Hormones & Healthy Birth: Walk, Move Around and Change Positions Throughout Labor

In continuation of our Hormones and Healthy Birth series, in connection with the Hormonal Physiology of Childbearing report from Childbirth Connection, today we share how being active during labor can allow your body's hormones to do their important work during labor and birth. The Lamaze "Healthy Birth Practice 2: Walk, Move Around and Change Positions Throughout Labor" encourages women to seek different kinds of movement during labor in order to:

• keep labor progressing
• avoid the use of Pitocin to speed up labor
• decrease pain
• enhance comfort

So what does this have to do with labor and birth hormones? Let's look first at avoiding the use of Pitocin to speed up (augment) labor.

Pitocin's Affects on Hormones in Labor and Birth

Pitocin is a synthetic version of the natural hormone oxytocin. Chemically, they are identical. But the affects on the body are very different (Buckley, 2015, page 27). Oxytocin, which is often referred to as the "hormone of love," is produced naturally in the brain and plays an important role in love, intimacy, bonding, breastfeeing, and you guessed it, childbirth! During labor, the production of oxytocin causes contractions. Sometimes, when labor is not progressing well, or if labor has "stalled" for a period of time, care providers may recommend the use of pitocin to increase the strength and frequency of contractions. Pitocin is administered introvenously (through an IV) and works differently in the body. Unlike oxytocin, pitocin:

• Has less calming, stress-reducing, and pain relief effects
• May interfere with breastfeeding success
• Can increase risk of postpartum hemorrhage (excessive bleeding)
• May hinder mother-baby attachment/bonding
• Can overstimulate the uterus, causing overly intense contractions, which can affect baby's oxygen levels and blood supply
• Decreases the ability to naturally cope with pain
• Requires continuous electronic fetal monitoring , which limits movement and can lead to increased medical interventions
• Can increase the risk of more medical interventions, including cesarean

If you think pitocin is easy to avoid, it's important to know that a large survey of women showed that more than 1/3 of women (36%) received pitocin to speed up their labor (augmentation) (Listening to Mothers III, 2012, page 19). However, many maternal-child health experts and practitioners argue that this intervention is over-used, and in most cases, a stalled labor is not cause for concern or medical intervention (source). To better understand your chances of receiving pitocin in labor, talk with your care provider well in advance of labor. Consider asking:

• When/why would you use pitocin in labor?
• What are alternatives to pitocin?
• How can you help me avoid the use of pitocin?

If, during labor, it is suggested you receive pitocin to augment your labor, consider asking your care provider the following questions to better assess the situation:

• Why is pitocin being suggested?
• Is my baby OK?
• Am I ok?
• What's the risk in doing nothing or waiting?

Epidurals and Birth Hormones: What You Should Know

In addition to keeping your labor moving along, Healthy Birth Practice #2 allows you to use more of your body's natural ability to relieve pain and increase comfort. Doulas, who are trained to help laboring moms find comfort in labor, encourage moms to change positions often throughout labor. While sitting on a birth ball early in labor may feel great, it may not be comfortable later in labor. It's important to use the many options available to move and position your body during labor. When women are limited in the ability to move and change positions, they often report an increased sensation of pain during labor, which can lead to the use of pain medication, including epidural analgesia. An epidural, while typically very effective at eliminating nearly all pain during labor and birth, can have significant impacts on the progress of labor and birth as well as undesirable side effects, including those caused by an interruption of birth hormones. An epidural can:

• Reduce the amount of naturally occuring oxytocin, increasing the need for pitocin (see side effects above)
• Due to low levels of oxytocin, labor may be slower, pushing may take longer, and the risk for use of forceps or vaccuum extraction and cesarean may increase
• Affect breastfeeding and mother-baby attachment
• Increase the incidence of maternal fever, which carries additional risks
• Affect memory of and satisfaction with birth experience due to the disruption in oxytocin levels

It is very possible to give birth without an epidural -- and enjoy your birth experience! Some of the best ways to be successful in avoiding an epidural include choosing a care provider and place of birth that are experienced in and enjoy supporting women without pain medication; hiring a doula; taking a comprehensive childbirth class; and communicating with your partner and/or birth support team about your preferences for birth.

Walk, Move Around, Change Positions Throughout Labor - Here's How

• Limit interventions, like epidural and routine IV fluids, both of which can restrict your ability to move during labor.
• Bring a trusted friend, family member, your partner, or doula to serve as your birth support person who will be in charge of reminding you to change positions and offer suggestions for movement that keeps labor progressing, facilitates baby's positioning, or allows you to rest in between contractions.
• Find a care provider who supports evidence-based practices for a healthy birth, including remaining mobile during labor .
• Make sure your place of birth is one that encourages women to move around and change positions during labor.
• Request intermittent fetal monitoring (usually 20 minutes out of every hour) instead of continuous fetal monitoring, which is more restrictive for movement and has been shown to increase the risk of more interventions .
• Labor as long as possible at home, where you are free to move around as much as you like.
• If you must be monitored continuously or hooked up to an IV (like you would during an induction), you can still get out of the bed! Enlist the help of your support person(s) to help you move around with wires in tow.
• Familiarize yourself with the many different labor positions you can use to help promote comfort and facilitate labor and birth.

Choosing the Best Care Provider to Maintain Movement Throughout Labor - Questions to Ask

• How do you support the natural hormones that help my baby and me through labor, birth, breastfeeding and bonding?
• What do you do to avoid things that might disturb birth hormones?
• What, if any, medical treatments or monitoring do you regularly use for all women during labor and birth? (If a doctor or midwife recommends medical treatments for all or most women, you may want to look for someone else.)
• What natural pain relief alternatives do you recommend and support in place of an epidural?
• When would you recommend pitocin and why?
• How will you help me remain mobile throughout my labor and birth?

Additional Resources

• Download the Lamaze Healthy Birth Practice Paper, available in eight languages, to learn more about letting labor begin on its own
• Watch a video on why it's important to walk, move around, and change positions throughout labor
• Learn about the pros and cons of 11 labor positions
• Read more tips for maintaining movement in labor

References

Buckley S. 2015. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies and Maternity Care. Childbirth Connection, Washington, DC.

Childbirth Connection. 2015. Pathway to a Healthy Birth: How to Help Your Hormones Do Their Wonderful Work. National Partnership for Women & Families, Washington, DC.

Childbirth Connection, 2013. Listening to Mothers III: Pregnancy and Birth. Childbirth Connection, Washington, DC.