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Blog Archive

The Report, Part 1

May 2016

In my last post, I began the discussion of a recent report by Sarah J. Buckley, entitled, "Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care", (2015). Throughout the month of May, I will present various pieces of information from this commissioned report, through Childbirth Connection, that was published in January of last year.

In Part 1, let's look at the physiologic onset of term labor in humans.

 tummy present


Spontaneous term labor is not completely understood, but believed to be triggered by the infant's maturity coordinated with the mother's readiness for delivery. "With the physiologic onset of labor at term, maternal and fetal systems are fully primed and precisely aligned for safe, effective labor and birth, and for optimal postpartum physiologic transitions including breastfeeding initiation and maternal-newborn attachment," (Buckley, pg. xi). The mother's body prepares for labor in the weeks, days, and hours before the birth with:

  1. rising estrogen levels which activate the uterus
  2. increasing levels and activity of oxytocin and prostaglandin to ripen the cervix
  3. increasing inflammation to active the cervix and uterus
  4. increasing uterine oxytocin receptors to reduce bleeding
  5. increased brain receptors for beta-endorphins, providing endogenous analgesia during labor
  6. elevations in oxytocin receptors in the breast and body to promote breastfeeding and bonding

Meanwhile, the baby is also preparing to enter the extra-uterine environment with:

  1. pre-labor maturation of the lungs and other organs
  2. pre-labor development of brain-protecting oxytocin processes
  3. pre-labor increases in receptors for epinephrine-norepinephrine which protect the baby from labor hypoxia
  4. in-labor catecholamine surges to provide neuroprotective effects and preserve blood supply to the heart and brain
  5. in-labor catecholamine-mediated preparations to promote breathing, energy and glucose production, and heat regulation following birth

When labor is scheduled, whether through induction or pre-labor surgical delivery, these processes are disrupted. Scheduling a birth can have the following possible impacts:

  1. reduced contraction efficiency (and subsequent failed induction, increased use of vacuum/forceps during the delivery, and postpartum hemorrhage)
  2. reduced oxytocin and prolactin receptors in the breasts and brain, impacting breastfeeding, bonding, and maternal adaptations.
  3. increased potential for labor hypoxia and fetal distress due to immature protective processes such as the catecholamine surge
  4. decreased infant maturation of brain, brain-hormone, and organ systems
  5. long-term impacts of epigenetic programming on offspring

There is a lot we still have to learn about how inductions and surgical deliveries affect both mother and infant. Granted, there are selected situations where the scheduling is necessary, and perhaps even life-saving. However, what long-term affects are we creating with the very high rates of inductions and surgical deliveries?


Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA
Professional Development Educator, Step2Education International



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