In Defense of Normal Birth

This year, the New Jersey Symposium for Physiologic Birth focuses on how malpractice claims limit the accessibility of physiologic birth practices particularly in the hospital setting.  Even though birth at its most normal results in the best birth outcomes (source), routine care of the laboring patient on labor and delivery is controlled, monitored intensely and rarely allowed to proceed without interference.

Unnecessary Interventions Dramatically Impact Birth Outcomes

Healthcare workers generally believe childbirth is a disaster waiting to happen.  This belief is grounded in the reality of what they experience every day on labor and delivery. They see labors and births that are seemingly “normal” become abnormal quickly, and without much warning, end in STAT procedures and surgeries. They find it hard to believe that things go better when there is less monitoring and fewer interventions.  Very few birth workers have witnessed a normal, physiologic birth.  They are completely unaware of the impact that environment has on the normal progress of labor. Many of the poor outcomes are a result of unnecessary interventions in a physiologic process, not a result of a worldwide collapse of the female reproductive system.

The Birth Environment’s Effect on Physiologic Birth

The  environment in most Labor and Delivery units stops or interrupts normal labor.

For birth to proceed normally, women must feel safe, private and unobserved (source).  The routine procedures on labor and delivery can be frightening. Privacy is something that is easily forgotten by birth workers. Women are often mortified by things that routinely happen in American hospitals like being left uncovered with doors wide open, being examined and observed by strangers during this very intimate and vulnerable time or during the pushing stage being told “poop” their baby out.  While fully understanding the need for students to learn, a crowd gathering for a delivery at the end of a woman’s bed with her legs held apart by stirrups is the ultimate in being observed under a microscope.

When women do feel safe, private and unobserved, they are in their parasympathetic nervous system where Oxytocin flows.  When they are frightened or exposed, they move into their sympathetic nervous system where catecholamines are secreted to facilitate “fight or flight”.  When we encounter a laboring woman who is angry and aggressive, do we ever think that this is her “fight” created by the scary things we are doing to her?

Oxytocin is released in the parasympathetic nervous system. Labor often slows on labor and delivery because it is not a calm, soothing environment. Beeping machines, strange people, hard surfaces, invasive procedures (did you ever consider how intimate a vaginal exam is?) and the lack of freedom of movement are found on a typical labor and delivery unit. These things are intimidating and frightening sending her into her Sympathetic nervous system where Oxytocin stops flowing.

Pitocin is not Oxytocin

Labor requires the secretion of the hormone Oxytocin for the uterus to contract and deliver the baby. The development of synthetic Oxytocin (Pitocin) enabled us to “help” the woman’s body by causing contractions of the uterus to induce labor and stop postpartum hemorrhage. Pitocin is a wonderful medication when absolutely needed but it carries many risks to both the mother and the baby. We must remember that Pitocin is not Oxytocin.

How Pitocin and Oxytocin Differ

1. Oxytocin is released from the Pituitary gland in a pulse-like manner. Pitocin is administered by a continuous intravenous drip.  You must assume that the uterus never totally relaxes when Pitocin is running. Oxygenated blood pumps into the placenta when the uterine muscles are relaxed.
2. The secretion of Oxytocin is reduced or stopped in the presence fear or anxiety and even hunger.  Because the Oxytocin stops being released, labor slows. Healthcare workers don’t respond by offering reassurance and food, they usually start Pitocin.
3. Oxytocin release is controlled by a biofeedback mechanism. This prevents stress to the baby by responding to messages from her and the baby to decrease the frequency and/or intensity of contractions.  Pitocin has no such control, it is usually slowed or stopped by medical staff AFTER the baby is stressed by frequent contractions or no relaxation between contractions which then leads to more intervention.  Studies have shown that flooding the oxytocin receptors with a continuous drip of Pitocin increases the risk of postpartum hemorrhage (source).
4. Maternal Oxytocin secreted in the brain from Oxytocin neurons stimulates the release of beta endorphins, natural pain medication. Because Oxytocin and Pitocin in the bloodstream do not cross the blood brain barrier, intravenous Oxytocin acts on peripheral organs like the uterus and breast but is believed to have no direct effect on the brain. Maternal oxytocin is secreted into the nervous system by Oxytocin neurons, causing the secretion of other hormones including endorphins in response to maternal pain (source 1) (source 2).
5. Along with Vasopressin (another parasympathetic hormone), Oxytocin has a neuroprotective mechanism to protect the fetus from any hypoxic episodes during labor (source).
6. Oxytocin may increase a woman’s trust in those around her and definitely helps her bond to her baby, partner AND provider (I have basked in the warmth of many a woman’s Oxytocin high after the birth) thus reducing likelihood of litigation (source).

Keep in mind that the administration of Pitocin is one of top causes of litigation in Obstetrics.  Creating an environment on Labor and Delivery where maternal Oxytocin flow is not interrupted will serve to both decrease liability and improve birth outcomes.  When the mother is secreting the Oxytocin rather than the IV pump, fewer things go wrong.  That is the nature (excuse the pun) of physiologic processes.

We hope that you can attend our fabulous conference this year!  You will learn how to avoid liability and meet many other birth workers interested in Improving Birth Outcomes in New Jersey.  For more information, visit https://midwivesofnj.com/the-new-jersey-symposium-for-physiologic-birth-2019-in-defense-of-birth/