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Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care

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Abstract

This report synthesizes evidence about innate hormonally-mediated physiologic processes in women and fetuses/newborns during childbearing, and possible impacts of common maternity care practices and interventions on these processes, focusing on four hormone systems that are consequential for childbearing. Core hormonal physiology principles reveal profound interconnections between mothers and babies, among hormone systems, and from pregnancy through to the postpartum and newborn periods. Overall, consistent and coherent evidence from physiologic understandings and human and animal studies finds that the innate hormonal physiology of childbearing has significant benefits for mothers and babies. Such hormonally-mediated benefits may extend into the future through optimization of breastfeeding and maternal-infant attachment. A growing body of research finds that common maternity care interventions may disturb hormonal processes, reduce their benefits, and create new challenges. Developmental and epigenetic effects are biologically plausible but poorly studied. The perspective of hormonal physiology adds new considerations for benefit-harm assessments in maternity care, and suggests new research priorities, including consistently measuring crucial hormonally-mediated outcomes that are frequently overlooked. Current understanding suggests that safely avoiding unneeded maternity care interventions would be wise, as supported by the Precautionary Principle. Promoting, supporting, and protecting physiologic childbearing, as far as safely possible in each situation, is a low-technology health and wellness approach to the care of childbearing women and their fetuses/newborns that is applicable in almost all maternity care settings.
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... When the newborn is placed skin to skin with the mother, there is a significant increase in oxytocin, which will reduce maternal and newborn stress and help the newborn transition to postnatal life (Bergman & Bergman, 2013;Buckley, 2015;Moore et al., 2016;Uvnäs-Moberg et al., 2015). Furthermore, skin-to-skin contact with the mother will help to meet the newborn's basic biological needs, activate neuroprotective mechanisms, enable early neurobehavioural self-regulation and give the newborn a more stable heart rate, blood pressure, breathing and higher blood glucose (Buckley, 2015;Moore et al., 2016;Widström et al., 2010). ...
... When the newborn is placed skin to skin with the mother, there is a significant increase in oxytocin, which will reduce maternal and newborn stress and help the newborn transition to postnatal life (Bergman & Bergman, 2013;Buckley, 2015;Moore et al., 2016;Uvnäs-Moberg et al., 2015). Furthermore, skin-to-skin contact with the mother will help to meet the newborn's basic biological needs, activate neuroprotective mechanisms, enable early neurobehavioural self-regulation and give the newborn a more stable heart rate, blood pressure, breathing and higher blood glucose (Buckley, 2015;Moore et al., 2016;Widström et al., 2010). Skin-to-skin contact after birth has additional benefits, including increased infant axillary temperature and extended exclusive breastfeeding after hospital discharge (Moore et al., 2016). ...
... Skin-to-skin contact and the release of oxytocin by the mothers will promote maternal-newborn attachment (Bergman & Bergman, 2013;Buckley, 2015;Moore et al., ;Uvnäs-Moberg et al., 2015). In a study by Noren et al., mothers were asked about their experience of skin-to-skin contact with their newborns. ...
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... Beta-endorfin adalah opioid endogen yang memberikan respon analgesik dan adaptif terhadap stres dan rasa sakit. Beta-endorfin juga mengaktifkan kerja otak dan pusat-pusat kesenangan, perilaku reproduksi dan memotivasi dan bermanfaat, mendukung fungsi kekebalan tubuh, aktivitas fisik, dan kesejahteraan psikologis (Buckley SJ. 2015). ...
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... The physical environment can influence labor outcome and women's experience of labor and birth (Nielsen & Overgaard, 2020;Nilsson et al., 2020;Setola et al., 2019). A birth environment perceived by a birthing woman as private, safe, and undisturbed has been mentioned as important for the labor and birth progress to be physiologically normal, as well as reducing the occurrence of medical interventions (Buckley, 2015). Such a birth environment promotes the release of endogenous oxytocin, which has numerous beneficial effects, such as enhancing labor contractions and well-being and reducing fear, anxiety, and pain. ...
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Article
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... In turn, the fear that may be felt by a mother will affect her hormones, promoting the release of adrenaline and inhibiting oxytocin-the hormone that is released when we feel love and which body produces during labor. This shift in the hormonal balance is understood to in turn slow down a labor (Buckley 2011(Buckley , 2015. When labor slows down, the importance of time comes to the foreground. ...
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Data collection and analysis: Two review authors independently assessed all studies identified by the search for inclusion in the review. Four review authors independently extracted data. Two review authors assessed risk of bias and certainty of the evidence using GRADE. Main results: We included four studies that randomised a total of 755 women, with data analysed for 744 women and their babies. Interventions used to assess labour progress were routine vaginal examinations, routine ultrasound assessments, routine rectal examinations, routine vaginal examinations at different frequencies, and vaginal examinations as indicated. We were unable to conduct meta-analysis as there was only one study for each comparison. All studies were at high risk of performance bias due to difficulties with blinding. We assessed two studies as high risk of bias and two as low or unclear risk of bias for other domains. The overall certainty of the evidence assessed using GRADE was low or very low. Routine vaginal examinations versus routine ultrasound to assess labour progress (one study, 83 women and babies) Study in Turkey involving multiparous women with spontaneous onset of labour. Routine vaginal examinations may result in a slight increase in pain compared to routine ultrasound (mean difference -1.29, 95% confidence interval (CI) -2.10 to -0.48; one study, 83 women, low certainty evidence) (pain measured using a visual analogue scale (VAS) in reverse: zero indicating 'worst pain', 10 indicating no pain). The study did not assess our other primary outcomes: positive birth experience; augmentation of labour; spontaneous vaginal birth; chorioamnionitis; neonatal infection; admission to neonatal intensive care unit (NICU). Routine vaginal examinations versus routine rectal examinations to assess labour progress (one study, 307 women and babies) Study in Ireland involving women in labour at term. We assessed the certainty of the evidence as very low. Compared with routine rectal examinations, routine vaginal examinations may have little or no effect on: augmentation of labour (risk ratio (RR) 1.03, 95% CI 0.63 to 1.68; one study, 307 women); and spontaneous vaginal birth (RR 0.98, 95% CI 0.90 to 1.06; one study, 307 women). We found insufficient data to fully assess: neonatal infections (RR 0.33, 95% CI 0.01 to 8.07; one study, 307 babies); and admission to NICU (RR 1.32, 95% CI 0.47 to 3.73; one study, 307 babies). The study did not assess our other primary outcomes: positive birth experience; chorioamnionitis; maternal pain. Routine four-hourly vaginal examinations versus routine two-hourly examinations (one study, 150 women and babies) UK study involving primiparous women in labour at term. We assessed the certainty of the evidence as very low. Compared with routine two-hourly vaginal examinations, routine four-hourly vaginal examinations may have little or no effect, with data compatible with both benefit and harm, on: augmentation of labour (RR 0.97, 95% CI 0.60 to 1.57; one study, 109 women); and spontaneous vaginal birth (RR 1.02, 95% CI 0.83 to 1.26; one study, 150 women). The study did not assess our other primary outcomes: positive birth experience; chorioamnionitis; neonatal infection; admission to NICU; maternal pain. Routine vaginal examinations versus vaginal examinations as indicated (one study, 204 women and babies) Study in Malaysia involving primiparous women being induced at term. We assessed the certainty of the evidence as low. Compared with vaginal examinations as indicated, routine four-hourly vaginal examinations may result in more women having their labour augmented (RR 2.55, 95% CI 1.03 to 6.31; one study, 204 women). There may be little or no effect on: • spontaneous vaginal birth (RR 1.08, 95% CI 0.73 to 1.59; one study, 204 women); • chorioamnionitis (RR 3.06, 95% CI 0.13 to 74.21; one study, 204 women); • neonatal infection (RR 4.08, 95% CI 0.46 to 35.87; one study, 204 babies); • admission to NICU (RR 2.04, 95% CI 0.63 to 6.56; one study, 204 babies). The study did not assess our other primary outcomes of positive birth experience or maternal pain. Authors' conclusions: Based on these findings, we cannot be certain which method is most effective or acceptable for assessing labour progress. Further large-scale RCT trials are required. These should include essential clinical and experiential outcomes. This may be facilitated through the development of a tool to measure positive birth experiences. Data from qualitative studies are also needed to fully assess whether methods to evaluate labour progress meet women's needs for a safe and positive labour and birth, and if not, to develop an approach that does.
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