Feeling Safe in Childbirth: What does the research say about your birth?
Although a positive birth experience can occur in any setting, research shows there are several elements that will have a direct impact on how your labour and birth pan out. If you’d like to know about the top 5 factors research shows will impact on how your baby is born, then this article is for you…
“Giving birth is a landmark experience in any woman’s life.” (Howarth, Swain & Treharne, 2010, p.17). This experience is significantly influenced by psychological factors such as love, fear, and feeling safe.
In fact, love is such a powerful emotion that it helps a woman’s body to relax during labour. This in turn can increase labour efficiency, making labour both shorter and significantly less painful. Love also decreases a birthing mother’s levels of stress. Loving words spoken to a mother during her labour can help her cervical dilation (Gaskin, 2008; Hodnett, Gates, Hofmeyr, Sakala, & Weston, 2011; Howarth et. al, 2010).
Continuous one on one labour ‘support’ is an excellent example of the effect love has on labour and birth. Labour support/companionship is effective in reducing fear and distress -The negative impact of these emotions can be often be seen when a woman is labouring alone in an unfamiliar environment. A woman feels loved and is empowered by her birth team when she experiences their kindness, respect, compassion and love. Supportive care has been shown to shorten labour and birth, lessen the likelihood of caesarean, decrease the risks of maternal morbidity and mortality, increase birth satisfaction, lessen the need for pain relief, and limit the ‘cascade of intervention’ (Hodnett et. al., 2011; Howarth et. al., 2010; Moberg, 2011).
Kashanian, Javadi & Haghighi (2010) believe it is important to increase the positive and reduce the negative aspects of birth, as birth has ongoing physical, emotional and psychological effects. Therefore feeling loved during your birth would seem to be of upmost importance, not only for the impact it has during your birth but also in the long-term.
In New Zealand many women feel fearful of giving birth. As medical knowledge has increased, so has the fear of what can go wrong. Feeling afraid releases stress hormones such as adrenaline and cortisol, which can have an effect on how labour progresses, potentially lengthening labour and creating an exhausted mother. These hormones can also cause a reduction in blood supply to the baby, abnormal foetal heart rate, decreased uterine contractility and low Apgar scores at birth. During pregnancy prolonged high cortisol levels can have effects on the foetus such as inhibited foetal growth, and high blood pressure and hyperglycaemia as an adult. Severe stress during childbirth is toxic to both mother and baby (Daub, 2007; Hodnett et. al., 2011; Howarth et. al., 2010).
Odent (2001) describes fear as the most common cause of difficult and painful labour. The adrenaline released in the body when a woman is afraid increases muscle tension that gives rise to pain. Fear also worsens the perception of pain, and pain increases fear. This snowball scenario can be a self fulfilling prophecy when horrific childbirth stories are told to a pregnant mother by the significant women in her life. She is setup to believe birth will be great agony -and so it will be (Gaskin, 2008; Howarth et. al., 2010). Fear even has the power to stop labour. Gaskin (2008) retells stories of labour pausing at 7cm dilation due to secret fears being present. These labours only progressed once the fears were expressed.
How a mother felt during her labour can negatively or positively impact early interaction with her newborn. A negative experience, e.g. if she felt afraid, can be detrimental to interaction, impair the development of her maternal identity, and contribute to postnatal depression (Howarth et. al., 2010).
Adrenaline is a hormone that is released during stressful or defensive situations, stimulating the fight/flight/freeze response. It was never intended to be present in early labour and actually inhibits the natural process. It can cause labour to take longer or to stop. This response can sometimes be seen when a labouring woman arrives at the hospital, as stress hormones are produced by being in an unfamiliar environment. Adrenaline can cause abnormal foetal heart rate patterns and low Apgar scores. Therefore it is important to encourage an environment in early labour that will see oxytocin levels rise and adrenaline levels kept at a minimum.
Surprisingly however, adrenaline does have a key role in the labour process. A sudden rise in adrenaline levels in the second stage of labour can stimulate the foetal ejection reflex. The symptoms of adrenaline in this scenario can be seen as the birthing mother suddenly wanting to grab hold of something, being alert, and feeling especially thirsty for a drink of water. The baby also secretes adrenaline during the last few contractions of labour, which helps baby adjust to the oxygen deprivation that occurs during the second stage (Daub, 2007; Gaskin, 2008; Hodnett et. al., 2011; Moberg, 2011; Odent, 2001).
Hodnett et. al. (2011) describes one of the types of situations where a birthing woman may feel unsafe as when she is subjected to routine institutional obstetric care. Institutional care typically includes high rates of intervention, unfamiliar personnel, lack of privacy etc. ‘White coat hypertension’ also applies to the anxious birthing mother. And as we discussed earlier, experiencing fear in a situation releases stress hormones, which interfere with the progress of labour. Odent (2001) explains that when hormones of the adrenaline family are triggered, the situation is likely to have stimulated the neocortex of the birthing woman, inhibiting the birth as a result. When a woman is giving birth in a place she does not feel safe in, her body instinctively holds back in order to protect the baby (Daub, 2007).
Caesarean section can be another feared situation that affects the release of hormones. On average, a woman who has a caesarean has less oxytocin pulses compared to a woman who has a vaginal birth. This can lead to difficulty with breastfeeding and a less calm mother. It’s a staggering thought to consider that our generation may be the first to commonly have babies born without the mother’s brain being impregnated with labour hormones (Moberg, 2011; Odent, 2001).
#5 Choosing a birth place where Mama feels safe
Feeling safe in labour is a prerequisite for changing the level of consciousness in the brain from the neocortex to the primitive brain (the part of the brain that instinctively knows how to birth a baby). If a woman is able to labour and birth in the place where she feels the safest, she will be able to relax and tap into her calm and connection system. Therefore her oxytocin levels will be at their optimum (Daub, 2007; Odent, 2001). Hodnett et. al. (2009) recommends all women should have support during labour, and explain that this can provide a ‘buffer’ to the fear created by routine obstetric care to some extent. Labour support also enhances normal labour processes (including the release of oxytocin) as well as feelings of control and competence. Anxiety and fear are reduced through the provision of emotional support, information, advice, comfort measures and advocacy. This helps to minimise the level of stress hormones. Therefore, when choosing your birth place ensure it is a place where your support team is welcome (whether that be your partner, doula, family, friend or all of these options).
Gaskin (2008) states “An intricate and exquisitely balanced combination of hormones is necessary to trigger all of the functions of labor and birth…” (p.147). The responses they stimulate in mother and baby are vital to baby’s survival. Oxytocin is a hormone that allows the body’s calm and connection system to be tapped into, and seems to be the way love works in the body. Research suggests oxytocin levels increase when we breastfeed, eat, make love or have physical contact with another individual (Daub, 2007; Moberg, 2011). Oxytocin’s symptoms are a reduction in feelings of stress, levels of stress hormones, fear, blood pressure and pulse rate, and an increase in calmness, digestion, nutritional storage, and fluid balance maintenance. Specifically within a childbirth setting, oxytocin stimulates uterine contractions, helps to expel baby, increases tolerance to pain, encourages maternal behaviour and makes breastfeeding possible. Sensory nerves stimulate the release of oxytocin. So when a newborn baby is skin to skin with its mother oxytocin is released in both persons, helping baby to be relaxed and warm (Daub, 2007; Gaskin, 2008; Moberg, 2011; Odent, 2001).
How can you have a better birth experience?
There are many easy practical things you can do that will have a positive influence on your birth hormones. The first is to ensure you will have continuous one to one support during your labour and birth. This companionship includes advocacy, emotional support, praise and reassurance, comfort measures, touch, massage, and providing food and drink. All of these things encourage the release of oxytocin, lessen fear (therefore keeping stress hormones low), and surround you as the birthing mother with feelings of love (Daub, 2007; Howarth et. al., 2010).
The next practical step is to choose your birth environment wisely. During early labour set up your birth space to have privacy, dim lighting, and quietness. This is an invitation to relax, helps to keep the neocortex part of your brain quiet, and your oxytocin levels high.
The small things your partner or birth support person does during your labour can also make a difference. For example, looking into the eyes of the birthing woman and saying loving words such as “you can do it” produces oxytocin and therefore has a calming effect. (Daub, 2007; Gaskin, 2008).
Be informed. The Birthing Room’s Online Courses will provide your family with in-depth, practical information about birth hormones, choosing your birth location and team, natural comfort measures and lots more, so that you are able to look forward to your positive birth experience with confidence.
In summary, love, fear and feeling safe have a significant impact on labour and birth. Love helps a woman relax in labour, and increases labour efficiency, safety, and tolerance to pain. Fear releases stress hormones which have a negative impact on labour, increase the perception of pain, and can impair mother/baby interaction and development of maternal identity. Feeling safe in labour is essential for optimum oxytocin levels. Continuous one on one support increases feelings of control and competence, and reduces fear and anxiety. Ensuring the birthing environment is well set up will allow the mother to have high oxytocin levels and low stress hormone levels, while accessing her primitive brain and keeping her neocortex quiet (Daub, 2007; Hodnett et. al., 2011; Howarth et. al., 2010; Kashanian et. al., 2010; Odent, 2001).
Daub, C. (2007). Birthing in the Spirit.
Gaskin, I.M. (2008). Ina May’s Guide to Childbirth. (2nd ed.) London, United Kingdom: Vermilion.
Hodnett, E.D., Gates, S.,Hofmeyr, G.J., Sakala, C., & Weston, J. (2011). Continuous support for women during childbirth. Cochrane Database Systematic Reviews, Feb 16(2). 10.1002/14651858.CD003766.pub3.
Howarth, A.M., Swain, N.R., & Treharne, G. (2010). A review of psychosocial predictors of outcome in labour and childbirth. New Zealand College of Midwives, 42. 17-20.
Kashanian, M., Javadi, F., & Haghighi, M.M. (2010). Effect of continuous support during labor on duration of labor and rate of cesarean delivery. International Journal of Gynecology & Obstetrics. https://doi.org/10.1016/j.ijgo.2009.11.028
Moberg, K.U. (2011). The Oxytocin Factor: Tapping the hormone of calm, love and healing. (2nd ed.). London, United Kingdom: Pinter & Martin Ltd.
Odent, M. (2001). The Scientification of Love. (Revised ed). London, United Kingdom: Free Association Books.