Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care

Abstract

This report synthesizes evidence about innate hormonally mediated physiologic processes in women and fetuses/newborns during childbearing, and possible impacts of common maternity care practices and interventions on these processes, focusing on four hormone systems that are consequential for childbearing. Core hormonal physiology principles reveal profound interconnections between mothers and babies, among hormone systems, and from pregnancy through to the postpartum and newborn periods. Overall, consistent and coherent evidence from physiologic understandings and human and animal studies finds that the innate hormonal physiology of childbearing has significant benefits for mothers and babies. Such hormonallymediated benefits may extend into the future through optimization of breastfeeding and maternal-infant attachment. A growing body of research finds that common maternity care interventions may disturb hormonal processes, reduce their benefits, and create new challenges. Developmental and epigenetic effects are biologically plausible but poorly studied. The perspective of hormonal physiology adds new considerations for benefit-harm assessments in maternity care, and suggests new research priorities, including consistently measuring crucial hormonally mediated outcomes that are frequently overlooked. Current understanding suggests that safely avoiding unneeded maternity care interventions would be wise, as supported by the Precautionary Principle. Promoting, supporting, and protecting physiologic childbearing, as far as safely possible in each situation, is a low-technology health and wellness approach to the care of childbearing women and their fetuses/newborns that is applicable in almost all maternity care settings.

Abuse and Disrespect in Childbirth Care as a Public Health Issue in Brazil: Origins, Definitions, Impacts on Maternal Health, and Proposals for Its Prevention

“…The medical providers should be valued for their ability to make diagnosis and medical or surgical prescriptions in the minority of cases that need them, so that the majority of cases could be assisted by professionals trained for protecting normalcy 52 . The experience of the direct-entry Midwifery program, in the School of Arts, Sciences and Humanities (EACH-USP) can be a great starting point for replication across the country 53 .…”

The Nurses’ Role in Providing Comfort During Childbirth Using Ambulation and Hydrotherapy

“…The physical environment should be tailored to the woman's desires, including any tools she does or does not want available -shower, bathtub, birthing ball, birthing bed. In an environment where a woman feels safe, beta-endorphins help a woman respond to pain by using coping strategies (Buckley, 2015;Ondeck, 2014). Practices by professionals that promote a woman's freedom of mobility include offering oral fluids and calories, intermittent fetal monitoring, non-pharmacologic coping strategies (position changes, ambulation, relaxation, massage, acupuncture, immersion in water, warm showers), and enabling her to choose the positions of choice in labor (Ondeck, 2014).…”

“…Physiologic hormones involved in labor and childbirth are specifically timed and released at key points when they will be the most beneficial to the process (Buckley, 2015;Sakala, Romano & Buckley, 2016). The release or suppression of these hormones is internally and externally affected, in a complex manner that is key to the mother's and baby's survival and success of the birthing process, in addition to the success of breastfeeding and maternal-infant attachment.…”

“…Because of the complexity of the connection between hormonal systems, a disruption to one or more of these systems has the potential to be catastrophic to childbirth. Often, when one disruption occurs from a medical intervention leads to a cascade of additional interventions to monitor the effects of the initial intervention and this continues in a circular fashion until the mother is overwhelmed with interventions and physiologic childbirth is inhibited (Buckley, 2015). Buckley (2015) explores four different hormone groups that are active in labor and common maternity practices that impact that hormones physiology: oxytocin, beta-endorphins, epinephrine-norepinephrine and cortisol, and prolactin.…”

A Childbirth Educator’s Commentary on Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care

“…Buckley (2015) quotes Michel Odent who recommends that maternity care providers "create such interactions that a pregnant woman feels even happier after a prenatal visit than before . .…”