childbirth, labor, oxytocin, pregnancy

Pitocin Is Not Oxytocin

Pitocin-Is-Not-Oxytocin
The role of hormones in our body are so vast and dynamic!  Here is a quick article looking at only one of the hormones that help regulate us.

BY KELLY BROGAN MD

“The Love Hormone”.  Sounds important, no? Turns out that we know very little about the hormone oxytocin, beyond that it is incredibly relevant to multiple metabolic, behavioral, and endocrine functions. In a compelling review entitled Beyond Labor: The Role of Natural and Synthetic Oxytocin in the Transition to Motherhood, Bell et al explore the literature suggesting that, once again, we cannot outsmart, outdo, or circumvent nature with pharmaceutical products.

What is Oxytocin?

One of the known roles of oxytocin is in the complex physiology of labor and birth. Perceived by the obstetrical establishment to be a “contraction chemical”, oxytocin’s effects are bodywide, and most notably, brain-based. During pregnancy, oxytocin receptors increase in areas of the maternal brain related to mood, stress, and attachment behavior. Specifically, its activity has been studied in the hypothalamus, lateral septal nucleus, periaqueductal grey, Broca’s area, nucleus basalis of Meynert, locus coeruleus, vagus, solitary tract, trigeminal nerve, and lateral reticular formation. It is secreted continuously in the brain and in a pulsatile manner to the body through the posterior pituitary. Despite efforts, the brain-blood ratio has not been well-elucidated leaving major gaps in our understanding. When it comes to hormones, the production and release of the hormone is critical, but so is the receptor activity – the action of the baseball in the catchers mitt, and receptor sensitivity varies from person to person based on genetics and adaptation to experience.

What is Pitocin?

So, when we manufacture a synthetic version of this hormone and commandeer a woman’s labor physiology, it should come as no surprise that there are unintended and poorly understood consequences. Pitocin®  or “Pit” as it’s called on the floors, is the obstetrician’s whip. They snap this whip when your baby is not conforming to their non-evidenced-based schedules. When your due date is wrong, when you’re forced to birth in highly artificial circumstances, or when your physiology has been hijacked by an epidural.

Bell et al discuss a number of concerns related to the administration of synthetic oxytocin:

  • Because of its hydrophilic (fat-loving) nature and molecular size,Pitocin®  is unlikely to cross the blood brain barrier. But maternal oxytocin is very active in the brain, inducing secretion of other hormones including endorphins (buffering fear and pain). It is also active in the fetalbrain, protecting receptors such as GABA, from potential hypoxia of birth.
  • If, in fact, synthetic oxytocin does reach the maternal brain (because of barrier permeability or active transport of some kind), the authors state:

    “Whether the maternal brain will reliably respond to exogenous oxytocin by decreasing or increasing the synthesis or release of endogenous oxytocin is unknown.”

What about after labor is over?

Women are struggling to breastfeed in proportions likely never seen in human history. Bell et al reference a powerful study that implicates Pitocin in this phenomenon.

“Compared to all other study groups, women exposed to Pitocin® in labor combined with an epidural demonstrated significantly lower oxytocin levels during breastfeeding. Overall, the total quantity of synthetic oxytocin administered during parturition was negatively correlated to levels of oxytocin in plasma two days following birth.”

This may be related to the effects of a pharmaceutical-grade agonist stimulating the oxytocin receptor and causing modeling changes at the membrane level. When receptors are overstimulated, they are internalized and downregulated through changes in gene transcription. Bell et al reference a study demonstrating that:

Participants with oxytocin-induced labor had a 300-fold down-regulation of the OTR gene in uterine muscle, when compared to receptor availability in spontaneous labor.

The role of oxytocin in the HPA axis (hypothalamic-pituitary-adrenal) may explain why:

“Lactating women show increased vagal tone, decreased blood pressure and decreased heart rate when compared to non-lactating women, especially in response to a stressor.”

Data analyzing the role of oxytocin in response to postpartum stress suggests that it is a buffer to the negative effects of the experience. When this buffering effect is inadequate, we may see the emergence of postpartum depressive symptoms. One study found that bottle feeding women had lower levels of oxytocin, higher heart rates, and higher cortisol, but that breastfeeding depressed women shared this profile, implicating low oxytocin levels in depression.

Amazingly, some of oxytocin’s effects may actually be mediated by gut bacteria (is there anything the microbiome doesn’t manage?) as was demonstrated in this study showing a lactic acid bacteria accelerated (doubled) wound healing in rodents by increasing oxytocin levels. In psychiatry, there is sparse literature supporting the use of intranasal oxytocin in autism, schizophrenia, OCD, social phobia, depression/postpartum depression, and anorexia but notable theoretical underpinnings for consideration in these cases and minimal risk.

While we attempt to understand the variables contributing to altered oxytocin response in the body, deliberately interfering with this feedback system through the use of synthetic hormone should be exposed for what it really is: a dangerous fix for the problems of a medicalized birth.

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alternative medicine, homebirth, hood river midwife

New Report Urges Less Intervention in Births

I appreciate the message of this article, however it lacks a definition of post dates safety.  Questions we could be asking; what are more natural methods to support induction? Should we wait 43 weeks?  How often do we monitor placental health?  Birth is a complex journey and in our culture of unacknowledged emotions and mental states, it is no wonder we are resistant to surrender to the birth powers.  motherlode-childbirth-articleLargeBy KJ DELL’ANTONIA

A few weeks ago, Britain’s national health service advised healthy women that it was safer to have their babies at home, or in a birth center, than in a hospital. For low-risk mothers-to-be, giving birth in a traditional maternity ward increased the chances of surgical intervention.

new report from the Childbirth Connection; a program of the National Partnership for Women and Families, stops short of recommending home births in the United States, but does challenge the same issue addressed by Britain’s health service: Many hospitals approach childbirth from the premise that “more technology is better,” while significant research shows that less intervention is safer and healthier in most cases.

“If overtreatment is defined as instances in which an individual may have fared as well or better with less or perhaps no intervention,” the report states in its forward, “then modern obstetric care has landed in a deep quagmire. Navigating out of that territory will be challenging.”

Dr. Sarah Buckley, who collected and interpreted the research and wrote the report, suggests within it a number of ways of escaping that quagmire, all based on the premise that the hormonal physiology of childbirth nearly always works best when it is left to work at its own speed. The benefits of the natural process, her synthesis of the research suggests, go far beyond what we had previously understood; preparing mother and baby for birth through hormonal changes up to and during the labor and birth process.

Hospitals and clinicians should wait for labor to begin on its own, encourage and support women laboring at home during early labor, and have patience with women in labor in their facilities rather than using interventions to speed up the process. Women, too, should be patient, trust their bodies to work through the process and “stay calm and relaxed” (frustrating advice for many women, but advice that might be more easily heard and heeded in an atmosphere less stressful than that of many maternity wards).

“It’s important for both clinicians and women to understand that common interventions, that we have come to view quite casually, are actually quite consequential,” said Carol Sakala, director of Childbirth Connection Programs at the National Partnership for Women & Families.

“Our current high rates of intervention are not serving women well,” she said. “But the community is really moving in the right direction. Professional societies are breaking with the past,” and talking publicly about the overuse of cesarean sections, the need to avoid constant fetal monitoring, and not permitting elective inductions or cesareans. “We are hopeful that the timing of this report will support that change.”

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birth, hood river midwife, pregnancy

10 Things I Wish All Women Knew About Giving Birth

Love this article by Aviva Romm in Pathways Magazine.  She hits on many points that are so true about labor, but can also be linked to our everyday life.
art-of-birth-baby

When I was pregnant, I seemed to be a magnet for birth war stories—cords around the neck, emergency cesareans, and more.
It took a lot of inner conviction to believe in birth as a natural, beautiful event that my body was capable of, rather than a “disaster waiting to happen,” as one obstetrician warned me it was.

But inner conviction I decided to have, and my four children were born at home, peacefully, without drama or trauma. I made sure I was in awesome health throughout my pregnancies, eating an organic, plant-based diet. I did yoga daily, spent time in nature, and meditated on the type of birth I wanted to have.

And then I surrendered to the forces of nature. The power I experienced as a woman has given me confidence in so many areas of my life, and I so wish this for other women.

Sadly, however, natural birth is becoming endangered. About one in three women in the United States will have their babies by cesarean section. Maybe that sounds like no big deal—but actually, cesareans are major abdominal surgery that increases your risk of complications over natural birth.

Cesareans are grossly overdone in U.S. hospitals. And they often make recovery and breastfeeding much more challenging. They expose your baby to an antibiotic (all moms having a cesarean are given antibiotics at the time of surgery) before she or he is even born. And most of the ones that are performed turn out to be unnecessary.

Also, many more women will have their labor induced or experience some form of obstetric intervention. The downturn in natural birth is so significant that a group of researchers wanting to study the natural course of labor couldn’t find a large enough group of women birthing naturally in any one place to study them!

But we can’t let natural birth go extinct, because it’s way more than just a romantic ideal. Babies born vaginally (and without medication) have many health advantages. For example, just being exposed to mom’s flora on the way out of the birth canal decreases the lifetime likelihood of developing digestive problems, allergies, and even obesity.

While we can’t fully control what happens in our births, and of course, sometimes interventions are necessary (though often they aren’t!), you can embrace core beliefs that will increase your chances of having the birth experience that is healthiest for you and baby.

Here are the 10 most important philosophies that helped me have my babies naturally, which I’ve used to support thousands of women in their birthing experiences. My hope is that these can help you have an optimal birthing experience…maybe even the birth of your dreams!

Though a spiritual journey, birth is not all incense and candles. It asks us to call upon our primal instincts and sometimes even to get primal—making animal sounds, assuming poses that have us buck naked on our hands and knees, moving our hips in deep sultry belly-dancing undulations.

Planning to take a deep dive into your subconscious and intuition to let your primal self emerge can allow you to open and birth your baby with a raw strength and power you might not even realize lives within you.

1 Birth is a spiritual journey; it’s also primal.  Birth is, to say the least, a physically and emotionally demanding experience. Approaching the challenge as a spiritual journey can help you dig deep into your core for the resources to persevere, and to learn about yourself and your innate strength and power.

Birth should not be taken lying down.  Lying down simply doesn’t let gravity do the work of helping your baby come down and out! Walking, moving your hips like a belly dancer, and generally staying active facilitates a more physiologic process for your baby than lying on your back in a hospital bed, which increases your chances of a cesarean.

3 Contractions are amazing sensations that get your baby born. During my own births, I used my imagination and awareness to dive deep into the sensation of my muscles working to help my baby get born. This focused aware- ness transformed my perception of the pain of birth into the power of birth.

I even used the term “expansions,” rather than “contractions,” to help me think about the sensation in a new way. It did not make the experience less intense, but it made the sensation my ally rather than my enemy. As I welcomed each new wave of labor, I knew I was closer to bringing my baby into my arms.

4 Fear stops labor.
Mammalian mamas have powerful instincts that allow us to keep our babies safe from harm. For

example, mama giraffes on the tundra will spontaneously stop labor if they sense a predator in the area, rather than dropping a helpless newborn to the ground. We too, have hormones that can stimulate labor (oxytocin) and those can stop labor if pumped out early because of fear (adrenaline).

So learning to transform fear into power and confi- dence is essential for a smooth birth. How is this done? Make sure you feel safe where you are birthing, that you have good support in labor, and that you have talked with your birth provider about any fears you are harbor- ing or repressing about your health and safety, your baby’s health and safety, or the birthing process. Being educated and informed can help you to dispel fears.

5 Question authority! (Remember, nice girls can ask questions and say no.) Obstetrics practices are not always based on

the best science. The September 2011 issue of Obstetrics and Gynecology, the official publication of the American College of Obstetricians and Gynecologists (ACOG), reported that only one-third of all obstetrics guide- lines in the U.S. are based on good scientific evidence. Another third are based on limited or inconsistent evidence, and the remaining third are based on expert opinion, which is “subject to bias, either implicit or subconscious.”

So just because a doctor (or midwife) tells you something is required (lying down in labor, having a vaginal exam, wearing an external fetal monitor for your entire labor, having an IV drip routinely), doesn’t mean you have do it unquestioningly—
or at all. As girls and young women, many of us learn not to question authority—we’re encouraged to just be a “good girl,” and not be the geek who asks questions. Many of the procedures done in hospitals are done “just because”—they are routine, but often not necessary.

So if something is recommended or expected that makes you uncomfortable or you’re not sure of the reason, ask! And if you’re not comfortable with the explanation, you can decline. Having an advocate there who can help you sort through decisions, especially when you are otherwise occupied doing the work of labor, is especially valuable.

6 Women should eat and drink during labor. Current scientific evidence has demonstrated that women who eat and drink in labor are not at significantly increased risk of food aspiration in the event of a cesarean, which has been the much-feared reason for keeping women on an ice-chips and fruit-pops-only regimen in labor for the past few decades.

In fact, keeping up your energy with light and nourishing fare has been found, by many midwives and mamas, to facilitate labor and reduce the likelihood of labor petering out, or needing Pitocin or a cesarean.

Your body is a marvelous, perfectly crafted force of nature.  Believing in yourself is powerful medicine!

Yet most of us go into labor believing our bodies might be lemons—the reject in the batch that just doesn’t work properly and needs to be sent back to the factory on a recall.

The reality is, nature is amazing at creating power- ful systems that work. Setting intentions and learning to have confidence in the birthing process—and your body—are among the most powerful tools you can use to go with the natural flow of labor and birth and gain some self-enlightenment in the process.

8.  Obstetrics is big business.
There is a whole system of medicine out there, called obstetrics, making a fortune off of your body! In fact, there is enormous financial incentive for obstetricians to do ultrasounds (in my community, a doctor’s office charges the insurance company $700 per ultrasound), offer endless tests, and perform cesareans rather than support natural, vaginal births.

Want to avoid unnecessary medical interventions? Then make your body your business by getting educated. Read about birth. Some good places to start: Ina May Gaskin’s Ina May’s Guide to Childbirth, Henci Goer’s The Thinking Woman’s Guide to a Better Birth, and my book, The Natural Pregnancy Book.

Birth is something you do, not something that is done to you.
Whether you dance, groan, or Hypnobirth your way through labor, it ain’t called labor for nothing. It takes work, focus, and sweat to get a baby out. Powerful muscles move a 6- to 8-pound being (on average) a short distance through a relatively small space. This means effort is required.

Just as with any hard task, being realistic about what’s involved, setting your mind and heart to it by getting psyched ahead of time, and then having strate- gies to call upon when your energy or determination wavers will get you to the other side of the finish line with power and pride.

10 Birth can be ecstatic.
While there might be some huffing and puffing, grunting and groaning, and even a holler or two if you need to vocalize the intense energy moving through you as you bring your baby out into the world, birth can be an ecstatic experience, particularly when you appreciate yourself for the accomplishment of a hard job done with determination and experience the ecstasy of holding your new baby in your arms.

As you get closer to your baby’s birth, and even in labor, here’s a simple mantra to tell yourself:
I’ve got this!

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