ļ»æEpisode 15 - The hormones of labour
Mel:
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host,
Mel:
[0:03] Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. And each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey. Welcome everybody to episode 15 of the great birth rebellion and today i've invited an amazing guest and friend and work colleague with me today on the podcast and i'd love to introduce you to dr sarah buckley who many of you i'm sure will know because she's been in the birth world a long time a lot longer than me. She's written a very famous book, which I hope everyone has read. And if you haven't, take note, Gentle Birth, Gentle Mothering by Dr. Sarah Buckley can highly recommend it. And Sarah's here with me. But as you all know, I like to do a little bit of an introductory bio. I feel like I know Sarah well enough that I could do it. But Sarah, you'll have to fill in the gaps if I miss anything on what I've introduced for you today. Sarah, Dr. Sarah Buckley is a GP but also PhD candidate. Have you finished your thesis yet?
Sarah:
[1:20] No, no, got a while to go, Melanie.
Mel:
[1:23] So Dr. Sarah Buckley because of her medical training and her work as a GP but soon also because you are a PhD candidate so you'll be another kind of doctor then. Sarah's had four babies at home. Sarah has also written a lot of research papers. You're big in the research world and a lot of your work focuses on the physiology of childbirth and placental birth and parenting, which is what I'd love to talk to you about today. You can see all of Sarah's resources and there's a lot of them at her website, sarahbuckley.com and also on social media, mostly on Facebook, I think you're probably most active. Would that be right?
Sarah:
[2:07] Yes, yeah, I do some tweeting as well.
Mel:
[2:10] And tweeting. What's your Twitter handle?
Sarah:
[2:13] At Sarah J Buckley.
Mel:
[2:15] At Sarah J Buckley and on Facebook as Dr. Sarah Buckley. But all of this information will be put up for those who are on the podcast mailing list. And if you're not on the podcast mailing list, go to www.melaniethemidwife.com. Get on the mailing list because there are folders and folders and folders of resources and information on every single episode that we do. And this episode will be no different. So get on the list if you want any of the resources that we're talking about today. Sarah, did I leave anything out?
Sarah:
[2:45] That's pretty good. Yeah. I actually, if little, some fun facts.
Sarah:
[2:51] My father was an obstetrician in my hometown of Whangarei in New Zealand. And my grandfather was actually a GP obstetrician. And there's stories about him going out on horseback to help women having babies in the bush. And he was actually very skillful with keelan rotation forceps in the days before cesarean. So it kind of has come down through several generations. Yeah. And also both of my parents were born at home, I found out.
Mel:
[3:15] Amazing. Were you born at home?
Sarah:
[3:17] No, I was born in hospital. Yeah. But actually what I also found out was that my mother, when she was born, was attended by the granny midwife who was actually her grandmother. So my father's, my grandfather's mother was a granny midwife in the area of Te Aroha in New Zealand.
Mel:
[3:34] Oh, what a story. What a family line your partner. Incredible. You're always destined for greatness. Yeah.
Mel:
[3:41] Amazing. So, and Sarah, we've worked together on a previous project, Transformative Birthwork, where we spoke a lot about the hormones of labour and that's what I want to talk to you about today. So I've basically got a very targeted list of questions that I'd love to talk to you about and I'm sure you just have the answers at the tip of your tongue because this is your life. All right, let's get into it. Hormones of labour. Sarah, could you talk us through how does labour start? Do we have an understanding of what sets labour off?
Sarah:
[4:17] Well, actually, Melanie, if I could answer that question, I would get a Nobel Prize because we don't actually know what causes the physiological onset of labor in women. It's crazy, isn't it? Imagine how much research is going into this. Imagine how valuable it would be to know this. But we kind of know some of the preparations that happen. So, there's a whole lot of hormonal interactions between mothers and babies. So, we kind of, you know, one of my touchstones is actually evolution. I studied anthropology a little bit. So, if you think about, you know, So humans, like all our mammalian cousins giving birth in the wild, it's absolutely critical that the mother is totally ready for the birth so she can have an efficient, effective labour and birth. And it's obviously totally critical that the baby's ready for the birthright so that they come out healthy and well. And not just that, not just for a successful birth, but also to survive and thrive and go on to have more offspring who survive and thrive. So it's really not just about birth. Actually, it's about breastfeeding, about lactation and all mammals being successful. And it's also actually about bonding, about the mother, every mammalian mother being rewarded and motivated to give the dedicated care that every mammalian newborn needs. So all these preparations are happening in the background. And as I said, hormonal signals crossing the placentas are that the mother's in this peak of readiness, mostly to do with estrogen. And estrogen upregulates or kind of activates the oxytocin system, which I'm sure we'll talk about a lot. And then for the baby.
Sarah:
[5:39] It's actually cortisol, the increase in cortisol that happens in that helps to mature all the baby's organs. So that's happening for the baby at the same time it's happening for the mother through the maturing of the baby's adrenal gland, which actually sends a chemical precursor of estrogen to the placenta. So it's this really beautiful hormonal signaling happening between mother and baby so that both are at this peak of readiness. So we know that all of those things kind of contribute to the readiness of mother and baby. But what it is that makes labor happen right now, today, as opposed to yesterday or tomorrow, we don't really know the answer to that question. Seems to be like there's a day-night cycle for sure.
Sarah:
[6:18] Melatonin helps the whole system to get activated. So, day-living species like humans are more likely to give birth in the night time and conversely, night-living species are more likely to give birth in the day. But it's kind of crazy, isn't it? Because here we are like stepping over all of those final preparations with like induction or pre-labor caesarean when we don't actually understand what's happening. And some of the studies that are coming out now, like these are big population studies looking at gestation of the child in relation to long-term development, school achievement and things like that. And it seems like, you know, even up to 40, 41 weeks, there's advantages for children getting that full-term gestation. So, we're kind of meddling a little bit in things we don't really understand is the way that I interpret it, including what it is that causes the onset of labour in humans, in women.
Mel:
[7:08] But essentially, we know then that the labour process will start when both the mother and baby are ready.
Sarah:
[7:16] But often it is. I mean, I think there is, you know, good reasons behind that, right? Because we've got to be really relaxed to start labour. It's not just all that kind of internal readiness. We've got to also feel comfortable in our external environment. You know, we've been giving birth in the wild and we really need to be in a safe place to give birth? Because if we're not, we won't survive, the baby won't survive. So actually knowing that we're in a safe environment and feeling safe to start labour, it's really important. And often you know that like women, they've got a few children at home and labour doesn't start until the children are in bed or the children have gone out. You can kind of get that settled feeling, right? So that's really important. That subjective sense of safety is so important for birth and all mammals. And we're mammals, right? We have mammary glands, we suckle our young and we kind of forget that, you know, it's like dogs and cats and elephants and horses and all of those, you know, you may know domestic animals and, you know, you, one of the main things that you do to safeguard the birth is you preserve, help the mother to feel safe. Yeah. And that's oxytocin as well. You know, we don't release oxytocin when we don't feel safe. Right.
Mel:
[8:17] So maybe we then can talk about The hormones of labor, so we've already established we don't really know how labor starts, which actually for me, I kind of like that because I feel like the minute we do find out as a civilization, the way the birth culture is at the moment, we're going to be very inspired to try and interrupt and mimic it,
Mel:
[8:39] find new and fantastic ways to bring babies out before everybody's ready. So I kind of like that birth has kept itself an absolute and total mystery to science.
Sarah:
[8:49] Yeah, I agree. I agree. It is a mystery and we can understand certain aspects of it or certain layers of it, if you like. But I think ultimately it is a mystery because it is so subjective. We could say it's so subjective for the individual mama, like whether you're a human or a dog or an elephant, like it's how you feel, how your environment is, you know, your specific physiology, your baby's specific physiology. I mean, that whole thing about saying baby should be born in a kind of mathematical number, like 40 weeks or something. it's like saying every child should walk on their 12th birth or 12 months. It doesn't happen. Like there's all these degrees of variation in nature and we're part of nature and we have all these degrees of variation. And I think the most important thing is to respect that, you know, and I'm saying this as a mama who had one early baby and one baby, he was supposedly late, but turned out with lots of verdicts and two in the middle. So, you know, we do all have that 37 to 42 weeks as normal human gestation.
Mel:
[9:44] Yeah, exactly. So we know less about the start of labor, but what do we know about the hormones that govern the labor and birth process?
Sarah:
[9:53] Yeah, well, my PhD is actually about oxytocin and childbirth. So I'll talk about that. And it's a good illustration of everything, really, because, you know, the lead up to labor is we call it the activation stage. Like there's a quiescent, you know, the calm stage where not much happens with your uterus. It's kind of relaxed, you could say. There's lots of progesterone, progestation, keeping it nice and calm. And then we get into the activation stage where it becomes a little bit more, you probably you notice this yourself as a pregnant mama, like you get some Braxton Hicks, it's a little bit more kind of things are happening a bit more. And that's what's happening there is as you get towards term, you get more and more estrogen. We talked about that as an activating hormone made by the placenta. And that actually upregulates all of your oxytocin system. By upregulating, I mean kind of activates so you get a little bit more oxytocin as pregnancy goes on, but you also get more oxytocin receptors.
Sarah:
[10:50] And just going to go back to the whole hormone thing. So a hormone is a substance that's made in one part of the body with effects at another part of the body. So oxytocin is actually made in the brain. It's made in the hypothalamus, stored in the pituitary gland, released into the body, goes to the uterus, and that's where it has an effect. But it has an effect via a receptor. So hormones have specific receptors and it's like a key and a lock. You have a specific key, oxytocin, a specific lock, the oxytocin receptor. And oxytocin released from the pituitary comes to the uterus, finds the receptors, which are on the outside of the uterine muscle cells, and they lock into those receptors. And it's like turning a key. And that sends a chemical message into the cell saying contract.
Sarah:
[11:32] So specific key, oxytocin, specific lock, the oxytocin receptor. So we have this somewhat increase in oxytocin as pregnancy goes on, it's kind of like an upward curve, you know, it's like a line. The more pregnant you are, the more oxytocin you have, right? And the more estrogen you have as well. But also the more oxytocin receptors you have, and they increase massively. This is actually from measurements in real life women as we get towards not just the end of pregnancy, but also early labor. You know, one study measured them and it was 1.8 in early, you know, non-pregnant through to about 11 in early pregnancy, a bit over 1,000 in late pregnancy, and then 3,500 in early labor. So that's incredible. That's how sensitive your body becomes to oxytocin. So what we've found in some of the studies I've been involved with for my PhD is that oxytocin levels when women go into labor are actually not very high. You know, in the old days, they thought oxytocin causes labor to start, so levels must suddenly go up. And then they actually found out, no, they don't actually go up very much. But what does go up is the woman's uterine sensitivity to oxytocin. And again, you might notice this yourself if you're pregnant, like things make your uterus contract that didn't make it contract before, like orgasm, for example, you know, like breaks next contraction. So your uterus gets more like contractible.
Sarah:
[12:47] And one story is actually, you can't do this these days, right? So thank you to the woman who did this. It was a German obstetrician and he got his patients to come in every day and injected them with a little bit of synthetic oxytocin in the lead up to labor. and every day they had more and more contractions in response to that. And then the day they went into labor was the most responsive that they were to that little bit of oxytocin. And an anecdote for myself, I breastfed through my second pregnancy and every day my daughter would come in and have a little suckle. That was all good. But the day I went into labor, she came in and had a suckle and I had the most massive contraction. I had to literally throw her off because at that point my uterus was so much more sensitive than it was the day before and that was the start of my labor. So this massive increase, but it's not just the receptors, it's also a whole lot of other activating things like your uterus gets literally wired up to respond to all those hormones and electrical neurological signals that go through, you know, your cervix gets soft and flexible.
Sarah:
[13:46] Your prostaglandins get high, your progesterone gets a little bit lower, you have inflammation, like a whole lot of things happening. And that's all, you know, it's the magical moment, really that onset of labor. And, you know, I say that inducing labor is a bit like, you know, a royal wedding, like William and Kate getting married and turning up at Westminster Cathedral like a week before and thinking everything will be the same because some of those last minute touches only happen at the very end, you know, from animal studies.
Sarah:
[14:12] So, even a day before, even an hour before, it's not actually exactly the same as when it happens according to, you know, I call it Mother Nature's superb design. So, that's really how the process happens. So, then we have this maximally sensitive, our uterus is maximally sensitive, our body's primed, And we have to guess, but we don't know for sure, that those other processes, the breastfeeding and the bonding are also kind of primed with the onset of labor. You know, you could have a very short labor and it all has to kick in. You have to bond with your baby. You have to suckle, you know. So, all of those things we know in animal studies are all getting ready as well for that duration of labor, whether it's long, whether it's short, you know, everything has to be ready the moment that mama meets her babies. So, yeah, it's pretty amazing. and the oxytocin levels go up as labour progresses. We have some negative feedback systems. I say it's like the snowball of labour. So labour starts small, becomes bigger and bigger and the end becomes virtually unstoppable because some of these positive feedback systems that happen that fuel oxytocin release. I'll tell you about that in a minute, but you got any questions about any of that? Is that making sense?
Mel:
[15:19] Well, it's making sense to me in that it still harks to that readiness to actually go into labor, that your uterus has to be ready to receive the oxytocin that it's going to get when you're in labor. And that leads me also to think about these women who are subjected to the induction process, for example, before their uterus is actually ready and it explains why not all inductions actually work because their body's not ready to receive that level of oxytocin that's given to them.
Mel:
[15:56] In Australia where something like 45% of women are being induced and then obviously also now there's a higher cesarean section rate than there used to be, it's 37% now or something. It's almost a ridiculous concept to think that we're trying to induce women before this whole physiological readiness has happened. Yet the process you're explaining makes sense from a physiological perspective and it just makes me think about those women who are being induced early and then wondering why it didn't work. And that's because there's not, well, part of it would be there's not enough oxytocin receptors to receive the artificial oxytocin. Yeah.
Sarah:
[16:34] And it's the whole, it's not just the receptors, there's this whole activating process that's not optimally ready either. So yeah, so all of those processes are not switched on adequately. And you know, some women, they turn up to get induced and you give them a little bit of something, a little bit of prostaglandins, a little bit of synthetic oxytocin and everything happens right, well, they probably would have gone into labor the next day. And some women, you can pour bucket loads in and nothing happens. As you say, we call it a failed induction, but her body wasn't ready and her baby wasn't ready critically. So, we're kind of trying to push things that really aren't designed to be pushed, I guess, is one of the take-homes about that.
Mel:
[17:10] Yes. Another question I did have, and it's kind of off topic, but also related to oxytocin receptors. I did a bit of research. As a home birth midwife, we encounter a lot more women who go beyond 42 weeks because we don't induce women for going overdue. And I did do some reading about the possibility that women who go past 42 weeks might actually have a deficit in oxytocin receptors as a fundamental kind of inbuilt situation and could explain why they didn't go into labor until beyond 42 weeks. But also there's that small group of women whose cervix just doesn't dilate for some reason or they never get into a labour pattern that leads them to full dilation and the birth of their baby. Have you read anything about oxytocin receptor deficiencies?
Sarah:
[18:05] Yeah, well, people have looked at some of those things to say, does this explain why some women need synthetic oxytocin and some women don't? Sometimes they have found variations of oxytocin receptors, but really they don't explain very much, like maybe 5% of the differences. So, nothing very big has been found in terms of oxytocin receptors. And I guess, as I said, it's not just the receptor, it's the whole system. And I think we all have a biological variation and some women and some families even do tend to have a longer gestation. And I wouldn't be presuming there's a deficit in oxytocin receptors, particularly if women then go on and have a normal labor. I mean, that means everything's working fine, right? So yeah, I think it's easy to think more about the individual woman and what's going with her physiology and then think about the context really. I mean, is she feeling safe? Is she feeling comfortable in this situation? Has she got like domestic problems that might not make her feel safe?
Sarah:
[18:58] So I think we need to take into account all of those kinds of things as well.
Mel:
[19:02] So what's the recipe for safety then? Hormonal safety or birth safety?
Sarah:
[19:07] Yeah, that's a good question. I mean, I say, you know, like you talk about other animals giving birth, it's really the same process. And I say that the core requirements for birth in all mammals is that the labouring mama feels private, safe and unobserved. And sometimes when I'm doing lectures, I tell all these different animal birth stories, right? And some animals are quite solitary birthers like cats. Some animals are more social birthers like elephants. They have a circle of female helpers around them who sway in time with the laboring mama and soothe her with their trunks, apparently, and obviously form a very formidable barrier, right? So, and I say as a birth worker, as a midwife, as a doula, you're that circle of elephants for the laboring mama, right? Feeling safe, feeling unobserved. Because again, if you think in the wild, that sense of like something's watching me is not a good sense, right? And no animal would ever give birth with strangers or in a strange place. And so, you know, we put women with strangers in a strange place a lot of the time, and then we wonder why birth doesn't work. So, yeah, so I think the circumstances of birth are so critical. And another perspective on it is to say that the processes of having a baby, the hormonal processes are almost identical to the hormonal processes of making a baby. So, if you're thinking about having a baby, you might want to think, could I make a baby in this situation?
Mel:
[20:20] And when you're choosing your birth team or when you're choosing the people who you want to have at your birth because I know some people and it's happened to me as a midwife where the woman is like oh my gosh my friend or my sister or my mom or my mother-in-law want to come to the birth and I just don't feel comfortable with them then I say to them you have to not have them there if The birth process is to unfold as you want it to. You can't invite people into your space that you don't want there. And I guess it's the same, you know, where women walk into a hospital if they're part of a fragmented system and they haven't met any of their birth care team. So you're saying that is one thing that can really stop birth physiology from unfolding properly.
Sarah:
[21:07] Exactly, exactly. And so many women, you know, listeners might have had the experience themselves of like labouring at home, it's all going well, and then it's time to move to hospital. And as soon as that kind of thought happens or you get to hospital, everything slows down or stops because you're not, you know, you might kind of intellectually think think this is a safe place. But your limbic system, your primitive brain doesn't agree, right? The strange smells, strange noises, all that sensory information. So, you know, I'm sure you've all got your own tips and tricks for this. But if you want to make that transition to hospital and keep that sense of feeling private and safe, you might want to pay attention to your senses, like put an eye mask on, put headphones on, take a pillow or your partner's t-shirt and bury your nose in it, right? Firm in your smells, all of those things to protect basically your limbic system from that transition. So yeah, that's really important. Private, safe and unobserved as I call it and or otherwise, could you make a baby? Yeah.
Mel:
[22:00] So basic rule, if you feel like you couldn't have sex in that environment with those people watching and feel safe and unhindered, then that is also going to impact your birth.
Sarah:
[22:13] Yeah. That's a good way of putting it. Yeah. Yeah. I I remember when I was actually, my sister-in-law was a home birth midwife in New Zealand and she inspired us to have our babies at home. And she said to me, every extra person you have at the birth adds an hour. I think that's quite a good rule of thumb, really. My fastest births were certainly when there was no one else around.
Mel:
[22:35] I can a little bit attest that I did have a bit of a crowd for my first birth and it took a long, long time. And then for my second birth, actually the birth time team who did the documentary birth time which you were on correct yes they had approached me early in the piece and said hey could we film your birth for birth time and I thought whoa a really big part of my birth plan was to not have any extra people this time because I feel like it could have extended the time of the labor and I didn't have many people the second time and it was a much much much shorter labor so I think you're right there needs to be a paring back of people in the birth space.
Sarah:
[23:14] Yeah, and it's kind of respect for the process really, isn't it? It's not a spectator sport. You don't owe anyone anything to beat your birth. And as you say, having more people there is actually going to interfere with the process. It's such, you know, birth is such a subjective experience. You really need to pay attention to, you know, your subjective reality and, dare I say, like your womb knowing what actually your instincts tell you. No, that's not a good person to have here. And the other thing is, you know, I have a great midwife that can clear the room if needed and, you I think being responsible in birth is being able to respond to the situation. So all your family turns up, that's great. But at some point, you need to be able to say, no, this doesn't work for me. And you don't know, like I didn't know with each of my births, what was going to feel like next time. I might be completely different. My baby's going to be different. So you really need to have a lot of, I'd say, flexibility in your birth plan and your situation so that if you want people there, you can get them there. Sometimes births are long and you do need that support. or you can clear the room if you need to. So that's really important in the service of, you know, feeling subjectively private, safe and as unobserved as possible.
Mel:
[24:22] So what happens to a woman's body if she's not feeling safe,
Sarah:
[24:27] Unobserved and what was the other one? Private, private, private, safe and unobserved, yeah. Yeah, well basically, you know, your oxytocin release goes down. You know, you don't release the hormone that's making your labour run. labor run. So yeah, your labor slows down or can even stop. And that phenomenon where you come to hospital and labor slows down or stops, apparently, Ina Mae Gaskin says in South America, they call that PASMO. It's got a name. I went to hospital, I had PASMO and I had to go home again because my labor stopped. So very, very recognizable phenomenon. So oxytocin goes down. And even if you're more kind of afraid, you can have a burst of adrenaline as well. And I call that the saber tooth tiger effect. You know, if you have four mothers birthing in the wild to say, but tooth tiger turns up, right, adrenaline is really going to stop your labor. You know, you need that rush of fight or flight energy to not just stop your labor, but to be able to run away and find a safe place and then labor resumes. Yeah, your labor can slow down or even actually stop if you don't have those conditions. So, you know, as I said, all those things, if you're transiting to hospital,
Sarah:
[25:30] you know, your senses, but also having someone with you. This is a beautiful thing of, you know, one-on-one midwifery care or taking a doula to hospital with you, is there someone that can really be your circle of elephants, guard that space for you, going into a, we say, unphysiological, like an unevolutionary context for having a baby.
Mel:
[25:48] Hospital does seem like the opposite to private, safe and unobserved.
Sarah:
[25:54] Yeah. Yeah, it is. It is the opposite. Yeah. You know, and obviously it's been well-intentioned and there are times when we do need to go to hospital and we do need that medical help, but the very setup of it really doesn't support our birthing physiology and that's a problem. We haven't actually realized that. And I think we are starting to wake up to that because we know, I mean, I'm sure you You know, all the evidence of one-on-one midwifery care, having that relationship-based care in labour and birth, you know, that we've had. As I said, my great-grandmother, a granny midwife, we've had it for millions of years, the oldest profession, midwifery, right? So, we've always known that, you know, women need to be supported in labour. Women need to feel safe, you know, in traditional models of care. You know, the most important thing is a woman's emotional well-being in labour. And we've kind of put that at the bottom of the list and kind of surprise, surprise, often labour slows down or stops or doesn't work. And then we need to intervene and kind of, as we say, fill in hormonal gaps. You've created fear, you've created lack of safety, your oxytocin's gone down, maybe your adrenaline's gone up, you've caused a hormonal gap, and then you've got to fill it in with synthetic oxytocin to get labor going again. So we're kind of countering the whole thing. And yeah, I'll come back to this point because there are other ways of kind of, if you're going to hospital, like using your hormonal physiology to make labor effective in hospital. But I need to talk about something else first if I can, which is the snowball of labour. So, just going back to that idea.
Sarah:
[27:19] So, just all of us sitting here, like we're all in what we call homeostasis. Like we're sitting here, our blood pressure's even, our heart rate's even. You know, if we've got a fright, you know, like a loud noise, our heart rate would go up. And then we've got these mechanisms to detect that elevated heart rate and bring it down right. And that keeps us even in homeostasis. But labour is not a homeostatic event, right? It starts small, gets bigger and bigger, and in the end, becomes virtually unstoppable. So I call it the snowball of labor. And the way it becomes virtually unstoppable in that way is because we don't have negative feedback systems that kind of bring things down when they get too high. We actually have positive feedback systems that when things get high, they get even higher. And this is true for oxytocin. So we have this feedback system where.
Sarah:
[28:03] The sensations from the lower pelvis, like the baby's head coming low, the uterus, the cervix, those sensations feed back to our brain by a specific nerve pathway in labor. And that feedback actually tells our brain to release more oxytocin, not less, but more. So we get more released and then that goes back down to our uterus and makes the contraction stronger. We get more sensations and more oxytocin release. So that's kind of what fuels the positive feedback, the snowball of labor. But the really cool thing is at the same time, that oxytocin is released not just from the brain, but into the brain. So all the benefits of oxytocin are happening all the way through labor. And that includes calming, connecting, pain relieving, switching on pleasure and reward centers in the brain and anticipation of bonding. So all this help that the laboring mama or mammals, laboring mammalian mama is getting during labor. And basically, the more intense the labor is, the more intense the contractions, the more intense the sensations. The more brain oxytocin she has. So it's a really perfect and perfectly evolved system for the acceleration of labor and at the same time supporting that laboring mama as she goes through. And then of course, we get to the end and we get those really intense sensations. You might've noticed this yourself.
Sarah:
[29:20] They're bearing down and that's when this positive feedback loop, it's called the Ferguson reflex, starts getting really strong and that helps us to push our babies out quickly and easily because in evolutionary terms, that's so critical. I was listening to the last episode, love it all, about the pushing reflex, you know, and 63 million years of mammalian evolution in the wild, right? If we took two hours to push our babies out, we wouldn't survive. The baby wouldn't survive. So there is a much more effective, efficient way, which is the Ferguson reflex, the oxytocin, and also some adrenaline that helps the mama to get that energy and augments the contraction so that she can push her baby out quickly and easily within just a few contractions.
Sarah:
[30:00] And it all happens efficiently and improves, increases the chance of survival. It's what it's all designed for.
Mel:
[30:07] And what's the importance of oxytocin crossing your blood-brain barrier?
Mel:
[30:13] Why would it, what effect does it have on our brains during labor?
Sarah:
[30:17] Yeah, well, that's a really important question because that's where some of the juices and we're someone we don't kind of haven't really understood how labor works because, as I said, it's not just about oxytocin in the body. Like oxytocin was discovered more than 100 years ago and called oxyfastocin births, like the hormone that makes birth go fast, right? But then we started to discover all these other things about oxytocin in the last 30 years or so, which is that it's calming, it's connecting, it's a social hormone, it's a feel-good hormone, it's the hormone of love, it's the cuddle hormone, a hormone of orgasm, all of those good stuff, right? And basically a feel-good hormone. And it's a feel-good hormone because it has such powerful actions in the brain. So in the brain, it actually reduces activity in their fear center, the amygdala, so we're not so fearful. Important in labor, right? That the mama can feel not fearful and can feel safe. It switches on the reward and pleasure centers so that at that moment of birth, when the mama meets her babies for the first time, a source of pleasure and reward, she goes, oh, these are my babies. It feels really good. I want to be with them, rewarded and motivated, right? Or even ecstasy, euphoria, as I talk about, that's ecstatic birth. It's a hormonal blueprint for labor to be rewarded and pleasured to a maximal extent when we meet our babies. I say, it's like the best first date ever, right, when we meet our babies, yeah, because it's not just a good feeling. It's about survival of the species. So reward and pleasure, intrinsic pain relief, oxytocin has pain relieving qualities as well.
Sarah:
[31:44] There's also something we don't understand, whether it's oxytocin in the brain or the body, but these oxytocin peaks in labor and birth, and I'll come back to that peak idea in a minute, actually change our personality. So when women have been through physiological labor and birth, they report themselves as like less tense, less anxious, more relaxed, more sociable, like kind of seek more social contacts, which is all going to help you taking care of your baby. And also the other thing oxytocin does in the brain is that it actually changes the balance of the autonomic nervous system. And this is like the automatic nervous system. So it's... The nervous system that controls our blood pressure, our heart rate, our skin temperature, et cetera. And when we get a high level of oxytocin, like in labor and birth, it switches on the parasympathetic, which is the rest and digest, calm and connection system, and switches down the sympathetic, the fight or flight system. So labor is actually designed to make us more calm, more connected.
Sarah:
[32:39] And what we actually found out in one of our research papers was that it's not just oxytocin that causes the labor contractions, actually the switching on of the parasympathetic nervous system, they're very closely linked, actually fuels the contractions of labor as well. And it helps to give a kind of feedback cycle within each contraction, the balance between the sympathetic and parasympathetic. You'll have to read our next research paper about all of that. But yeah, all these benefits in the brain. But as you see, Melanie, it only happens when oxytocin is naturally released. So when we naturally release it, we release it into the brain at the same time as into the body, which means that it has both of these effects. But if we inject it into the body, it doesn't cross into the brain through the blood-brain barrier, as you say. So the blood-brain barrier is kind of like a fence around our brain, right? Because we want to protect our brain. We don't just want any old thing going into our brain. So we have this virtual fence. So even though oxytocin could go from the brain into the body, it actually is the kind of molecule that can't cross this fence. It can't go from the body back into the brain. So synthetic oxytocin, And it can cause the contractions of labor, but it doesn't by itself give us those calming, connecting, pain-relieving effects.
Mel:
[33:50] I had a question while you were talking.
Sarah:
[33:52] Synthetic oxytocin. Ask me all your questions because I'm just writing it. We just finished a research paper on it. So, yeah.
Mel:
[33:58] So, then what we're saying is that when oxytocin is released from the brain into the body, then we feel the mental benefits of having that oxytocin in our bodies. But when it's injected into the body, it can't go into the brain. And so that really talks to the fact that women who have inductions do talk about them being a lot more painful than a physiological labor that unfolds.
Mel:
[34:20] So that explains part of that. But also what happens when women have inductions, because there's a lot, as you said, benefits of love and bonding from oxytocin. Is there some research about what happens to women's experience of birth and their experience of their baby once it's born? Yeah. As a result of having been induced instead of going into labour spontaneously?
Sarah:
[34:42] Yeah, look, those are such good questions, Melanie, and we really don't have research about that. But I do need to say a couple of caveats about synthetic oxytocin and these things are a little complicated, right? And also, we don't have a big body of research to draw from in these things. So, just going back to our positive feedback loop, right? So, strong contractions.
Sarah:
[35:01] You have to go to my website, to the epidural blog, and you'll see a nice little picture of this. So, strong contractions, feedback to the brain, release oxytocin, oxytocin to the uterus, strong contractions. It's a feedback loop, right? So, if we do give synthetic oxytocin and it causes stronger contractions, it actually can get that positive feedback loop going. In fact, anything that causes strong contractions. And I think this is kind of explains why there's so many pathways to induce labor if a woman's at an adequate stage of readiness, like castor oil can induce contractions and she gets going on the feedback loop. sex can do it, prostaglandins can do it, those things can do it. But if you do get onto that positive feedback loop, part of that, the stronger contractions, the sensations feed back to the brain. So there can be some brain oxytocin release indirectly from anything that causes strong contraction. So synthetic oxytocin actually can, in some circumstances, cause oxytocin release into the brain. And the conclusion we came to, based on the evidence that we've looked at, is that if you give moderate doses, it's probably not going to cause major upset. But if you give higher doses, that causes stress and not just kind of emotional stress of pain, but actually physiological stress within the tissues. I mean, the uterus is a muscle, right? So you go for a long jog or walk or something and your muscles get sore and you don't have the blood flow that you need to clear all the metabolites in the muscles So you get a buildup of lactic acid and they get a bit painful, right?
Sarah:
[36:31] And the same thing happens in labor. You know, the uterus contracts, then it rests. And during the contraction, you get this, a lot of use of oxygen, not enough blood flow to clear the metabolites. And you get a buildup of lactic acid in the muscle. And then the contraction comes to an end, the blood flow comes back, the lactic acid, all those things, you know, acidity gets cleared away and you start again. Whereas when you give synthetic oxytocin, the contractions are stronger. You might have noticed this right if you had it. But also closer together. So you're basically exaggerating all of those effects. So you get more of a buildup of lactic acid, you get more pain, more stress, and actually more switching on of the stress system. So synthetic oxytocin kind of causes more of a variation, more kind of a trend towards a stress system than that anti-stress, the parasympathetic system that we were talking about.
Sarah:
[37:25] So what we think happens, and this is a theory at the moment because it hasn't been tested is that synthetic oxytocin may push women more towards sympathetic stress than the parasympathetic calm and connection system. So, you may come out of labor and there's some evidence for this with your system a little bit oriented more towards the stress system than the anti-stress system and that could impact even, you know, some studies have shown it could impact oxytocin release with breastfeeding later on. And the other problem with synthetic oxytocin is the whole cascade of intervention that we talk about because, as you said, it causes contractions that are more painful, but more painful at an early stage of labor because, you know.
Sarah:
[38:05] The snowball builds up, you get a bigger and bigger unstoppable contractions, but you also get all this intrinsic pain relieving mechanisms as well. Whereas if it starts off with a big snowball before you've had time to build up, then it is going to be more painful. And if it's more painful, you're going to need some kind of pain relief and often that's an epidural. And those two things together seem to be the most disruptive to the hormones,
Sarah:
[38:26] the epidural plus the synthetic oxytocin, as far as we know from the research we've looked at.
Mel:
[38:31] So interesting. So it's making me think, really, one of the really most important things that women and care providers can do is to really honour and respect oxytocin in labour. And allow it to do its work. But how can we get out of the way of oxytocin? How do we as care providers help facilitate a process where oxytocin can do its work so that the woman's body functions as it should?
Sarah:
[38:58] Good question. Well, I think as a midwife, that's your job, really. You know how to do that, right? You're with women. You know how to hold that space for women because as a midwife, as a continuity of care midwife, you have the opportunity to get to know women right from the very beginning, you're going to have a sense of that and you'll probably discuss that. What is it that helps you to feel safe in labour? And the woman's going to know. She can go off by herself if she needs to. She can have the support if she needs. She can ask for what she wants from you in that situation. And that's really also the brilliance of home birth because it's so much easier to do that at home. And it's really why the need for intervention is so much lower at home because women almost by definition have that sense of being private, safe and unobserved in their own space. And, you know, no animal goes out of its own space to give birth, right?
Sarah:
[39:45] You know, they don't go to an unfamiliar place and they don't have unfamiliar people. So, we're really to take care of the oxytocin system. You know, those are kind of, we could say, hormonal gaps or social gaps in labor. We need to fill those in. We need to soothe the limbic system. We need to support the primitive brain in labor. It's probably, it's probably something like in a quiet, safe place, whatever that is for the woman. And and allowing the woman the space to go and find that place. It might be a shower. It might be often first-time mummers. It's the toilet, right? The smallest room they can find feels the safest. No one's going to come in there. It might be water and water's brilliant for that because you do get your own space and people can't kind of intrude or interfere so much when you're in a tub. So it's kind of, it's a very individual thing. But it is, you know, also an oxytocin is a hormone of relationship, right? No, it's a social affiliative hormone. And, you know, my own story, when I went into labor with my first baby, I was a bit early and I was a bit scared and my labor went faster than I thought.
Sarah:
[40:45] And I called the midwife and she came in as I was pushing and I was like, oh, my God, I was in some fear. And she walked in and this woman, like I'd seen her for hour long consultations right through my pregnancy, like we knew each other well. And just I looked in her eyes and I had this transmission of safety. I feel safe now and I can push my baby out. And you can't kind of, you know, you can't categorise that. You can't put that into a machine. Like that's relationship. And that's what makes midwifery care so critical. And that's why we've had midwives for however many millions of years, right? Because that's what works. You know, we need relationship. We need to feel safe inside relationship. And that's what you provide as a midwife. Yeah.
Mel:
[41:22] I can attest to a similar thing happening with me as the midwife and a woman ringing and going, oh my, I think we're close. I think you need to get here. and I was luckily very close to her house and I arrived and I'll never forget she was on her hands and knees in her bathroom and her husband said uh oh Mel's here and she looked back and she went oh thank god and just went and pushed and the whole baby came out and it was as if she was like no I am not doing this until Mel gets here whether it was a sense of safety or you know whatever it was but she was she had this level of control over her body and then obviously when all the pieces fell into place for her she's like good Mel's here, I can let this baby out. So it's so powerful what women can do. So if there's been a situation in a woman's birth where it's obvious that her oxytocin flow has been interrupted, are there things that women can do to get it back on track? And you alluded to that of sort of hiding away and finding a safe space where you are. But have you got any top tips for women? What can women do to bring the oxytocin flow back?
Sarah:
[42:32] Yeah, well, as we're saying, I mean, how can you find a place that's private, safe and unobserved? But the other hint I would have, as we talked about oxytocin being a hormone of sexual activity, right? As Anna May Gaskin says, the energy that gets the baby in can help to get the baby out. So if you want a really good way of releasing oxytocin, you know, sexual activity, orgasm. My good friend, Deborah Pascali-Banaro, made the film called Orgasmic Birth. I recommend that you check it out. And she actually, she's a in New York and she tells women, take a vibrator to hospital with you and leave it on the bed. And if that doesn't clear the room, turn it on. And if you really need oxytocin, use it, right? Sexual activity releases oxytocin. Orgasm releases oxytocin. It's much more fun than an oxytocin drip. So sexual activity or at least hugging, kissing, there's some beautiful examples of that in the orgasmic birth film, you know, and at least the circumstances that would make you feel safe to do those things.
Mel:
[43:29] And things like nipple stimulation, I guess that's the same sort of thing.
Sarah:
[43:33] Yeah, yeah.
Mel:
[43:35] Exactly.
Sarah:
[43:35] Nipple stimulation releases oxytocin, yeah. Releases high peaks of oxytocin quite powerfully, actually. There's a really interesting study of that. But I just want to go back to one more thing before we move on, which is I talked a little bit about epidurals, but that's a real problem in labor and birth for oxytocin because just going back to our feedback loop, right, you get the strong contractions, the sensations, the brain oxytocin release, the oxytocin release to the uterus. Well, the trouble with epidurals is they're so powerful at stopping the sensations. And if you stop the sensations, you basically stop that whole feedback cycle. And if you stop the whole feedback cycle, you don't just stop oxytocin in the body and slow contractions down, which is usually what happens. And then you give synthetic oxytocin to fill in that gap. You also actually stop the release of oxytocin in the brain. So there've been some interesting studies looking at that. And one found that, remember, I talked about the personality changes that happen in physiological labor and birth that didn't happen when women had an epidural, right? And the other thing I didn't mention is that we think something happens in labor and birth with the oxytocin system, maybe in the brain, maybe in the body, that makes the mother's body sensitive so that when she has her baby on her skin-to-skin after birth and the baby does those pre-breastfeeding behaviors of massaging the nipple and suckling, she releases a lot of oxytocin. But if she's been through a pre-labor But caesarean, for example, she doesn't release oxytocin. She's missed that.
Sarah:
[45:00] Something switching on. We don't know what it is. And it seems like with an epidural, the same thing happens to some extent. So, the baby's skin to skin and the mom has had an epidural. The baby has to work harder to try and get the mother to release that oxytocin. And even then, she doesn't release as much, according to some research that's been done. And kind of, we think the baby knows that because the baby expects to come into this soft, warm, parasympathetic nervous system, oxytocin-fueled state after birth. You know, the oxytocin peaks that happen when the mama pushes her baby out. Remember we said the Ferguson reflex, that positive feedback loop that's going so strongly in those moments, the pushing stage. So the mother has like from early labor to the pushing stage, three to four times increase in oxytocin as we can measure, as far as we can measure it in labor, which is quite difficult. But then in that hour after birth, it can go up even 10 times higher, right? because the baby comes onto the mother's chest and the oxytocin that the mother releases at that time literally pulses heat to her baby. It causes, we call, vasodilation, opening up of the blood vessels on the chest wall, forming that magic of skin-to-skin, that very effective way of keeping the newborn baby warm. And after a pre-labor cesarean, the mother doesn't have those peaks and she doesn't form that soft, warm place for the baby to be. The baby knows, the mama knows, there's a hormonal gap there. And we can fill in that hormonal gap, but first of all, we have to know that it is there.
Mel:
[46:26] So then pain is actually an important and vital part of labour for that hormonal process to unfold, but then also has the capacity to turn on mothering.
Sarah:
[46:39] Yes. Yeah. Well, I wouldn't say necessarily pain because women could have a painless physiological birth. So it doesn't have to be necessarily the sensation, you know, the physical sensation of pain.
Sarah:
[46:51] But yeah, that feedback loop of the sensations to the brain is really important. And if we switch that off with an epidural, yes, that's exactly right. It doesn't activate the oxytocin in the brain in all mammals. It's critical for mothering. Like it switches on those instinctive mothering behaviors. It switches on the pleasure and reward centers. You get that euphoria. You know, you get the literal firing and wiring in the brain. You get the sensations of the babies. And imagine a mammal that's never given birth. Like what the hell is going on here? That'd be quite frightening, right? So then they get this reward and pleasure center activation, the calming effect of the labor of oxytocin and labor. And then they get the sensations of the babies at birth, the smell, the taste when they look at them, the sight, the touch. And then that gets fired and wired with the pleasure and reward centers in the brain. So then the mom literally is wired for pleasure, for reward and pleasure from connection with that baby. And that's what happens in humans as well. We're designed to, we could say fall in love, but we could say be rewarded by the physical sensations of our baby, you know, and that's what's going to have us do all those difficult things that every mammalian mother has to do to take care of their babies. Like it's hard work, right? But you get that reward and pleasure that gets activated. And another interesting study in relation to this was actually a study of mothers who'd had either a physiological birth or a pre-labor caesarean.
Sarah:
[48:16] And two to four weeks afterwards, they wheel them into an MRI machine in this big metal box, right? And they play them the sound of their baby crying. And inside this MRI machine, they could look at what happened to the mother's brain in that circumstance. And the women who'd had a physiological birth had the reward and pleasure centers lit up, the empathy centers lit up, the alertness centers lit up. This is my baby. I need to do something. But in the pre-labor cesarean mothers, those things didn't happen to the same extent. So that activation that should have happened, that hormonal gap from later and birth, had that ongoing effect.
Mel:
[48:49] So then for women who've been through either a pre-labor cesarean without having gotten contractions and that oxytocin or who've had an epidural or an induction, is there anything that they can do to fill the hormonal gaps that get left behind?
Sarah:
[49:06] That's the most important question. Thanks, Melanie. Yeah, but also an in-labor cesarean because some of those really big peaks of oxytocin only happen at the very end at the pushing stage. And to be honest, we can't really even measure that. We don't even know how big they are because, well, first of all, the peaks are very narrow. So you have to take multiple samples in a short phase of time. And women, when they're pushing their babies out, right, which is kind of like any of the data we've got there, I'm very grateful for to the women who did that. It's hard to get those peaks, but we think the peaks could be massively high, especially at that stage. And it's probably the peaks.
Sarah:
[49:43] Rather than little pulses, rather than kind of a general increase that activate the brain and all those things we're talking about. So, if you don't push your baby out, if you have an in-labor cesarean, you're still going to end up, I mean, it's better, but you'll end up with a hormonal gap as well. So, basically, something that should have happened didn't happen. That's my definition of a hormonal gap. So, you've got basically an oxytocin deficit. And the other point about these hormonal gaps is, as I hope has been clear, it's not just about what happens. It's about the window of opportunity, we could call it. So the same thing happens in labor and birth. There's this window of opportunity when everything's all lined up, all the things we've talked about, oxytocin, estrogen, the receptors, prostaglandins, inflammation, it's all there. The mother's body's ready. The mother's brain's ready. You get this release of oxytocin, all these things get switched on, meets the baby. It's all good. That's mother and she's superb design. But if we miss that window of opportunity, we're going to have to work harder. And the things we're going to do to fill in that oxytocin gap is basically two things. Skin to skin releases oxytocin for mama and baby. And then breastfeeding releases oxytocin for mother and baby. It's the hormone of the letdown reflex for the mother. When the baby suckles and stimulates the nipple and then you get this big surge of milk coming down, that's the release of oxytocin from the mother's brain. We actually did a study...
Sarah:
[51:04] Looking at oxytocin levels released during breastfeeding. There was a beautiful, we did a review of the studies of that. There was a beautiful study where they looked at the oxytocin levels going up and the cortisol levels going down. They were like mirror images of each other. So oxytocin settles all of those stress systems as well. So that's happening with every breastfeed. So breastfeeding fills in hormonal gaps, skin-to-skin fills in hormonal gaps, but you're going to have to do it for longer than you would if it was a physiological labor and birth. So you can fill in the hormonal gaps, but you're going to have to take longer. But basically holding your baby, especially skin to skin, and breastfeeding liberally is really important.
Mel:
[51:42] It's really comforting news for women whose births hadn't gone as they would hope, that you can actually recover that process. But just know then that it would take a bit longer if it happens outside of that window of opportunity, but it can be done.
Sarah:
[51:57] Exactly, yeah. Yeah.
Mel:
[51:59] So then the impact of, let's say we'll go back to physiological birth. What happens then with physiological birth of the placenta? In my own work, most of the women who I care for at home end up having physiological placental birth. And I talk to them about how, well, if we can rely on the birth process, bringing out your baby, and we don't interrupt it at that point, then we can assume that your body's going to do the same with your placenta if it's all left alone. And so that People talk about this golden hour, which is probably a lot longer than a golden hour. But in that immediate time after the baby is born, I make a very conscious effort to extract myself from the birth space and not make too much noise. And I encourage them not to make phone calls and do any of this chaotic stuff after the baby is born because we still need to protect the hormonal situation to facilitate placental birth. So can you talk to us what happens? the baby's born and then what happens to that oxytocin as we await the placenta.
Sarah:
[53:01] Yeah. Yeah. So a few studies have looked at oxytocin release after the birth. There's a very beautiful study actually from 2001 where they measured every 15 minutes, they measured the mother's blood oxytocin levels. And they also videotaped the interactions between the mother and the baby for two hours after birth. And the first thing, I recommend the listeners go and look up breast crawl and look at some of the breast crawl videos because there's this instinctive behavior that babies do at birth. And it was quite a revelation in human babies. We knew that animal babies did that, but actually human babies can actually find the nipples. Like when I was at medical school, we learned about all these like reflexes that newborn babies have, like the stepping reflex and those kinds of things. But actually they had a purpose to help the baby find the nipple. That was quite amazing to discover that. When we stopped taking the babies away, they're actually quite smart. Anyway, so in the breast crawl, the baby will actually crawl itself up the mother's belly and on the way will step on the uterus, which kind of massages the uterus, helps it to contract. The baby will find the nipple, probably because it smells like amniotic fluid and it's a nice little target. You know, the baby can see it. And the baby will start actually to massage the nipple with the hand, yeah.
Sarah:
[54:14] And that will cause a release of oxytocin in the mother. And then the baby will suck the fist, like get the salivary juices going, and then the baby will suckle eventually. And the whole process can take 40 minutes or longer, right? And in this particular study, as I said, they looked at, videotaped the baby's behavior and they also measured the mother's oxytocin. And what they found was that the mother's oxytocin level, every time the baby massaged the mother's breast and eventually suck or the mother had a peak of oxytocin. So what's really important to know about that is the mother's oxytocin release after the birth, it doesn't just happen from the birth, that actually happens from the baby's activities on the mother's body. So we only know this because we stopped taking babies away, right? When I trained in hospital obstetrics, we took the babies away. We took the baby over there, we examined them, we gave them oxygen if they needed. That's what we did. We cut the cord and took the baby away. I remember the first home birth that I attended as a doctor. It was very funny. I took the baby and I was going to take the baby away and the mother said, what are you doing?
Sarah:
[55:20] Oh, that's right. The baby belongs to the mother. Anyway, so if you leave the baby with the mother, it all happens. The baby will find the nipple, will massage the nipple, will suckle the fist, will massage the nipple, will suckle the breast eventually. All of those things cause this peak of oxytocin. In this study, They had a beautiful illustration of one of these mamas and her oxytocin levels went up 10 times from birth with that first infant breast massage. So all of those things the baby's doing is stimulating their release of oxytocin, which is, as I mentioned, vasodilating the mother's chest wall, forming this very, very effective warming mechanism for the baby. I mean, it's the only way babies have stayed warm for millions of years, right? And it pulses heat to the baby and we know if the baby's a bit warm, it pulses less heat. If the baby's a bit cool, it pulses more heat. Like it's this beautiful, we say mutual regulation process.
Sarah:
[56:13] But not only that, but that oxytocin peak is critical for the mother as well because she's just had the placenta peel away from the inside of her uterus and it kind of causes some tearing of the blood vessels that is going to bleed to some extent. And the tighter her uterus contracts at that time, the more that's going to get sealed off. So it's critical that she has these strong uterine contractions at the same time. So these peaks of oxytocin happen because of the interactions with the baby. They support the baby at that time by keeping it warm. They support the mother
Sarah:
[56:46] at that time by contracting her uterus. And the most important thing is don't take the baby. If you take the baby, you remove those opportunities for the mothers to release oxytocin.
Mel:
[56:56] And I also talked to other midwives about not speaking to the woman because you can see that they're in this really insular bubble. They're looking down at their baby. Their partner might be in that space looking and you know in this bubble and then to suddenly talk to or expect an answer from a woman you're almost drawing them away from that internal that experience with their baby and I just think if we're going to keep women safe in that placental birth phase we've got to let them stay right right deep in that little baby bubble that they're in to allow the oxytocin to flow that's very possible in a situation where a woman's chosen at home birth always got a care team that respects that process But do we know what happens to that important phase at the end with the placental birth if the placental birth is actively managed with an injection of oxytocin?
Sarah:
[57:50] Yeah, there have been a couple of studies that have looked at synthetic oxytocin. One was really interesting. We've just been reviewing these studies. So they measured oxytocin levels in mothers. This was quite an old study, so we presume the babies were probably taken away, but we don't know. It wasn't commented on. that they had mothers who'd had the injection of synthetic oxytocin or not.
Sarah:
[58:11] And the mothers who didn't have the injection, I think about a third of them had peaks of oxytocin almost very similar to the woman who had the injection.
Sarah:
[58:20] So you can release oxytocin at that time, but even better if you have the baby. And as I said, synthetic oxytocin kind of started to be given, I think, to fill in that hormonal gap that we created by taking the baby away. And I just want to say, I so agree with you about that, the preciousness. I mean, it is an early sensitive period after birth. And I like what Michelle O'Donnell says. He says, don't wake the mother. No, she's still in this hormonal bubble, as you say. And it's so critical not to disturb that because this oxytocin is vulnerable to interference. You know, if she feels frightened, if she feels not safe, I mean, that could reduce her oxytocin release, which is going to increase her risk of bleeding, is going to increase the risk of her not warming up her baby, all of those things. And it's also really important for the baby too because this is a whole other story, but the baby at the end of birth gets a peak of adrenaline actually that helps to protect the baby, the baby's brain particularly during those strong contractions of labor and also helps to prepare the baby for life outside the womb in a number of levels. But anyway, as the baby's born, they have this peak of adrenaline and noradrenaline. So the baby born after physiological birth is like wide-eyed and alert, yeah?
Sarah:
[59:30] But that peak of adrenaline and noradrenaline is actually what I call metabolically expensive, right? Because when we have adrenaline and noradrenaline, we're kind of hyped up and using a lot of metabolic fuels. And the newborn baby doesn't have a lot of metabolic fuel. So it's really important for the newborn baby as well that they go skin to skin on the mother so that those adrenaline levels can come down, the oxytocin comes in, counteracts all the stress, the baby relaxes.
Sarah:
[59:57] The baby feels warm and safe, and then the baby's metabolism will slow down as well. And also, oxytocin is a social hormone, as you say, that little social bubble that happens. And also, it's eye-to-eye and skin-to-skin releases oxytocin. So it's all designed for those peaks of oxytocin in that, as you say, magical hour after birth. And it is kind of, you know, it really is. I mean, it can extend to some extent, but the hour or the first one to two hours seems to be the most critical. And it was interesting, you know, in that study that I was mentioning where they videotaped the mother.
Sarah:
[1:00:34] The mother had three peaks of oxytocin. The first one was when the baby massaged her nipple. The second one was a second bout of nipple massage. And the third one was when the baby suckled. This is over about 90 minutes. And those peaks of oxytocin actually got lower each time. So it seemed like in this instance, the mother was most sensitive in the early time after birth. And she lost some of that sensitivity in relation to releasing oxytocin with contact with her baby.
Sarah:
[1:01:04] So that sensitivity probably does decline. And I'm going to mention another study, which was a really amazing study. You couldn't do it these days. It was done in Russia, where all the babies were automatically taken away and wrapped up like little babushkis and put in those long nursery photos you see, right? So they could randomize babies to skin-to-skin contact or being swaddled or being put in the nursery, right? So there were several groups. And the babies that had the skin-to-skin contact in the first two hours, well, they followed all the babies up to one year and they again did a videotape of the babies and mothers engaging in like a play episode. And the babies that had that skin to skin in that first two hours had more kind of self-soothing, more like self-regulation and they had a better interaction with the mother as well from something that happened in that first two hours after birth. And the babies that were swaddled or taken away to the nursery, that didn't happen. And it also didn't happen in the babies that were taken away but then later given to the mother, you know, rooming in. So it really emphasizes that the time after birth is a sensitive period,
Sarah:
[1:02:09] is a magical hour when we really want to keep mothers and babies together as much as possible.
Mel:
[1:02:13] Oh, my gosh. I feel like I've heard you speak on this all before, but every time you speak, I learn something new, and I'm just so glad that you could share this with us today. Oh, man, thank you so much. I feel like that is a beautiful package of information.
Sarah:
[1:02:32] My pleasure, my pleasure from my uterus to yours.
Mel:
[1:02:36] All of our uteruses, we wish upon you oxytocin in an uninterrupted fashion, but know that if that cycle does get interrupted, there's ways that you can fill those hormonal gaps with extended skin to skin and engaging in breastfeeding and a protected postpartum period where you don't have to let your baby go.
Sarah:
[1:02:59] Exactly. Beautiful, beautiful. Wonderful. And midwifery, you know, big call out for midwifery, really. I mean, it is, that's the exciting thing that's happened, you know, in the birth activism stage is that we knew instinctively how good it was to have your own midwife, right? And in Australia, like continuity of midwifery care, choosing your midwife is part of home birth. But now there's so much evidence around that and the Lancet and the World Health Organization and all these big mega organizations are saying continuity of midwifery care, one-on-one midwifery care is going to, you know, benefit mothers and babies around the world. And, you know, not just all the things we've talked about, but, you know, it reduces the risk of fetal death, you know, it reduces preterm birth. I mean, so many benefits to one-on-one midwifery care. So, wherever you are, if you have that opportunity to have that model of care, to have your own midwife, I'd really highly recommend it.
Mel:
[1:03:52] Absolutely. I'm so glad you mentioned that because this is one of my most ranty points that I get on when people are like, oh, how can we reduce the cesarean section rate? How can we reduce all this and that and that? I'm like, gosh, we've already got this research. We know that women feel safe with midwives and that midwives protect physiological birth and that physiological birth protects women and baby. We don't need to keep researching more interventions and more strategies and more locations and more health professionals. Oh, my gosh.
Sarah:
[1:04:24] Yeah, and other ways to prevent preterm birth. I mean, some of the studies now are just brilliant, like Indigenous models of midwifery care reduce preterm birth by half, you know, 12% to 6% here in Brisbane. It's just incredible. So it really is, you know, relationship is brilliant, you know, the relationship you have with your midwife. Highly recommend it.
Mel:
[1:04:42] Yeah. Oh, take home that. Learn a private midwife or any midwife. Continue to care with a midwife.
Sarah:
[1:04:50] And if you can't get, in your model of care, you can't do that, then I would highly recommend a doula. If you have to go to hospital and you can't get that continuity and you're going to end up with a shift, whoever the midwife is on the shift, she'll probably be lovely or he, even he, but really having a doula, someone that you get to know in your pregnancy that's going to be there in your labor and birth, that's going to help you to feel safe. And that also knows how to, you know, we could say reconfigure the hospital to make it more adapted to you. So if you can't have a midwife, have a doula.
Mel:
[1:05:18] I'm glad you mentioned that because we go on about doulas being, you know, the best birth companion you can take with you into hospital as well. So amazing. Well, that's the end of our episode, episode 15 with Dr. Sarah Buckley. If you want access to any of the resources that Sarah was talking about in today's episode, sign up to the mailing list at melanethemidwife.com. And Sarah, where can we find out about you? Because your website's got a stack of resources as well.
Sarah:
[1:05:46] Yeah, yeah. SarahBuckley.com. And I recommend you look at the blogs. There's a really good blog about epidurals. There's blogs about induction. There's blogs about midwives. And you can get on my email list as well. And all my papers are linked there as well. So you'll find out when that comes out as well.
Mel:
[1:06:01] All right. That's it for this episode. We will see you in the next episode of The Great Birth Rebellion.
Sarah:
[1:06:08] Thank you.
Mel:
[1:06:10] To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com. And to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com follow me mel at meli the midwife on socials and the show at the great birth rebellion all the details are in the show notes
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