Hormones, Childbirth And The Mother-Baby Connection
A new report explores how maternal healthcare can disrupt or enhance the hormonal physiology of birth.
Few people would dispute that hormones rule the world of pregnancy and childbirth. Many people don’t realize however, that mothers and babies’ hormonal systems are interconnected and that common maternal health interventions that disrupt those connections may lead to poor health outcomes.
Childbirth Connection, a program of the National Partnership for Women and Families, released a report this month entitled, “Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care.” Their research discusses how hormone systems function from late pregnancy through the early postpartum period and how commonly used interventions — such as labor induction, epidural analgesia, and cesarean section — can disturb hormonal processes and interfere with the benefits they offer. They specifically explore four interconnected hormonal processes between mother and baby that can optimize their labor, delivery, and postpartum experiences and how hormonal actions of one phase anticipate and prepare for subsequent phases. In healthy pregnancies, these processes foster efficient labor, mother-baby safety, bonding and successful breastfeeding. When they’re interrupted by common medical interventions like routine use of synthetic oxytocin and epidurals, then a cascade of complications can occur. For example, it often happens that maternal oxytocin levels decrease after a mother receives an epidural. That leads to mom receiving synthetic oxytocin (Pitocin) to make her contractions stronger, which can lead to desensitization of her natural oxytocin receptors, reduce the ability for her uterus to contract after the placenta is delivered and increase her risk for postpartum hemorrhage.
The report is jam-packed with information for mothers and healthcare providers and specific suggestions for promoting a low-stress birth environment and non-pharmacologic pain management. But since interventions like routine Pitocin-use and epidurals are so much a part of the American birth landscape, we asked Carol Sakala, Director of Programs at Childbirth Connection, how they expect this report to impact maternal healthcare.
Sakala says, “Maternity care in the United States is at a tipping point. In recent years, induction and cesarean rates have slowed down and 2014 was a watershed year from the perspective of professional leadership. Hormonal Physiology of Childbearing is another force in this momentum to foster better alignment of practice with best evidence.”
Sakala provides these examples:
- ACOG and the Society for Maternal-Fetal Medicine issued a statement that cesarean section is overused and causing excess harm. It makes many recommendations reflecting proven practices that can be used to reduce the cesarean rate.
- The Association of Women’s Health, Obstetric, and Neonatal Nurses issued a practice statement opposing elective labor induction and augmentation plus a revised performance measure set that includes provision of labor support, comfort measures, and skin-to-skin contact.
- The American Academy of Nursing issued its Choosing Wisely selections, including a recommendation against electronic fetal monitoring for low-risk women and for periodic listening (“intermittent auscultation”).
- The American College of Nurse-Midwives issued a physiologic birth toolkit.
The U.S. doesn’t offer many pain management options for laboring women other than epidurals. Sakala addressed how the report can alleviate women’s worries about their options. She says, “We support giving women high-quality information and options for pain relief. We don’t propose taking any options away. Pregnancy is the time to make plans for a safe, smooth birth. This might include finding a setting where tubs, showers, birth balls, and other comfort measures are available or having a doula and learning about beta-endorphins, the body’s own pain relief and stress reducer, and how to enhance their action. Midwifery care or a freestanding birth center can also give good access to non-pharmacologic pain management approaches. Knowledge, confidence, and preparation — which might be gained from a good childbirth education class — are important.”
So there’s still room for epidurals?
Sakala says, “Epidurals have a definite role in some situations. We encourage women to step up to epidurals as needed rather than using them as the initial, front-line approach to pain relief. And when women do use epidurals and other consequential interventions, we recommend adhering to practices that enhance physiologic processes. For example, waiting for labor to begin on its’ own, experiencing early and ongoing skin-to-skin contact, and getting breastfeeding off to a good start. Our Pathway to a Healthy Birth booklet provides many tips for patients and clinicians to enhance these processes.
What about women who need interventions?
Desiree Bley, MD, an obstetrician in Portland, OR says, “I like that this report asks patients and providers to think about hormones and to be patient. But it also presumes somewhat that every patient is naturally hormonally perfect. Some mothers are challenged metabolically and some mothers and babies lack hormonal triggers. All hormonal interactions are important but as humans we’ve figured out ways to adapt in situations where we weren’t given the best of everything to start with. As for epidurals — we can do a better job of providing other pain management approaches, but we can’t discount the fact that when moms are fatigued physically or mentally, epidurals are very good tools. I tell my patients before they go into labor that we’re going to work together to make this experience healthy, pleasant and effective. I tell them, ‘It’s going to be hard but you’re going to have help.’ Then, we do our best to provide the help that’s safe and appropriate.”
The value of this report may be in providing more information and incentive for mothers and other clinicians to take a similar approach to utilizing safe and appropriate health care.