What is Physiological Birth?

Compiled notes from information sessions for doulas, with Dr Michel Odent and Liliana Lammers

We are at a turning point in the history of childbirth.  

There have been spectacular technical advances in the last few decades that push childbirth a certain way: towards routine operations and painless births.   At the same time, we are acquiring scientific knowledge that suggests that the way we are born may have life-long consequences.

It's a fact that the number of women who give birth to a child completely naturally -physiologically- is approaching zero.

Our knowledge of the meaning of natural childbirth is skewed.  We have a deep-rooted lack of understanding of true, natural home births.   All cultures have transmitted beliefs and traditions which can interfere with birth's physiological process, for instance: "You cannot do it yourself; you need someone to help you give birth!"  It's interesting to note that a subtle way to control is to help.  We need to realise that we cannot help, but we can hinder!

These cultural theories have even influenced "natural" childbirth.  The only way to remove ourselves from our controlled, culturally conditioned trap is to learn from modern physiologists, and to accept the recent discoveries provided by a variety of scientific disciplines.  

For instance, a baby needs its mother.  And yet, culturally, there is an almost ritual separation that takes place as the cord is cut, moments after birth, between baby and mother. This could easily be left for hours instead of separating right away.  Of most immediate importance after birth is a critical period of mother to baby attachment, as human babies naturally find the breast post-birth, and their bodies are instantly colonised with the mother's friendly microbes and bacteria.  The new baby is the only other person with the same antibodies as the mother.  

The dominant paradigm at the moment is controlled birth.  The new paradigm is the physiological concept of birth as an involuntary process.  The birth process must be protected from situations that can inhibit this involuntary process.  

So what does physiological birth look like?  These next few paragraphs sketch out an appropriate environment for a labouring woman.

1) Adrenalin and oxytocin are antagonistic to each other.  Women need to feel secure during labour so there can be a successful, continuous release of oxytocin, the hormone responsible for stimulating uterine contractions.  Oxytocin release is highly dependent, more than any other hormone, on environmental factors.  

2)  All emotional states are contagious.  The release of adrenaline is contagious; it's impossible to be in a complete state of relaxation when someone close to you has in increase in adrenaline.  [Adrenaline will stimulate the uterus' alpha-receptors, which inhibit the activity of the uterine muscles]  High levels of adrenalin also greatly increase the pain of the contractions.

3)  Our human handicap of "thinking too much" can get in the way.  During the birth process, the neo-cortex, the part of our brain that contains our intellect, must stop working!  Labouring women need to be protected from any sort of neo-cortical stimulation.  Silence...  Around labouring women, we must choose our words with extreme caution.  Our rational language, continuously going over the facts -for instance,"how many centimetres now?"-  can inhibit the process.  Don't ask questions of a woman in labour!  Simple baby-talk is much more appropriate.  Darkness... Light should be kept to a minimum. The "darkness hormone" -melatonin- reduces neo-cortical activity.  Observation... or lack of!  The neo-cortex is stimulated when we feel observed.  Careful with language, careful with light, make a woman feel secure without feeling observed.

The final stage of labour, after the birth of the baby, is the delivery of the placenta.  Immediately after the birth, the mother has the capacity to release a very high concentration of oxytocin.  This is vital and necessary for a safe and bloodless placental delivery.  What causes this release?  First, the mother must not be cold at the time of the birth.  Secondly, she must not be distracted.  [Typical distraction: cutting the cord!]  The mother needs the baby in order to release this peak of oxytocin and deliver the placenta.

The prototype of the person to be with a woman in labour is the traditional midwife/doula mother figure.  The disappearance of midwives is a symptom of a culture that fails to understand the physiology of birth.   The midwife is calm; she is present; she is quiet.  She keeps the husband out of the room if he is nervous or anxious.  If he is calm, he assists her in surrounding the labouring woman with normality.  "Pretend it's a usual day in your house."  She finds repetitive tasks -knitting, running a bath- with which to occupy herself, to bring further calm to the woman.  If it's night-time, she goes to sleep!  She works from her heart, not her head.

In a small minority of cases, labour doesn't progress.  It just doesn't work.  If the labouring woman's environment has been ideal [careful with language, careful with light, make a woman feel secure without feeling observed], this remains a very small minority.  It is easy, though, to create problems during a birth that can result in the need for interventions and put an end to the naturally occurring physiological process.