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Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care
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.
... At the background of these effects, we assume hormonal processes of birth, mainly central oxytocin production of the brain. According to Buckley (2015), the innate, hormonal physiology of mothers and babies-when promoted, supported, and protected-has significant benefits for both in childbearing, and likely later on, by optimizing labor and birth, newborn transitions, breastfeeding, maternal adaptations, and maternal-infant attachment. Interventions such as analgesia, epidural anaesthesia or caesarean section affect normal hormonal processes (Buckley, 2015, Varga, 2011. ...
... According to Buckley (2015), the innate, hormonal physiology of mothers and babies-when promoted, supported, and protected-has significant benefits for both in childbearing, and likely later on, by optimizing labor and birth, newborn transitions, breastfeeding, maternal adaptations, and maternal-infant attachment. Interventions such as analgesia, epidural anaesthesia or caesarean section affect normal hormonal processes (Buckley, 2015, Varga, 2011. Research with animals show that beta-endorphins prime reward centers of mothering behaviour at birth, this way facilitating maternal adaptations and mother-infant contact and attachment. ...
... Research with animals show that beta-endorphins prime reward centers of mothering behaviour at birth, this way facilitating maternal adaptations and mother-infant contact and attachment. Together with the effects of beta-endorphins, the release of oxytocin with breastfeeding and maternal-infant contact may maintain maternal attachment (Buckley, 2015). Synthetic oxytocin for inducing or speeding up labour seems to hinder the natural central oxytocin effect, thereby blocking psycho-emotive changes connected to natural labour and birth (Varga, 2011). ...
In the present study I would like to report about a research that addressed to examine the relationship between circumstances of birth, mothers' subjective experience of birth and quality of early attachment. Earlier (Héjja-Nagy, 2015) we found that among the factors that have a positive effect on subjective experience of birth are preparation for birth, positively perceived social support (mainly the presence of an accompanying female), and the possibility for informed decisions, while any intervention and absence of social support seems to negatively influence the birth experience. However, positive birth experience, positive altered state of consciousness during delivery has important benefits: by means of neurophysiological processes it enhances maternal care, supports attachment from right after birth (Héjja-Nagy-Varga, 2017). Experience of midwives and research findings suggest that fulfilment of mothering behaviour (breast feeding, responsive caring, nighttime parenting etc.) is easier after an undisturbed vaginal delivery. In the recent self-report survey, 180 mothers having a child from 6 to 12 months were asked to fill in the questionnairs. I developed a questionnaire to chart circumstaces of labour and delivery, and used the Phenomenology of Consciousness Inventory I. (Pekala, 1982) to map phenomenology of subjective experiences of birth. To uncover the quality of attachment I used Mothers' Object Relation Scale (MORS), and Baby/Child-Mother Bonding Instrument (BMBI) (both developed by Oates, Hungarian version reported in Danis et al., 2005), and a questionnaire about maternal care practice. Recent results proved former correspondence between circumstances of labour and delivery and mothers' subjective experience of birth. We found significant differences between responses of the attachment questionnaires according to child care practice, circumstances of birth and subjective experience of birth. The results may draw attention to the fact that subjective experience of birth is an important factor of mother-child relationship, which may affect the quality of attachment, that has a long-term influence on personality development. That is one more reason why circumstances and attitude of staff should help the optimal positive birth experience. Keywords: circumstances of birth, subjective experience of childbirth, early attachment, maternal care Introducion Earlier (Héjja-Nagy, 2015) we found that among the factors that have a positive effect on subjective experience of birth are preparation for birth, positively perceived social support (mainly the presence of an accompanying female), and the possibility for informed decisions, while any intervention and absence of social support seems to negatively influence the birth experience. However, positive birth experience, positive altered state of consciousness during delivery has important benefits: by means of neurophysiological processes it enhances maternal care, supports attachment from right after birth (Héjja-Nagy-Varga, 2017). Experience of midwives and research findings suggest that fulfilment of mothering behaviour (breast feeding, responsive caring, nighttime parenting etc.) is easier after an undisturbed vaginal delivery (e.g. Cetisli et al, 1992).
... A szülés alatt (többek között) négy fő hormonális rendszer aktív: az oxitocinrendszer, a béta-endorfinok, az adrenalin-noradrenalin rendszer és a prolaktin (Buckley, 2015;Dérné Faust, 2019). A legismertebb, és talán legfontosabbnak tartott hormon a szülés folyamatával kapcsolatban az oxitocin. ...
... A béta-endorfinok a szervezet saját fájdalomcsillapítói, az agyalapi mirigyben termelődnek, és jó közérzetet, eufóriát tudnak okozni a szülés alatt (Buckley, 2015;Stadelmann, 2007). Fájdalmas helyzetekben fájdalomcsillapítóként, stresszhormonként működnek. ...
... Fájdalmas helyzetekben fájdalomcsillapítóként, stresszhormonként működnek. Koncentrációjuk végig magas a várandósság során, és még tovább emelkedik a szülés folyamán (Buckley, 2015;Héjja-Nagy és Varga, 2017). ...
A tanulmány első része áttekinti a szülés szubjektív élményét és az azt meghatározó tényezőket, valamint a szülésélmény lehetséges hosszú távú hatásait. A második rész egy empirikus vizsgálat eredményeit ismerteti. Kérdőíves vizsgálatban arra kerestem a választ, hogy van-e kimutatható kapcsolat a szülésélmény és a szülés körülményei, illetve az anya-gyerek kapcsolat minősége között. A kérdőíves vizsgálat 180, 6–12 hónapos korú csecsemő édesanyjának bevonásával zajlott.
A szülés körülményeinek vizsgálatára saját összeállítású kérdőívet
használtam, a szülés módosult tudatállapot élményét a Phenomenology of Consciousness Inventory I. változatával mértem fel (Pekala, 1982). Az anya-gyerek kapcsolatot a Szülő–csecsemő kapcsolat skála (MORS) és a gyermekgondozási/gyermeknevelési kérdőív (BMBI/
CMBI) magyar változataival (Danis, Oates és Gervai, 2005) mértem, valamint a gyermekgondozási szokásokat saját kérdőívvel vizsgáltam. Az eredmények alapján különbség volt a gyermeknevelési kérdőívek válaszaiban a szülés módját, a szülés körülményeit, a szülés szubjektív élményét és a gyermekgondozási szokásokat tekintve. Úgy tűnik, összességében nemcsak a szülés módja, hanem számos körülmény befolyásolja a szülésélményt, és hat hosszú távon az anya-gyermek kapcsolat elemeire.
... International Breastfeeding Journal (2022) 17:66 during the perinatal period is challenging because at this time complex mechanisms take place in the body of both the mother and the fetus [2]. The role of prolactin in the maternal and neonatal body is associated with many physiological processes, such as conception, postpartum maternal adaptations (including personality changes), lactation, and infant growth and brain development [3]. Prolactin is a protein hormone which belongs to the prolactin/growth hormone/ placental lactogen family and is synthesized and released by the cells of the anterior pituitary gland [4]. ...
... Prolactin is a protein hormone which belongs to the prolactin/growth hormone/ placental lactogen family and is synthesized and released by the cells of the anterior pituitary gland [4]. The secretion of this hormone is promoted by estrogen, thyroidreleasing hormone, norepinephrine, oxytocin, and some forms of stress; however, the release of prolactin is triggered mainly during the childbirth and lactation process [3]. The success of breastfeeding, which is understood as producing sufficient milk to meet the newborn's nutritional and immune requirements, is influenced by several factors [5][6][7]. ...
... At the same time, in women who received an infusion of synthetic oxytocin during labor, significantly higher levels of prolactin were observed on the second day postpartum, as well as a decrease in endogenous oxytocin, particularly in those who received epidural analgesia during labor [14,15]. The maternal cortisol plasma levels are elevated during childbirth, which represents hormonal adaptation to acute stress preventing maternal hypoglycemia [3,9,16]. On the other hand, breastfeeding seems to inhibit the extended increase in maternal cortisol levels [17,18]. ...
Background
Childbirth and lactation are intricate processes, involving several hormones, the most important of which are prolactin (a protein hormone) and cortisol (one of the glucocorticoids). The early postpartum period is crucial for both mother and newborn and has an impact on the lactation and breastfeeding process.
Methods
The study included 78 patients who were admitted to the Gynecology-Obstetrics Clinical Hospital in Poznań for labor induction and/or in the active phase of the first labor stage. The levels of cortisol and prolactin in serum were assessed in these women during admission in labor, during the third labor stage, and on the second day postpartum. The levels of cortisol and prolactin in the umbilical cord serum were assessed immediately after cord clamping. The “Protocol for the assessment of breast-suckling skills” was used to assess the neonatal breast-suckling skills on the second day postpartum. Some additional parameters were evaluated in mothers via a telephone interview at three and six months postpartum. The study was conducted from January to August 2020, however the study was suspended during April–July 2020 due to the SARS-CoV-2 pandemic, which led to restrictions in the hospital limiting access to the hospital wards unless necessary.
Results
Early breastfeeding with skin-to-skin contact was associated with low levels of hormones, cortisol levels were lower in serum ( p = 0.0108) and umbilical vein ( p = 0.0273) in mothers who breastfed immediately after childbirth. At three months postpartum, 88% of the mothers who did not offer a pacifier to the child during the first few days of life breastfed the child naturally ( p = 0.037), and at six months, 96% of those who did not offer a pacifier continued to breastfeed ( p = 0.0008). Multiple, statistically significant correlations were observed between the variables assessed according to the “Protocol for the assessment of breast-suckling skills” and breastfeeding after three months.
Conclusions
Breastfeeding immediately after childbirth, appropriate assessment of the breast-suckling skills of newborns, avoiding pacifiers and infant formula feeding, and offering support to new mothers in the early days after childbirth seem to be important factors for sustaining breastfeeding after three and six months of childbirth.
... Aromatherapy is one of the CAMs used to stimulate labor. It is usually applied in a footbath, via scent inhalation, or by massage using clary sage, lavender, or jasmine oil [5][6][7][8][9][10]. 2 of 14 In medical induction of labor, synthetic oxytocin is infused to induce uterine contractions and the subsequent onset and augmentation of labor [11,12]. Similarly, aromatherapy for stimulating labor is considered to be associated with the release of hormonal oxytocin. ...
... The concentration of oxytocin receptors was related to the responsiveness to the oxytocin change [64]. The concentration of oxytocin receptors was found to increase through pregnancy and reach a peak in early labor or 40 weeks of gestation with labor [12,65,66]. The mean gestation weeks of the women in the present study was 38, and thus they might not be responsive to the increase in the oxytocin level. ...
Background:
Aromatherapy is usually used to stimulate labor. However, its specific physiological effects have been scarcely examined. We evaluated whether an aromatherapy footbath increases oxytocin levels in term pregnant women.
Methods:
In this quasi-experimental study, low-risk term pregnant women in Japan underwent aromatherapy using a footbath (1) infused with clary sage and lavender essential oils, (2) infused with jasmine oil, or (3) with no infused oils (control group). The primary outcome was the salivary oxytocin level. The secondary outcomes were uterine contractions and cortisol levels.
Results:
In the clary sage and lavender group (n = 28), the oxytocin level increased significantly after the footbath (p = 0.035). The jasmine group (n = 27) and control group (n = 27) exhibited trends toward a respective increase and decrease in the oxytocin level; however, the changes in the oxytocin levels between the clary sage and lavender group and the control group showed no significance difference. There were no significant differences in the changes in the uterine contractions and cortisol levels between the experiment and control groups.
Conclusions:
The changes in the oxytocin levels in the clary sage and lavender group did not differ significantly with those in the control group, possibly because of the small sample size. Further studies are required to examine the effects of repeated aromatherapy footbaths to stimulate labor.
... Oksitosin adalah hormon reproduksi yang kuat dan memiliki efek menyebar luas diotak dan semua tubuh mamalia, misalnya, dengan mediasi ejeksi sperma, kontraksi persalinan, dan pengeluaran air susu. Oksitosin juga mengurangi stres dengan cara terpusat mengaktifkan sistem saraf parasimpatis, yang memberikan efek tenang dan penyembuhan; dan dengan mengurangi aktivitas di sistem saraf simpatik yang mengurangi rasa takut, stres, hormon stres, dan meningkatkan sosialisasi (Buckley SJ. 2015). ...
... 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). ...
Program Keluarga Berencana (KB) terancam gagal di masa pandemi Covid-19.
Mulai dari terbatasnya akses masyarakat ke fasilitas kesehatan, menunda kunjungan
ke fasilitas kesehatan karena takut tertular Covid-19, hingga fasilitas kesehatan
yang menyediakan layanan kontrasepsi ditutup karena belum terpenuhinya fasilitas
pencegahan penularan dari Covid-19. Selain itu, tidak sedikit fasilitas kesehatan
yang dialihkan untuk melayani pasien Covid-19, sehingga tidak melayani kesehatan
ibu dan anak, termasuk layanan kontrasepsi. Pelayanan kesehatan, salah satunya
pelayanan KB, di fasilitas kesehatan ikut terdampak pandemi Covid-19. Hal ini
menyebabkan pasangan usia subur atau akseptor KB khawatir untuk datang ke
fasilitas kesehatan. Kondisi ini berakibat timbulnya risiko putus-pakai kontrasepsi
yang kemudian berdampak pada kehamilan tidak direncanakan. Keterbatasan akses
terhadap layanan kontrasepsi dapat menyebabkan peningkatan jumlah kehamilan
yang tidak direncanakan (Kemenkes RI, 2021).
Kata Kunci: Kehamilan Tidak Direncanakan, Fenomena Baby Boom, Pandemi
Covid-19
... They approached the birth with a low level of fear. Underscoring our findings, Buckley [28] has described how knowledge of the significance of oxytocin for labour progress can influenced their desired childbirth experience. It is important to note that the positive effects of oxytocin can be diminished in stressful situations. ...
Objective:
Hypnobirth is a technique that incorporates elements from hypnosis and is used to prepare women for birth. It aims to promote a normal birth and create a positive birth experience by equipping women with knowledge and tools to reduce fear, anxiety, and pain during labor. The objective of this study was to investigate women's experiences in using this technique during childbirth.
Methods:
Qualitative study with nine in-depth interviews, analysed using a descriptive phenomenological method.
Results:
The women changed their perspective on birth and got to know their inherent resources. They acquired various coping strategies and techniques that enhanced their sense of control. The women gained ownership of their birth and found their active participation to be meaningful. They were informed of different options concerning their birth which made it possible to make informed decisions. The participation in hypnobirth classes, and personal experience from giving birth, made women wish for integration of mental birth preparation in the public health service, thus strengthening women's trust in ther ability to give birth, which was pivotal to the participants' birth satisfaction.
Conclusion:
The participants experienced an empowered birth because of the knowledge, coping strategies and mental training they gained from hypnobirth classes.
... Endocrine system significantly affects the mother and baby during the delivery [8]. In a study on the evidencebased effects of the hormonal physiology on mothers and babies during birth, it was found that studies depending on the measurement of hormones should be prioritized to understand the beneficial or damaging effects of hormones in maternal care [9]. Oxytocin and prolactin (PRL) play a significant role during labor and in maintaining the health of the mother and baby; natural oxytocin increases uterine contraction, calmness, and reduce pain. ...
To evaluate the effect of delivery in a vertical birth chair (VBC) and traditional delivery table (DT) supported by women’s movement during labor on the labor process, fetal outcome, maternal hormone levels, birth comfort, and satisfaction. This randomized controlled trial was conducted with 1:1:1 allocation. Group 1: in the VBC in upright position, Group 2: on the DT in supine position, these groups supported by freedom of movement, control group: on the DT in supine position, labor in bed. The duration of second stage of labor was not different between the groups ( p = 0.246). The occurrence of instrumental birth, episiotomy, and perineal laceration was also not different among the groups ( p = 0.772, p = 0.953, and p = 0.124). The use of uterotonic was observed in control group ( p = 0.001). 1 and 5 APGAR scores of newborns were not different in all groups ( p = 0.121, p = 0.268). The lowest pain score was observed in Group 1 ( p = 0.001). Birth comfort and satisfaction were higher in Group 1 ( p = 0.001 and p = 0.001). Decreased postpartum prolactin levels and increased postpartum oxytocin levels were observed in the control and Group 1 ( p = 0.004, p = 0.006). Freedom of movement during labor and delivery using VBC in upright position can play birth-promoting and supporting role. There were no negative effects on the fetal outcome.
In this column, the associate editor of The Journal of Perinatal Education discusses the impact of birth physiology on the transition to motherhood. The associate editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.
Respectful maternity care (RMC) is part of a global movement addressing the previous absence of human rights in global safe maternal care guidance. RMC is grounded in kindness, compassion, dignity and respectful working conditions. The decolonisation movement in healthcare seeks to dismantle structural biases set up from a historically white, male, heteronormative Eurocentric medical system. This article applies a decolonising lens to the RMC agenda and examines barriers to its implementation in UK healthcare systems. Searches of peer-reviewed journals about decolonising maternity care in the UK revealed little. Drawing from wider information bases, we examine power imbalances constructed throughout a history of various colonial biases yet lingering in maternity care. The overarching findings of our analysis revealed 3 areas of focus: professional structures and institutional biases; power imbalances between types of staff and stakeholders of care; and person-centred care through a decolonial lens. To uproot inequity and create fairer and more respectful maternity care for women, birthing people and staff, it is vital that contemporary maternity institutions understand the decolonial perspective. This novel enquiry offers a scaffolding to undertake this process. Due to significant differences in colonial history between Western colonising powers, it is important to decolonise with respect to these different territories, histories and challenges.
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