Laboring Women Don’t Need Support
Laboring women don't need support during childbirth. They need protection. This comes in many forms; however, it is not this idea that most of us have for childbirth today. It isn't a protection for "safety" when something goes wrong. It isn't protection from pain. It is protection to feel like the environment is supporting a private and comfortable environment. It is protection for mom to feel ready for the next phase for her family. "Support," although well-intentioned (and many times needed because of the completely inappropriate-for-biological-birth environment women are birthing in) is not always conducive to safety, happiness, or long-term emotional wellness of the mother.
"Transition" during labor is not a change in physical contractions - but a change in emotional comfort and function. Only when you feel safe and protected will your body "transition" into the primal act of bringing your baby earthside. Everything prior to this transformation is undefinable by numbers, textbooks, or time frames.
Michel Odent says it best in his article, "Laboring Women Don't Need Support" below:
"So many words commonly used to describe childbirth--support, patient, management, delivered by, coached, helped, guided-- suggest that a woman does not have the power to give birth without being dependent on somebody else. This isn't the case at all.
Imagine a little girl who can't fall asleep without her mother. Then imagine "an expert' explaining that this little girl can't fall asleep without the presence of a "support person." You would probably think the "expert" has completely misunderstood what's going on. This is what I feel every time I read or hear the word support used in reference to childbirth.
So many words commonly used to describe childbirth--support, patient, management, delivered by, coached, helped, guided suggest that a woman does not have the power to give birth without being dependent on somebody else. This isn't the case at all. The laboring woman doesn't need support. She needs to feel privacy and security. Birth attendants need to understand the complex physiological changes the mother is undergoing to avoid making dangerous mistakes. Not only does the word support indicate misunderstanding, it also perpetuates a harmful lack of knowledge of the birth process.
PRIVACY AND PROTECTION
All the hormones released during labor originate from the primitive part of the brain, i.e., the structures we share with all other mammals (hypothalamus, pituitary gland, and so forth). When there are inhibitions during the birth process (or, for that matter, any sexual experience), such inhibitions originate in the new brain, or neocortex--that part of the brain so highly developed in humans.
During the birth process, there is a time when the mother behaves as though she is "on another planet," doing a sort of inner trip. This change of consciousness can be interpreted as a reduction in neocortical activity. When this is going on, any stimulation to the neocortex can interfere with the progress of labor. There are many ways for this to happen. The most common is to talk to the laboring woman. Imagine that a woman is in hard labor and already "on another planet": She dares to scream out, she dares to do things she would never otherwise do, she has forgotten what she has been taught or what she has read in books. Somebody enters the room and asks her a question that requires her to think. This is risky stimulation.
Switching on a bright light is another way to stimulate the neocortex of a laboring woman. You can even stimulate the neocortex of a person just by looking at her: It's common knowledge that we feel different when we feel we're being observed. This is why a laboring woman needs privacy for her labor to progress. Other mammals have a strategy for giving birth in privacy--those who are active during the night, like rats, tend to give birth during the day, and the opposite is true for those, like horses, who are active during the day.
Any release of adrenaline also tends to stimulate the neocortex, thereby inhibiting the birth process. This means that a laboring woman needs first to feel secure. Through the ages, most women have adopted a strategy to feel secure when giving birth: They have made sure that their own mother was at hand, or a substitute for their mother in the framework of the extended family, or a mothering and experienced woman belonging to the community, i.e., a midwife. When we go back to the roots of midwifery, we realize that a midwife is first a mother figure and that a mother is first a protective person. In the presence of her mother (or somebody playing the role of a mother), the laboring woman not only feels protected and therefore secure but also doesn't feel observed or judged.
THE ROLE OF ADRENALINE
The word support suggests a need for an energy transmitted by somebody else. Laboring women don't need any sort of extra energy--on the contrary, the condition needed for labor to progress is a low level of adrenaline. When your adrenaline level is low, you don't feel energetic; all your voluntary muscles tend to relax. During a typical first phase of undisturbed labor, women tend to be passive, and need more than anything to feel private and secure.
During the final contractions preceding birth, even though hormonal conditions change, the laboring woman's basic needs remain the same. There is a peak release of hormones in this period, including the emergency hormone of adrenaline. When birth is unguided and undisturbed, this is the time when women tend to be upright, need to grasp something, and are full of energy. This is what I call the "fetus ejection reflex."
When the actual ejection reflex occurs, there is no room for any voluntary effort. This reflex is not well understood because it doesn't happen in most births. It doesn't occur, for example, if there are two or three people around the laboring woman, or if the mother feels guided; it doesn't occur, in particular, if she is told that her cervix is now completely dilated and she should start pushing. In almost all birth contexts, the fetus ejection reflex is transformed into a second stage, characterized by voluntary efforts and less effective contractions.
Certain signs suggest a high level of adrenaline during the very last contractions: The woman's pupils are fully dilated, she often feels a need to drink a glass of water (like a speaker in front of an auditorium), and some women have a very short episode of fear, which is a sign of sudden hormonal release.
We can better understand the complex role of adrenaline during the birth process by looking at other mammals. During the first stage of labor (and during any other episode of sexual life), adrenaline has an inhibitory effect. In birth, this is an advantage for the survival of the species: If a female mammal is threatened by a predator when she's in labor, the release of adrenaline tends to stop the birth process, to give the mother the energy to fight or escape. But after a point of no return, it's an advantage to give birth as quickly as possible, to be alert when the baby is born, and to ensure that the mother has enough energy to protect her newborn baby.
THE LOVE HORMONE
Oxytocin is the hormone that enables the mother to maintain effective contractions of the uterus up to the birth of the baby, and then up to the delivery of the placenta. Just after the baby's birth, the mother can have a very high peak of oxytocin, so that the placenta will be separated easily and safely without any significant bleeding. The conditions for such a high peak are that the room is overheated and the mother has nothing else to do but look at her baby and feel the baby's skin close to her own. Any sort of distraction can be harmful.
Once again, the primary role of the midwife is to keep a low profile and to protect the mother by taking the telephone off the hook, for example, or making sure distracting people or influences are kept to a minimum. People are often surprised that I accept home-births when the mother has had a previous complication in the third stage, such as hemorrhage, transfer to a hospital, or manual removal of the placenta. A homebirth can be possible in these circumstances if the physiological conditions that encourage the release of a high peak of oxytocin are understood and respected.
Oxytocin is more than just the hormone responsible for uterine contractions. When it is injected into the brain of a mammal, even a male or virgin rat, it induces maternal behavior, i.e., the need to take care of pups. One of the greatest peaks of oxytocin a woman can have in her life is just after childbirth, if the birth has occurred without any intervention. It is also necessary for the "milk ejection reflex." In fact, oxytocin is involved in any episode of sexual life, and both partners release oxytocin during intercourse. It is even involved in any aspect of love and friendship: When we share a meal with companions, we increase our levels of oxytocin.
Morphinelike hormones, commonly called endorphins, also play important roles in the birth process. Up to the birth of the baby, both mother and fetus release their own endorphins, so that during the hour following birth they are still impregnated with opiates. It's well known that opiates induce a state of dependency. When mother and baby haven't yet eliminated their endorphins and are close to each other, the beginning of a deep bond is created. In fact, when sexual partners are close to each other and impregnated with opiates, another kind of bonding may result that follows exactly the same model as the bonding between mother and baby.
THE CRITICAL, SENSITIVE PERIOD
It is not only the mother who is releasing hormones during labor and delivery. During the last contractions, the fetus is also releasing a high level of hormones of the adrenaline family. One of the effects of this is that the baby is alert at birth, with eyes wide open and pupils dilated. Mothers are fascinated by the gaze of their newborn babies. It seems that this eye-to-eye contact is an important feature of the beginning of the mother-baby relationship, which probably helps the release of the love hormone, oxytocin. Both mother and baby are in a complex hormonal balance that will not last long and will never happen again. Physiologists today can interpret what ethologists have known for half a century by studying the behavior of animals: Where the development of the capacity to love is concerned, there is a critical, sensitive period just after the birth.
If the privacy of mother and baby is well protected, it's likely that the baby will find the breast during the hour following birth, at a time when the mother is still "on another planet" and knows how to adapt her behavior to her baby's.
The bacteriological perspective is one more reason to be convinced that the whole period surrounding the birth is critical for mother and baby. If the baby can consume the precious colostrum of the first hour following birth, it will be a good start for the development of the gut flora. The germ-free newborn baby shares the same antibodies as his mother. For the newborn there is a major difference between familiar and friendly germs (those satellites of the mother) and unfamiliar and potentially dangerous ones. The question is: Which germs will be the first to colonize the baby's body? From a bacteriological point of view, the baby urgently needs to be in contact with only one person: his mother.
What a responsibility for those whose role it is to protect mother and baby during the time surrounding birth! Because we are highly adaptable creatures who amalgamate our behaviors in a cultural milieu, the responsibility is not so much at the level of one given baby or one given family, but at the level of a civilization.
It's easy enough to see our mistakes. Health statistics show, for example, that the use of electronic fetal monitoring during labor makes the birth more difficult and therefore more dangerous.[1,2] We know that in countries where there are many midwives and a small number of well-trained obstetricians, such as Scandinavian countries, the birth outcomes are much better than in the countries where it is the opposite, such as Italy and the US.
We now know enough to start a new phase in the history of childbirth . . . let's call it the post-electronic age. It's time to reconsider many "modern" ideas about childbirth and to go back to its roots. Going back to the roots means first becoming aware of what is physiological. If we try to deviate too much from the physiological process by using drugs and intervention, we must at least be aware of what we're doing.
Going back to the roots also means rediscovering the roots of midwifery. It means, finally, that we must realize the power of words. Our depowering and misleading vocabulary is one of the main obstacles to the advent of a new age in childbirth. We urgently need a collective reconditioning, with the help of relevant key words like privacy and protection."
Odent M. Why laboring women don't need `support'. Mothering [serial online]. Fall96 1996;(80):46. Available from: MasterFILE Premier, Ipswich, MA. Accessed December 16, 2013.
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