Sarah J Buckley, MD
General Practitioner and Family Physician
Brisbane, Queensland, Australia
www.sarahjbuckley.com

More about Sarah Buckley

 

In Orgasmic Birth, you mention a recent study about the safety of home birth. What does the research say about the safety of home birth compared to hospital birth for women who are at low risk for birth-related problems?

The study, published in the prestigious British Medical Journal (BMJ) in 2005, is exceptional for several reasons.

First, the number of women involved, almost 5,500, was unusually large, making the results more valid than if the study had included fewer women.

Second, the study began when each woman first planned her home birth, making the data more reliable than in studies that look back at births after they have happened.

Third, the midwives providing care were certified practicing midwives (CPMs), who are not trained as nurses. This implies that home birth is safe with less medicalized attendants as well as with more extensively trained certified nurse-midwives, who are more often included in such studies.

In the study, which was done in North America, no mothers died. Perinatal mortality—the number of babies dying at around the time of birth—was about 2 per 1000, approximately the same as in studies of low-risk mothers and babies.

Also striking are the extremely low rates of interventions used. For example, once labor had started, only 3.7% of mothers were transferred to the operating room for a cesarean section and 3.7% required an epidural. In contrast, 19% of low-risk mothers giving birth in hospitals had a cesarean and 63% of hospital births involve an epidural.

As a physician and mother, I believe that these figures indicate even more important safety factors. Babies born at home are protected from the harms that may be caused by unnecessary interventions. For example, we do not know for certain the long-term effects of exposing babies to the powerful drugs used in epidurals. In addition, we are rapidly discovering that depriving the newborn of continual contact with the mother, as is usual after a cesarean, may increase susceptibility to stress life-long. I have written about these issues in my book Gentle Birth, Gentle Mothering (see below).

These drugs and procedures make birth harder for both mother and baby by interfering with the delicate hormonal orchestration of both partners, which is designed to enhance ease, safety, and pleasure.

Johnson KC, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ 2005;330:1416-1422.

This study is available free:
Download the study (pdf)

To learn more:
Gentle Birth, Gentle Mothering: The Wisdom and Science of Gentle Choices in Pregnancy, Birth, and Parenting (One Moon Press, 2005). Available at: www.sarahjbuckley.com/html/gentle-birth-gentle-mothering.htm. In January 2009, Celestial Arts will release an updated version that will be available through Amazon.com.

You speak throughout Orgasmic Birth about the hormones of labor, birth, and breastfeeding. How does a technology-driven birth environment influence the flow of natural hormones? Does this interruption affect the woman’s and baby’s experience?

Women’s bodies are superbly designed for giving birth. This design has evolved over 175 million years. Humans are mammals. We share with other mammals the complex hormonal orchestration of labor and birth, which ensures that birth is as safe, easy, and pleasurable as possible for every mammal mother and baby.

One element of this hormonal orchestration involves adrenaline/noradrenaline (epinephrine/norepinephrine), also known as the “fight or flight” hormones.

In labor and birth, these hormones contribute an important safety factor. When a laboring woman senses danger, these hormones are released and her labor will slow or stop, giving her time to run away and find a safe place to give birth. A rush of adrenaline will also divert blood to a laboring woman’s lungs, heart, and large muscles to help with fight or flight. This will take blood away from the baby and is a short-term strategy to help mother and baby. These effects will continue as long as the mother feels stressed or unsafe.

These safety factors, present in all mammals, continue to be active in modern women who give birth in hospitals. In fact, it is common for labor to go well at home, but stop when the woman reaches the hospital, because she feels, at a primal level, disturbed and even unsafe in this new and unfamiliar environment. The hospital setting is full of people who are strangers, with whom she will find it hard to relax and feel safe. Unfamiliar noises, smells, and sights can further disturb the laboring woman, who is more sensitive to her surroundings than she will ever be outside of birth. In these circumstances, labor can slow or even stop, and the baby can be deprived of blood and oxygen, sometimes enough to cause distress.

In comparison, when the laboring woman feels undisturbed and relaxed, her hormones can flow easily and help both her and her baby. Oxytocin will be released efficiently from her middle brain, enhancing the efficiency of labor and adding safety factors for her and her baby. Beta-endorphin, along with oxytocin, will provide natural pain relief. These and other hormones will peak at the moment of birth, giving pleasure and reward to the new mother and helping her to attach to her newborn and the newborn to attach to her.

Many other obstetric factors can interfere with the laboring mother’s hormonal flow, including epidurals, Pitocin, and cesareans.

To learn more:
www.sarahjbuckley.com/articles/ecstatic-birth.htm

What can a birthing woman do to increase the flow of oxytocin and other birth hormones?

Women who want to work with their hormones to enhance ease, safety, and pleasure in labor need to ensure that they are in an environment, and with people, that make them feel safe. Home is ideal. If that isn’t possible, I recommend taking along an experienced doula or labor support person who can help to guard the space. Avoiding all unnecessary interventions and setting up a situation where the laboring mother feels private, safe, and unobserved are also important for helping labor to proceed with maximum ease.

For more recommendations, see my article “Ecstatic birth: nature’s hormonal blueprint for labor,” originally published in Mothering magazine. A summary of the article is available at:
www.sarahjbuckley.com/articles/ecstatic-birth.htm