Love, the Best Drug of All
By Laura Maxson LM
Love – it’s something you want in big doses during labor. Feeling loved and being loving, both help release the hormone oxytocin – the fuel that runs the engine of labor. Pulsing into the bloodstream from the posterior pituitary gland, oxytocin goes directly into the brain, triggering the release of endorphins (nature’s opiates) as it also finds oxytocin receptors in the uterus, causing contractions.
Oxytocin and endorphins go hand in hand in labor, resulting in a cycle of oxytocin release, answered by heightened endorphin levels. As labor progresses, the laboring person sinks further and further into their body, deepening their journey out of the thinking brain and into the more instinctive, primitive brain where they know how to give birth, a place also known as labor-land.
Semidarkness, soft sounds, privacy, trust and loving support all encourage oxytocin to flow and enhance labor. Loud conversations, beeping machines, opening doors, and announcements on the loudspeaker tend to inhibit oxytocin flow, which inhibits labor.
Pitocin, a synthetic oxytocin, is commonly used in the hospital to create or enhance contractions, most often to correct a problem. Administered directly into the bloodstream through an IV, Pitocin is delivered continuously, in an ever-increasing dose that stimulates the uterus. Pitocin is not able to cross the blood/brain barrier to trigger endorphin release. While Pitocin does increase contractions, it can also upset the normal flow of hormones involved with labor, birth and breastfeeding.
A planned homebirth is dependent on naturally occurring oxytocin to drive labor, so midwives do all they can to promote optimal levels of birth hormones by encouraging privacy and instinctual behavior. The midwife stays out of the way as much as possible while still providing a touchstone of trust and security. While some planned homebirths will transfer to the hospital for Pitocin, these numbers are much lower than the percentage of planned hospital births receiving Pitocin in labor.
In the classic movie, The Business of Being Born, it seemed that everyone in the hospital got Pitocin in that frantic montage showing care providers ordering nurses to, “pit her!” Pitocin can be good medicine, increasing contractions in dysfunctional labors, often making the difference between a vaginal birth and cesarean. The problem comes from the number of labors that are classified dysfunctional when in fact it could be the labor environment that is dysfunctional.
Even here in groovy Santa Cruz, Pitocin rates are high. It is hard to know what comes first: an epidural causing labor to slow, necessitating Pitocin augmentation, or strong Pitocin augmentation or induction contractions prompting an epidural request. Pitocin use and epidural placement are not routinely reported.
Soft lighting, being undisturbed, feeling loved by the labor support team, especially partners, are critical to coping with labor. Because it can be so difficult to achieve an undisturbed state in the hospital, many do opt for pain relieving drugs in order to cope. Distractions often increase with Pitocin administration (IVs, extra fetal monitoring, etc.,) and while it is much harder to go deep into the primitive brain to find labor-land when on Pitocin, it’s not impossible. Laboring on Pitocin, without an epidural will take intimate, undisturbed connection with a partner and/or labor support provider.
How to achieve this connection in the hospital?
A birth doula on the team can help. A partner has more opportunities to gaze lovingly into a laboring parent’s eyes, when a doula is applying counter-pressure to their back, getting more juice or getting up to close the door one more time – doulas increase intimacy for the laboring couples. Intimacy decreases stress and increases relaxation and oxytocin production.
When weighing Pitocin’s benefits against the risks, we often only consider the risk of over-stimulating the uterus or stressing the baby. Risks inherent in shifting the maternal hormonal response, as well as the baby’s during Pitocin labors, have barely been studied. We need to better understand the function of the normal hormonal mix of fetal and maternal endorphins and catecholamines (stress hormones) that nature provides at the moment of birth.
What can people do to give their hormones the best chance to work for a normal, natural labor?
Birth doulas and labor tubs are a start, along with the midwifery model of care and, if not birthing at home, then a homelike environment. At the very least – just shut the door and turn off the lights to let the love (and oxytocin) flow.
Sarah Buckley MD has written much about oxytocin – www.sarahbuckley.com
The Business of Being Born – www.vimeo.com/ondemand/thebusinessofbeingborn2
Listing of birth doulas, childbirth educators, midwives and more – www.birthnet.org