FEELING SAFE IN CHILDBIRTH: What does the research say?

LOVE

“Giving birth is a landmark experience in any woman’s life.” (Howarth, Swain & Treharne, 2010, p.17). This experience is significantly influenced by psychological factors such as love, fear, and feeling safe (Howarth et. al, 2010).
Love is a powerful emotion which helps a woman’s body to relax during labour. This in turn can increase labour efficiency, therefore making it shorter, as well as significantly less painful. Love also decreases the stress response in the mother. Hearing loving words during labour can help cervical dilation (Gaskin, 2008; Hodnett, Gates, Hofmeyr & Sakala, 2009). Continuous one to one labour ‘support’ is an excellent example of the effect of love on labour and birth. Labour support is effective in reducing the effects of the fear and distress which come from labouring alone in an unfamiliar environment (Hodnett et. al., 2009). Kashanian, Javadi & Haghighi (2010) believe it is important to increase positive and reduce negative aspects of birth as it has ongoing physical, emotional and psychological effects. A woman feels loved and is empowered by her birth team when she experiences their kindness, respect, compassion and love. Supportive care has been shown to shorten labour and birth, lessen the likelihood of caesarean, decrease the risks of maternal morbidity and mortality, increase birth satisfaction, lessen the need for pain relief, and limit the ‘cascade of intervention’ (Hodnett et. al., 2009; Howarth et. al., 2010; Mosberg, 2011).

FEAR

In New Zealand many women feel fearful of giving birth. As medical knowledge has increased, so has the fear of what can go wrong. Feeling afraid releases stress hormones such as adrenaline and cortisol, which can have an effect on how labour progresses, potentially lengthening labour and creating an exhausted mother. They can also cause a reduction in blood supply to the baby, abnormal foetal heart rate, decreased uterine contractility and low Apgar scores. Prolonged high cortisol levels can have effects on the foetus such as inhibiting foetal growth, and high blood pressure and hyperglycaemia as an adult. Severe stress during childbirth is toxic to mother and baby (Daub, 2007; Hodnett et. al., 2009; Howarth et. al., 2010). Odent (2001) describes fear as the most common cause of difficult and painful labour. The adrenaline released in the body when a woman is afraid increases muscle tension that gives rise to pain. Fear worsens the perception of pain, and pain increases fear. This can be a self fulfilling prophecy when horror childbirth stories are told to a pregnant women by the significant women in her life. She is setup to believe birth will be great agony -and so it will be (Gaskin, 2008; Howarth et. al., 2010). Gaskin (2008) retells stories of labours pausing at 7cm dilation due to secret fears being present. The labours only progressed once the fears were expressed.
How a mother felt during her labour can negatively or positively impact early interaction with her newborn. A negative experience, e.g. if she felt afraid, can be detrimental to interaction, impair the development of her maternal identity, and contribute to postnatal depression (Howarth et. al., 2010).

INTERVENTION

Hodnett et. al. (2009) describes one type of situation where birthing women may feel unsafe as when she is subjected to routine institutional obstetric care. This process includes high rates of intervention, unfamiliar personnel, lack of privacy etc. ‘White coat hypertension’ also applies to the anxious birthing mother. Experiencing fear in a situation releases stress hormones, which interferes with the progress of labour. Odent (2001) explains that when hormones of the adrenaline family are triggered, the situation is likely to have stimulated the neocortex of the birthing woman, inhibiting the birth as a result. When a woman is giving birth in a place she does not feel safe in, her body instinctively holds back in order to protect the baby (Daub, 2007).
Caesarean section can be another feared situation that affects the release of hormones. A woman who has a caesarean on average has less oxytocin pulses compared to a woman who has had a vaginal birth. This can lead to difficulty with breastfeeding and a less calm mother. This generation may be the first to commonly have babies without the mother’s brain being impregnated with labour hormones (Moberg, 2011; Odent, 2001).

CHOOSING A BIRTH PLACE WHERE THE WOMAN FEELS SAFE

Feeling safe in labour is a prerequisite for changing the level of consciousness in the brain from the neocortex to the primitive brain. If a woman is able to labour and birth in the place where she feels the safest, she will be able to relax and tap into her calm and connection system. Therefore her oxytocin levels will be at their optimum (Daub, 2007; Odent, 2001). Hodnett et. al. (2009) recommends all women should have support during labour, and explain that this provides a ‘buffer’ to the fear created by routine obstetric care to some extent. Labour support also enhances normal labour processes (which includes the release of oxytocin) as well as feelings of control and competence. Anxiety and fear are reduced through the provision of emotional support, information, advice, comfort measures and advocacy. This helps to minimise the level of stress hormones.
Gaskin (2008) states “An intricate and exquisitely balanced combination of hormones is necessary to trigger all of the functions of labor and birth..” (p.147). The responses they stimulate in mother and baby are vital to the baby’s survival. Oxytocin is a hormone that allows the body’s calm and connection system to be tapped into, and seems to be the way love works in the body. Research suggests oxytocin levels increase when we breastfeed, eat, make love or have physical contact with another individual (Daub, 2007; Moberg, 2011). Oxytocin’s symptoms are decreased stress, reduction in stress hormones, calmness, less fear, increased digestion and nutritional storage, fluid balance maintenance, and decreased blood pressure and pulse rate. Specifically within a childbirth setting, oxytocin stimulates uterine contractions, helps expel baby, increases tolerance to pain, encourages maternal behaviour and makes breastfeeding possible. Sensory nerves stimulate the release of oxytocin. So when a newborn baby is skin to skin with it’s mother, oxytocin is released in both persons, helping baby to be relaxed and warm (Daub, 2007; Gaskin, 2008; Moberg, 2011; Odent, 2001).

ADRENALINE

Adrenaline is a hormone that is released during stressful or defensive situations, stimulating the fight/flight response. It was never intended to be present in early labour and inhibits the natural process. It can cause labour to take longer or stop. This is a response that can sometimes be seen when a woman arrives at the hospital. Adrenaline can cause abnormal foetal heart rate patterns and low Apgar scores.Therefore it is important to encourage an environment in early labour that would see oxytocin levels high and adrenaline levels at a minimum. Adrenaline does however also have a key role in the labour process. A sudden rise in adrenaline levels in the second stage of labour can stimulate the foetal ejection reflex. The symptoms of adrenaline in that scenario can be seen as the woman suddenly wanting to grab hold of something, being alert, and may be thirsty for a drink of water. The baby also secretes adrenaline during the last few contractions of labour, which helps baby adjust to the oxygen deprivation that occurs during the second stage (Daub, 2007; Gaskin, 2008; Hodnett et. al., 2009; Moberg, 2011; Odent, 2001).

SO WHAT CAN YOU DO?

There are many great practical solutions in labour that can have a positive influence on hormones. The first is continuous one to one support. This includes advocacy, emotional support, praise and reassurance, comfort measures, touch, massage, and providing fluids and food. All of these things encourage the release of oxytocin, lessen fear (therefore keeping stress hormones low), and surround the birthing mother with feelings of love (Daub, 2007; Howarth et. al., 2010).
The next practical solution is privacy, dim lighting, and quietness. This is an invitation to relax, helps to keep the neocortex part of the brain quiet, and oxytocin levels high. Looking into the eyes of the birthing woman and saying loving words such as “you can do it” produces oxytocin and therefore has a calming effect.
Choosing a birth team and place of birth that feels safe is also important to keep stress hormones down (Daub, 2007; Gaskin, 2008).
In summary, love, fear and feeling safe have a significant impact on labour and birth. Love helps a woman relax in labour, increases labour efficiency, safety, and tolerance to pain. Fear releases stress hormones which have a negative impact on labour, increase the perception of pain, and can impair mother/baby interaction and development of maternal identity. Feeling safe in labour is essential for optimum oxytocin levels. Continuous one to one support increases feelings of control and competence, and reduces fear and anxiety. Ensuring the birthing environment is well set will allow the mother to have high oxytocin levels and low stress hormone levels, while accessing her primitive brain and keeping her neocortex quiet (Daub, 2007; Hodnett et. al., 2009; Howarth et. al., 2010; Kashanian et. al., 2010; Odent, 2001).

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