Episode 01 of Midwives with no Lives released Sunday May 14, 2023. Through our first 08 episodes, we'll be releasing every few days. Then bi-weekly on Sundays thereafter. We hope you enjoy our content and encourage you to submit your ideas and feedback and PRETTY PLEASE subscribe, rate & review us so we continue to grow!
Hey! Thank you so much for joining us! In this episode we discuss the hormones of physiological labor/birth as well as how childbirth changes your brain! We'll happily revisit this topic as a whole later once we figure our shit out. But we breakdown each hormone responsible during labor and we will definitely dive into these MUCH more on an individual level as we become a little more experienced. Please note: These episodes have been recorded since Fall 2022 and we have since decided that Ashleigh and Erica will EACH present a topic each episode. So we do genuinely hope you enjoy and if not, you're so totally free not to listen... Now that's out of the way, who wants to get buzzed and talk about birth shit?
Resources for this episode:
Hormonal Physiology of Childbearing: Evidence & Implications for Women, Babies and Maternity Care; by Dr. Sarah Buckley
UpToDate - Preparation for Childbirth; by Judith A. Lothian RN, PhD., LCCE, FAAN
Scientific America article - Pregnancy causes lasting changes in a woman’s brain; by Catherine Caruso
Recommended reading:
Our Bodies, Ourselves: Pregnancy & Birth Edition; by The Bosten Women’s Health Book Collective
Gentle Birth, Gentle Mothering; by Dr. Sarah Buckley
Birth & Breastfeeding: Rediscovering the Needs of Women during Pregnancy and Childbirth (Health & Healing); by Michele Odent
Mindful Birthing; by Nancy Bardacke
The Birth Partner; by Penny Simkin & Rina Ríos
Labor Progress Handbook: Early Interventions to Prevent and Treat Dystocia; by Penny Simkin
[00:23] Erica Lea: Hey, I'm Erica!
[00:25] Ashleigh: Hi, I'm Ashleigh!
[00:26] Erica Lea: And we own Cloverleaf Midwifery in Florida State. We are one licensed midwife and one student midwife. However, we're not your midwives. We seek out current and evidence based stats and information for topics we present. But this podcast should not be used as a substitute for real obstetrical or gynecological care, nor should it serve to replace the advice of your chosen provider.
[00:48] Ashleigh: We do encourage you to ask hard questions and or seek out care of a provider that is a better fit for your needs. Please also note that we absolutely use filthy language during our discussions, which may occasionally be about controversial or triggering subject matter.
[01:04] BOTH: So now that's out of the way, who wants to get buzzed and talk about birth shit?
[01:11] Erica Lea: Bradley editing this episode for the fourth time; because I don't know what I'm doing.
[01:18] Ashleigh: He's really enjoying this information... like "I'm so glad I know this. This is exactly what I want to know about."
[01:24] Erica Lea: He could give a fuck. (I know I know, it should be "he COULDN'T give a fuck!)
[01:29] Ashleigh: Do you feel like at this point he could be in midwife?
[01:33] Erica Lea: No.
[01:35] Ashleigh: After all these years listening to you on the phone, he hasn't osmosis-ed the information?!
[01:41] Erica Lea: No. I believe midwives like to think that their partner listens to them.
[01:51] Ashleigh: I don't care about this birth shit.
[01:54] Erica Lea: I think that there is a little bit of tuning in and a little bit of tuning out. It's like when people are I answer a call in the middle of the night and my husband's like triaging them in their sleep. That doesn't fucking happen. They're not paying attention that intently that they're like because you also have to have a basis for that knowledge and have an understanding how these things work. And so if you don't have that base, especially if you have no context for this.
[02:41] Ashleigh: Most of the time you're like, are you bleeding? Are you cramping? What's your discharge like? He's like, no, don't need to know.
[02:48] Erica Lea: He just walks out of the room.
[02:50] Ashleigh: Yeah, I can see that.
[02:51] Erica Lea: I don't think he wakes up when the phone rings. Or sometimes he does get like when he's sick, he doesn't sleep well and he startles awake very easily and he's like uber sweaty. I can see that he is not getting good quality sleep. And sometimes if the phone rings, he will startle and he'll try to start talking to me.
[03:20] Ashleigh: Is he like "Erica, your phone is ringing."??
[03:21] Erica Lea: No, I don't think he's still in a half dream state. And so he's like trying to make sure that I'm okay physically. He thinks something is like on me or whatever falling on me, I don't know. So I'll be like "SHHH" and he's like, okay and he goes back to bed.
[03:44] Ashleigh: Well, first of all, I'm Ashleigh. I'm the student.
[03:47] Erica Lea: And I'm Erica. I'm the licensed midwife.
[03:52] Ashleigh: Thank you for being here.
[03:54] Erica Lea: It's really cool of you because new podcasts typically suck and so it's very admirable that you're here and listening to these very awkward new episodes.
[04:07] Ashleigh: How we fumble our way through this to good information, though.
[04:12] Erica Lea: Yes! And figure out how we can sound the best for you because we don't know what we're doing right now.
[04:21] Ashleigh: Yeah, so feedback. Feedback would be great!
[04:24] Erica Lea: We would love your feedback. Just don't be dicks about it.
[04:27] Ashleigh: Yeah, constructive.
[04:30] Erica Lea: So what question do you have for me this week, Ashleigh?
[04:36] Ashleigh: Okay, so I have "how does unmedicated birth change our physiology"?
[04:43] Erica Lea: Do we want to say how the format is generally going to be?
[04:48] Ashleigh: Yeah.
[04:49] Erica Lea: Okay.
[04:50] Ashleigh: That way they know what they're getting into.
[04:51] Erica Lea: Yeah.
[04:51] Ashleigh: Agreed. Okay, so we are going to do one or two topics in episode. I'm going to ask a question as a student and Erica is going to give us a well informed answer. Vice versa sometimes, but not often.
[05:08] Erica Lea: And we're just going to try to have a genuine conversation. Like, we have our research laid out, so sometimes it might sound a little scripty, but then we also want to have a genuine conversation. So that's our goal here, and that's what we hope it sounds like for you. So what is your question for me this week?
[05:34] Ashleigh: How does birth change your physiology?
[05:39] Erica Lea: This was a really fun topic to do, and also very overwhelming because I felt like there was so much about each of the hormones that are involved in labor. And I feel like we could do a whole entire series on each of the hormones and take up, like, a whole episode because they're just so in depth and they do so much and they're so fascinating to me anyway. And I think they obviously would be very fascinating to you, Ashleigh. Anyway, so I basically just tried to answer your question initially, like, how does it change your physiology? And we'll get into that in a second. But ultimately, I did kind of break down the hormones that are involved in labor. The resources that I used for this research were an article by Dr. Sarah Buckley called Hormonal physiology of Childbearing Evidence and Implications for Women, Babies, and Maternity Care. There was an UpToDate article, Preparation for Childbirth by Judith Lothian, and a Scientific America article, pregnancy Causes Lasting Changes in a Woman's Brain by Catherine Caruso.
[07:14] Ashleigh: Wow.
[07:19] Erica Lea: We'll kind of talk about that Scientific America article a little bit first because that was kind of like the shortest part of my research. There was a study performed by a research team at Autonomous University in Barcelona, and it found lasting changes that linger for up to two years postpartum after undergoing significant brain remodeling during pregnancy.
[07:46] Ashleigh: So pregnancy brain is a real thing?
[07:48] Erica Lea: Yes. And brain scans found gray matter in regions of the brain associated with social cognition and theory of mind. They were activated when looking at photos of their infants. So the mothers were being scanned, and those regions of the brain would activate when looking at pictures of their babies. And these changes predicted scores on maternal attachment. And they were so clear that an algorithm could identify which women had been pregnant.
[08:22] Ashleigh: Wow.
[08:24] Erica Lea: Surges in the sex, steroids, progesterone, and estrogen caused dramatic structural and organizational changes in the brain and could be used to predict how mothers scored on the attachment scale. These gray matter reductions could also determine which mothers were new mothers based solely on their patterns of gray matter loss. And gray matter loss was not visualized in the non pregnant partner or parent. So that was really cool.
[08:57] Ashleigh: Yeah. I feel like it's good because so many women are like they get so frustrated when they're pregnant, when they've lost their memories.
[09:04] Erica Lea: Yes.
[09:04] Ashleigh: But it's for a good reason.
[09:06] Erica Lea: Yes! There are actual changes happening within the brain that do linger for a time postpartum, but they're not fully permanent. But that would be like the I feel like, most dramatic change in our physiology because of being pregnant.
[09:28] Ashleigh: That's cool.
[09:32] Erica Lea: So the down and dirty is that it doesn't permanently change our physiology. Sorry if I'm being a little repetitive, though. I think some will disagree, but someone who achieves a totally undisturbed physiological birth will experience the following. Oxytocin is the main hormone, at least one of the main hormones involved in labor. Oxy means fast, and tosin means birth, but this is also the hormone of love, trust, calm, and connection. Synthetic oxytocin is chemically identical to endogenous oxytocin endogenous means of the body. But has different effects because it's not released from and within the brain. Okay. Responsible for orgasm, rhythmic uterine contractions, let down reflex, among other effects that we'll get into later. Oxytocin is released systemically from the mother's pituitary, causing the uterine contractions of labor, and at the same time is released into the limbic system.
[10:54] Ashleigh: What is our limbic system?
[10:55] Erica Lea: The limbic system is a part of our autonomic nervous system, which controls, like, our fight or flight response or our feed and breed state. So the limbic system is the more like relaxed parasympathetic nervous system. Feed and breed
[11:17] Ashleigh: Yes. And loving connection.
[11:18] Erica Lea: And you must be calm and relaxed to feel for these hormones to be released.
[11:31] Erica Lea: So at the same time, it's released into the limbic system, where it activates maternal circuits that foster the rapid and beneficial responses to their offspring after birth that promote infant survival.
[11:45] Ashleigh: This is like baby cries and then we're alerted?
[11:51] Erica Lea: And it's like that desire to want to of course, like a cry doesn't sound good. It makes us want to, like we inherently don't like that sound, but it's meant for us to bond with our baby, to protect that baby and respond in a healthy way when that baby cries.
[12:10] Ashleigh: Awesome.
[12:12] Erica Lea: Animal studies have found that during labor, oxytocin at physiological levels transfer from the mother to the fetus's brain and provides neuroprotective effects.
[12:27] Ashleigh: Unbelievable.
[12:27] Erica Lea: It's really cool. Oxytocin is also made in local tissues, including the uterus and decidua, which is the uterine lining, and also within the baby's amniotic sac.
[12:39] Ashleigh: Okay; I encourage you to look up what that is. The decidua. I did not know what that was, but Google's great. Look at the images.
[12:48] Erica Lea: Yes. within the brain, oxytocin can auto-regulate or influence its own release. So this is really cool. This is something I remember learning in my early semesters at school. autoregulatory positive feedback mechanisms can lead to the extreme peaks of oxytocin that characterize the physiologic events of labor, birth and lactation. Also developing in late pregnancy and distinctive in the postpartum period is the ability of oxytocin cells in the hypothalamus to burst fire in a coordinated way.
[13:30] Ashleigh: So what does that mean? That as it's releasing, it's like, triggering more release?
[13:34] Erica Lea: Yes, that's exactly what that means! So that's why the contractions in labor, as you move through early labor to active labor to transition, the contractions get longer, stronger and closer together, because the oxytocin is like, okay, this is working, but we got to keep building towards that end goal of getting, like.
[13:59] BOTH: A relay? Yes. Wow. Okay.
[14:04] Erica Lea: Fun and amazing effects of oxytocin orgasm. Yes, that's the big one. Pain reduction, anti inflammatory effects, healing and growth of tissues, which I thought was really cool. Vasodilation, which is the warming effect of a mother's skin to assist in the thermoregulation of the newborn. So to keep the baby's temperature regulated because they cannot regulate their own temperature yet, our vessels will dilate, allowing more blood flow to go through, increasing the temperature, which keeps our baby warm.
[14:52] Ashleigh: That's incredible. That's incredible, Erica.
[14:53] Erica Lea: I love it.
[14:55] Ashleigh: Can I also just say that the words that you're using, you say them so effortlessly, constantly, like, I'm keeping up with you.
[15:04] Erica Lea: Thank you.
[15:05] Ashleigh: For sure. Yeah.
[15:07] Erica Lea: I was told by a preceptor once not to use such big words, and I was like, but I think people would appreciate learning what these words mean.
[15:18] Ashleigh: I like to learn what they mean. But also I feel like it just gives validity to what you do as a midwife where some people think it's so fluffy.
[15:27] Erica Lea: Yeah. I don't want to come across as like, look at me and all of these big words I'm using, but this is like what they are. And I love those words. It helps in regulating the autonomic nervous system for stress reduction. It promotes calm and connection, reduces activity in the sympathetic nervous system, which is the fight or flight, remember? And increases the parasympathetic nervous system activity and AIDS in the dropping of stress hormone levels, which was also another thing that was really cool to me. And then Dr. Sarah Buckley mentioned this state in her this emotional state in her article, and I had never heard it before. It's kind of like the feed and breed, and she called it tend and befriend. And this is so fucking fascinating. Moderate levels of stress provoke this oxytocin mediated tend and befriend state, which promotes the desire to gather together for mutual support. This tend and befriend caretaking response to danger may have been more pivotal in offspring survival than fight or flight response.
[16:54] Ashleigh: Unbelievable.
[16:55] Erica Lea: What?!!?
[16:55] Ashleigh: Yeah, I've never heard that before either!
[16:57] Erica Lea: It's crazy. I love that so much. So that's why I think certainly as new parents, there can be a hard time setting boundaries with people because those people maybe have had children and they do want to help you. And I think it for the most part can come from a very loving place. But we maybe just need to work on how we set those boundaries before a baby is born. I think as people have maybe subsequent children, they kind of get a little more confident in setting boundaries and they also know how to accept help. But I just love this tend and befriend.
[17:51] Ashleigh: Well, especially because I feel like when we talk about postpartum issues, I think a lot of that has to do with being overwhelmed and feeling alone, especially with not having for us not having the same kind of maternity/paternity leave.
[18:04] Erica Lea: Yes.
[18:05] Ashleigh: But I think that's beautiful because honestly, sometimes all you want to do is have someone hold your baby so you can shower.
[18:11] Erica Lea: Yes. Or just take a nap on your belly or without having to worry about your baby right there. Awesome. So that basically wraps up oxytocin.
[18:28] Ashleigh: That is beautiful.
[18:29] Erica Lea: The next big hormone involved in labor are well, it's kind of a group of hormones, I guess they're known as catecholamines. And while I am going to collectively refer to these stress hormones as catecholamines, they're not all actually catecholamines. Some of them are released by the adrenal glands, and some of them are released from the brain. So it's not they're not I'm getting I'm getting really wrapped up in this. But these are the stress hormones epinephrine, norepinephrine, adrenaline, noradrenaline, dopamine, and cortisol. These are involved in the fight or flight response. Cortisol helps to actually restore homeostasis in the presence of stress, which was really cool to me. Catecholamines increase eight fold over normal baseline levels by late labor or transition.
[19:43] Ashleigh: Which is interesting because I feel like when you think stressful more and you think it's inherently negative right?
[19:49] Erica Lea: Yes; Catecholamines are extremely beneficial in labor in the right quantities. We will talk about what happens when there are too many stress hormones present and for too long, but they are extremely pivotal in our late labor and beginning of second stage or pushing. Signs that catecholamines are present include dry mouth, upright posture. So this is why we'll see when people are getting into or right before pushing, they go more upright into a squat or hands and knees or maybe want to be almost like kind of not reclined on their back, but reclined with lots of pillows propped behind them or something more upright. Verbal and nonverbal expressions of physiological fear, like shaking the head no. Or nonverbal signs like that. Or saying, I can't do this. I don't want to do this.
[21:00] Ashleigh: I feel like that's the most common that I've seen.
[21:03] Erica Lea: It's very common.
[21:03] Ashleigh: You're about to have a baby.
[21:04] Erica Lea: Yeah. Or like kicking your midwife would be another nonverbal.
[21:12] Ashleigh: I'm really stressed out. Just let me kick you.
[21:16] Erica Lea: So the benefits and the functionality of catecholamines in labor, so they will reduce the function of digestive organs. And obviously, we do see this at least by transition labor, because most of the time we might be hungry or have an appetite for things in early labor that starts to drop off through active labor. We are maybe cleaning ourselves out in early labor, but we're still a little hungry. And then as we move through active and certainly into transition, we are not having an appetite anymore. That's why things like broth or smoothies or bites of very easily digestible snacks in late labor, just for some energy, are helpful, and those are usually more desired at that point. The catecholamines mobilize the fuel molecules, such as glucose; So this is also helpful when we don't have an appetite, is that we are at least using the energy that we've had stored. Exactly.
[22:26] Ashleigh: Got you.
[22:27] Erica Lea: Increases blood pressure, which increased blood supply to vital and major organs. So, again, in little doses, this is very helpful. Got you. We certainly don't want low blood pressure in labor. It dilates your pupils for enhanced vision and dilates the airways for effective respiration.
[22:50] Ashleigh: The last two for me, that's hard to believe. I know that your body is doing all these amazing things, but just to be acutely aware and do these small things, because breathing, you're struggling through contractions. And then to remember, take a breath. Take a breath. And your body's helping that be more effective yes. Is amazing.
[23:15] Erica Lea: And that's like part of the fight or flight. Right. In moments of true danger. Right. Pupils are very dilated. We're focused. We are maybe having to run away from a bear. And so we need good breaths. And it's just like, get out of here. Right. But those particular things are very helpful. Dilated pupils for vision and airways for respirations. Those are helpful because sometimes we want to during a contraction, and then we need to breathe, have effective breathing.
[24:00] Ashleigh: I feel like I was definitely like I was just breathing so quickly that I wasn't really getting good breath to know that my body was helping me. That even though when I was like, it was more effective.
[24:12] Erica Lea: And those shallow, quick breaths increase anxiety, which is obviously increasing more catecholamines.
[24:20] Ashleigh: Oh, wow.
[24:22] Erica Lea: So it's like almost working against yourself, which was why Lamaze eventually was like, oh, that's not working. It's so much. And it's all like, up here in your head that it's like making the blood go to your brain, like, too much, and you are getting dizzy, and you're not actually oxygenating your body with good, deep breaths. Again, catecholamines are pivotal in late labor and pushing. It's responsible for the fetal ejection reflex, which is rapid and completely involuntary. These promote maternal alertness and focus assists in maturation of fetal organs in late pregnancy, which was really cool to me. So I think there's this thing that happens. I don't know if you remember this with your pregnancies. I certainly do remember it, at least with my pregnancy with Everette, my second baby. But there's this kind of impending feeling of doom. And that sounds so terrible because I was so confident getting ready for the birth of my second baby. I was like, I've already fucking done this. I know I'm going to do this again. There's no way I'm going to a hospital. Problematic things like that. But there was also this."What if I can't this time?" Or there's this like, "when the fuck is it going to happen?" There's all of these weird doubts that set in. And I wonder if that's the catecholamine surges that are happening to mature babies organs.
[26:23] Ashleigh: Because I feel like knowing you not pregnant, if I was like, oh, could you have another home birth? You'd be like, of course I could.
[26:29] Erica Lea: Yeah.
[26:30] Ashleigh: So I definitely think it must be your hormones are doing this.
[26:37] Erica Lea: The placental enzymes may also assist in metabolizing catecholamines for reduced negative effects on the fetus during late pregnancy. So isn't that funny? It assists in the maturation. There's got to be this little surge that assists in maturation of the fetal organs. But then also the placental enzymes are like but not too much because the catecholamines can potentially then be negative, like stress the baby out, stress the baby out and possibly lead to fetal distress, things like that. So that's really fascinating to me. Catecholamines prepare the baby for transition after birth and promotes alertness, but they may severely impact the functionality of labor if present in elevated quantities for an extended amount of time. So, for example, cold will exacerbate the fight or flight response, which is why we want the birthing environment to be at least warm and comfortable. We might start really working very hard and then be like, I need a cool rag, or get someone get a fan on me, or I need to get out of this hot tub. But aside from that, we generally want the environment warm. And mom can cool off if they need to. They increase the resting uterine tone between contractions. So this is something that I've absolutely seen in people having like a dysfunctional labor, maybe one that's prolonged because of exhaustion. And they will start to notice that their contractions never really go away. It'll peak, and they know that it's peaking, but then it comes down and it's still kind of like staying...not getting a break, not really getting a break at all. It can lead to catacomines, can lead to uncoordinated and very intense and frequent contraction patterns. And then prolonged exposure or presence of catecholamines may affect fetal development and then the ability to transition after birth. So again, it's like, we've got to find that sweet spot of when it's helpful and when it's not helpful. And then catecholamines may reduce prolactin release and ultimately disrupt lactogenesis postpartum that's milk production.
[29:27] Ashleigh: Okay, I like that.
[29:28] Erica Lea: Yes.
[29:31] Ashleigh: Okay, but wait, before we move on, so I know you were saying, like, we have to find this sweet spot. I feel like our bodies must be really good at doing this on our own. And again, we can save this for another episode. But how do they find that sweet spot when it's not your own hormones? Like, when they're synthetic? Is that just like, trial and error?
[29:59] Erica Lea: So I think that's definitely going to have to be for another episode because this is just in regards to undisturbed physiological birth. Right. But even in a labor that starts on its own and is left undisturbed for a while, there's a slight chance that exhaustion or something dysfunctional is going on. And so then the catecholamines can be released for too long and maybe are just too much at that point. But when we start introducing any kind of intervention, that is going to change the physiology. Right, but we definitely have that on our topic list.
[30:53] Ashleigh: Okay.
[30:53] Erica Lea: Yeah.Beta endorphins are going to be the next big hormone involved in labor. Endo, meaning of the body. Right. And fiends is morphine. So this is our own natural morphine relief. Pain relief. Exactly. Part of the medium term stress response designed to restore homeostasis. Beta endorphins are neurotransmitters that act on our opiate receptors in the brain and body to alleviate pain and promote feelings of pleasure. These have an involvement in brain based motivation and reward circuits. I love these so much.
[31:41] Ashleigh: I feel like that reminds me of the affirmation that's, like, I'm one contraction closer to meeting my baby because it's.
[31:50] Erica Lea: Like a reward, right?
[31:51] Ashleigh: Yeah.
[31:51] Erica Lea: Oh, I did that one and now I'm one step closer.
[31:53] Ashleigh: Yeah.
[31:55] Erica Lea: They optimize maternal mammalian adaptations.
[31:59] Ashleigh: Okay.
[32:02] Erica Lea: They provide immunosuppressant effects. The immunosuppressant effects of beta endorphins may be important in making the mother tolerant to their immunologically foreign fetus.
[32:16] Ashleigh: Wow. So your body doesn't fight your own baby.
[32:19] Erica Lea: Exactly.
[32:21] Ashleigh: Awesome.
[32:23] Erica Lea: One study randomized pregnant women to flexibility and endurance exercises, or a control group.
[32:31] Ashleigh: Okay.
[32:31] Erica Lea: So the control group is where they don't do anything.
[32:34] Ashleigh: Okay.
[32:35] Erica Lea: And then the other group is where they are doing flexibility and endurance exercises.
[32:40] Ashleigh: Okay.
[32:40] Erica Lea: So the study found higher levels of beta endorphins in labor with less reported pain among women who exercise in pregnancy.
[32:52] Ashleigh: Hello! I feel like that's what we need to say.
[32:55] Erica Lea: Yeah.
[32:56] Ashleigh: We're not just worried about your weight.
[32:58] Erica Lea: Right? No.
[32:59] Ashleigh: Actually going to be really and it's.
[33:00] Erica Lea: Not generally related to weight gain or trying to control that in some way. It is mobilizing fuel molecules, not storing too much of a bad thing, and increasing beta endorphins for labor.
[33:18] Ashleigh: Okay. But next time we're having this conversation with one of our clients, I hope one of us remembers I can be like, hello. Wait a second.
[33:26] Erica Lea: Yes. So now remember, beta endorphins do help the body in alleviating pain and promoting feelings of pleasure. So those beta endorphins, like, you're not only going to not feel so terrible with the contractions, it's more like welcoming and then the feelings of pleasure. Now, I'm not saying to the point of orgasm, although some people out there have definitely reported that it's not common, I feel like at all.
[34:08] Ashleigh: Have you seen that?
[34:09] Erica Lea: I have not personally seen that, no. Especially as someone who was told by a midwife that I "sexed my baby out". I was definitely not on the verge of having an orgasm. AT ALL. No. And another study found that the release of beta endorphins in response to exercise was enhanced in pregnancy. So together these would suggest that regular exercise in pregnancy may enhance beta endorphins in pregnancy and labor with reduced need for analgesia or pain relief.
[34:52] Ashleigh: I mean, listen, suck it up.
[34:55] Erica Lea: Walk now. And not just walking. Walking is kind of bullshit. I'm like, okay, but what else are you doing? I'm a little judging in that way. I mean, certainly walks are better. Walks are better than nothing, but what else are we doing? Are you doing a good stressful walk? Are you getting your heart rate up? Because then of course cardio is going to build like what is the word? Endurance. Thank you. It's going to build endurance. So you could potentially get through the longer labor without feeling as tired. But certainly it's like also pushing yourself through hard things.
[35:43] Ashleigh: Yeah.
[35:46] Erica Lea: Actually has this effect within your body to give you more reward you for it, to reward you for it, but to also provide this pain relief for you when you're going through hard things.
[36:00] Ashleigh: I realize that we may have to change the wording to make it more palpable.
[36:04] Erica Lea: Sure.
[36:05] Ashleigh: I'm not just saying to exercise because it's good for your weight. When we say it prepares you for labor, I feel like maybe more specifically yeah, agree.
[36:15] Erica Lea: Or they could just listen to the stuff. I mean, you could listen to this episode! Beta endorphins are also involved in fetal neuro-protection in response to hypoxia during late labor contractions and pushing.
[36:29] Ashleigh: Amazing.
[36:31] Erica Lea: Very cool. Beta endorphins produced by fetal tissues present in placenta and amniotic fluid also contain placental opioid enhancing factor. And this may give extra sources of rewarding and pain relieving hormones when consuming the raw form of the placenta.
[36:55] Ashleigh: Okay.
[36:55] Erica Lea: Which is absolutely a conversation we're going to have another time.
[36:58] Ashleigh: Placenta smoothie.
[36:59] Erica Lea: Yes. Do you want the sexy word for it?
[37:02] Ashleigh: Yes.
[37:02] Erica Lea: Placentaphage. I love it. And of course the beta endorphins provide reward and reinforcement in the mother during breastfeeding and then prolactin. This is more postpartum, but it is I don't know why I do that to myself.
[37:30] Ashleigh: Okay.
[37:31] Erica Lea: Prolactin is more of a postpartum hormone. It's an essential hormone in milk synthesis or lactogenesis release. Its release is controlled by dopamine, prolactin secretion is promoted by estrogen and thyroid stimulating hormone, or TSH.
[37:56] Ashleigh: You remembered that. You are so smart.
[38:02] Erica Lea: This is one of those things where anyone who has ever pumped knows that there's a certain window of time very early in the morning, like a 05:00 to 07:00, a.m. Pump sesh, where you.
[38:19] Ashleigh: Get the most milk.
[38:21] Erica Lea: Milk, yes. Thyroid stimulating hormone peaks at that time.
[38:28] Ashleigh: I'm telling you, yes.
[38:31] Erica Lea: Prolactin adjusts your appetite, which is why everyone's fucking ravenous postpartum. They're just like, thirsty and give me all the fat.
[38:40] Ashleigh: I don't care if I just ate, I'm hungry.
[38:46] Erica Lea: Provides fluid balance and immune function through the postpartum period. So that part is cool that it is involved in your immunity and probably has that effect on your breast milk as well. It optimizes postpartum and maternal adaptations, including behaviors, attachments, and of course, lactogenesis. I don't know why that was necessary. Why the fuck did I put that in there?
[39:17] Ashleigh: Because you're thorough. I knew you would get all the answers in there.
[39:19] Erica Lea: Several times, yes. Progesterone, which is produced by the placenta, inhibits prolactin effects on breast milk until placental expulsion completes.
[39:34] Ashleigh: Okay. Yes. So what you're saying is that until I deliver my placenta, I'm not going to start. That's why our breast milk comes in days later.
[39:43] Erica Lea: Yes.
[39:43] Ashleigh: Oh, my God.
[39:44] Erica Lea: And so it has to be like a minimum of 24 hours between placental expulsion and actually seeing full milk onset, it is a minimum of 24 hours.
[39:59] Ashleigh: Wow.
[40:00] Erica Lea: But that is why it can take closer to five days for someone who has never breast or chest fed before. And usually someone who has breast or chest fed before could potentially see breast milk coming in sooner, sooner than five days. But the placenta has to come out, has to shear and come out for that. And if there are bits of the placenta left in the body, it is still getting the progesterone and so it won't come in. And so the milk will not come in.
[40:36] Ashleigh: Wow. I mean, I feel like I know that this is what our body does, but the science behind it.
[40:43] Erica Lea: I know.
[40:44] Ashleigh: Oh, my God. Yes.
[40:48] Erica Lea: Benefits of spontaneous onset of labor. Increased oxytocin and prostaglandin receptors prime the uterus to promote effective contractions in labor. Increased cortisol, part of the catecholamines, supports maturation of the fetal lungs and other organs. Pre-labor preparations in oxytocin and catecholamine systems promote fetal protective processes in labor for optimal fetal transition and well-being postpartum.
[41:23] Ashleigh: Wow.
[41:25] Erica Lea: Short term elevations and proper amounts of stress in labor and birth allow the mother to remain focused and alert. Yes. And surges of catecholamines in late labor protect the baby from hypoxia, or lack of oxygen, and promotes adequate newborn transition and alertness.
[41:45] Ashleigh: Okay, so when we talk about protects the baby from hypoxia, is that like when we're having transition contractions that are really long, that are just like, squeezing poor baby?
[41:54] Erica Lea: Yes. Because they're not getting blood flow, therefore they're having a cut off of oxygen during the time that we're having a contraction.
[42:04] Ashleigh: Unbelievable.
[42:07] Erica Lea: Dangers of excessive stress levels during labor and birth or prolonged fight or flight response flows blood away from the uterus and therefore the placenta to vital maternal organs, leading to a stalled labor and or dysfunctional uterine contractions, but also will increase the risk of fetal intolerance of labor and or poor neonatal transition following delivery. Bananas.
[42:40] Ashleigh: So this is also like in our setting if we see someone who's not progressing, if they don't like if there's someone in there that shouldn't be at your birth, stuff like that.
[42:52] Erica Lea: Any person that is going to cause you extra stress. Some people are like working on their kitchen or something. And the fact that people like that their kitchen isn't done, isn't done, is stressing them out. Anything that's like in your environment or your birth space that would cause you stress, could potentially lead to that.
[43:21] Ashleigh: Wow. I feel like this reminds me of when people say, how many people are allowed to come to my birth? And you talk about it not being a "spectator sport".
[43:32] Erica Lea: Yeah. So prepping for birth ways that you can encourage your body to have a physiological birth in a healthy way, have these hormones kind of be healthy and balanced. So understanding the hormonal physiology of labor, understanding how these hormones come into play, how they affect you in positive and negative ways, seeking out childbirth ed that resonates with your beliefs and geared towards natural birth, but that is also evidence based and realistic to any and all outcomes. And I'm fucking looking at you. Hypnobirthing. Come-for-me. And I think we're going to talk about that a little later on.
[44:21] Ashleigh: I feel like we should because I'm pretty sure there's going to be some people who are like, hypnobirthing is the best. It was so good for me.
[44:28] Erica Lea: Yeah. We'll talk about why it's unrealistic, certainly. I think our next episode, we're planning to talk about that. Reading birth stories of all types or watching birth videos, right. Home births. Water births. The difference in newborn transition between a land home birth and a water birth are different. Those babies transition differently. So kind of like getting accustomed to that and knowing what's normal because there's such a wide range of normal. But also maybe someone has had to transfer and just watching hospital births. If you can find those videos. But I certainly think that reading birth stories, because there are a lot of home birth transfer stories out there. First time parents having home deliveries, someone who's having their 8th baby and their first baby at home or something like that, those are all so helpful in so many different ways. Obtaining the stories of your mothers, your siblings, friends, just coworkers like whoever in your life that has had a baby, find out what that was like for them and just what their story was. And a lot of people don't talk about it, but they want to. And I think if we just ask more, people would be very willing to get that information. Or maybe they're not. Maybe they're not ready to talk about their birth story. If there's been some kind of trauma.
[46:23] Ashleigh: Maybe like, working that out is good too. I feel like there's a lot of generations before us that it was just like, accepted whatever happened to them and they had to move on.
[46:34] Erica Lea: Find helpful and truly supportive, both physically and emotionally, team Members surround yourself with love and minimize stressful distractions. Use the B-R-A-I-N acronym when making decisions for your care. Benefits, risks, alternatives and intuition. And an important observation that we've made as midwives over our years of attending families in homebird settings and supporting those who have transferred to the hospital is this putting in the physical work to be healthy can improve function of labor and lead to optimal delivery outcomes and such, right? Exercising regularly, balanced eating habits, spinning babies, et cetera. But families who go beyond the physical, seeking out childbirth education that resonates with their beliefs, not just forcing an idea onto your pregnancy or birth, maintaining emotional stress, trust in the process, trust in their body's ability to labor and birth their baby, trust in their baby. Those who do their own research and lead the choices in their care. Those who surround themselves with a great doula, encouraging support team, and most importantly, love, are truly the ones most likely to achieve their dream birth.
[48:06] Ashleigh: Erica, you did so good..
[48:10] Erica Lea: Thank you! What was your favorite thing that you.
[48:14] Ashleigh: I feel like when we're telling people to do certain things, I mean, at least for me, maybe this is because I'm kind of a birth nerd, but knowing the sciency reason why you're telling someone to do something because it really does have such a huge impact on your overall well being. Yeah, that's cool that nature designed this perfectly, but then learning what it does.
[48:40] Erica Lea: Yeah. And that most of the time, like 90% of the time when we allow a person's body to just go into labor on its own and they have all of the tools and they've prepped most of the time, that 90% of the time it's just going to go like this. It could be long, sure, but it will still be a healthy labor that progresses and ultimately lead to a successful vaginal delivery. Really, only 10% of the time do we need some kind of intervention, and that is when we are thankful that we have interventions available to us. Sometimes I've seen people having very long early labor. Like, it becomes protracted in a way where there's no progress, but their contractions are right on top of one another and they're now having difficulty coping because the stress hormones are too high. And then, of course, what do we do? We tense up and it just gets worse and worse through every contraction. And so sometimes pain management is really helpful. Getting an epidural is not the end of the world. It is a great tool for someone who is maybe having very elevated blood pressure because the epidural can help bring that down. It's very helpful for someone who has not slept in three days and just needs to fucking take a nap.
[50:31] Ashleigh: Yeah, for sure.
[50:33] Erica Lea: And then that way they can just take a nap and their whole body is relaxing and they are able to labor down without having to do this work anymore. And they can still then have a vaginal delivery. And if they ever decide to have another baby, that labor is most likely going to be so much different.
[50:56] Ashleigh: Sure.
[50:58] Erica Lea: And typically, like, much more effective, efficient labor. And so those things are not the end of the world. And we do like having intervention when it's actually indicated.
[51:11] Ashleigh: Of course. Yeah. I just feel like women who are like, there's no way I could do that. I feel like this is the evidence behind but your body, you absolutely can do this.
[51:23] Erica Lea: Yes. And those who maybe have had very painful periods growing up, those people are really fucking good at having babies. They're just like going through a labor once a month. Yeah, that like when they're actually having a baby. They're like, I've been doing this my whole life, and now I get a baby, but now I get a baby out of it. And the uterus is just so used to doing strong, effective contractions that it's like, now I have a purpose. But then it's like the people who have never really noticed any cramps, they're like, I don't know if I can do this because I don't have that frame of reference. I don't know what contractions feel like. I stub my toe and I call out of work for a week or whatever and it's like, no, but this isn't stubbing your toe. This is literally an alternative state of being. For someone who has the capacity for pregnancy. Right. It is something that we are literally built for. Literally, it's in our DNA to utilize these hormones and to go through labor to get a baby out. And so it's a function of our body. It's not a toothache, it's not stubbing your toe.
[52:54] Ashleigh: Well, especially because when you're hurting yourself, your body's not then rewarding you with pleasure hormones. Do you know what I mean? So when you experience pain, nothing else is coming in to be like, it's okay, you're fine. The way you get that in labor.
[53:08] Erica: Yes.
[53:10] Ashleigh: You can do it.
[53:12] Erica Lea: You can do it. You can so fucking do it. Yeah.
[53:17] Ashleigh: Good job, Erica.
[53:18] Erica Lea: I really loved having this conversation with you.
[53:21] Ashleigh: You're so smart. Oh, my gosh. You make me feel real good about myself. I'm so excited.
[53:30] Ashleigh: So that's it.
[53:34] Erica Lea: And I really can't thank you people enough for coming by here and checking us out, because this is probably really awkward for everybody, but I hope you stick with us and we'll see you next time with some more fun shit to talk about.
[53:50] Ashleigh: That's right. Thank you.
[53:51] Erica Lea: Bye.
[53:54] Ashleigh: We live in practice in Florida State, meaning we are referencing our laws and protocols here. So if you're a midwife in another state with different or no laws or protocols, we'd really love to hear from you.
[54:06] Erica Lea: If you're a midwifery client, fan, or otherwise interested in traditional midwifery care, share your questions, experiences and birth stories by writing to us at Midwiveswithnolives@gmail.com or visit us on Instagram. And until next time, may your coffee be strong and your birth be well informed. Shout out to my talented and frustrating husband, Bradley John, for editing our episodes ever so lovingly.
[54:31] Ashleigh: And to Ashleigh Hoffman for designing our incredible jingle.
[54:34] Erica Lea: Yay. Bye.
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