Ecstatic Birth- Nature’s Hormonal Blueprint for Labor

© Dr Sarah J Buckley MD 2007

This article may be copied and circulated for personal use and also for use by birth professionals, provided that all information is retained and credited.
For permission to translate, publish or post online, please contact Sarah via her website www.sarahjbuckley.com

Previous versions of this article have been published in Mothering Magazine, issue 111, March-April 2002, and Byron Child (Australia), issue 5, March 2003. This material has been further expanded and updated as “Undisturbed Birth: Mother Nature’s hormonal blueprint for safety, ease and ecstasy” available in Sarah’s book, Gentle Birth, Gentle Mothering: The wisdom and science of gentle choices in pregnancy, birth, and parenting. See www.sarahjbuckley.com for more of Sarah’s writing and to buy her book.

Giving birth in ecstasy: this is our birthright and our body’s intent. Mother Nature, in her wisdom, prescribes birthing hormones that take us outside (ec) our usual state (stasis), so that we can be transformed on every level as we enter motherhood.

This exquisite hormonal orchestration unfolds optimally when birth is undisturbed, enhancing safety for both mother and baby. Science is also increasingly discovering what we realize as mothers: that our way of birth affects us life-long, both mother and baby, and that an ecstatic birth — a birth that takes us beyond our Self — is the gift of a life-time.

Four of our major hormonal systems are active during labor and birth. These produce, during labor and birth, peak levels of oxytocin, the hormone of love; endorphins, hormones of pleasure and transcendence; epinephrine and norepinephrine, hormones of excitement; and prolactin, hormone of tender mothering. These systems are common to all mammals and originate in our mammalian or middle brain, also known as the limbic system.

For birth to proceed optimally, this part of the brain must take precedence over the neocortex, or rational brain. This shift can be helped by an atmosphere of quiet and privacy, with, for example, dim lighting and little conversation, and no expectation of rationality from the laboring woman. Under such conditions a woman will intuitively choose the movements, sounds, breathing, and positions that will birth her baby most easily. This is her genetic and hormonal blueprint.

All of these hormonal systems are adversely affected by current birth practices. Hospital environments and routines are not conducive to the shift in consciousness that giving birth naturally requires. A woman’s hormonal physiology is further disturbed by practices such as induction, the use of painkillers and epidurals, caesarean surgery, and separation of mother and baby after birth, as described below.

Hormones in Birth

Oxytocin

Perhaps the best-known birth hormone is oxytocin, the hormone of love, which is secreted during sexual activity, male and female orgasm, birth, and breastfeeding. Oxytocin engenders feelings of love and altruism; as Michel Odent says, “Whatever the facet of love we consider, oxytocin is involved.”1

Oxytocin is made in the hypothalamus, deep inside the mammalian brain, and stored in the posterior section of the pituitary, the “master gland” of the endocrine (hormonal) system, from where it is released in pulses. It is a crucial hormone in reproduction and mediates what have been called the ejection reflexes: the sperm ejection reflex with male orgasm (and the corresponding sperm introjection reflex with female orgasm); the fetal ejection reflex at birth (a phrase coined by Odent for the powerful contractions at the end of an undisturbed labor, which birth the baby quickly and easily)2; and, postpartum, the placental ejection reflex, and the milk ejection or let-down reflex in breastfeeding.

As well as reaching peak levels in each of these situations, oxytocin is secreted in extra amounts in pregnancy, when it acts to enhance nutrient absorption; reduce stress; and conserve energy by making us more sleepy.3 Oxytocin also causes the rhythmic uterine contractions of labor, and levels peak at birth through stimulation of stretch receptors in a woman’s lower vagina as the baby descends.4

High maternal oxytocin levels during labor and birth also benefit the baby. Research has found that maternal oxytocin crosses the placenta and enters the fetal brain during labor, when it acts to protect brain cells by switching them off, giving low oxygen consumption at a time when fetal oxygen levels may be naturally low.5

High maternal oxytocin levels continue after birth, culminating with the birth of the placenta, 6 and are enhanced by the baby’s pre-breastfeeding and breastfeeding behaviors.7 Elevated maternal levels of oxytocin will protect against postpartum hemorrhage at this crucial time by ensuring efficient uterine contractions.8

The baby also has been producing oxytocin during labor, perhaps even contributing to the processes of labor;9 so, in the minutes after birth, both mother and baby are bathed in an ecstatic cocktail of hormones. At this time, ongoing newborn oxytocin production is enhanced by skin-to-skin and eye-to-eye contact. Newborn levels subside during the first hour after birth, but are elevated above normal for at least 4 days.10 Infant oxytocin levels are also elevated during and following breastfeeding, through activation of the vagal nerve.11

During breastfeeding, oxytocin mediates the let-down reflex and is released in pulses as the baby suckles. During the months and years of lactation, oxytocin continues to act to keep the mother relaxed and well nourished. One researcher calls it “a very efficient anti-stress situation which prevents a lot of disease later on.” In her study, mothers who breastfed for more than seven weeks were calmer, when their babies were six months old, than mothers who did not breastfeed.12

Outside its role in reproduction, oxytocin is secreted in other situations of love and altruism, for example, sharing a meal.11 Researchers have implicated malfunctions of the oxytocin system in conditions such as schizophrenia,13 autism,14, 15 cardiovascular disease11, 16 and drug dependency,17 and have suggested that oxytocin may mediate the antidepressant effect of drugs such as Prozac.18

More recent research has implicated oxytocin in trusting interactions between individuals, 19 which may reflect its role in lowering activity in the amygdala: a brain structure that processes fearful emotions.20

Beta-endorphin

As a naturally occurring opiate, beta-endorphin has properties similar to opiate drugs such as pethidine (meperidine, Demerol), morphine, and heroin, and has been shown to work on the same receptors of the brain. Beta-endorphin is also secreted from the pituitary gland, (and other parts of the brain and nervous system) and high levels are present during sex, pregnancy, birth, and breastfeeding.

Beta-endorphin is also a stress hormone, released under conditions of duress and pain, when it acts as an analgesic (pain killer) and, like other stress hormones, suppresses the immune system. This effect may be important in preventing a pregnant mother’s immune system from acting against her baby, whose genetic material is foreign to hers.

Like the addictive opiates, beta-endorphin induces feelings of pleasure, euphoria, and dependency or, with a partner, mutual dependency. Beta-endorphin levels are high in pregnancy and increase throughout labor,21 when levels of beta-endorphin and corticotrophin (another stress hormone) reach those found in male endurance athletes during maximal exercise on a treadmill.22 Such high levels help the laboring woman to transmute pain and enter the altered state of consciousness that characterizes an undisturbed birth.

Beta-endorphin has complex and incompletely understood relationships with other hormonal systems.23 In labor, high levels will inhibit oxytocin release. It makes sense that when pain or stress levels are very high, contractions will slow, thus “rationing labor according to both physiological and psychological stress.”24

Beta-endorphin also facilitates the release of prolactin during labor,25 which prepares the mother’s breasts for lactation and also aids in the final stages of lung maturation for the baby.26

Beta-endorphin is also important in breastfeeding. Levels peak in the mother at 20 minutes27 and beta-endorphin is also present in breast milk,28 inducing a pleasurable mutual dependency for both mother and baby in their ongoing relationship.

Fight-or-Flight Hormones

The hormones adrenaline and noradrenalin (epinephrine and norepinephrine) are also known as the fight-or-flight hormones, or, collectively, as catecholamines (CAs). They are secreted from the adrenal gland, above the kidney, in response to stresses such as fright, anxiety, hunger or cold, as well as excitement, when they activate the sympathetic nervous system for fight or flight. Noradrenaline is also part of an important brain signalling system that activates (and is activated by) the fight-or-flight response.

High maternal CA levels are associated with the inhibition of labor, which may reflect their direct inhibiting effects on uterine muscle29 and possibly a reduction in oxytocin release, as suggested in mice.30 As part of the fight-or-flight response, CAs also act to divert blood to major muscle groups: this leads to reduced blood flow to the uterus and placenta (and therefore also to the baby).

This makes sense for mammals birthing in the wild, where the presence of danger would activate this fight or flight response, inhibiting labor and providing the muscular energy to flee to safety. In humans, high levels of CAs have been associated with longer labor and adverse fetal heart rate patterns (an indication of lack of blood and oxygen for the baby in labor).31

After an undisturbed labor, however, when the moment of birth is imminent, these hormones may act in a different way. A sudden increase in CA levels, especially noradrenaline, can activate the ‘fetal ejection reflex’. This gives the mother a sudden rush of energy; she will usually adopt an upright, alert position and may experience the dry mouth and shallow breathing associated with high adrenaline/epinephrine levels, and may also have the urge to grasp something. She may express fear, anger, or excitement, and the CA rush will cause several very strong contractions, birthing her baby quickly and easily. 2

This physiological model is supported by research showing that low levels of epinephrine inhibit uterine contractility, while very high levels of mixed epinephrine/norepinephrine, as may occur at the end of an undisturbed labor, increase contractility.29 Studies also show a wide range of maternal CA levels at birth, with some women having 5 to 10 times higher levels of epinephrine or norepinephrine than others.31-33

Some birth attendants have made good use of this reflex when a woman is having difficulties in the second stage of labor. For example, one anthropologist working with an indigenous Canadian tribe recorded that when a woman was having difficulty in birth, the young people of the village would gather together to help. They would suddenly and unexpectedly shout out close to her, with the shock triggering her fetal ejection reflex and a quick birth.2

After the birth, the mother’s CA levels drop steeply, and she may feel shaky or cold as a consequence. A warm atmosphere is important, as if the mother is not helped to warm up, the ongoing cold stress will keep her CA levels high, inhibiting her natural oxytocin release and therefore increasing her risk of postpartum hemorrhage.34

Noradrenalin, as part of the ecstatic cocktail, is also implicated in instinctive mothering behavior. Mice bred to be deficient in noradrenaline will not care for their young after birth unless noradrenaline is injected back into their system.35

For the baby also, birth is an exciting and stressful event, reflected in high CA levels.36 In the final stages of labor, the baby experiences a CA surge, which assists during birth by protecting against the effects of hypoxia (lack of oxygen). These hormones also prepare the baby for life outside the womb by enhancing lung function; increasing metabolic fuels; and activating newborn thermogenic (heat producing) systems.37

High CA levels at birth also ensure that the baby is wide-eyed and alert at first contact with the mother.37 The baby’s CA levels also drop rapidly after an undisturbed birth, being soothed by contact with the mother.

Prolactin

Known as the mothering hormone, prolactin is the major hormone of breast milk synthesis and breastfeeding. Traditionally it has been thought to produce aggressively protective behavior (the “mother tiger” effect) in lactating females, and human studies suggest that prolactin increases vigilance and aggression.38

Levels of prolactin increase in pregnancy, although milk production is inhibited hormonally until the placenta is delivered. Levels in labor initially decrease, and then increase in late labor, peaking at birth.39

Prolactin is also a hormone of submission or surrender — in primate troops, the dominant male has the lowest prolactin level40 — and produces some degree of anxiety. In the breastfeeding relationship these effects activate the mother’s vigilance and help her to put her baby’s needs first.38

The baby also produces prolactin in pregnancy, and levels are high following labor,41 where it may enhance newborn adaptation of the respiratory 26 and heat regulating42 systems.

Undisturbed Birth

Undisturbed birth is exceedingly rare in our culture, even in birth centers and home births.

Two factors that disturb birth in all mammals are firstly being in an unfamiliar place and secondly the presence of an observer. Feelings of safety and privacy thus seem to be fundamental. Yet the entire system of Western obstetrics is devoted to observing pregnant and birthing women, by both people and machines, and when birth isn’t going smoothly, carers respond with yet more intense observation. It is indeed amazing that any woman can give birth under such conditions.

Some writers have observed that, for a woman, having a baby has a lot of parallels with making a baby: same hormones, same parts of the body, same sounds, and the same needs for feelings of safety and privacy. How would it be to attempt to make love in the conditions under which we expect women to give birth?

Impact of Drugs and Procedures

Induction and Augmentation

In the US, between 21.2%43 and 41% 44 of women have their labor induced, and up to 55% of women have an augmentation 44–stimulation or speeding up of labor–with synthetic oxytocin (syntocinon, Pitocin).

Synthetic oxytocin administered in labor does not act like the body’s own oxytocin. First, Pitocin-induced contractions are different from natural contractions, and these differences can cause a reduced blood flow to the baby. For example, Pitocin-induced contractions can occur almost on top of each other when too high a dose is given, and it also causes the resting tone of the uterus to increase, (33) which can lead to a precipitate (overly fast) labor.

Second, oxytocin, synthetic or not, cannot cross from the mother’s bloodstream to her brain through the blood-brain barrier. This means that Pitocin, introduced into the body by injection or drip, does not act as the hormone of love, and may interfere with the labouring woman’s own oxytocin system.

Recent research has shown that, following the use of Pitocin, the number of oxytocin receptors in the labouring woman’s uterus is down-regulated (reduced) by the body to prevent over-stimulation.45 This means that a woman who has been administered a Pitocin infusion during labor will be at higher risk of bleeding after the birth, because her own oxytocin release, critical at this time for contracting her uterus to prevent bleeding, will be ineffective because of low receptor numbers.

Further, given our growing understanding of the life-long psycho-emotional effects of oxytocin, a major hormone of the ’emotional brain’ (limbic system), we might also be concerned about the developmental and maternal consequences of interfering with this calming, connection-enhancing system at birth.46

As Michel Odent comments, “Many experts believe that through participating in this initiation of his own birth, the fetus [unborn baby] may be training himself to secrete his own love hormone.” 47 Odent speaks passionately about our society’s deficits in our capacity to love self and others, and he traces these problems back to the time around birth, particularly to interference with the oxytocin system.1

Opiate Painkillers

Opiate drugs are derived from, or chemically related to, substances found in the opium poppy. In the U.S., several opiate drugs have been traditionally used in labor. These include the classical opiates meperidine (Demorolol, pethidine) and morphine, as well as nalbuphine (Nubain), butorphanol (Stadol), alphaprodine (Nisentil), hydromorphone (Dilaudid), and fentanyl citrate (Sublimaze).

The use of simple opiates, usually administered via the muscle (IM) or intravenously (IV), in the labor room has declined in recent years, with many women now opting for epidurals, which may also contain these drugs (see below).

As with oxytocin, use of opiate drugs will likely reduce a woman’s own BE production in labor,48 as well as producing possible side effects such as nausea, drowsiness, pruritis (itching) and dysphoria.49 Several studies have suggested that the analgesic effect of these drugs is modest, and that the major effect is heavy sedation.50, 51

Note also that, at a brain level, opiates reduce oxytocin release from the pituitary, which is reflected in findings from the small number of studies of the impact of these drugs on labor duration.. Thomson and Hiller summarize, ‘There is a strong suggestion in the literature that the use of this drug [pethidine/meperidine] is associated with a lengthening of labor and this association is dose-related. Studies in animals support this view.’52

And again we must ask: What are the psychological effects for mother and baby of laboring and birthing without peak levels of these hormones of pleasure and co-dependency? Beta-endorphin powerfully activates the brain reward system, and some researchers believe that endorphins are the mammalian reward for performing crucial reproductive functions such as mating and birthing.53

It is interesting to note that most countries that have adopted Western obstetrics, which prizes drugs and interventions in birth above pleasure and empowerment, have experienced steeply declining birth rates in recent years. As feminist Germaine Greer presciently noted in 1984, “…if we succeed in crushing all pride and dignity out of child bearing, the population explosion will take care of itself.”54

Of perhaps greater social concern is a study that looked at the birth records of 200 opiate addicts born in Stockholm from 1945 to 1966 and compared them with the birth records of their non-addicted siblings. When the mothers had received opiates, barbiturates, and/or nitrous oxide gas during labor, especially in multiple doses, the offspring were more likely to become drug addicted. For example, when a mother received three doses of opiates, her child was 4.7 times more likely to become addicted to opiate drugs in adulthood.55

This study was recently replicated with a U.S. population, with very similar results.56 The authors of the first study suggest an imprinting mechanism, but perhaps it is equally a matter of ecstasy–if we don’t get it at birth, as we expect, we look for it later in life through drugs. Perhaps this also explains the popularity (and the name) of the drug Ecstasy.

Animal studies suggest a further possibility. It seems that drugs and other substances administered around the time of birth, even in single doses, can cause effects in the brain structure and chemistry of offspring that may not be obvious until adulthood,56-60 Whether such effects apply to humans is not known; but one researcher warns, “During this prenatal period of neuronal [brain cell] multiplication, migration and interconnection, the brain is most vulnerable to irreversible damage.”59

Epidural Drugs

Epidural drugs are administered over several hours via a catheter (tube) into the space around the spinal cord. Such drugs include local anesthetics (all cocaine derivatives, eg. bupivicaine/Marcaine), more recently combined with low-dose opiates. Spinal pain relief involves a single dose of the same drugs injected through the coverings of the spinal cord, and is usually short acting unless given as a combined spinal-epidural (CSE).

Epidural pain relief has major effects on all of the above-mentioned hormones of labor. Epidurals inhibit beta-endorphin production61, 62 and therefore also inhibit the shift in consciousness that is part of a normal labor. This may be one reason why epidurals are so acceptable in labor and delivery rooms, where carers may have the resources to deal with the irrationality, directness, and physicality of a woman laboring on her own terms.

When an epidural is in place, oxytocin levels decline, and the oxytocin peak that occurs at birth is also inhibited63, possibly because the stretch receptors of a birthing woman’s lower vagina, which trigger this peak, are numbed. This effect likely persists even when the epidural has worn off and sensation has returned, because the nerve fibers involved are smaller than the sensory nerves and therefore more sensitive to drug effects.64

A woman giving birth with an epidural will therefore miss out on the strong final contractions of labor, designed to birth her baby quickly and safely. She must then use her own effort, often against gravity, to compensate. This explains the increased length of the second stage of labor and the extra need for forceps when an epidural is used.65

Use of epidurals also inhibits catecholamine release,66 which may be advantageous in the first stage of labor; close to the time of birth, however, a reduction in CA levels may inhibit the fetal ejection reflex and prolong the second stage.65

Another hormone also appears to be adversely affected by epidurals. Prostaglandin F2 alpha helps to make a laboring woman’s uterus contractible and levels increase when women labor without epidurals. In one study, women with epidurals actually experienced a decrease in PGF2 alpha, and average labor times were increased from 4.7 to 7.8 hours.67

Drugs administered by epidural enter the mother’s bloodstream immediately and go straight to the baby at equal, and sometimes effectively greater, levels.68, 69 Some drugs will be preferentially taken up into the baby’s brain,70 and almost all will take longer to be eliminated from the baby’s immature system after the cord is cut. For example, the ‘half life ‘of bupivacaine- the time it takes to reduce blood level by 50%- is 2.7 hours in the adult, but around 8 hours in a newborn baby.71

Another indication of the effects of epidurals on mother and baby comes from French researchers who gave epidurals to laboring sheep. The ewes failed to display their normal mothering behavior; this effect was especially marked for the ewes in their first lambing that were given epidurals early in labor: seven out of eight of these mothers showed no interest in their offspring for at least 30 minutes.72 These researchers subsequently showed lower brain oxytocin levels amongst epidural sheep and also demonstrated a partial reversal of the effects on maternal behavior when oxytocin was administered into the new mother’s brain.73

Some studies indicate that this disturbance may apply to humans also. Mothers given epidurals in one study spent less time with their babies in hospital, in inverse proportion to the dose of drugs they received and the length of the second stage of labor.74 In another study, mothers who had epidurals described their babies as more difficult to care for one month later.75

Such subtle shifts in relationship and reciprocity may reflect hormonal dysfunctions and/or drug toxicity and/or the less-than-optimal circumstances that often accompany epidural births–long labors, forceps, and cesareans.

There have been few high-quality studies of the effects of epidurals on breastfeeding, which is surprising given the widespread use of this intervention. Babies born after epidural may have subtle neurobehavioral deficits, as above, that interfere with breastfeeding.

Epidural studies confirm that babies with higher drug levels have worse neurobehavior scores76 and that babies with worse scores have less breastfeeding abilities,77 including diminished suckling reflexes and capacity78.

Two recent studies have particularly implicated epidural opiates in breastfeeding difficulties.

Researchers randomized 176 women (who had previously breastfeed and intended to breastfeed again) into nil, low-and high-dose fentanyl epidurals. At six weeks, 19% of women in the high-dose group had ceased breastfeeding, compared to 6% and 2% in the low-dose and nil fentanyl groups respectively All women with breastfeeding problems attributed them to their infant, not themselves.79

In an observational study, researchers found increasing risk of formula feeding at discharge following: intravenous opiate; epidural with local anesthetic; epidural with morphine: epidural with fentanyl. Consistent with the above study, and with its ease in crossing the blood-brain barrier to cause newborn neurobehavioral effects, these researchers also found increased formula feeding with increasing doses of fentanyl.79, 80

Caesarean Surgery

In 2005 30.2% of US women gave birth by caesarean: the largest percentage in US history, and representing over 1.25 million babies born by ‘vaginal bypass’.81 . Cesarean section involves major abdominal surgery and increases the risk of maternal death by about four times overall, and around two times for low-risk mothers having elective surgery.82, 83. Recent research also suggests higher infant mortality following caesarean birth,84 which may reflect increased risks of respiratory problems for caesarean newborns.85

As well as these short-term risks, a previous caesarean will increase risks for mother and baby’s health in all subsequent pregnancies. Increased long-term risks include: infertility and ectopic pregnancy;86 unexplained stillbirth;87 placental problems including placental abruption,88 placenta previa, placenta accreta and percreta,89 and emergency postpartum hysterectomy,90 all of which represent life-threatening risks for mother and baby

Obviously there is a shorter or absent labor with caesarean birth, and the peaks of oxytocin, endorphins, catecholamines, and prolactin are absent. Furthermore, mothers and babies are usually separated for some hours after birth, so the first breastfeed is usually delayed. Both will also be affected to some extent by the drugs used in the procedure (epidural, spinal, or general anaesthetic) and for post-operative pain relief.

The consequences of such radical departures from our hormonal blueprint are suggested in the work of Australian researchers who interviewed 242 women in late pregnancy and again after birth. The 50 percent of women who had given spontaneous vaginal birth were the most likely to experience a marked improvement in mood and an elevation of self-esteem after delivery. In comparison, the 17 percent who had caesarean surgery were more likely to experience a decline in mood and self-esteem. The remaining women had forceps or vacuum assistance, and their mood and self-esteem were, on average, unaltered.91

Another study looked at the breastfeeding hormones prolactin and oxytocin on day two, comparing women who had given birth vaginally with women who had undergone emergency cesarean surgery. In the cesarean group, prolactin levels did not rise as expected with breastfeeding, and the oxytocin pulses were reduced or absent. In this study, first suckling had been at 240 minutes average for cesarean babies, and 75 minutes average for babies vaginally born. Duration of breastfeeding was not significantly different for the mothers.

The authors comment, “These data indicate that early breastfeeding and physical closeness may be associated not only with more interaction between mother and child, but also with endocrine [hormonal] changes in the mother.” 92

Other research has shown that early and frequent suckling positively influences milk production and the duration of breastfeeding. 93

These studies not only indicate important links between birth and breastfeeding, but also show how an optimal birth experience can influence the long-term health of mother and baby. For example, successful breastfeeding confers advantages such as reduced risk of breast cancer and osteoporosis for the mother and reduced risk of diabetes and obesity long-term for the child. And enhanced self-esteem and confidence after a natural birth is a solid base from which to begin our mothering.

The connections between events at birth and long-term health certainly deserve more study. (See Michel Odent’s Primal Health Database www.birthworks.org/primalhealth for a summary of current research.) But we cannot afford to wait for years for researchers to “prove” the benefits of an undisturbed birth. Perhaps the best we can do is trust our instincts and vote with our birthing bodies, choosing models of care that increase our chances of undisturbed- and ecstatic- birthing.

Early Separation

Even in non-interventionist settings, it is uncommon for the baby to remain in the mother’s arms for the first one to two hours. And yet this time is exceptional, from a hormonal perspective, and will never again occur for this mother and baby. Mother Nature’s superb design, as described above, includes peak levels of the hormones of love, pleasure, excitement and tender mothering, which enhance attachment as well as breastfeeding initiation for both partners. Interference with this opportunity, by separation of mother and baby, may have significant implications in the short, medium, and long terms.

For both mother and baby, the time immediately after birth is associated with high CA levels which increase alertness and energy and enhance breastfeeding initiation. Peak maternal levels of oxytocin in the first hour enhance maternal responsiveness, both in breast and brain, and activate the “maternal circuit” — brain areas that mediate instinctive mothering behaviors – in mammalian mothers. High beta-endorphin levels at this time ensure pleasure and reward for maternal-infant interactions, and optimal prolactin levels may be important for longer-term breast milk production.

All of these hormonal systems are enhanced through skin-to-skin contact between mother and baby immediately after birth, which reduces crying and stress, keeps the newborn warm, and enhances physiological adaptation and maturity,94, 95 even up to two days later.96

For the mother, skin to skin contact with early breastfeeding initiation also enhances early breastmilk production,97 and early and frequent breastfeeding is also associated with increased breastfeeding duration.93

Conversely, removal of newborn from mother, even for short periods, disturbs the innate sequence of newborn pre-breastfeeding behaviour, which includes crawling up the mother’s abdomen, locating the breast and spontaneous sucking and rooting behaviour.98

As Bergman comments, ‘The neurobehaviour called “breastfeeding” is a critical survival strategy for the newborn human being, and is a behaviour which depends entirely on a limbic system brain programme, which in turn depends entirely on being in the right habitat: the maternal milieu. Any separation results in an opposing and potentially harmful neurobehavioural programme. Thus, the maternal milieu is specifically needed from the moment of birth, and should be continuous. Without this, the neurobehaviour that results is “protest-despair”, which actively shuts off the “breastfeeding behaviour.’99

Several older studies have shown advantages, up to age three, for mother-child relationship in dyads who experienced extra contact in the hour after birth. These include more positive interactions;100-102 longer duration of breastfeeding 102, 103; and more complex language interactions at age two.104

Optimizing the Ecstasy

The following suggestions will help a woman to use her hormonal blueprint and so optimize the experience and safety for herself and her baby. Remember that birth is “orgasmic in its essence”105 so that conditions for birth are ideally as close as possible to conditions for lovemaking.

 

    • Take responsibility for your health, healing, and wholeness throughout the child-bearing years
    • Choose a model of care that enhances the chance of a natural and undisturbed birth (eg home birth, birth center, one-on-one midwifery care).
    • Arrange support according to individual needs; trust, a loving relationship, and continuity of care with support people are important.
    • Consider having an advocate at a hospital birth- eg private midwife or doula.
    • Ensure an atmosphere where the laboring woman feels safe, unobserved, and free to follow her own instincts
    • Reduce neocortical stimulation by- keeping lighting and noises soft and reducing words to a minimum.
    • Cover the clock and any other technical equipment.
    • Avoid drugs unless absolutely necessary.
    • Avoid procedures (including obvious observations) unless absolutely necessary.
    • Avoid caesarean surgery unless absolutely necessary.
    • Don’t separate mother and baby for any reason, including resuscitation, which can be done with the cord still attached.
    • Breastfeed and enjoy it!

Giving birth is an act of love, and each birth is unique to the mother and her baby. Yet we also share the same womanly physiology and the same exquisite orchestration of our birthing hormones. Our capacity for ecstasy in birth is also both unique and universal, a necessary blessing that is hard-wired into our bodies, yet that requires, especially in these times, that we each trust, honor, and protect the act of giving birth according to our own instincts and needs.

Dutch professor of obstetrics G. Kloosterman offers a succinct summary, which would be well placed on the door of every birth room:

Spontaneous labor 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–nil nocere [Do no harm].106

References 1. Odent M. The Scientification of Love. Revised ed. London: Free Association Books; 2001.
2. Odent M. The fetus ejection reflex. The Nature of Birth and Breastfeeding. Sydney: Ace Graphics; 1992:29-43.
3. Uvnas-Moberg K, Eriksson M. Breastfeeding: physiological, endocrine and behavioural adaptations caused by oxytocin and local neurogenic activity in the nipple and mammary gland. Acta Paediatr. May 1996;85(5):525-530.
4. Dawood MY, Raghavan KS, Pociask C, Fuchs F. Oxytocin in human pregnancy and parturition. Obstet Gynecol. Feb 1978;51(2):138-143.
5. Tyzio R, Cossart R, Khalilov I, et al. Maternal oxytocin triggers a transient inhibitory switch in GABA signaling in the fetal brain during delivery. Science. Dec 15 2006;314(5806):1788-1792.
6. Nissen E, Gustavsson P, Widstrom AM, Uvnas-Moberg K. Oxytocin, prolactin, milk production and their relationship with personality traits in women after vaginal delivery or Cesarean section. J Psychosom Obstet Gynaecol. Mar 1998;19(1):49-58.
7. Matthiesen AS, Ransjo-Arvidson AB, Nissen E, Uvnas-Moberg K. Postpartum maternal oxytocin release by newborns: effects of infant hand massage and sucking. Birth. Mar 2001;28(1):13-19.
8. Odent M. Don’t manage the third stage of labour! Pract Midwife. Sep 1998;1(9):31-33.
9. Chard T. Fetal and maternal oxytocin in human parturition. Am J Perinatol. Apr 1989;6(2):145-152.
10. Leake RD, Weitzman RE, Fisher DA. Oxytocin concentrations during the neonatal period. Biol Neonate. 1981;39(3-4):127-131.
11. Uvnas-Moberg K. The Oxytocin Factor. Cambridge MA: Da Capo Press; 2003.
12. Chapman M. Oxytocin has big role in maternal behaviour: interview with Professor K Uvnas-Moberg. Australian Doctor. 1998, 7 August:38.
13. Feifel D, Reza T. Oxytocin modulates psychotomimetic-induced deficits in sensorimotor gating. Psychopharmacology (Berl). Jan 1999;141(1):93-98.
14. Insel TR, O’Brien DJ, Leckman JF. Oxytocin, vasopressin, and autism: is there a connection? Biol Psychiatry. Jan 15 1999;45(2):145-157.
15. Carter CS. Sex differences in oxytocin and vasopressin: Implications for autism spectrum disorders? Behav Brain Res. Jan 10 2007;176(1):170-186.
16. Knox SS, Uvnas-Moberg K. Social isolation and cardiovascular disease: an atherosclerotic pathway? Psychoneuroendocrinology. Nov 1998;23(8):877-890.
17. Sarnyai Z, Kovacs GL. Role of oxytocin in the neuroadaptation to drugs of abuse. Psychoneuroendocrinology. 1994;19(1):85-117.
18. Uvnas-Moberg K, Bjokstrand E, Hillegaart V, Ahlenius S. Oxytocin as a possible mediator of SSRI-induced antidepressant effects. Psychopharmacology (Berl). Feb 1999;142(1):95-101.
19. Zak PJ, Kurzban R, Matzner WT. Oxytocin is associated with human trustworthiness. Horm Behav. Dec 2005;48(5):522-527.
20. Kirsch P, Esslinger C, Chen Q, et al. Oxytocin modulates neural circuitry for social cognition and fear in humans. J Neurosci. Dec 7 2005;25(49):11489-11493.
21. Brinsmead M, Smith R, Singh B, Lewin T, Owens P. Peripartum concentrations of beta endorphin and cortisol and maternal mood states. Aust N Z J Obstet Gynaecol. Aug 1985;25(3):194-197.
22. Goland RS, Wardlaw SL, Blum M, Tropper PJ, Stark RI. Biologically active corticotropin-releasing hormone in maternal and fetal plasma during pregnancy. Am J Obstet Gynecol. Oct 1988;159(4):884-890.
23. Laatikainen TJ. Corticotropin-releasing hormone and opioid peptides in reproduction and stress. Ann Med. 1991;23(5):489-496.
24. Jowitt M. Beta-endorphin and stress in pregnancy and labour. Midwifery Matters. 1993;56:3-4.
25. Rivier C, Vale W, Ling N, Brown M, Guillemin R. Stimulation in vivo of the secretion of prolactin and growth hormone by beta-endorphin. Endocrinology. Jan 1977;100(1):238-241.
26. Mendelson CR, Boggaram V. Hormonal and developmental regulation of pulmonary surfactant synthesis in fetal lung. Baillieres Clin Endocrinol Metab. Jun 1990;4(2):351-378.
27. Franceschini R, Venturini PL, Cataldi A, Barreca T, Ragni N, Rolandi E. Plasma beta-endorphin concentrations during suckling in lactating women. Br J Obstet Gynaecol. Jun 1989;96(6):711-713.
28. Zanardo V, Nicolussi S, Carlo G, et al. Beta endorphin concentrations in human milk. J Pediatr Gastroenterol Nutr. Aug 2001;33(2):160-164.
29. Segal S, Csavoy AN, Datta S. The tocolytic effect of catecholamines in the gravid rat uterus. Anesth Analg. Oct 1998;87(4):864-869.
30. Douglas AJ, Leng G, Russell JA. The importance of oxytocin mechanisms in the control of mouse parturition. Reproduction. Apr 2002;123(4):543-552.
31. Lederman RP, Lederman E, Work B, Jr., McCann DS. Anxiety and epinephrine in multiparous women in labor: relationship to duration of labor and fetal heart rate pattern. Am J Obstet Gynecol. Dec 15 1985;153(8):870-877.
32. Lederman RP, McCann DS, Work B, Jr., Huber MJ. Endogenous plasma epinephrine and norepinephrine in last-trimester pregnancy and labor. Am J Obstet Gynecol. Sep 1 1977;129(1):5-8.
33. Lederman RP, Lederman E, Work BA, Jr., McCann DS. The relationship of maternal anxiety, plasma catecholamines, and plasma cortisol to progress in labor. Am J Obstet Gynecol. Nov 1 1978;132(5):495-500.
34. Saito M, Sano T, Satohisa E. Plasma catecholamines and microvibration as labour progresses. Shinshin-Thaku. 1991;31:381-389.
35. Thomas SA, Palmiter RD. Impaired maternal behavior in mice lacking norepinephrine and epinephrine. Cell. Nov 28 1997;91(5):583-592.
36. Lagercrantz H, Bistoletti P. Catecholamine release in the newborn infant at birth. Pediatr Res. Aug 1977;11(8):889-893.
37. Lagercrantz H, Slotkin TA. The “stress” of being born. Sci Am. Apr 1986;254(4):100-107.
38. Uvnas-Moberg K. Physiological and psychological effects of oxytocin and prolactin in connection with motherhood with special reference to food intake and the endocrine system of the gut. Acta Physiol Scand Suppl. 1989;583:41-48.
39. Stefos T, Sotiriadis A, Tsirkas P, Messinis I, Lolis D. Maternal prolactin secretion during labor. The role of dopamine. Acta Obstet Gynecol Scand. Jan 2001;80(1):34-38.
40. Keverne EB. Sexual and aggressive behaviour in social groups of talapoin monkeys. Ciba Found Symp. Mar 14-16 1978(62):271-297.
41. Heasman L, Spencer JA, Symonds ME. Plasma prolactin concentrations after caesarean section or vaginal delivery. Arch Dis Child Fetal Neonatal Ed. Nov 1997;77(3):F237-238.
42. Mostyn A, Pearce S, Stephenson T, Symonds ME. Hormonal and nutritional regulation of adipose tissue mitochondrial development and function in the newborn. Exp Clin Endocrinol Diabetes. Jan 2004;112(1):2-9.
43. Martin J, Hamilton B, Sutton P, Ventura S, Menacker F, Kirmeyer S. Births: Final data for 2004. National vital statistics reports. Vol 55. Hyattsville MD: National Center for Health Statistics; 2006.
44. Declercq ER, Sakala C, Corry MP, Applebaum S. Listening to Mothers II: Report of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection; October 2006. 2006.
45. Phaneuf S, Rodriguez Linares B, TambyRaja RL, MacKenzie IZ, Lopez Bernal A. Loss of myometrial oxytocin receptors during oxytocin-induced and oxytocin-augmented labour. J Reprod Fertil. Sep 2000;120(1):91-97.
46. Carter CS. Developmental consequences of oxytocin. Physiol Behav. Aug 2003;79(3):383-397.
47. Odent M. The Nature of Birth and Breastfeeding. Sydney: Ace Graphics; 1992.
48. Thomas TA, Fletcher JE, Hill RG. Influence of medication, pain and progress in labour on plasma beta-endorphin-like immunoreactivity. Br J Anaesth. Apr 1982;54(4):401-408.
49. American College of Obstetricians and Gynecologists. Obstetric Analgesia and Anesthesia. ACOG Technical Bulletin. 1996;225(July).
50. Olofsson C, Ekblom A, Ekman-Ordeberg G, Hjelm A, Irestedt L. Lack of analgesic effect of systemically administered morphine or pethidine on labour pain. Br J Obstet Gynaecol. Oct 1996;103(10):968-972.
51. Tsui MH, Ngan Kee WD, Ng FF, Lau TK. A double blinded randomised placebo-controlled study of intramuscular pethidine for pain relief in the first stage of labour. Br J Obstet Gynaecol. Jul 2004;111(7):648-655.
52. Thomson AM, Hillier VF. A re-evaluation of the effect of pethidine on the length of labour. J Adv Nurs. Mar 1994;19(3):448-456, p 448.
53. Kimball CD. Do endorphin residues of beta lipotropin in hormone reinforce reproductive functions? Am J Obstet Gynecol. May 15 1979;134(2):127-132.
54. Greer G. Sex and Destiny: the Politics of Human Fertility. London: Picador, p 30; 1984.
55. Jacobson B, Nyberg K, Gronbladh L, Eklund G, Bygdeman M, Rydberg U. Opiate addiction in adult offspring through possible imprinting after obstetric treatment. Br Med J. Nov 10 1990;301(6760):1067-1070.
56. Nyberg K, Buka SL, Lipsitt LP. Perinatal medication as a potential risk factor for adult drug abuse in a North American cohort. Epidemiology. Nov 2000;11(6):715-716.
57. Kellogg CK, Primus RJ, Bitran D. Sexually dimorphic influence of prenatal exposure to diazepam on behavioral responses to environmental challenge and on gamma-aminobutyric acid (GABA)-stimulated chloride uptake in the brain. J Pharmacol Exp Ther. Jan 1991;256(1):259-265.
58. Livezey GT, Rayburn WF, Smith CV. Prenatal exposure to phenobarbital and quantifiable alterations in the electroencephalogram of adult rat offspring. Am J Obstet Gynecol. Dec 1992;167(6):1611-1615.
59. Mirmiran M, Swaab D. Effects of perinatal medication on the developing brain. In: Nijhuis J, ed. Fetal behaviour. Oxford: Oxford University Press; 1992.
60. Csaba G, Tekes K. Is the brain hormonally imprintable? Brain Dev. Oct 2005;27(7):465-471.
61. Browning AJ, Butt WR, Lynch SS, Shakespear RA, Crawford JS. Maternal and cord plasma concentrations of beta-lipotrophin, beta-endorphin and gamma-lipotrophin at delivery; effect of analgesia. Br J Obstet Gynaecol. Dec 1983;90(12):1152-1156.
62. Scull TJ, Hemmings GT, Carli F, Weeks SK, Mazza L, Zingg HH. Epidural analgesia in early labour blocks the stress response but uterine contractions remain unchanged. Can J Anaesth. Jul 1998;45(7):626-630.
63. Rahm VA, Hallgren A, Hogberg H, Hurtig I, Odlind V. Plasma oxytocin levels in women during labor with or without epidural analgesia: a prospective study. Acta Obstet Gynecol Scand. Nov 2002;81(11):1033-1039.
64. Goodfellow CF, Hull MG, Swaab DF, Dogterom J, Buijs RM. Oxytocin deficiency at delivery with epidural analgesia. Br J Obstet Gynaecol. Mar 1983;90(3):214-219.
65. Lieberman E, O’Donoghue C. Unintended effects of epidural analgesia during labor: a systematic review. Am J Obstet Gynecol. May 2002;186(5 Suppl Nature):S31-68.
66. Neumark J, Hammerle AF, Biegelmayer C. Effects of epidural analgesia on plasma catecholamines and cortisol in parturition. Acta Anaesthesiol Scand. Aug 1985;29(6):555-559.
67. Behrens O, Goeschen K, Luck HJ, Fuchs AR. Effects of lumbar epidural analgesia on prostaglandin F2 alpha release and oxytocin secretion during labor. Prostaglandins. Mar 1993;45(3):285-296.
68. Fernando R, Bonello E, Gill P, Urquhart J, Reynolds F, Morgan B. Neonatal welfare and placental transfer of fentanyl and bupivacaine during ambulatory combined spinal epidural analgesia for labour. Anaesthesia. Jun 1997;52(6):517-524.
69. Brinsmead M. Fetal and neonatal effects of drugs administered in labour. Med J Aust. May 4 1987;146(9):481-486.
70. Hale T. The effects on breastfeeding women of anaesthetic medications used during labour. Paper presented at: The Passage to Motherhood, 1998; Brisbane Australia.
71. Hale T. Medications and Mother’s Milk. Amarillo TX: Pharmasoft; 1997. 72. Krehbiel D, Poindron P, Levy F, Prud’Homme MJ. Peridural anesthesia disturbs maternal behavior in primiparous and multiparous parturient ewes. Physiol Behav. 1987;40(4):463-472.
73. Levy F, Kendrick KM, Keverne EB, Piketty V, Poindron P. Intracerebral oxytocin is important for the onset of maternal behavior in inexperienced ewes delivered under peridural anesthesia. Behav Neurosci. Apr 1992;106(2):427-432.
74. Sepkoski CM, Lester BM, Ostheimer GW, Brazelton TB. The effects of maternal epidural anesthesia on neonatal behavior during the first month. Dev Med Child Neurol. Dec 1992;34(12):1072-1080.
75. Murray AD, Dolby RM, Nation RL, Thomas DB. Effects of epidural anesthesia on newborns and their mothers. Child Dev. Mar 1981;52(1):71-82.
76. Radzyminski S. Neurobehavioral functioning and breastfeeding behavior in the newborn. J Obstet Gynecol Neonatal Nurs. May-Jun 2005;34(3):335-341.
77. Chang ZM, Heaman MI. Epidural analgesia during labor and delivery: effects on the initiation and continuation of effective breastfeeding. J Hum Lact. Aug 2005;21(3):305-314; quiz 315-309, 326.
78. Riordan J, Gross A, Angeron J, Krumwiede B, Melin J. The effect of labor pain relief medication on neonatal suckling and breastfeeding duration. J Hum Lact. Feb 2000;16(1):7-12.
79. Beilin Y, Bodian CA, Weiser J, et al. Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study. Anesthesiology. Dec 2005;103(6):1211-1217.
80. Jordan S, Emery S, Bradshaw C, Watkins A, Friswell W. The impact of intrapartum analgesia on infant feeding. BJOG. Jul 2005;112(7):927-934.
81. Hamilton BE, Minino AM, Martin JA, Kochanek KD, Strobino DM, Guyer B. Annual summary of vital statistics: 2005. Pediatrics. Feb 2007;119(2):345-360.
82. Deneux-Tharaux C, Carmona E, Bouvier-Colle MH, Breart G. Postpartum maternal mortality and cesarean delivery. Obstet Gynecol. Sep 2006;108(3 Pt 1):541-548.
83. Enkin M, Keirse M, Neilson J, et al. Effective Care in Pregnancy and Childbirth. 3rd ed. Oxford: Oxford University Press; 2000.
84. MacDorman MF, Declercq E, Menacker F, Malloy MH. Infant and neonatal mortality for primary cesarean and vaginal births to women with “no indicated risk,” United States, 1998-2001 birth cohorts. Birth. Sep 2006;33(3):175-182.
85. Levine EM, Ghai V, Barton JJ, Strom CM. Mode of delivery and risk of respiratory diseases in newborns. Obstet Gynecol. Mar 2001;97(3):439-442.
86. Hemminki E, Merilainen J. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol. May 1996;174(5):1569-1574.
87. Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet. Nov 29 2003;362(9398):1779-1784.
88. Odibo AO, Cahill AG, Stamilio DM, Stevens EJ, Peipert JF, Macones GA. Predicting placental abruption and previa in women with a previous cesarean delivery. Am J Perinatol. May 2007;24(5):299-305.
89. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. May 2005;192(5):1458-1461.
90. Habek D, Becarevic R. Emergency peripartum hysterectomy in a tertiary obstetric center: 8-year evaluation. Fetal Diagn Ther. 2007;22(2):139-142.
91. Fisher J, Astbury J, Smith A. Adverse psychological impact of operative obstetric interventions: a prospective longitudinal study. Aust N Z J Psychiatry. Oct 1997;31(5):728-738.
92. Nissen E, Uvnas-Moberg K, Svensson K, Stock S, Widstrom AM, Winberg J. Different patterns of oxytocin, prolactin but not cortisol release during breastfeeding in women delivered by caesarean section or by the vaginal route. Early Hum Dev. Jul 5 1996;45(1-2):103-118.
93. Salariya EM, Easton PM, Cater JI. Duration of breast-feeding after early initiation and frequent feeding. Lancet. Nov 25 1978;2(8100):1141-1143.
94. Christensson K, Siles C, Moreno L, et al. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. Acta Paediatr. Jun-Jul 1992;81(6-7):488-493.
95. Ferber SG, Makhoul IR. The effect of skin-to-skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial. Pediatrics. Apr 2004;113(4):858-865.
96. Bystrova K, Widstrom AM, Matthiesen AS, et al. Skin-to-skin contact may reduce negative consequences of “the stress of being born”: a study on temperature in newborn infants, subjected to different ward routines in St. Petersburg. Acta Paediatr. 2003;92(3):320-326.
97. Bystrova K, Widstrom AM, Matthiesen AS, et al. Early lactation performance in primiparous and multiparous women in relation to different maternity home practices. A randomised trial in St. Petersburg. Int Breastfeed J. 2007;2:9.
98. Righard L, Alade MO. Effect of delivery room routines on success of first breast-feed. Lancet. Nov 3 1990;336(8723):1105-1107.
99. Bergman NJ. Skin-to-Skin Contact and Perinatal Neuroscience. Paper presented at: Capers Breastfeeding Seminar: Breastfeeding A Lifelong Investment; May 13 2006, 2006; Brisbane, Australia.
100. de Chateau P, Wiberg B. Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. II. A follow-up at three months. Acta Paediatr Scand. Mar 1977;66(2):145-151.
101. de Chateau P, Wiberg B. Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. I. First observations at 36 hours. Acta Paediatr Scand. Mar 1977;66(2):137-143.
102. de Chateau P, Wiberg B. Long-term effect on mother-infant behaviour of extra contact during the first hour post partum. III. Follow-up at one year. Scand J Soc Med. 1984;12(2):91-103.
103. Klaus MH, Jerauld R, Kreger NC, McAlpine W, Steffa M, Kennel JH. Maternal attachment. Importance of the first post-partum days. N Engl J Med. Mar 2 1972;286(9):460-463.
104. Ringler NM, Kennell JH, Jarvella R, Navojosky BJ, Klaus MH. Mother-to-child speech at 2 years–effects of early postnatal contact. J Pediatr. Jan 1975;86(1):141-144.
105. Baker JP. Prenatal Yoga and Natural Childbirth. 3rd ed. Berkley: North Atlantic Books; 2001 p 90.
106. Kloosterman G. The universal aspects of childbirth: Human birth as a socio-psychosomatic paradigm. J Psychosom Obstet Gynaecol. 1982;1(1):35-41, p 40.