Hormones & Healthy Birth: Letting Labor Begin on Its Own

Last week, we introduced the new report from Childbirth Connection on the important roles that hormones play during pregnancy, birth, and postpartum. If you haven't had a chance yet, I encourage you to check out the accompanying parents' guide, "Pathway to a Healthy Birth." As promised, we're going to delve a little further into the report and share with you how hormones play into each of the Lamaze Healthy Birth Practices. Today, we're talking about "Healthy Birth Practice 1: Let Labor Begin on Its Own" and the important function of prolactin and oxytocin.

The Lamaze Healthy Birth Practice 1, in a nutshell, says that letting your body go into labor spontaneously (on its own time) is almost always the best way to know that you and your baby are ready for birth, and increases you and your baby's chances for a smooth and healthy labor and birth, and good start in life after birth. Similarly, the Hormonal Physiology of Childbearing report, crafted and written by Sarah Buckley, tells us that allowing birth to begin on its own increases the chance of a more efficient labor and better transition for mom and baby (Buckley, 2015, page xi). While the process and reasons behind "going into labor" is not yet understood completely, it is believed that baby releases cortisol (steroid hormone) at the same time that mom increases production of estrogen (female sex hormone) (Buckley, 2015, page xi). Allowing this process to unfold on its own, and providing space for the complete symphony of hormones to play out, as is done in a physiologic (normal, naturally occurring) birth, can offer the following benefits (Buckley, 2015, page xii):

For Mom

• Rising estrogen levels before labor, helping prepare the uterus to be more efficient in labor
• Increasing oxytocin and prostaglandin to help ripen cervix before labor
• Increased oxytocin receptors in the uterus before labor to create more effective contractions during labor and after birth, which reduces bleeding after birth
• Increased beta-endorphin receptors before labor, which provides natural pain relief in labor
• Increased oxytocin and prolactin receptors, which encourage successful breastfeeding and bonding with baby after birth

For Baby

• Baby's lungs and other organs mature prior to labor
• Increase in catecholamine receptors before labor to ensure baby has enough oxygen during the labor process
• Surge of catecholamines during labor to ensure baby has enough blood supply to heart and brain
• Catecholamines in labor also help baby after birth with breathing, energy and glucose production, and regulating body temperature

But what happens when we cut off these natural hormonal processes with a scheduled labor (induction) or scheduled c-section? Won't mom and baby's hormones naturally kick into gear once the induction process starts? Or what about when a cesarean is scheduled before mom goes into labor naturally? In the report, Buckley shares with us the possible side effects of interrupting the natural flow of hormones via scheduled induction or c-section (Buckley, 2015, page xii):

For Mom

• Less efficient contractions, which increase risk of failed induction, use of forcep or vaccuum, and postpartum hemorrhage (excessive bleeding)
• Reduced prelabor oxytocin and prolactin receptor peaks, which can make breastfeeding and attachment to baby more difficult

For Baby

• Increase in the possibility for reduced oxygen during labor, leading to "fetal distress"
• Increased possibility for breathing difficulties, increased risks of postpartum breathing difficulties, low blood sugar, and low body temperature after birth
• Brain, brain hormones, and other organ systems that are not as mature as they should be

Advancements in modern medicine have resulted in the ability to save mothers and babies who need special care or are high risk and otherwise would not have survived. When special care is medically necessary, induction and cesarean can be life-saving and may be the best choice, despite the affect on birth hormones. However, as Buckley states, "current high rates of maternity care interventions may be disadvantageous for the healthy majority" (Buckley, 2015, page x). And since recent research suggests that less than half of US mothers and babies experience labor starting on its own (Buckley, 2015, page 20), it's likely that induction and c-section are performed for some women without medical necessity, causing increased risk with little or no reward (Buckley, 2015, page 2).

So how can you increase your chance of letting labor begin on its own and allow your birth hormones to do their critical work? I'm glad you asked! We've prepared a to-do list for just the occasion:

Let Labor Start on Its Own - Here's How

• Choose a doctor or midwife who has a low rate of induction and who is comfortable with a pregnancy that lasts 42 weeks.
• Know that your "due" date is not an expiration date. Only about 5 percent of moms give birth on their due date. Instead of a day, think of it as your due "month."
• Learn about induction -- when it's needed for medical reasons and when it's used for reasons of convenience. A good childbirth class will cover this topic in detail, as well as give you the tools you need to ask the best questions and make an informed decision.
• If your care provider suggests an induction, ask questions . Is it an emergency? What's the risk in waiting? What are the alternatives?
• Hire a doula who can provide resources and information on labor and local care providers and birth places.
• Remind yourself that every day your baby is still on the inside is one more day she needs to grow and develop. Healthy babies are worth the wait.
• If you end up needing an induction, learn how you can keep your labor as normal and healthy as possible . If you are induced through the use of Pitocin, consider asking if your care provider can turn down or turn off the Pitocin once your body has established a good contraction pattern.

Choosing the Best Care Provider to Let Labor Start on Its Own - Questions to Ask

• How do you support the natural hormones that help my baby and me through labor, birth, breastfeeding and bonding?
• What do you do to avoid things that might disturb birth hormones?
• What, if any, medical treatments or monitoring do you regularly use for all women during labor and birth? (If a doctor or midwifere commends medical treatments for all or most women, you may want to look for someone else.)
• When would you recommend induced labor and why?
• When would you recommend a cesarean and why? (Childbirth Connection, 2015, page 13)

Additional Resources

• Download the Lamaze Healthy Birth Practice Paper, available in eight languages, to learn more about letting labor begin on its own
• Watch a video on why it's important to let labor begin on it's own
• Learn about the "best evidence" for induction of labor

References

Buckley S. 2015. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care. Childbirth Connection, Washington, DC.

Childbirth Connection. 2015. Pathway to a Healthy Birth: How to Help Your Hormones Do Their Wonderful Work. National Partnership for Women & Families, Washington, DC.