Bridging Hormonal Gaps

In her podcast conversation with Katie James and Dr Rachel Reed on the Midwives’ Cauldron, Dr Sarah Buckley explores ‘Hormones from conception to pregnancy, birthing to feeding, bonding & attachment’. That is where I heard her speak about the idea of ‘Hormonal Gaps’ created by birth interventions. Dr Buckley is a medical doctor with a long personal and professional history in undisturbed birth. Her curiosity has produced a catalogue of work that is invaluable to families and to birth professionals alike. If you support home birth or plan to birth at home, assisted or unassisted, you must explore Dr Buckley’s books, podcasts and free resources. I suggest you start by downloading her free ebook. I remember very well the first time I came across it and a quick search of my 99+ thousand emails revealed that I downloaded  her free gem of a read ‘Ecstatic Birth’ on November 15th, 2013, one day after my daughter’s thirteenth birthday (no, I haven’t tidied my inbox in a long long time and that is, in equal measure, a curse and a blessing!).

The date struck me immediately. Lena’s birthday had always been an occasion for me to reflect on how I could help mothers avoid being railroaded into interventions they didn’t even know existed. 

Like I had been.

Now I no longer impact immediately the journeys of individual women within the NHS. My context has changed and I witness women in their journeys through maternity services entirely from outside the system. This has been an eye-opener! While there are women who experience outstanding care, it is frightening how many women’s stories resemble mine. This is why my focus has broadened to sharing how you can heal from the impact of interventions in the days, weeks and even years after the birth of your baby.

It is no surprise that I should have downloaded this book about the hormonal orchestra of birth the day after Lena's special day. Though I had come a long way, I recognise now that in 2013 I was still on my path of healing. My experience of giving birth had left me feeling disconnected from my body, It had taken me years to rediscover my sensuality and the joy that I had been so used to finding in simply being alive inside a female human body. My labour hadn’t been distressing to me until that final vaginal examination performed by a midwife I couldn’t find a connection to. After Lena was born I felt flat for days, weeks even and I felt guilty for feeling flat. 

You can read about my birth story in my blog post ‘Don’t Push’.

It is not until I heard Dr Buckley speak about ‘Hormonal Gaps’ that another piece of the puzzle fell into place. That is what I had experienced! A gap! My body had needed to catch up with having become a mother without the benefit of the final crescendo of birth hormones. The oxytocin rush at the physiological release of the placenta is unique only to placental birth. It is beautifully designed to help you ease into early motherhood shrouded in the haze produced by this magnificent hormone. No man can ever experience this. Nor can women like me; women who receive an ‘injection to help the placenta come away’ whilst they are numbed from below the ribcage by an epidural. This amount of oxytocin, aka ‘the hormone of love’, is only ever produced in a hormonally intact and undisturbed birth and nature has good reason for her design: 

It is part of the pleasure-reward system that helps us imprint on our babies so that we can find delight in tending to the full time task of early parenting.

The good news is that nature has her ways and you can catch up. Dr Buckley recounts the story of a woman who had experienced undisturbed births first and then a scheduled birth. According to Dr Buckley this woman said that she felt differently towards this baby initially but that she felt exactly the same way she had with her older children after a few days of uninterrupted skin to skin. This is hopeful and it is a testament to our resilience as mothers and babies. 

I do believe that we choose and create our own reality and I can see now how, step by step, I chose the birth experience I got. I had a birth that was filled with interventions and as a result, like so many of us, I experienced trauma. Thankfully I knew intuitively to keep my baby skin to skin. I carried her in a sling, had her on my body for hours every day, did baby massage with essential rose oil and gradually I felt myself adjust. 

The Hormonal cocktail in a physiological birth consists of an intricate interplay between hormones and neurotransmitters in both the mother and the baby. There is an intelligent feedback loop between mothers and babies that ensures that the woman can deal with the physical sensations of labour and birth. Meanwhile the baby has ways to communicate with the mother. This hormonal feedback system helps the baby withstand the relative stress of being born and make the adaptation to life outside the womb so beautifully.

There is no match for nature and I truly believe that every practitioner in the world of childbirth has a duty to take the time to study this physiology in detail. If practitioners were humble enough to recognise that our primal blueprint of birth cannot be improved upon, every single mother, baby and extended family would benefit. It would mean that we would stop interfering for arbitrary reasons. The potential harm that is caused by interfering when it is not necessary does not just concern this mama and baby, it has potential to impact the baby’s future lineage, too.

At this stage it must be acknowledged that there are circumstances when the benefits of interfering outweigh the benefits of waiting and interferences do not exclusively come from medical interventions. 

Your birthing body can perceive a well-meaning birth partner who keeps asking you if you are ‘okay' as interference. You leaving your house to go to a birth centre or hospital will release adrenaline, which, in turn, will slow your contractions down momentarily. The interference could be caused by a membrane sweep or any of the common interventions in labour such as vaginal examinations. It could be the homebirth midwife explaining a procedure in order to find out if you wish to consent or decline. Your conscious and subconscious responses are individual and there are too many variables to study each and every possible effect. There have been studies, though, of the effects of common interventions like epidurals, inductions of labour and caesarean sections and we are starting to figure out some of their impacts on you and your baby.

We know that any kind of scheduled birth skips parts of your hormonal priming. At the end of pregnancy you and your baby are still making receptor cells for the hormones and neurotransmitters at play in birth. The complete physiology of a spontaneous labour is not fully understood, though we know that the baby seems to be giving the final go-ahead. This is why babies born after a spontaneous labour find the adaptation to life on Earth easiest. Your receptor cells are often described as locks and the matching hormones as keys. Regardless of how many keys you have, if you can’t find the matching locks, they are no good to you. It is the same with oxytocin for instance. If your womb hasn’t got enough locks to match the hormonal key, flooding your body with synthetic oxytocin (as in induction of labour) will not do the same job as you would do given the time. This is the reason why more induced labours result in caesareans or instrumental births. 

We live in an increasingly industrialised world and the effects of this are far reaching and they are expressed in all aspects of life. Very few women, unless they consciously remove themselves entirely from industrial birth (which brings its very own considerations, of course), will have a pregnancy and birth entirely free from intervention. 

Intervention may become a reality for you. You might choose it for a medical reason, or you might choose it because you simply want it. Often it is because you don’t have the support to decline from your midwife, doctor, spouse or extended family. Regardless of why you have an intervention, it is always a choice and as such, I invite you to explore the impacts of it in the spirit of curiosity and of self-love. 

Birth is not a performance act, nor is it any kind of test.

Whilst birth practitioners and birth advocates must keep the big picture in mind and many of their attitudes are shortsighted, ill informed and inexcusable, you as an individual do not have to concern yourself with the politics of birth.

If you have come to the conclusion that you want an epidural (or that you now need it in labour), then wear it with absolute confidence.

You do not have to make any sacrifices at the altar of birth because you know that induction of labour and caesarean section rates are soaring.

If you feel they are your best option given your big picture then go for it with conviction!

The potential shift of risk caused by an intervention for you and your baby particularly is likely to be marginal, just like the potential disadvantage of not having the intervention would be marginal when expressed statistically in absolute risk. Imagine ‘risk’ on a continuum; a line with the potential disadvantage of doing nothing on one end versus the potential disadvantage of having the intervention instead on the other. Either action will move the needle towards one end of this continuum, risk can never be totally eliminated.

This is what it means to be alive.

Make your choices and own them! Whilst the euphoric, orgasmic experience of birth is likely to escape you when your birth is medically managed, you can absolutely plan to make up for it in the hours and days after your baby is born.

Here’s how you can support your hormonal body in late pregnancy and after the baby’s birth particularly if you know that you are going to opt for a scheduled birth:

Remember that you make billions of new cells every day and that your mind is incredibly powerful. My tip to my clients is to visualise that your new cells are becoming the receptor cells you need for a smooth transition into parenthood. Visualise the same thing for your baby!

Have a chat with your baby. Tell your baby out loud or with your internal voice why you need them to get ready to be born. Ask for your baby’s help and tell your baby that you will help each other adapt. 

How much are you looking forward to meeting the baby? Let them know!

Indulge in aromatherapy. I recommend aphrodisiac sensual essential oils in the bath, diffuser and as a massage oil. My favourites are sandalwood, ylang-ylang and rose. Remember to adapt your blends and bath salts to pregnancy dosages. 

If you can, get plenty of skin to skin with your significant other. 

Remember that in an induced labour or caesarean section you can still dim the lighting, have pleasant sounds and smells around you and get your partner to massage you if it feels good. Pack your sunglasses, aromatherapy blend and earplugs.

After the birth get uninterrupted skin to skin and keep your baby there for the hours and days following the birth. This helps you and your baby make oxytocin and supports the breastfeeding process. Baby checks can absolutely be performed on your chest! Your birth partner can have the naked baby on the chest just as much as you can. If you are tired or being transferred from a theatre bed, that is where baby can go.

Consider whether you want to have a hat on your baby after the birth. Some health care trust observe this practice more tediously than others (though it is always your choice!). The hats that are offered are made from synthetic yarn and they tend to fall off. Arguably, after a medical birth a baby is more vulnerable to heat loss. Epidurals interfere with temperature regulation, too. To avoid repeated disturbances by midwives repositioning the hat and if you don’t like the thought of artificial fibres next to your baby’s delicate skin but you wish to have a hat on your baby, bring a cotton bonnet that you can tie under the chin. 

Midwives will offer you assistance with breastfeeding within the first hour of birth. This potentially constitutes a lot of handling of your baby and you may wish to give your baby the opportunity to do a breast crawl instead. This can be done after a caesarean section, too, by simply placing your baby in between your breasts and giving them some time. Keep in mind that your baby, too, will have to catch up with their physiology and they may be dealing with the effects of opiates in their system. It is possible that they are too tired to do a breastcrawl and they may need assistance, the midwives can help you. An initial reluctance to feed can be overcome, it requires some work and perseverance. The more you, yourself work with your baby, lift them, stimulate them, hand-express some milk into their mouth, the better. Your baby is likely to want to feed lots at night, be prepared for that. Keep your baby skin to skin when they are not feeding. Typically the immediate effects of birth interventions on your baby start to subside by ‘Day 3’. If you are struggling with breastfeeding let your midwives know. If maternity services are stretched consider enlisting the help from a lactation consultant. 

Formula feeding, too, can take time to establish if your baby is sleepy after a medical birth. Be patient and consider your baby’s physiology when you get them established with their feeding routine.

Most importantly be kind to yourself and take your time to adjust. There’s a lifetime to parent your baby.

My online program R.O.A.D. To Birth now includes my workshop on ‘Bridging Hormonal Gaps Holistically’ after medical birth and in the rare circumstance when your baby needs to be cared for in a neonatal unit for a period of time. To join the program and the R.O.A.D. To Birth community, send me an email to [email protected]