Helping Your Mammalian Body (and Baby!) Have an Easier and More Connected Birth
Helping Your Mammalian Body (and Baby!) Have an Easier and More Connected Birth
Helping Your Mammalian Body (and Baby!) Have an Easier and More Connected Birth
Episode Transcript
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<!DOCTYPE html><html lang="en"><head><script nonce="AxDPinBGMAo1r8gZ9UDCKw">var DOCS_timing={}; DOCS_timing['pls']=new Date().getTime();</script><meta property="og:title" content="240417_SarahBuckley_Hormones_Transcript"><meta property="og:type" content="article"><meta property="og:site_name" content="Google Docs"><meta property="og:url" content="https://docs.google.com/document/d/1TBwsKqxJwyNJELWKDTt0HH4Jo0d1shH3tiLXdk-HIAo/edit?usp=sharing&usp=embed_facebook"><meta property="og:image" content="https://lh7-us.googleusercontent.com/docs/AHkbwyKyqFihWgNmhxCJnKnbQzu9K3XLESRitbmrnMq3EuTjnAbv98gvJDbzkTzSumx-6jdbJfIug7Jnqa2RtHWaNWHhBepjRBsESxYIPNOxwAIPcEwyRkA=w1200-h630-p"><meta property="og:image:width" content="1200"><meta property="og:image:height" content="630"><meta property="og:description" content="Helping Your Mammalian Body (and Baby!) Have an Easier and More Connected Birth During labor, you want contractions that are longer, stronger, and closer together. But why? Dr. Sarah Buckley and Adriana take a deep dive into the amazing and fascinating hormonal dance that happens during the birth..."><meta name="google" content="notranslate"><meta name="viewport" content="width=device-width, user-scalable=no, initial-scale=1.0, minimum-scale=1.0, maximum-scale=1.0"><meta http-equiv="X-UA-Compatible" content="IE=edge;"><meta name="fragment" content="!"><meta name="referrer" content="origin"><title>240417_SarahBuckley_Hormones_Transcript - Google Docs</title><link rel="shortcut icon" href="https://ssl.gstatic.com/docs/documents/images/kix-favicon-2023q4.ico"><link rel="chrome-webstore-item" href="https://chrome.google.com/webstore/detail/apdfllckaahabafndbhieahigkjlhalf"><script nonce="AxDPinBGMAo1r8gZ9UDCKw">_docs_webfonts_fontFaces = null; _docs_webfonts_iframe_fontFaces = null;DOCS_timing['wpid']=new Date().getTime();</script><style nonce="vqLPDn7RSX_A8MXpNaMxYw">.gb_ib:not(.gb_kd){font:13px/27px Roboto,Arial,sans-serif;z-index:986}@-webkit-keyframes 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I’m Adriana Lozada, and as we forge on in our series about Birth Beyond The Clinical Experience, today we’re going to take a deep dive into the amazing and fascinating hormonal dance that happens during the birthing process. We’re also going to take a look at the protagonist role of oxytocin in not only bringing on contractions, but also helping you cope with the intensity so that you and your baby are more ready to fall in love, and we’ll also look at what all of this has to do with your motivation to take care of your baby. \nMy guest for this is none other than Dr. Sarah Buckley who has spent years, years deep in research, studying the hormones of physiological labor and birth along with how they are impacted by interventions and part of our conversation will be on how you may experience this physiological flow of hormones in your body, but also what happens to the physiology when you have, say, an induction, an epidural, or a pre-labor cesarean. 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Within the brain, it\u0027s actually what we call a neuromodulator. It modulates or changes a whole lot of settings we could say in the brain. So in terms of labor and birth, it makes us feel calmer. It really reduces fear and stress. It also has pain-relieving effects, which is very helpful in labor and birth as well. And at the same time, it switches on during labor and birth, what we call the \"pleasure and reward centers\" in the brain. These are the dopamine pathways. And the reason it\u0027s doing that is because straight after birth, the mother and any mammalian mother is gonna meet her babies for the first time, and Mother Nature does her best at making sure that\u0027s a positive experience.\nI say it\u0027s like the best first date ever, because the mother\u0027s brain, pleasure and reward centers are maximally activated. And then she gets the sensations of her babies, the smell, the sight, the taste. Most mammals lick their babies, a touch of her babies. 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And the reason it has this pattern is because labor involves what we call \"positive feedback loops.\" \"Feed forward cycles\" is another term for that. \nSo the opposite of that is negative feedback loops, and that\u0027s all of us sitting here— you know, if we hear a strange noise, my dog just barked, you know, I can get a burst of adrenaline, it puts my heart rate up, it puts my blood pressure up— I\u0027m ready for fight or flight. My body detects those signals, my heart rate\u0027s higher than it needs to be right now and it brings it down. That\u0027s a negative feedback. And that keeps my body even, all my body processes even— that\u0027s good homeostasis.\nBut that… it\u0027s not like that in labor. Labor is not homeostatic, as I said. Labor starts small, gets bigger and bigger, becomes unstoppable because of positive feedbacks. \nAn important one, involving oxytocin in the process of labor is what people might know as \"the Ferguson reflex.\" So what\u0027s happening all through labor is as the baby\u0027s going lower, it\u0027s pressing on the mother\u0027s cervix, lower uterus, lower vagina, and those sensations, which are quite intense, if you\u0027ve given birth you\u0027ll recognize that. Those sensations are actually fed back to the brain by a specific nerve pathway. And when that information from those sensation reaches the brain, the brain actually releases more oxytocin, and that oxytocin comes from the brain through the bloodstream, back to the uterus, binds with the receptors causes, stronger contractions, more sensations, and then more release from the brain. So that\u0027s a positive feedback cycle. \nAnd that\u0027s one of the positive feedback cycles that has labor be an accelerating process. 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DOCS_modelChunkLoadStart = new Date().getTime(); _getTimingInstance().incrementTime('mp', DOCS_modelChunkLoadStart - DOCS_modelChunkParseStart); DOCS_warmStartDocumentLoader.loadModelChunk(DOCS_modelChunk); DOCS_modelChunk = undefined;</script><script nonce="AxDPinBGMAo1r8gZ9UDCKw">DOCS_modelChunkParseStart = new Date().getTime();</script><script nonce="AxDPinBGMAo1r8gZ9UDCKw">DOCS_modelChunk = [{"ty":"is","ibi":12329,"s":"If we go back to that evolutionary model, any animal, the pushing stage in the wild is especially dangerous. So Mother Nature builds in these processes to make sure that the pushing stage in particular is as efficient and effective as possible.\nAnd all that time that this positive feedback loop is happening, we\u0027re also getting that release not just from the brain, but also into the brain. So all those calming, connecting, pain, relieving, switching on reward and pleasure center effects are happening, even more as time goes on to help any mammalian mother to, you know, to get too unsettled by labor to not have an aversive experience. You know, Mother Nature wants it to be a positive experience, and most animals don\u0027t go to classes to learn. You know, it has to happen through the processes of labor and birth, and that\u0027s part of what I call Mother Nature\u0027s superb design.\nAdriana: And I think it\u0027s really important to note that, because when we put birth in the hospital, then we start having all these medical checks and making sure things are being measured and cervical checks, but the body doesn\u0027t care about any of that. So what I\u0027m hearing is that progress in labor, from a mammalian point of view, it\u0027s kind of tuning into is it getting longer, stronger? Are contractions closer together? Like: Is it building? Are these loops really working?\nSarah: That\u0027s right! That\u0027s right. And I\u0027ve got to also say that, you know, labor isn\u0027t… I mean, we put it on a partogram, near the little graph they fill out in hospital of how many centimeters dilated your cervix is, and how strong your contractions are. And it\u0027s kind of expected to go in a linear way. But you know, most biological processes aren\u0027t linear. If you\u0027ve watched a child develop, you know that they are crawling and it might take a very long time. Some children, until they walk, and some children, it\u0027s not very long. Like everyone has their own individual pattern and just going back to what you said before that the pattern of labor, we would have to say reflects the feelings of the woman, of the birthing female.\nIs she safe? If she feels safe, it\u0027s gonna go pretty well. If she doesn\u0027t feel safe, it may slow down. And many women have had that experience of starting labor at home. It\u0027s all going well. They feel like they\u0027re almost ready to give birth, they get to hospital and everything slows down or stops and that\u0027s exactly what we are talking about.\nAt this limbic system, primitive brain level, that birthing person doesn\u0027t feel safe. So, you know that feeling of safety is so essential during labor and birth. So, you know, one takeaway from this is what I say the basic needs of the laboring woman is that she feels private, that she feels safe. And actually, if you think about mammals birthing in the wild, is that she feels unobserved.\nSo, you know, the most skillful birth attendants, which are generally midwives, are skillful for supporting physiological birth, really know how to observe without being obvious. They know where a woman is in labor by the sound she\u0027s making, by the way she\u0027s moving, you know, and we\u0027ve superimposed on that, as you say, the cervical examinations and that is quite disruptive to women. It\u0027s not a safe feeling to have someone you don\u0027t know put their hand in your vagina, right? So how do all those things and all those observations that we do in hospital contribute to the progress of labor and birth? Probably in a negative way, we would have to guess.\nAdriana: Well, and we know… I mean, if you look at the work of Michel Odent, which I know you\u0027re a big fan of his amazing work, also saying that observation/feeling observed is one of those things that triggers your neocortex— triggers your thinking brain— which then if you are thinking, it\u0027s hindering those mammalian activities of these hormone secretions, because it\u0027s not letting your body just do the birthing. Like, if you\u0027re thinking, you\u0027re not birthing… and back and forth.\nSarah: Yes, that\u0027s exactly right. We really have to sink into the limbic system, not just for that assessment of safety, but that\u0027s kind of where it\u0027s all happening. That\u0027s where oxytocin\u0027s being released from. That\u0027s where we\u0027re gauging what\u0027s going on. And for women that really feel unobserved and free to move in labor, it\u0027s a very primal, it\u0027s an almost animalistic process. 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So for the mother, you know, the lack of an adequate break, the lack of the ability to replenish between contractions for a uterine muscle is significant, and it\u0027s also very significant for the baby because the baby also relies on that gap between contractions to replenish.\nI mean for the baby, you know, as in all placental mammals, there\u0027s only one way out physiologically— which is through the vagina, which is due to the contraction of the uterus. But every time the uterus contracts, it squeezes not only the baby, but it squeezes the placenta, you know, the baby\u0027s lifeline. And as it squeezes the placenta, the blood flow through the placenta, which is what nourishes the baby, gets cut off to some extent, gets reduced or cut off for some period of time. And then, the uterus relaxes, everything\u0027s restored, the blood flow\u0027s restored, the baby gets the blood flow replenished. 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Because we\u0027ve got to know, is this too much hypoxia for the baby? \nAnd for some babies it is… you know, some babies can’t cope with those extra strength of contraction and the reduced time for replenishment, and some of those babies go into distress and they need to be born quickly or to be born by cesarean.\nWe know that that\u0027s true for women who have synthetic oxytocin— there\u0027s more cesareans for fetal distress. So that\u0027s the risk for the baby and you know, is that harmful to the baby in the long run? We don\u0027t really know, you know. Is that extra hypoxic stress in labor… most babies can cope with it and it seemed to be okay at birth, but is there… are there any effects, more subtle effects that might be happening from that as well? 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And by the way, you can go to my website and go to my blogs and look at my epidural blog and this little picture of this feedback loop if it\u0027s easier to follow. \nSo the feedback loop, this positive feedback loop that helps to trigger the snowball of labor is dependent on the sensations from the mother\u0027s cervix, vagina, up to the the brain. That information coming up, and that\u0027s what tells the brain to release oxytocin. And the trouble with epidurals is they\u0027re so effective at reducing sensation, at relieving pain, and they actually stop that branch of the feedback loop. 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There\u0027s a couple of studies we\u0027ve reviewed that have looked at that, and one, for example, looked at, what we call \"personality changes.\"\nSo when women go through physiological labor and birth, and we think it\u0027s due to the oxytocin peaks in the brain, they not only get switching on pleasure and reward centers, but they also get a change in personality. And if you think about what we need to mother, you know, we do need to be slightly different or different from what we were beforehand.\nSo the changes in personality that women get, they become more sociable, they become more relaxed, they describe less physical tension in their bodies. And again, these are all kind of oxytocin effects as well. So in these studies, when women had had an epidural, they didn\u0027t get those personality changes. And the explanation that we would have for that is they didn\u0027t get those peaks of oxytocin in the brain during labor that triggered those changes in personality, that triggered that activation of pleasure and reward centers, calming, connecting, pain relieving effects either. \nAnd you probably are aware, you may be aware that when women have an epidural, they\u0027re less likely to be able to push their baby out. There\u0027s a disadvantage there. They\u0027re more likely to need forceps or a vacuum extraction. And again, that\u0027s our positive feedback loop that\u0027s been slowed down or even stopped. They\u0027re not getting that hormonal help, extra oxytocin to have an effective and efficient pushing stage.\nAdriana: So then if somebody\u0027s had a labor that required or had these interventions for whatever reason, what I\u0027m hearing is that it can affect the bonding. So if that\u0027s the situation, is there a way to kind of reset these or reconnect these opportunities or this bonding?\nSarah: Yes. Well, I\u0027ve gotta say, first up, we don\u0027t really have research that\u0027s looked at bonding with epidurals, or not high-quality research. There are some older studies that did find some, we could say changes. Example, in one study at one month, women who\u0027d had an epidural described their babies as less adaptable, more intense, and more bothersome.\nAnd it really, for me, that would be consistent with that they didn\u0027t have that full activation of the pleasure and reward centers at the time of birth and that first date ever, that best first impression wasn\u0027t triggered, and then that comes into the rest of the mothering. So I… and I also wanna say that I\u0027m not saying that if you have an epidural or a cesarean as well, that you can\u0027t bond with your baby. But I think this Mother Nature\u0027s best help, best possible start, there\u0027s a hormonal gap there. So the hormonal gap, as I said, is an oxytocin gap, and probably other hormones as well. 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DOCS_modelChunkLoadStart = new Date().getTime(); _getTimingInstance().incrementTime('mp', DOCS_modelChunkLoadStart - DOCS_modelChunkParseStart); DOCS_warmStartDocumentLoader.loadModelChunk(DOCS_modelChunk); DOCS_modelChunk = undefined;</script><script nonce="AxDPinBGMAo1r8gZ9UDCKw">DOCS_modelChunkParseStart = new Date().getTime();</script><script nonce="AxDPinBGMAo1r8gZ9UDCKw">DOCS_modelChunk = [{"ty":"is","ibi":41631,"s":"And I just wanna say something else about that because you know what happens is it\u0027s not just the processes of labor and birth that\u0027s missed. It\u0027s all of the lead up, all of the changes that happen in the lead up to labor that make birth as effective and efficient as possible. And one example, we talked about oxytocin receptors and the receptor is what oxytocin binds to like putting a key into a lock and just like oxytocin levels can go up and down, receptor numbers can go up and down.\nAnd if we want an effective and efficient labor and birth, we want a high number of receptors \u0027cause we want the mother\u0027s uterus to be as sensitive as possible to oxytocin. And that\u0027s actually what happens! People have done studies and measured oxytocin receptor density in the uterus from non-pregnant through to early-, mid-, late-pregnancy and labor, and the number of oxytocin receptors, or the density, goes up from about one and a half to three and a half thousand. So there\u0027s this massive increase in sensitivity, we could say responsiveness to oxytocin in the mother\u0027s uterus. \nSo then what happens at the onset of labor and birth? The mother releases oxytocin, but she actually doesn\u0027t need very much, she doesn\u0027t need very high levels of oxytocin because her uterus is so sensitive. So it\u0027s not just labor and birth, it\u0027s all these background preparations. \nI describe it a bit like a royal wedding, you know? There\u0027s been all these preparations for the exact moment that the spontaneous or physiological onset of labor. And if we induce women, for example, before they\u0027re fully ready, before their baby\u0027s ready it\u0027s like everyone turning up at Westminster Cathedral a week beforehand and expecting everything to be the same. All those final preparations won\u0027t be done! \nSo the full number, in terms of oxytocin receptors, the woman, by definition, is not gonna have the full sensitivity/responsiveness to oxytocin when she\u0027s being induced. So, it\u0027s… basically, we could call it a window of opportunity. The processes of labor and birth are a window of opportunity for all these things to happen, and if we miss that window of opportunity, for example, through a pre-labor cesarean, maybe even through an induction, it\u0027s gonna take a lot longer to fill in that hormonal gap.\nSo filling in a hormonal gap, and we\u0027re talking about epidurals to start with, you know, means filling in that brain deficit in oxytocin and in sheep studies actually, the way they fill that hormonal gap was actually injected oxytocin into the brain. But obviously we\u0027re not gonna do that, but we want to have a maximum number of opportunities to release oxytocin, and we do that when we\u0027re skin to skin with our babies. And we do that when our babies suckle, with the letdown or milk ejection reflex. So we release oxytocin. \nSo skin-to-skin and breastfeeding are the two things that will fill in the hormonal gaps. But we can\u0027t just do it one-off. We can\u0027t even do it for an hour. Actually, if we wanna fill in that hormonal gap, it\u0027s gonna take a lot of patience.\nFor example, in that personality study that I talked about where women who\u0027d had an epidural didn\u0027t get those changes in personality that women get after physiological labor and birth. Those women breastfed when they breastfed, exclusively for four to six months they got those changes in personality. So it takes a lot longer when you miss that window of opportunity. The window of those peaks of oxytocin on top of all the preparations that have happened. \nAnd same for a pre-labor cesarean. We haven\u0027t talked about that much, but obviously you miss all of the preparations and then you miss the in-labor processes. And the other thing that can happen after a cesarean is it can be hard to get the mothers and babies back together. There\u0027s so much paperwork, and as I said, sometimes the babies have problems. They\u0027re cold, they\u0027re hyperglycemic, their blood sugar\u0027s low, they have breathing difficulties and they get separated. \nSo for a pre-labor cesarean as well, skin-to-skin contact as soon as possible. You know that it is possible in some circumstances and some institutions to do a cesarean where the baby gets put on the mother\u0027s body straight away and never gets taken off— you know, that\u0027s the ideal. 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DOCS_modelChunkLoadStart = new Date().getTime(); _getTimingInstance().incrementTime('mp', DOCS_modelChunkLoadStart - DOCS_modelChunkParseStart); DOCS_warmStartDocumentLoader.loadModelChunk(DOCS_modelChunk); DOCS_modelChunk = undefined;</script><script nonce="AxDPinBGMAo1r8gZ9UDCKw">DOCS_modelChunkParseStart = new Date().getTime();</script><script nonce="AxDPinBGMAo1r8gZ9UDCKw">DOCS_modelChunk = [{"ty":"is","ibi":45889,"s":"And then opportunities to suckle as well. For the baby, the baby\u0027s missed all those preparations, the baby\u0027s missed the catecholamine surge that wakes the baby up on every level. So babies born by a pre-labor cesarean are often a bit sleepy. They\u0027re not quite ready. It\u0027s like I say, it\u0027s like someone coming into your bedroom at night and pulling back the covers and shining a bright light on you and pulling you out of bed— you know, you\u0027re not quite ready for it, you know?\nSo the pre-labor cesarean baby needs that patience as well to fill in those hormonal gaps. And I\u0027ll share another anecdote about this, which is a story I read in a magazine of a woman who\u0027d had two natural births. The third one, she needed a pre-labor cesarean. These interventions could be life-saving in some situations!\nAnd she said, \"When I got my baby back, my baby felt different.\" And she\u0027s kind of explaining everything that I just explained about the catecholamine surge. 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That is almost impossible. And also the levels really aren\u0027t high enough to cross into the mother\u0027s brain and have biologically significant effects. So that was a reassuring finding from our report about synthetic oxytocin.\nAdriana: Well, thank you so much. Sarah for being here today and for sharing all your expertise. and best of luck with the PhD!\nSarah: Thanks so much, Adriana! And just I just want to end by saying that, you know, our bodies are superbly designed for growing babies, having babies, mothering our babies, and all we have to do really is tune into this Mother Nature, superb design and in labor. You know, how private, safe and unobserved can you make your laboring situation? Can you have a doula? Can you have your own midwife? \nModel of care is really the one thing that\u0027s gonna make the biggest difference to your experience of labor and birth. 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From The Podcast
Birthful
On Birthful, working doula and former journalist Adriana Lozada talks pregnancy, birth and postpartum with top experts and new parents. Every episode distills the overload of pregnancy information down to the most relevant and useful stuff. Adriana Lozada is a mom, author, speaker, birth doula, postpartum educator, and healthy-sleep consultant. Visit Birthful.com.Please note: Adriana has years of experience but she's not a doctor, and does not expect anyone to treat the show like medical advice. Please always consult with your care provider. This show does not dispense medical advice.Join Podchaser to...
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