Disclaimer

I am a midwife, childbirth educator, lecturer, doula, and natural mother of eight children. This is not a medical reference; I do not proclaim to give medical advice. Anything stated here is from personal experience, research, study, and opinion. Each woman has the responsibility to do her own research, consult with her own medical team, and make her own decisions about pregnancy and birth.



Wednesday, April 13, 2011

A Plea for Natural Birth

Bismillah al-Rahman al-Rahim
I am pleased to share this thought provoking article by Zuzana Nadova, a trained midwife and dear friend.  She shares her research about some very important points concerning the risks and effects of the all-too-common practice of interfering with laboring women's natural patterns of hormonal secretions for birth.
Most mothers who agree to drug induced labor induction, augmentation (speeding labor), and non-emergency Cesarean are unaware of the interference in the natural hormonal symphony that is designed to take place in our bodies during labor for a reason, subhan'Allah.  These important points are brushed over by the medical community, usually without a single mention to the mother who usually puts her unquestioning trust in her doctor.
 I hope this article raises the awareness of many mothers and will cause them to think twice before allowing their birth team to interfere with the natural hormonal plan provided to us by our Creator..  I welcome such thought provoking articles and would love to share others...now on to the article...A Plea for Natural Birth... 


In modern societies most childbirths occur in hospitals with the assistance of the latest technologies. Protocols are being carried out and policies followed. But what about mothers and their wishes or decisions? What do we really know about  the consequences of such approaches to pregnancy and childbirth, the beginning of a journey of a new human being? Can we comprehend the effect it will have and what we will face in the future?
Currently, a lot of births are conducted as follows:
  • Induction (forcing labor to start) by the administration of drugs (oxytocin and prostaglandins)
  • Augmentation (speeding spontaneously occurring labor) by administrating drugs (oxytocin)
  • Use of analgesics and epidural anesthesia (pain medications)
  • Cesarean sections (surgical removal of baby) and even elective Cesarean section
  • Deliveries in an unfamiliar environment (hospital)
Birth is a unique hormonal process activated by the body`s own production of oxytocin.  This serves the purpose of safe delivery of the baby, the onset of lactation (milk in the breast), and creating a bond between the mother and child. During the birth many cascading neuro-hormonal reactions (prostaglandins, prolactin, endorphines) take place which ensure progress and coping with labor.
Oxytocin is hormone which produced in brain. It stimulates:
  • Peripheral action 
    • uterine contractions 
    • let down reflex of lactation
  • Central effect 
    • decreases fear 
    • increases trust 
    • encourages bonding  
    • stimulates maternal behavior
Synthetic oxytocin, which is routinely administered during induction and augmentation of labor, does not cross the blood brain barrier like natural oxytocin.  Therefore it provides only peripheral actions which have effects on the uterus and breasts. It cannot affect the mother's feelings or behaviors, thus depriving her of natural releases of stress and anxiety. Also administrating synthetic oxytocin may interfere with the natural progress of birth.

Prostaglandins regulate contractions and are directly responsible for contraction of the uterus during labor. Synthetic prostaglandins, which are administered during induction of labor,  suppress prolactin secretion , the hormone responsible for milk production, and thus cause difficulties with breastfeeding.

Endorphines are produced in brain during pain and prolonged workouts like childbirth.  They resemble opiates and produce analgesia (natural relief from the pain). They also cross the placental barrier and help the baby coping with labor.  Administering medical analgetics and opiates during labor may disturbe the natural opioid system and decrese the production of natural endorphins, thus decreasing the natural supply to the baby.
 
Delivering by Cesarean section disturbs hormonal balance and processes that are meant to take place during childbirth.
Childbirth in an unfamiliar environment may produce anxiety and stress. During stressful situations the body releases adrenalin to cope with emergencies. Adrenalin acts as an antagonist to oxytocin, so a stressful birthing environment can slow the progress of birth and endanger its results.

Clearly, interventions and the use of medications during labor have immediate effects on the mother and baby in terms of the spontaneous progress of labor.  Interventions also create need for more interventions.  Notably, many interventions result in difficulties with breastfeeding. 

Some scientists are examining the long-term effects of such labors, hypothesing about possible conseqences after interfering with the natural hormonal system.  They are studying the possible links between hormonal interference during labor and the baby's stress reactions, human bonding, anxiety disorders, depression, and even autism.
          http://www.midwiferytoday.com/enews/enews1215.asp#main
" 80% of the blood reaching the fetus via the umbilical vein goes directly to the inferior vena cava via the ductus venosus, bypassing the liver, and therefore immediately reaching the brain: it is all the more direct since the shunts (foramen ovale and ductus arteriosus) are not yet closed. . . . Furthermore, it appears that the permeability of the blood-brain barrier can increase in situations of oxidative stress—a situation that is common when drips of synthetic oxytocin are used during labor. We have, therefore, serious reasons to be concerned if we take into account the widely documented concept of “oxytocin-induced desensitization of the oxytocin receptors.” In other words, it is probable that, at a quasi-global level, we routinely interfere with the development of the oxytocin system of human beings at a critical phase for gene-environment interaction."  M. Odent



REFERENCES:
 http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02256.x/full


http://www.wombecology.com/physiological.html
S Jordan1, S Emery2, A Watkins3, JD Evans4, M Storey5, G Morgan6: Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02256.x/full


CG70:Induction of labour:NICE guidline
http://guidance.nice.org.uk/CG70/NICEGuidance/doc/English

Begley C. The effect of Ergometrine on breast feeding. Midwifery 1990;6:60–72.
http://www.ncbi.nlm.nih.gov/pubmed/2195299


Winberg J. Mother and newborn baby: mutual regulation of physiology and behavior – a selective review. Dev Psychobiol 2005;47:217–29.

http://onlinelibrary.wiley.com/doi/10.1002/dev.20094/abstract


Dunne C, Da Silva O, Schmidt G, Natale R.:Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks' gestation.

http://www.ncbi.nlm.nih.gov/pubmed/20085677


Alfirevic Z, Kelly AJ, Dowswell T.:Intravenous oxytocin alone for cervical ripening and induction of labour.

http://www.ncbi.nlm.nih.gov/pubmed/19821304


Elkamil AI, Andersen GL, Salvesen KA, Skranes J, Irgens LM, Vik T.:Induction of labor and cerebral palsy: a population-based study in Norway
http://www.ncbi.nlm.nih.gov/pubmed/21275920

Anim-Somuah M, Smyth RMD, Howell CJ:Epidural versus non-epidural or no analgesia in labour
http://www2.cochrane.org/reviews/en/ab000331.html

Gülmezoglu AM, Crowther CA, Middleton P: Induction of labour for improving birth outcomes for women at or beyond term
http://www2.cochrane.org/reviews/en/ab004945.html

22 comments:

  1. UmmuYahya SultaanahApril 13, 2011 at 7:48 AM

    Assalaamu alaikum. Sis JazaakiAllaahu khairan for this wonderful and very beneficial article. I'm going to share it right now InshaaAllaah! I am so happy to have met you and the likes of ppl like you who have educated me so much on natural birth and i wished i had known since i was pregnant with my first. Allaah does what he wills. Alhamdulillaah now i know :) May Allaah increase you in goodness and bless your family with imaan always Ameen.

    ReplyDelete
  2. This is a great post. Common sense and simple, great research! Thanks! I did not realize that abt oxytocin/pitocin, the blood/brain barrier and how pit cannot/does not affect the mom's feelings, only the musculature. Pretty interesting stuff!
    I am going to post this on my FB account!

    ReplyDelete
  3. Interesting post, but gives no references to any research involved with any of the claims that are made here. I would be very interested in seeing this research. As a midwife, I agree that there are too many interventions "routinely" done; however there are sometimes compelling reasons to intervene for the safety of the mother/baby. It has not been my experience that the use of prostaglandin/oxytocin in certain situations affects the success of breastfeeding. Again, referenced research rather than just claims are needed.

    ReplyDelete
  4. An excellent post with important information. Not only does artificial oxytocin not influence behaviour and interrupt the woman's own oxytocin production, some researchers are looking at the effect of artificial oxytocin as a cellular disruptor and the potential for cancer. Very worrying possibilities on all counts.

    ReplyDelete
  5. @ Kathy Thank you very much! I love your advices for babies on your blog.

    @ Carolyn It s such as honour to hear it from you! Would you send me links to researches you mention, I ll appreciate it

    ReplyDelete
  6. Thanks for this post. Women need this information because unfortunately not all care-givers know or respect the role of hormones for birth and beyond. Synthetic oxytocin also increases the risk of fetal distress, c-section, uterine rupture, PPH and much more. It is a serious drug with serious side-effects. Women need full information before agreeing to have it as part of their birth experience.

    ReplyDelete
  7. Asalam alaikum,

    Jzk to Zuzana, Midwife of Kuwait, for submitting this article. May we all benefit from its good and be protected from any harm, ameen.

    Thanks to everyone for taking the time to comment. I am honored to share an article that generates interest and comments.

    Best regards,

    Aisha, Natural Mom

    ReplyDelete
  8. @UmmuYahya Sultaanah, jzk for your dua and same for you, ameen. Everything done is quadr Allah, alhamdulelah. I'm sure there are cases where the benefits of induction of out weigh the risks. The issue comes when the drugs used to induce are given routinely and without consideration for the risk/benefits and without informing the mother of these risks/benefits. There is absolutely no doubt that far more women and babies are given induction drugs without geniune medical need, audthobillah.

    @Kathy Morelli, thanks for sharing on your FB wall! I appreciate the support of the blog. :)

    @JoAnn Yates, thank you for your request for more information. Zuzana, do you have any more documentaion about the research? I know Dr. Sarah Buckley has done a lot of extensive work regarding the symphony of hormones. I can ask her to comment as well, insha'Allah.

    @Carolyn Hastie, the truth is we really don't know enough about how all these interventions are truly effecting us. First of all I mean the mothers who are being injected with hormones are not given all or enough of the available information and secondly that science has its limitations. It's all very scary in terms of the bigger implications of how our meddling in nature is unknowingly impacting the human species overall.

    @Midwife of Kuwait, insha'Allah, you can post more of your references too for JoAnn.

    @Midwife Thinking,thanks for sharing more details about the risks. I really
    appreciate your input!

    Best regards,

    Aisha, Natural Mom

    ReplyDelete
  9. @JoAnn
    Firstly: Thank you for reading the article, I appreciate it. Hope you will visit frequenly so we can discuss more.

    Secondly: I m refering to certain situation in Gulf countries where rate of interventions and use of medications are very high. As for Kuwait where I live, we couldnt find any statistics or available reports on interventions rates. We even couldnt find protocols and guidlines for childbirth management.Midwifery isnt recognoised yet and direct entry midwives like me are not allowed to practice.
    We want do our best to inform women in Middle East about risks of unnecesary inductions and selective c sections.

    Thirdly: I m pleased to inform you that I created new blog
    http://midwiferyinkuwait.blogspot.com/

    Fourhtly: References

    S Jordan1, S Emery2, A Watkins3, JD Evans4, M Storey5, G Morgan6: Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey

    http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02256.x/full

    CG70:Induction of labour:NICE guidline
    http://guidance.nice.org.uk/CG70/NICEGuidance/doc/English

    Begley C. The effect of Ergometrine on breast feeding. Midwifery 1990;6:60–72.
    http://www.ncbi.nlm.nih.gov/pubmed/2195299

    Winberg J. Mother and newborn baby: mutual regulation of physiology and behavior – a selective review. Dev Psychobiol 2005;47:217–29.

    http://onlinelibrary.wiley.com/doi/10.1002/dev.20094/abstract

    Dunne C, Da Silva O, Schmidt G, Natale R.:Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks' gestation.

    http://www.ncbi.nlm.nih.gov/pubmed/20085677

    Alfirevic Z, Kelly AJ, Dowswell T.:Intravenous oxytocin alone for cervical ripening and induction of labour.

    http://www.ncbi.nlm.nih.gov/pubmed/19821304

    ReplyDelete
  10. @JoAnn - the research is there, although not often shared with women. You can find links to research on my post: http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/
    There are also links to drug manufacturers information re. side effects.

    As for the physiology of oxytocin check out 'The Oxytocin Factor' by Moberg which discusses the research in this area... there are also many studies being published in journals (too many to list) - do a search for Zak P and Kurzban R as they seem to be the key researchers in this area.

    Research into breastfeeding and artificial oxytocin (see above comment) and Jordan S, Emery S, Watkins A, Evans J, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02256.x.

    Sharing this information with women should be standard practice before administering artificial oxytocin. If this is not done consent is not gained as it requires 'adequate information' = assault.

    Interventions do save lives in some cases. I think the use of syntocinon in labour is rarely required to save lives - instead it is used to keep women on timelines that are not evidence based in the first place. Convenience not safety.

    ReplyDelete
  11. I've added your blog http://midwiferyinkuwait.blogspot.com/ to my list of blogs I read. Great job!

    ReplyDelete
  12. thank you for the references - I was thinking the same - interesting claims- but need references - perhaps Aisha could add them directly to the article :)
    Salaam Aleikum

    ReplyDelete
  13. @JoAnn - the research is there, although not often shared with women. You can find links to research on my post: http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/
    There are also links to drug manufacturers information re. side effects.

    As for the physiology of oxytocin check out 'The Oxytocin Factor' by Moberg which discusses the research in this area... there are also many studies being published in journals (too many to list) - do a search for Zak P and Kurzban R as they seem to be the key researchers in this area.

    Research into breastfeeding and artificial oxytocin (see above comment) and Jordan S, Emery S, Watkins A, Evans J, Storey M, Morgan G. Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02256.x.

    Sharing this information with women should be standard practice before administering artificial oxytocin. If this is not done consent is not gained as it requires 'adequate information' = assault.

    Interventions do save lives in some cases. I think the use of syntocinon in labour is rarely required to save lives - instead it is used to keep women on timelines that are not evidence based in the first place. Convenience not safety.

    ReplyDelete
  14. @ Aisha: Thank you!
    I tried to activate the links on references, if u place them to the article, they might open. I m not sure if it will work here in comments.

    S Jordan1, S Emery2, A Watkins3, JD Evans4, M Storey5, G Morgan6: Associations of drugs routinely given in labour with breastfeeding at 48 hours: analysis of the Cardiff Births Survey

    http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02256.x/full


    CG70:Induction of labour:NICE guidline
    http://guidance.nice.org.uk/CG70/NICEGuidance/doc/English

    Begley C. The effect of Ergometrine on breast feeding. Midwifery 1990;6:60–72.
    http://www.ncbi.nlm.nih.gov/pubmed/2195299


    Winberg J. Mother and newborn baby: mutual regulation of physiology and behavior – a selective review. Dev Psychobiol 2005;47:217–29.

    http://onlinelibrary.wiley.com/doi/10.1002/dev.20094/abstract


    Dunne C, Da Silva O, Schmidt G, Natale R.:Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks' gestation.

    http://www.ncbi.nlm.nih.gov/pubmed/20085677


    Alfirevic Z, Kelly AJ, Dowswell T.:Intravenous oxytocin alone for cervical ripening and induction of labour.

    http://www.ncbi.nlm.nih.gov/pubmed/19821304

    ReplyDelete
  15. Masha'Allh...I'll add these references to the end of the article, insha'Allah. Jzk!

    ReplyDelete
  16. @ MidwifeThinking: Rachel, thanks for info.

    I have to say I have a personal expirience with birthing in Kuwait. Infomed consent is not in local vocabulary.

    With my son I was overterm 41+1, labour already started while I was admitted to hospital. Some decelerations occured and my OB panicked cos of confirmed nuchal cord and without my consent booked theatre for c section. It took Head of OB dept to come and evaluate my case to continue with vaginal birth. I was however warned, that on my own responsibility. I delivered within 8 hours. Perfect apgar score and no signs of postmaturity. I had to be internally monitored and in supine position all the time. I had to compromise many of my wishes. I was really exhausted and scared for my baby`s health.
    My 2nd birth was much better, but still far away from natural birth.

    Main problem is that there is only one option available, no alternatives offered. Last update in Kuwaiti health care system was done in 1980!

    ReplyDelete
  17. More References I found in MidwiferyThinking article:

    Elkamil AI, Andersen GL, Salvesen KA, Skranes J, Irgens LM, Vik T.:Induction of labor and cerebral palsy: a population-based study in Norway
    http://www.ncbi.nlm.nih.gov/pubmed/21275920

    Anim-Somuah M, Smyth RMD, Howell CJ:Epidural versus non-epidural or no analgesia in labour
    http://www2.cochrane.org/reviews/en/ab000331.html

    Gülmezoglu AM, Crowther CA, Middleton P: Induction of labour for improving birth outcomes for women at or beyond term
    http://www2.cochrane.org/reviews/en/ab004945.html

    ReplyDelete
  18. Added these new references as well. Thanks so much for the follow up! :)

    ReplyDelete
  19. I appear to be having some problems with blogger... sorry about the double post!
    @MidwifeofKuwait - I am shocked and upset at your birth experience. A nuchal cord is present in around a third of births and is not associated with complications. The thought that c-sections are being done because of them is awful. However, it is good to know that women such as yourself are pushing for change and respect for birth and birthing woman. Knowledge is power!
    (I'll try and only send this post once :)

    ReplyDelete
  20. @MidwifeThinking Thanks for support :)
    Things may change and hopefully improve here. Kuwait is going to privatize part of health sector and is setting Authority to deal with reform of health care system.
    http://midwiferyinkuwait.blogspot.com/2011/04/reforms-in-health-care-system-in-kuwait.html

    We are starting NGO advocating improvement of maternity services starting with legislation, demanding updatading services inluding establishing misdwifery as a new branch of health care system and evidence based care.

    I dont know where this will take us but I m ready for the challenge!

    ReplyDelete
  21. @Midwife Thinkin, your blog is awesome! I am inspired by your work.

    @Midwife of Kuwait, we're right besides you here. Dua we can make a difference. Do you have hospital midwifery there? Can you send me the link again? Was it IBCO? I can't find it.

    ReplyDelete
  22. @Natural Mom: Thank you for your support
    http://www.imbci.org/ShowPage.asp?id=174

    ReplyDelete