How your hormones make birth happen!
Today we’re going to be talking all about hormones, well specifically 5 of the hormones that are important in labour & birth! I really love this bit, it’s my favourite lesson to teach in my group hypnobirthing course. Along with understanding about the muscles of your uterus and how they work to facilitate birth, I think knowing about how your hormones work really makes it all click and should hopefully highlight how important the brains role really is.
In a nutshell, your hormones are the complete toolkit for birth. Everything we consider about birth should be linked back to functioning of your uterine muscles and the production of birth hormones. We want our muscles to be working as best they can and our hormones to be beautifully balanced.
The big guys that we are going to focus on today are Oxytocin, Endorphins & Adrenaline; and then we’ll touch on the backing singers, those with important jobs but a bit less spotlight and they are Melatonin & Prostaglandins.
Before we get on to that - I thought we’d start by talking about what hormones are
Because I think, when you’re socialised as female, we’re kind of led to believe that our hormones make us moody bitches - that being ‘hormonal’ is a bad thing, we associate it with PMS which again is seen as a bad thing.
Hormones are chemical messengers - they are our bodies way of communicating with itself and making things happen. They are not good or bad, they just are - it’s our perception of them, and our beliefs about the behaviours they cause or inhibit that make us think they are either positive or negative.
In terms of the menstrual cycle - yes towards the end of each cycle, just before your period comes you may find yourself frustrated easily, wanting to be alone, but that doesn’t mean you’re being a bitch, and it’s not inherently a bad thing - what happens is that our bodies are running seriously low on oestrogen, our people pleasing hormone that makes us feel social.
Instead progesterone is running the show - and progesterone is the hormone that makes us want to retreat inwards. That lack of oestrogen can also mean that we have less time for people not treating us the way we want to be treated - again not always a bad thing! Oestrogen can mean we are more likely to go with the flow rather than thinking about ourselves and what we want & need.
Progesterone also shows up in pregnancy - this is the hormone that stops your uterus from contracting. It rises through pregnancy peaking around week 32. As your body gets ready for the onset of labour, one of the changes that allows labour to begin is the decline of progesterone alongside increasing oxytocin levels which allows the uterine muscles to begin contracting.
Now, the behaviours associated with progesterone are seen as a positive in pregnancy - we call it nesting, it’s seen as a good thing, getting ready for baby arriving. The tendency to focus more inward is again seen as a positive and something to support yourself - taking time to rest and reflect before the experience of birth.
However in the menstrual cycle, these same behaviours are often viewed through a very negative lens. Perhaps if it became more normal to acknowledge these cyclical changes and support ourselves through them - give ourselves space to rest and focus on our own needs - be a bit selfish (again something with a lot of negative connotations but sometimes you have to put on your own oxygen mask first).
From my own personal experience, since I began to recognise and appreciate why I might feel a particular way at the different points in my cycle and embrace those feelings as they arrive, I have had a much more positive experience of my cycle.
Obviously it’s not always possible to tailor your life based on when your period is coming but understanding and appreciate the changes that your body & mind may undergo allows you to think about how you can support yourself and be a bit kinder to yourself as well, because thinking ‘urgh my periods due and I’m a total bitch’ doesn’t really help us.
Now if this is something that interests you then PLEASE check out the work of Maisie Hill who is a menstrual health expert and explains beautifully how & why the different stages of your cycle can affect your day to day life as well as how to support yourself in these different stages. This book was on our recommended reading list when I did my hypnobirthing training with The Birth Uprising and I can honestly say it changed my life. I really hope that by the time my little girl is in school that sex education will include a big chunk around understanding the menstrual cycle in this way. It’s been amazing for me.
Well that was a bit of a tangent!
Anywaaaayy - back to birth hormones…
OXYTOCIN
We’re going to kick off with oxytocin - the love hormone; the shy hormone. Produced by the bucket load when we orgasm but also when we cuddle and when we kiss. If something triggers happy memories and makes you smile or gives you that warm feeling in your tummy, thats oxytocin.
Now describing it as the shy hormone should give you an idea about the kind of environment it needs. It likes privacy; it doesn’t like to feel observed and it doesn’t like interruptions (much like the kind of environment most of us like having sex in).
I want you to always be relating this back to your birth environment. Oxytocin is the most important hormone for progressing birth so thinking about things you can do to make the environment feel familiar, intimate, safe is a good idea to support your bodies production of it.
What does it do?
So oxytocin is responsible for making your contractions happen, that’s it’s super important number 1 job, but it does have some other great roles:
- it plays a role in facilitating bonding between parent & baby, there is a massive spike of oxytocin after baby is born, and this is natures way of trying to force us to bond with our babies.
- this spike after birth can also help us to feel calm, positive & full of love, some people will feel an enormous urge to cry. This was me - I was absolutely wailing, clutching this tiny scrunchy little girl on my chest.
- it also tells your breast or chest tissue that baby is out and to ramp up the milk production as well as stimulating the release of milk.
- the ebb & flow of oxytocin through your body corresponds with the production of endorphins & these 2 hormones rise together throughout labour before peaking at birth. This is a brilliant example of how clever our bodies are: as our brains produce more & more oxytocin causing the contractions to become strong & regular, alongside that it instigates the release of these endorphins which are our body’s natural pain relief to cope with the increasing intensity of labour. Just amazing!
Let’s talk now about synthetic oxytocin, which you may or may not have heard of before, sometimes just referred to as ‘the hormone drip’. This can be used a type of induction and also to augment labour, for example if your contractions stall, or slow you may be offered intravenous ‘oxytocin’. This synthetic oxytocin is called ‘syntocinon’, or Pitocin if you’re in America.
Lots of people say that syntocinon is completely different to oxytocin but that’s actually not true. On a molecular level, they are exactly the same, the difference is that our bodies don’t recognise the synthetic version in the same way.
Our homegrown oxytocin is produced in the brain, and so the brain knows it’s being released and can make all the lovely side effects of oxytocin happen. Synthetic oxytocin is administered by IV so straight in to your bloodstream, and our brain is very selective about what it let’s in and so synthetic oxytocin cannot cross the blood-brain barrier. Meaning that as far as our brain is concerned, that oxytocin isn’t there.
Being in the bloodstream though, syntocinon can head straight to the uterus to do oxytocin’s number 1 job: causing the contraction of the uterus, but it doesn’t come with the added benefits that happen in the brain - like the corresponding rise of endorphins release and the positive impact on our emotional state.
Hopefully from what I’m saying, you’re getting the idea that we want to encourage as much natural oxytocin production as we possibly can. It’s just as crucial for caesarean birth & induction of labour because our bodies won’t be making it as part of the physiological birth process. There’s loads we can do to encourage it’s production, and this is something that should be on the forefront of your birth partner’s mind at all times:
- physical contact: that could be massage, kissing, cuddling, hand holding, light touch/tickling on the arm, nipple stimulation as well is really effective and thats something that people often do instinctively.
- orgasm: on your own or together - you never know how you’ll feel! This is something that people quite often immediately doubt but actually a lot of people find birth to be a very sensual experience.
- laughter
- eating food that you love
- music: we had our wedding playlist on at home and on the drive and that always puts a smile on my face; songs that are special to you can be really emotive & bring you little rushes of oxytocin.
And how can we protect our oxytocin production - a big one is to watch out for interruptions! It can be a good idea to put a sign on your door if you’re in birth centre / hospital that says to knock first, and then either birth partner can go out and see whats going on, or you can invite HCPs in. A knock is still an interruption but it’s less of a shock to your environment than someone just coming in. It can also deter unnecessary visits meaning that you are less disturbed.
I also recommend having a think about what comforts work for your during pregnancy and working with your partner to build a toolkit that they can be in charge of during labour. This might include things like your favourite snuggly blanket from home, pictures of your family, a speaker & iPad with your birth playlists & some funny films downloaded - if something helps you to feel relaxed & happy then get it in this kit!
Your partner knows you better than anyone, they know what you like, you’ll have planned for this day together, birth partners are in charge of making sure that the oxytocin is flowing. And that you feel loved and safe and are comfortable.
ENDORPHINS
Natures incredible pain relief - said to operate at up to 40x the potency of morphine in the human body and in lab tests they’ve been shown to be over 200x stronger. Endorphin is actually a shortening of ‘endogenous morphine’ - morphine we make ourselves.
Not only do endorphins work to counteract any discomfort you may feel during labour, they can also help us to feel calm & in control and to feel ‘focussed’ - they play an important part in people experiencing the sensation of going entirely ‘inward’.
When people talk about ‘labour land’ - a state of mind where your experience of time is distorted, you may have a lack of awareness of your surroundings or the people around you, this is in part a result of endorphins flooding your body.
Another incredible thing to note about endorphins is that our body can bank them for use in the later stages of labour. This is one of the brilliant benefits of using a tens machine early in your labour because it encourages your bodies production of endorphins, which will then be stored and released as spikes when things get more intense further down the line.
How can we boost endorphins well as they rise & fall together with oxytocin, anything that we do to produce oxytocin is in turn helping our body to produce more endorphins. So lights off, laugh & have a cuddle! Light exercise can also help, another reason why the instruction of ‘go for a walk’ is actually quite good advice - but I am also a massive advocate of just listening to your body, so if you feel like resting, don’t force yourself, as this can end up stressing you out and having the opposite effect!
ADRENALINE
And now we come to the third major player in the birth hormone game but this is one that for the most part, we do not want to encourage!
Adrenaline & Oxytocin are antagonistic to one another, meaning that if our body is producing one, they are not producing the other. So, until we reach the transition stage of labour where adrenaline has a positive purpose, we really want to keep it at bay.
What that adrenaline does is it:
- heightens our senses, making it difficult to relax and would make entering something like ‘labour land’ pretty impossible
- stops the production of oxytocin which slows or stalls contractions
- increases breathing rate & heart rate
- dries up our mouth & makes us sweat (dehydrating us - again not good for muscle function when we want the big powerful uterine muscles working as best they can!)
- diverts blood flow away from the uterus, this reduces the oxygen supply to the uterus and can make contractions more physically challenging as the muscles struggle to work
In episode 2 I talked to you about the fear-tension-pain cycle. The less afraid we are, the more likely we are to be able to relax and let our bodies work.
However there are some other things that can cause adrenaline to spike, irrespective of your mindset:
- bright lights, interruptions, feeling observed, shift change in hospital can sometimes trigger this too
- notice they are the exact things that oxytocin hates
Travel is another one and a really important one to bear in mind because actually it’s kind of doing a good job here, if we can keep it under control. If you need to jump in the car to move from home to hospital / birth centre then that change in environment sends a signal to our bodies that ‘woah - hang on we’re moving, now is not the time’ and so the brain releases a shot of adrenaline to slow things down.
Understanding this is really important because if you feel stressed about things slowing in the car and then arrive at hospital feeling stressed that things have slowed, and you don’t know why, you’re then likely to continue producing more & more adrenaline and less & less oxytocin, making it more likely that things will stay slow.
BUT! if you understand that this might happen, you can be kinder to yourself, reassure yourself that this is normal, and work on switching that stress response off!
A good way to counteract this is to have a plan for the journey - listen to your favourite songs or something funny. Look at your favourite pictures. Using an eye mask / blindfold can be really good for tuning out the world, keeping you a little more in your own world.
And if things do slow, appreciate your body keeping you safe, realise that this doesn’t mean things are stopped forever, and when you get to hospital take yourself off to a deserted stairwell on arrival if you need time to get back in tune with yourself.
Now let’s talk about transition - this is when adrenaline gets good! Transition is a small stage between active labour (when your cervix is still dilating) and the second stage which is pushing & birthing baby.
Once your cervix is fully dilated, and the muscles being to switch or transition…from opening to pushing, your body releases a surge of adrenaline. This can help to wake you up if you’ve been totally focussed inwards; it makes sure that you alert & able to care for your baby (who is very nearly here at this point!) as well as a surge of energy for pushing. All of this helps to prepare you for the final effort before meeting your baby.
What it can also do though, is make you frightened, especially if you’ve been totally off in labour land - to suddenly feel your attention pulled in to the room, be very aware of the people around you. Some people also feel at this point that they can’t do it anymore so it’s really crucial for your birth partner to be aware of this so that they can reassure you and that it doesn’t stress them out too!
Of course your midwife will be aware of this and be trying to do exactly that but there is no one better placed to comfort, reassure & support you than the person you have trusted enough to ask to be your birth partner.
The Backing Singers… We’ll start with PROSTAGLANDINS
These are hormones which soften and help to dilate the cervix, and are thought to be a key component of labour starting - though the exact dance of labour beginning is still one of life’s great mysteries.
During pregnancy & when you’re not pregnant the cervix feels like the tip of your nose, and as the body prepares to give birth it softens to feel more like your lips, and then begins to thin out - these changes are part of a complex process, with lots of different factors. Prostaglandins and relaxin are 2 of these factors which work to soften & thin the cervix by breaking down the collagen which keeps it firm & closed.
Unlike most hormones, which are produced by glands and transported in the bloodstream to act on distant areas of the body, the prostaglandins are produced at the site where they are needed. And this is the theory behind ‘a membrane sweep’.
A membrane sweep is where a midwife uses their fingers to stimulate your cervix & separate it from the membranes surrounding baby. This can trigger the release of prostaglandins, which MAY encourage the onset of labour - a Cochrane review in 2020 stated that the evidence for this is of pretty low certainty, so that’s just something to bare in mind as here in the UK everyone is now offered sweeps from 39 weeks.
Synthetic prostaglandins are also used in induction and we’ll look at that in a future episode.
You’ve probably heard of having sex being touted as a natural induction method. Orgasm producing bucketloads of oxytocin is one of the reasons for that; note to all partners of pregnant folks - it’s got to be good sex for the pregnant person!
Another is that semen contains prostaglandins so having penetrative sex without a barrier contraception like condoms could help to bring on labour… but it’s kind of impossible to know. If you feel up for it then crack on, but don’t feel like you need to force yourself - the best thing we can do to help our bodies get ready for birth is to… relax and let them do their thing.
It’s also worth mentioning here that if your waters have broken, it’s not recommended that you have penetrative sex as there is an increased risk of infection.
MELATONIN
Yes the sleepy hormone, produced when it’s dark / when the sun goes down to trigger our bodies to feel sleepy and head for bed.
In birth melatonin’s job is to boost oxytocin, aiding the contractions of the uterus. As melatonin thrives in the dark and in privacy, this is why so many labours begin in the night - and also why it’s highly unlikely to all kick off in Tesco so you really don’t need to worry about that too much!
This is another reason to turn off the lights, draw the curtains, settle down. Avoid screens if you can. Any contacting that needs done, leave that to partner, and if you’re using an app to track your contractions, again this could be a job for partner meaning you can avoid that blue light that Melatonin hates.
As we come to end of today’s episode, I want to read you a little excerpt from Sara Wickham’s book ‘In Your Own Time’. An absolutely brilliant book all about the increasing rate of induction of labour and a dissociation from the physiology of labour. I recommend it to pretty much everyone I work with. This little chunk really highlights how the maternity service often forgets that the way people in labour FEEL is a key factor in the unfolding of their labour:
If a woman’s labour stops when she enters hospital, the logical conclusion, from a woman-centred approach is to consider that perhaps the woman does not feel safe and that a change of environment is required. Or perhaps they need a different caregiver? More support? More privacy? But what will often happen in modern maternity care is that they are told that their body is failing to labour adequately, and often subjected to interventions to make their bodies behave in the way that’s expected of them according to the mathematical principles that the medical model often expects nature to follow.
It is simply not true that we can separate out our mind, body & spirit (whatever that means to you) from our wider environment. The production of hormones which drive the physiological process of childbirth are profoundly linked with the mind & our nervous system.
I want you to lodge this in your mind; discuss it with your birth partner; make a note somewhere - that if your labour slows or stalls at any point - in the early stages at home; after labouring for a few hours in hospital or even when you’re preparing to birth the placenta - instead of questioning your body - instead of questioning yourself and your abilities; question your environment.
Has something changed to make you feel unsafe, or less comfortable - could you be warmer? Could the lights be dimmed? Have your midwives just swapped round? All of these things could be affecting how safe your body feels and therefore impacting on the progress of your labour by halting the production of oxytocin.
And I think we’ll leave it there for today. Thank you so much for tuning in - I’m about to jump in to a lovely lavender salt bath. I did some yoga with my 3 year old yesterday and I’m embarrassed to say that my ham strings are absolutely goosed from it, so that’s where I’ll be for the rest of this evening.
Membrane Sweeping for Induction of Labour, 27.02.2020
https://www.cochrane.org/CD000451/PREG_membrane-sweeping-induction-labour