August 7, 2008

Hormonal Blueprint of Labor

I finally sat down to go through the many books that are stockpiled on my bookcase to give away to Housing Works. As I was tossing several of my chick lit books into a paper bag, I came across a book I forgot I was given, Enjoy your labor: A new approach to pain relief for childbirth, by Dr. Gilbert Grant, Director of Obstetric Anesthesia at New York University Medical Center. Dr. Grant signed and gave me the book himself. Of course, he did this while I was acting as somebody’s doula during her final stages of pushing. Appropriate timing and interaction? I think not. Anyway, before throwing it into my rather large pile of recyclable books, I thought I would take a look at it. See what the good doctor had to say.

First of all, as an obstetric anesthesiologist, he is very pro-drugs. Fine, everyone is entitled to their opinion. But “Grant asserts that natural birthing is misogynistic in practice. In essence, it is hateful to women. In a Times Online article he asks why women are made to undergo labor without pain relief, when no man would be asked to undergo an appendectomy, which lasts about 24 minutes, without pain relief, yet the pain of labour, which can last for more than 24 hours, is viewed as something women have to endure.”

This is the kind of attitude that really upsets me. I don’t see how one can compare childbirth to surgery without pain medication. When someone undergoes surgery, it is because there is a dis-ease in the body. Something has gone awry which requires medical attention to correct it and restore the person to good health. And essentially he is saying that the female body is ill-equipped to birth babies – yet the female body is designed to birth offspring. I am not a particularly religious person, and I seldom use the word “God”, but somehow we were created to function and have been doing so for thousands of years. Our bodies are brilliantly designed to fight off many diseases, replenish itself from illness, repair broken bones, and certainly to procreate. Women are equipped with an amazing hormonal blueprint that allows them to manage the pain of childbirth. Pregnancy and labor are not illnesses.

Let’s take a closer look at the role hormones play in helping women through labor. The three main hormones that are involved in the labor and delivery process are oxytocin, endorphins and adrenaline.


Oxytocin is made in the hypothalamus, deep in our brains, and stored in the posterior pituitary, the master gland, from where it is released in pulses. Oxytocin, also referred to as “the hormone of love” is the hormone released during pregnancy, labor, orgasm and breastfeeding and is responsible for triggering feelings of love and nurturing.

During labor, oxytocin levels are peaked, and the secretion of this hormone helps regulate the rhythmic contractions of the uterus. It is the contractions of the uterus that help move the baby down, putting pressure on the cervix and allowing it to dilate. After the baby is born, the oxytocin levels continue to surge, helping birth the placenta. It is important to get the baby to the mother’s breast to start suckling to continue the flow of oxytocin. The mother will still experience some strong contractions at this point which will protect her against postpartum hemorrhage.


Like oxytocin, beta-endorphin is secreted from the pituitary gland, and high levels are present during sex, pregnancy, birth, and breastfeeding. Beta-endorphin is also a stress hormone, released under conditions of duress and pain, when it acts as an analgesic and, like other stress hormones, suppresses the immune system. High levels of endorphins during labor and birth act a lot like morphine or similar drug, allowing a woman in labor to enter an altered state of consciousness that will help her cope with the birth process, provided she is undisturbed.

Several months ago, I attended my friend Liz’s birth of her second son, Owen. She chose to do a natural birth in the Birthing Center at St. Lukes/Roosevelt. The atmosphere was quiet with very little disturbance. Towards the end of the labor, Liz laid in bed, very quiet and still between contractions, with moans and movement during the contractions. Her eyes were soft and somewhat glazed over, and words were scarce. Here is how she described her birth experience:

“I got in the tub, and immediately my back pain went away. The warmth of the water slowed the contractions a bit too, and I was able to relax. After a while, though, I started to feel like a raisin, and the bed looked so inviting, so I got out of the tub and laid down. I was actually able to doze a bit between my contractions. A little before 7pm my doctor checked me and said I was about 9.5 centimeters. She asked if I wanted her to break my water and I decided to wait a bit. I don’t know why. I wasn’t thinking specifics. I was in such a bizarre zone of pain and power and determination and anticipation, that I just said no. From that point on I was on a level that I can only compare to a psychedelic drug experience *I feel funny using that analogy, and I apologize if it’s not appropriate, but I have been searching for a way to describe how i felt, and that is truly the only thing that compares.*”

Liz’s words describe the brilliant hormonal design of the female body. Her body produced the endorphins needed to allow her to move away from the pain, let go of her rational mind and follow her instinctual desires. Unfortunately, most studies have found a sharp drop in endorphin levels with use of epidural or opioid pain medication.


Adrenaline, also known as the “fight or flight” hormone is secreted from the adrenal gland above the kidney in response to stresses such as fright, anxiety, hunger or cold, as well as excitement, when they activate the sympathetic nervous system for fight or flight.

I often explain the “fight or flight” hormonal reaction by viewing how animals birth. When an animal feels threatened, adrenaline is produced, slowing down the production of oxytocin and allowing the mama-animal to stop contracting, regather and find a safe, quiet place to birth her baby. As much as we may not want to admit it, we are animals and our bodies react the same way. It is not surprising that when a mother is at home, feeling safe and comfortable with her surroundings and birth attendants, her labor can often progress nicely. But the same woman that presents a strong laboring pattern at home may, upon entering the busy, noisy, bright hospital suddenly find that her contractions have spaced out or even stopped. This is because of the presence of adrenaline.

Now not everyone can birth like a dog and go hide under the porch. So what can you do if you choose to birth in the hospital? Try to keep interruptions to a minimum. Invite only those you want in the room to join you. Turn the lights down. Bring music that will help relax you. All of these things will help reduce the stress hormone and allow the oxytocin to flow.

And adrenaline is not all bad when it comes to birth. At the final stages of labor, high levels of adrenaline activate the fetal ejection reflex. It makes the laboring mom very strong, alert and determined, ready for the final pushes to birth her child.

So after taking a closer look at the design of the female body, it seems absurd to compare natural childbirth to a surgical procedure, like an appendectomy, without anesthesia. It is absolutely an individual choice whether or not to take pain medications. But remember, for many, pain medication is not a necessity. If you choose to forgo it, your body will kick in with its own special cocktail of protection and as Liz said, “psychedelic experience”.



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