Neurophysiology of the Childbearing Year: Maternal and Infant Responses

Considering the importance of the changes taking place in the brain during the childbearing year in both mother and baby, it would make sense that we would thoroughly understand the implications of the disruption of those natural processes and further, that we would avoid such disruption if at all possible.

Obviously, if there is a medical need for a life-saving intervention, disruption is unavoidable. In such cases, there are ways to lessen the severity of problems arising from such a disturbance. However, here I wish to address nature’s plan for a smooth transition, and the routine (thus avoidable) ways in which such a plan is often thwarted.

With 93% of women reporting routine interruption of labor through electronic fetal monitoring that keeps them strapped to the bed, (Lothian, 2003) and 34% of women undergoing surgical birth (ibid.) despite the World Health Organization’s admonitions that cesarean rates should not exceed 12-15%, (Wagner, 2006) we really need to explore the ramifications of such routine use of technology.

In 1983, Dr. Thomas Verny founded the Association for Prenatal & Perinatal Psychology and Health (APPPAH) to examine the possible repercussions of such meddling. Verny, author of The Secret Life of the Unborn Child, suspected that babies were conscious beings even before birth. It had long been assumed that babies were born ‘empty vessels’ so to speak; they didn’t think or even feel pain. David Chamberlain, a Boston psychologist and co-founder of the APPPAH explains in Babies don’t Feel Pain: A Century of Denial in Medicine that this determination may have come about because the early experiments (sticking babies with pins) were done on babies whose mothers had been anesthetized during birth. Because the babies were also anesthetized, having received the same dose of medication as their mother, it stands to reason that the babies would not react to painful stimuli. However, the researchers instead concluded that babies don’t feel pain, reinforcing the pervading belief that what happens to them during birth is simply not important.

However, Chamberlain and Verny weren’t buying it. Nor were Dr. Michael Odent, Joseph Chilton Pearce, Dr. Fredrick Wirth or others.

In The Biology of Transcendence: A Blueprint of the Human Spirit, Joseph Chilton Pearce explains that human fetal brain growth follows the pattern of other mammalian species:

“If a pregnant animal is subjected to a hostile, competitive, anxiety-producing environment, she will give birth to an infant with an enlarged hindbrain, and enlarged body and musculature, and a reduced forebrain. The opposite is equally true: If the mother is in a secure, harmonious, stress-free, nurturing environment during gestation, she will produce an infant with an enlarged forebrain, reduced hindbrain, and smaller body.” (Pearce, 2002. Pp. 115)

If babies have perceptions, and their brains are being shaped before birth (Wirth, 2001) through the experiences of the mother, some thinking people began to wonder how the birth process might affect brain growth. Again using what was known about other mammalian parturition, some postulated that if interruption of the natural processes of birth and natural infant feeding had detrimental consequences in other species, perhaps it did in human babies. And if that was so, then perhaps human mammalian mothers also suffered in some way. Nearly a century after routine medical interventions were introduced into birth, researchers finally started to wonder if we were creating problems for mothers as well as babies and if so, how?
For instance, beginning with the onset of labor, we know that 41% of women participating in the 2006 Listening to Mothers Survey began their labors medically induced. (Declercq, Skala, Corry, & Applebaum, 2006.) Eighty percent of those inductions were chemically induced with Pitocin, an artificial form of oxytocin. (ibid.)

There are many possible ramifications of the introduction of pitocin. The artificial substance does attach to chemical receptors in the uterus, therefore it does cause uterine contractions. However, it does not cross the blood-brain barrier, so it does not act exactly like naturally produced oxytocin, nor does it pair with other neurotransmitters to change behavior like naturally occurring oxytocin does. It seems it may also ‘take up’ receptor sites for endorphins, thus not only creating pain, but blocking the body’s own response to lessen pain.

To see how this impacts the physical process of birth first, it might be helpful to explain that current obstetrical practice encourages ‘active management’ of the third stage of birth. ‘Third stage’ is the final part of birth wherein the placenta is birthed. ‘Active management’ includes administration of pitocin, early cord clamping, and cord traction to ‘guide’ the placenta out. The rationale behind active management is that it reduces bleeding, which is the primary concern of third stage. Of course it would be if the hypothalamus was no longer making oxytocin because the brain wasn’t getting the message to produce. Thus at least 41% of women are being ‘managed’ in such a way as to interrupt the bonding process-oxytocin has been called the ‘love hormone’, and when paired with prolactin facilitates motherly love (Fisher, n.d.)-denying the baby about 100 ml of blood that he or she needs to perfuse his or her vital organs, not because third stage is dangerous, but because first stage (labor) has been meddled with. If we keep in mind that if pitocin is administered not only during inductions, but augmentation of labor (to make labor go faster), that number of mother-baby pairs impacted would be far higher.

Karen Strange, Certified Professional Midwife and Neonatal Resuscitation instructor explained during a HypnoBirthing® Conclave presentation this author personally attended (October, 2008) that undisturbed, the immediate period following birth is when the baby’s brain gets the message to ‘fire and wire’. It is the surge of oxytocin, along with beta-endorphin release and prolactin that help the mother and baby to fall deeply and immediately in love. Prolactin optimizes brain growth and according to Dr. Sara Buckley is important in neuroendocrine development in the growing baby, (Buckley, 2005) which she feels maybe be why breastfed babies have higher IQs and is reason to breastfeed as long as the baby’s brain continues rapid development; usually 2 or 3 years. Alarmingly, she also shares Dr. Michel Odent’s observations that:

“…the functioning of the oxytocin system, which is still developing in the baby at the time of birth, reflects our ability to love ourselves and others. Odent has suggested that many of our society’s problems-our current epidemics of drug addiction and teenage suicide, for example-may be traced back to the widespread and unprecedented interference with the oxytocin system of mothers and babies at birth.” (Buckley, 2005. Pp. 17)

While the possible implications of the disruption of the natural process is staggering from the perspective of the child, mothers suffer as well. Buckley discusses this in Gentle Birth, Gentle Mothering as manifesting in a number of different ways, such as increased incidences of postpartum depression. Mary Kroeger, in Impact of Breastfeeding: Protecting the Mother and Baby Continuum notes that most breastfeeding difficulties originate with routine birthing interventions. She devotes each chapter to common interventions and explains exactly how it disrupts the breastfeeding experience. Considering what we now know about the many ways in which breastfeeding encourages brain growth, separate and apart from the 100 or more ingredients found in mother’s milk that are not found in formula, (Williams & Stehlin, n.d.) anything that causes problems in breastfeeding should be avoided.

Neurological damage isn’t the only issue with alterations in natural birth and breastfeeding patterns. Nature has fine tuned the transition from womb to world so delicately that even our immune systems develop and function sub-optimally if the process is disturbed. (Penders, Thijs, Vink, Stelma, Snijders & Kummeling, et al., 2006). But even if our brains are the only thing effected by the casual disregard for natural birth and breastfeeding so prevalent today, isn’t that enough? If maternal and infant behavior is predicated on a hormonal cocktail entitlement that few receive, which the research suggests it is, (Russel, 2007) shouldn’t we be basing maternity care practices on said research? Shouldn’t there be some requirement to show that any non-medically indicated interventions are safe and effective? Because according to A Guide to Effective Care in Pregnancy and Birth, available in its entirety for free at ChilbirthConnection.com, much of what is done to women and babies routinely has not only been shown to be ineffective, but is dangerous as well. This conclusion is supported by the fact that infant and maternal outcomes have worsened, not improved as most might think, as routine use of technology has increased. (Wagner, 2006)

What we know is just the tip of the iceberg. Shouldn’t we be trying to understand if attachment disorders in children, postpartum depression in mothers, child neglect, abuse and abandonment, or learning disorders might stem from the needless interruption of the birthing process? Wouldn’t it be less expensive and easier to minimize the number of mothers and babies suffering by not messing with the hard-wiring taking place at the time of birth instead of trying to fix what’s broken later? Shouldn’t we at least be willing to consider that nature has a plan that usually works, and intervene only when it doesn’t?

Perhaps with the 30 years of research regarding the symbiotic relationship between mother and baby in the childbearing year we have thus far, we should implement protocols that protect that delicate balance and bring the ecstasy back to birth.
Fortunately, there is hope on the horizon. While evidence-based maternity care is still just an ideal we strive towards, there are people working diligently to inform parents of the weight of their pregnancy and birthing decisions. Debbie Takikawa produced What Babies Want, a documentary that features many of the experts mentioned here. Debra Pascali-Bonaro and Kris Liem just released Orgasmic Birth: The Best Kept Secret, a phenomenal DVD, while Elena Tonetti-Vladimirova lectures world-wide on the concepts laid out in her educational DVD Birth As We Know It. All of these works take the scientific evidence and distill it into language that speaks to the hearts of parents. These are hopeful reminders that we can get back what has been lost, and heal what has been harmed…if we only choose to listen.

Resources

APPPAH, (2009). Association of Prenatal & Perinatal Psychology and Health website, retrieved Oct 1, 2008 from http://www.birthpsychology.com/

Buckley, S. (2005). Gentle Birth, Gentle Mothering. One Moon Press. Australia.

Chamberlain. D., (2005). Babies don’t feel pain: A century of denial in medicine. Retrieved October 6, 2008 from http://www.terrylarimore.com/BabiesAndPain.html

Declercq, E.R., Skala, C., Corry, M.P., Applebaum, S., (2006). Listening to
mothers II: Report of the first national U.S. survey of women’s childbearing experiences. Maternity Center Association, New York. Retrieved October 11, 200 from
http://www.childbirthconnection.org/article.asp?ck=10397

Fisher, D., (n.d.) Falling in love: The chemistry of the first breastfeed. Retrieved October 4,2008 from www.breast-feeding-information.com/the-chemistry-of-the-first-
breastfeed.php

Kroeger, M., (2004). Impact of Birthing practices on breastfeeding: Protecting the mother baby continuum. Jones and Bartlett, Massachusetts.

Lothian J., (2003). Listening to mothers—The first national U.S. survey of women's childbearing experiences. Journal of Perinatal Education, 12(1).

Pearce, J., (2002). The Biology of Transcendence: A Blueprint of the Human Spirit. Park Street Press. Rochester, Vermont.

Penders, J., Thijs, C., Vink, C., Stelma, F. F., Snijders, B., & Kummeling, I., et al. (2006). Factors influencing the composition of the intestinal microbiota in early infancy. Pediatrics, 118(2), 511–521.

Russell, J., (2007). The maternal Brain. British Society for Neuroendocrinology. Retrieved October 12, 2008 from http://www.neuroendo.org.uk/content/view/23/11/

Verny, T., (1981). The secret life of the unborn child. Summit Books, New York.
Wagner, M., (2006). Born in the USA: How a broken maternity system bust be fixed to put women and children first. University of California Press, Berkeley.

Williams, R., Stehlin, I., (n.d.) Breast Milk or Formula: Making the Right Choice for Your Baby. Retrieved October 10, 2008 from http://www.fda.gov/fdac/reprints/breastfed.html

Wirth, F., (2001). Prenatal Parenting. Regan Books/Harper Collins. New York.

PPD or PTSD?

Now back to our regularly scheduled Birth Bitch:

I’ve been doing some research for a psychology class I’m taking. I chose to look at the impact of birthing practice on postpartum depression/post-traumatic stress disorder (PDD/PTSD). My reasoning is thus: if we know the perception of trauma in birth increases postpartum mental health issues, and we know how to make birth not just less traumatic, but actually an ecstatic experience, we can reduce the rate of maternal adjustment issues that impact not just mothers, but babies, families and society.

I made this decision because I had just watched Monty Python’s Miracle of Birth from the Meaning of Life.



It struck me (as it has every time I watch this) how odd it is that comedians in 1983 could plainly see that inserting routine, useless and potentially harmful technology into the birth process, while disengaging the mother because she’s ‘not qualified’ to participate, could contribute to ‘PND’ (Post Natal Depression-British for Postpartum Depression). I wanted to see if an idea commonsensical enough to be present in satirical humor 25 years ago had been seriously examined.

One would think that if there was research to suggest certain procedures were unnecessary or harmful, they would be discontinued. Unfortunately, one would be wrong. We already know that invasive, routine birth interventions disrupt bonding and breastfeeding. (The Impact of Birthing Practices on Breastfeeding; Delivery Self-Attachment; What Babies Want) Yet, practices persist. It would stand to reason if the processes of birth and bonding were disrupted, the mother and baby would be affected as we know other mammalian mother-babies are.

Prevalence and Predictors of Women’s Experience of Psychological Trauma During Childbirth (Soet, Brack & Dilorio, 2003; Birth 30:1) examined how often women experienced trauma during birth, what caused the trauma, and to look for ways to prevent such things.

Of the 103 women in the study, 34% felt traumatized by their birth experience. 1.9% of those met the criteria for PTSD diagnosis.

A PTSD reaction included “…nightmares, intrusive memories, depression, anxiety, difficulty bonding with the infant, fear of sexual intimacy and avoidance of future childbearing…” and possible “…long-term bonding problems.” Other studies were cited that put the rate of a PTSD reaction as high as 6%.

There were three pre-existing factors contributing to trauma were lack of social support, previous sexual assault and the expectation of pain.

Other predictive factors were pain (although 74.8% had epidurals), feelings of powerlessness (Monty Python nailed it) “expectations, medical intervention and interaction with medical personal”.

I was confused by the part that said, “A sick (n=15) or stillborn infant (n=1) was delivered in 17.4 percent of the cases. By the time of the follow-up interview, all [emphasis mine] babies who had initial complications were at home and were described as healthy by the mothers.” I get that a sick or stillborn infant would be a significant factor in a negative perception of the experience, but how is a stillborn infant then described as healthy?

The title of the next one, Psychological trauma symptoms of operative birth(Gamble & Creedy, 2005; British Journal of Midwifery, April) is pretty self-explanatory. At the time of publication, US cesarean rates would have been around 24%. They are now at 32%, even though as the article correctly states, the World Health Organization recommends no more than a 10-15% rate.

The study of 400 women found that those who had emergency cesareans or “operative vaginal delivery” (most likely referring to episiotomy, but perhaps forceps or vacuum extraction as well…unless I missed it, it was not specified) to be more likely to suffer PTSD, with cesareans being 6 times more likely.

The conclusion? “Results of this study provide evidence that the use of obstetric procedures during childbirth significantly contribute to the presence of acute trauma reactions in the postpartum.” It goes on to cite other studies that have come to the same conclusion as far back as 1979. In fact, studies done in 1979, 1980, 1991, 1992, 1993, 1997 and 2000. And yet here we are in 2008 with rates of intervention just as high, and operative deliveries even higher…with NO improvement in outcomes. Hm.

Two others, Post-traumatic symptoms after childbirth: What should we offer?(Slder, Stadlmayr, Tschudin & Bitzer, 2006; Journal of Psychosomatic Obsterics & Gynecology 27:2) and Post-traumatic stress following childbirth: A review of the emerging literature and directions for research and practice(Bailham & Joseph, 2003; Psychology, Health & Medicine 8:2) came to similar conclusions, but this is depressing the hell out of me so I’m not going to comment on them. It’s not just that we’ve known all this for so long and haven’t acted on it, thus dooming millions of women, babies and families to suffer needlessly. That’s disgraceful, of course. But I find it appalling that the US doesn’t even seem to considering these studies worthwhile enough to look into the possibility that routine obstetrical interventions applied with such a cavalier attitude are harming our most vulnerable. All of these studies were from Europe. One more reason to seriously consider the life of an ex-pat.

Finally, Shelia Kitzinger commented on PSTD in birth in her commentary, “Birth as rape: There must be an end to ‘just in case’ obstetrics.” In it, she compares the descriptors rape victims and PTSD victims use. Sadly they are nearly identical. She also notes that it is unnecessary routine obstetrical intervention that is causative in the perceived trauma in birth, and notes that while we know which routine interventions are harmful or useless, in obstetrics it takes an average of 15 years before evidence changes practice. Though, the Monty Python bit was done 25 years ago. The research began 30 years ago. Why are women still being brutalized in birth?