. National Partnership for Women & Families. All
rights reserved
Slide
57
Use of Synthetic Oxytocin
(SynOT)Pitocin, Syntocinon
• Chemically equivalent to
endogenous (natural) oxytocin
Slide
58
Use of Synthetic Oxytocin
(SynOT)• Acts very differently to
natural oxytocin
• Not pulsatile
• Higher levels (fewer receptors)
• Minimal passage through blood-
brain barrier
Slide
59
• Contractions,
stronger, longer
and closer together
• Can cause
hyperstimulation in
early labour
• Reduces fetal
blood/oxygen
• Requires monitoring
Acts very differently to natural oxytocin
Imag
e: W
ikim
edia
Co
mm
on
s
Synthetic Oxytocin
Slide
61
• Abnormal fetal heart
rate (FHR) patterns
(bradycardia,
arrhythmia)
• Permanent CNS or brain
damage
• Fetal death
• Low Apgar scores at 5
minutes
• Neonatal jaundice
• Neonatal retinal
from package insert for Pitocin 2005
http://dailymed.nlm.nih.gov/dailymed/drugI
nfo.cfm?id=4975)
Synthetic Oxytocin:
Side-effects
Slide
62
• Reduces number of
uterine oxytocin
receptors, increases
risk of bleeding after
birth (PPH)
• Cascade of interventions
More adverse
effects:
Synthetic Oxytocin:
Side-effects
Slide
64
Oxytocin is the drug most commonly
associated with preventable adverse
perinatal outcomes and was recently
added by the Institute for Safe
Medication Practices [US] to a small
list of medications “bearing a
heightened risk of harm, which may
require special safeguards to reduce
the risk of error.” Approximately half
of all paid obstetric litigation claims
Clark 2008 “Oxytocin: New perspectives on an old drug”
Synthetic Oxytocin:
Side-effects
Slide
65
• Effects on
breastfeeding?
• Passes to baby?
• Longer-term
effects?
More adverse
effects:
Synthetic Oxytocin:
Side-effects
HPOC 3.2.6
Slide
66
• Swedish epidural
study, 700
mothers and
babies after
normal birth
• Epidural vs non-
epidural matched
for age, parity,
gestational age
• Fewer exposed
babies suckled in
Wiklund 2009
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
jon
ny.
hu
nte
r
Synthetic OT :
Breastfeeding
Slide
67
Oxytocin levels with
breastfeeding Day 2
among 61 mother-babies
according to
interventions
Jonas et al 2009, Breastfeeding Medicine
“The higher the dose of
oxytocin infusion the women
received during labour, the
lower the women’s
endogenous oxytocin levels
were during a breast-
feeding episode during the
second day postpartum.”
Synthetic OT :
Breastfeeding
HPOC 3.2.6
Slide
70
Beta-Endorphins
Natural opioids
(morphine, heroin,
pethidine, fentanyl)
Released with stress
and duress
Natural pain
killer/analgesics HPOC 4.1.1
Slide
71
Pleasure,
euphoria,
dependency
Pro-social
Reward
reproductive acts
Sex
Birth
Breastfeeding
Imag
e: W
ikim
edia
Co
mm
on
s
Beta-Endorphins
Slide
72
Beta-Endorphins in
Labour
Alter state of
consciousness
Transcend pain
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
eyel
iam
Hormone of pleasure
and transcendence
In labour:
Slide
73
Beta-Endorphins in
LabourLevels gradually
increase
Equivalent to
endurance
athletic
performance
Very high levels
inhibit labour-
“ration labour”
In labour:
Slide
74
Beta-Endorphins in
LabourFacilitate
prolactin release
within limbic
system
Peak at birth,
subsides over
hours to days
Half-life:
Plasma 37 mins
Cerebrospinal fluid
>21 hours
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
jon
ty.f
ish
er
Slide
76
Beta-Endorphins:
Baby Secretes BE in
labour
Protects fetal
brain from
hypoxia (animal)
Levels peak at
birth, subside
over 2 hours
Present in
breastmilk
Baby:
Slide
77
(Zanardo 2001)
Significantly more beta-
endorphins in colostral milk
when mothers have normal
labour, birth (no epidural,
oxytocin) compared to pre-
labour cesarean (6pmol/l vs.
4.3)
Postpartum:
Helps baby with stress of
adapting to life outside the
womb
Beta-Endorphins:
Baby
Slide
78
Released as
mother
breastfeeds
Present in
breastmilk
Induces a
“pleasurable
Beta-Endorphins
Postpartum
Slide
80
What Disturbs Beta-
Endorphins?
• Synthetic oxytocin?
• Opiate drugs
• Epidural analgesia
• Cesarean surgery
Slide
81
Epidural Analgesia
“..epidural
analgesia is one
of the most
striking examples
of the
medicalisation of
normal birth,
transforming a
physiological
event into
WHO, 1995:
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns,
by
koad
mu
nke
e
Slide
83
Epidurals: Beta-
Endorphins• Totally
abolishes pain
sensation
• Dramatic drop
in BEs
• Postnatally:
as low as 20%
of physiologic
levels
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns,
by
arch
ibal
dju
de
HPOC 4.2.5
Slide
84
Epidurals: Oxytocin
• Epidurals reduce maternal oxytocin
levels
• Abolish sensory feedback
• Also, opiates inhibit oxytocin
release
• Numbing inhibits stretch receptor
feedback/Ferguson reflex
• Effects may persist after “wearing
off”
• Postnatally oxytocin reduced to
50% of normal levels
HPOC 3.2.5
Slide
85
Epidural: Effects on
Labour• Prolongs second
stage of labour
• Increases use of
synthetic oxytocin
• Increases
instrumental birth
• Increases CS for
fetal distress Anim-Somuah 2011, Cochrane SR
Imag
e: W
ikim
edia
Co
mm
on
s
Slide
86
Epidural: Maternal
Physiology• Drop in blood pressure (A-NA)
• Reduction in uterine blood
flow (Fratelli 11)
• Uterine hyperstimulation (A-
NA)
• Elevation in temperature
(Oxytocin/ autonomic NS)
All can affect the baby
Slide
88
• Reduced
oxytocin
• Reduced beta-
endorphin
• Reduced CAs
• Reduced
prolactin
Significant interference with
hormones of attachment, reward
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
jare
dan
dm
elan
ie
Epidurals: Maternal
Behaviour
Slide
89
Epidurals: Maternal
Behaviour
• 7/8 primiparous
sheep failed to
show interest
within 30 mins
of birth
• 8/27
multiparous
• 0/22 controls
• Substantially
reversed with
oxytocin into
Sheep:
Use
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ttp
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om
/
Slide
90
• Spent less time
with their babies
in hospital
• Babies “less
adaptable, more
intense and more
bothersome” at 1
month
Human mothers after epidural:
Epidurals: Maternal
Behaviour
HPOC 3.2.5
Slide
91
• Reduced
oxytocin
• Reduced beta-
endorphins
• Reduced
prolactin
Significant interference with
hormones of breastfeeding
Epidurals: Breastfeeding
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
jon
ny.
hu
nte
r
HPOC 3.2.5
Slide 96
Epinephrine/norepinephrine
Adrenaline/noradrenaline, CAs
Fight-or-flight
Released with anxiety, fright,
hunger, cold
Excitement, “tower of terror”Hormones of excitement
Catecholamines
Slide 97
In labour:
Levels gradually
increase
Very high levels:
Reduce uterine
contractions
Shift blood supply to
muscles, heart
Shift blood supply away
from uterus, baby
Prolong labour, fetal
distress
(Lederman 1985)
Catecholamines:
Mother
Slide 98
Catecholamines:
Mother
Private
Safe
Unobserved
CA levels
will rise when
the labouring
female does
not feel:
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
win
nie
-t
Slide 99
Catecholamines:
Mother Mother’s CA
levels naturally
rise at
transition
Physiological
fear
Very high levels
paradoxically
uterotonic
Fetus ejection
reflex
Imag
e ©
Eile
en S
ulli
van
HPOC 5.1.3
Slide
100
CA levels in labour (Alehagan 2005)
Catecholamines:
Mother
Phase of Labour
0
100
200
300
400
500
600
700
800
900
Early Mid Late labour
CA levels as % of later-
pregnancy levels
noradrenaline
adrenaline
Slide
101
CAs benefit the baby in
labour:
Catecholamines:
BabyCA surge with head
compression
Shift blood to
essential organs
Brain
HeartHPOC 5.1.3
Slide
102
Catecholamines:
BabyCAs benefit the baby in
labour:Neuroprotective
Reduces cell death from
hypoxia
Stimulates anaerobic
glycolysis
Glucose metabolism at low
oxygen levels
Slide
103
Lagercrantz, H. and T. A. Slotkin (1986). "The "stress" of being born." Sci Am 254 (4): 100-7.
Catecholamines:
BabyIMPROVES BREATHING
INCREASES LUNG SURFACTANT
INCREASES LUNG-LIQUID
ABSORPTION
IMPROVES LUNG COMPLIANCE
DILATES BRONCHIOLES
PROTECTS HEART AND BRAIN
INCREASES BLOOD FLOW TO
VITAL ORGANS
MOBILIZES FUEL
BREAKS DOWN NORMAL FAT INTO
FATTY ACIDS
BREAKS DOWN GLYCOGEN (IN
LIVER) TO
GLUCOSE
STIMULATES NEW PRODUCTION OF
GLUCOSE
BY LIVER
FACILITATES BONDING
DILATES PUPILS
APPEARS TO INCREASE ALERTNESS
INITIATES THERMOREGULATION
BURNS BROWN FAT
Slide
104
Lagercrantz, H. and T. A. Slotkin (1986). "The "stress" of being born." Sci Am 254 (4): 100-7.
Pre-Labour
PreparationsIMPROVES BREATHING
INCREASES LUNG SURFACTANT
INCREASES LUNG-LIQUID
ABSORPTION
IMPROVES LUNG COMPLIANCE
DILATES BRONCHIOLES
PROTECTS HEART AND BRAIN
INCREASES BLOOD FLOW TO
VITAL ORGANS
MOBILIZES FUEL
BREAKS DOWN NORMAL FAT INTO
FATTY ACIDS
BREAKS DOWN GLYCOGEN (IN
LIVER) TO
GLUCOSE
STIMULATES NEW PRODUCTION OF
GLUCOSE
BY LIVER
FACILITATES BONDING
DILATES PUPILS
APPEARS TO INCREASE ALERTNESS
INITIATES THERMOREGULATION
BURNS BROWN FAT HPOC Ch 2, 5.1.2
Slide
105
Catecholamines
Postnatal:
NE: hormone of
bonding
Norepinephrine
enhances baby’s
olfactory senses
Levels drop
steeply for mother
and baby after
birth
Slide
106
CatecholaminesMother needs to
feel:
Private
Safe
Unobserved
Warm
On-going CA elevation
physiologically risks bleeding
Image: Flickr Creative Commons, by Chad Crowell
HPOC 5.1.4
Slide
108
What Might Impact
CAs?• Maternity care provider and birth
environment (5.2.1)
• Prostaglandins for cervical ripening
and labor induction (5.2.2)
• Synthetic oxytocin for induction,
augmentation and postpartum care
(5.2.3)
• Opiate analgesic drugs (5.2.4)
• Epidural analgesia (5.2.5)
• Cesarean section (5.2.6)
• Early separation of healthy mothers
and newborns (5.2.7)
HPOC 5.2
Slide 109
Disturbance in
Labour
• Private
• Safe
• Unobserve
d
Conditions where
the mother does
not feel:
Slide 110
Disturbance in
Labour• Moving from familiar
to unfamiliar setting
• Presence of
strangers
• Change of carers
• Suggestion of risk to
self or baby
• Techniques of
monitoring
Examples:
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
pre
mu
s
Slide 111
In labour:
• Levels gradually increase
• Very high levels:
• Reduce uterine contractions
• Shift blood supply to muscles, heart
• Shift blood supply away from uterus, baby
• Prolong labour, fetal distress(Lederman 1985)
Disturbance in Labour
Slide
113
Caesarean: Hormonal
Impact• Mother: less
or no
ecstatic
hormones
• Baby: lack of
hormonal
protection
and
preparation
• Pre-labour
Imag
e: W
ikim
edia
Co
mm
on
s
Slide
114
Caesarean: Maternal
Hormones• Depressed mood up
to 8 months
• Depressed self-
esteem
• Postnatal
depression?
• Reduced
breastfeeding
success
• Attachment?
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
bre
ttn
eils
on
(Fisher 1997; Rowe-Murray 2001)
Slide
115
Less activation
of maternal
brain arousal
and reward
centres in
response to own
baby’s cry at
2-4w postpartum
Caesarean: Maternal
Hormones
(Swain 2008)
Imag
e: W
ikim
edia
Co
mm
on
s
HPOC 3.2.6
Slide
117
Caesarean: Impact on
Baby
• Oxytocin
• Beta-
endorphin
• Adrenaline
• Noradrenalin
e
• Prolactin
Prelabour CS: newborn hormones:
50% of
physiologic?
60% of
physiologic?
10-30% of
physiologic
20 to 60% of
physiologic
70% of
Slide
118
(Lagercrantz
1986)
IMPROVES BREATHINGINCREASES LUNG SURFACTANTINCREASES LUNG-LIQUID ABSORPTIONIMPROVES LUNG COMPLIANCEDILATES BRONCHIOLES
PROTECTS HEART AND BRAININCREASES BLOOD FLOW TO VITAL ORGANS
MOBILIZES FUELBREAKS DOWN NORMAL FAT INTO FATTY ACIDSBREAKS DOWN GLYCOGEN (IN LIVER) TO
GLUCOSESTIMULATES NEW PRODUCTION OF GLUCOSE
BY LIVER
FACILITATES BONDINGDILATES PUPILSAPPEARS TO INCREASE ALERTNESS
INITIATES THERMOREGULATIONBURNS BROWN FAT
Fetal CA Surge in
Late Labour
Slide
127
Caesarean: improving
outcome• After 39 weeks
• In-labor planned
• Skin-to-skin
• Skin-to-skin
• Skin-to-skin
(Fisher 1997; Rowe-Murray 2001)
Slide
129
Prolactin
Prolactation
Important in
maternal attachment
Associated with
care-taking
Hormone of paternityHormone of tender mothering
Slide
130
Prolactin
Steep rise at end
of pregnancy
May stimulate
formation of
mammary receptors
Prolactin
receptor theory
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns,
by
cpo
pp
77
t
Slide
131
Prolactin
Levels drop in labour
Rise again at full
dilation
Oxytocin, BEs increase
prolactin release
Peaks at 1-2 hours
postpartum
Slide
132
Prolactin
0
50
100
150
200
250
300
350
400
7 6 5 4 3 2 1 BIRTH 1 2 6
Pro
lact
in le
vels
ng/
ml
Time before/after birth in hours
Figure X. Maternal prolactin levels in physiologic labor, birth, and postpartum
Source: Adapted from Stefos 2001
Slide
133
Stress reducing
Care-taking, monotony
Secreted into breastmilk
Optimal brain development
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns,
by
bfh
oyt
Prolactin
Slide
136
Hormonal Safety
Mechanisms
Oxytocin pre-labour preparations:
OTRs increased: uterus,
brain (A), breasts (A)
Slide
137
Oxytocin promotes ease and
efficiency Effective contractions in
labour
Effective pushing
Hormonal Safety
Mechanisms
Slide
138
Oxytocin protects the fetal
brain Switches off brain
activity (A)
Hormonal Safety
Mechanisms
Slide
139
Oxytocin protects the mother from
bleeding after the birth.
Imag
e: W
ikim
edia
Co
mm
on
s
Hormonal Safety
Mechanisms
Slide
141
Beta-endorphins imprint reward
and pleasure after birth
• Reward and motivate ongoing
maternal caretaking
behaviours
Hormonal Safety
Mechanisms
Slide
142
Beta-endorphins inhibit labour
with stress Inhibits oxytocin release
Hormonal Safety
Mechanisms
Slide
147
Prolactin prepares for lactation
OT, BEs in labor promote
release
Hormonal Safety
Mechanisms
Slide 150
Private
Safe
Unobserved
Create and maintain a space
where the labouring mother
feels:
Imag
e: F
lickr
Cre
ativ
e C
om
mo
ns
by
jayg
oo
by
Suggestions for an
Undisturbed Birth
Slide 151
Dim lighting
Few words, no
numbers
Cover the clock
Encouraging
instinctive
behaviour
“On another planet”
Image: Eileen Sullivan
Suggestions for an Undisturbed
BirthReduce mother’s neocortical
stimulation through:
Slide 152
Keep technology as simple as
possible: Astute but
subtle
observation
Physical
support, hands-
on
Encourage
Breath
Sound
Movement
Imag
e u
sed
wit
h p
erm
issi
on
Suggestions for an Undisturbed
Birth
Slide
153
Spontaneous labour in a normal woman is an
event marked by a number of processes so
complicated and so perfectly attuned to each
other that any interference will only detract
from the optimal character.
The only thing required from the bystanders
is that they show respect for this awe-
inspiring process by complying with the first
rule of medicine –
Professor J. Kloosterman, 1982
nil nocere.
Suggestions: Undisturbed
Birth
Slide 154
http://transform.childbirthconnection.org/reports/physiology
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