Hormones In Labour & Birth | Natural Way The Body Helps You

Giving birth in ecstasy: this is our birthright and our body’s intent. Mother Nature, in her wisdom, prescribes birthing hormones that take us outside (ec) our usual state (stasis), so that we can be transformed on every level as we enter motherhood.

This exquisite hormonal physiology unfolds optimally when birth is undisturbed, enhancing safety for both mother and baby and, ultimately, human evolution.

Our birthing hormones in labour play a unique and key role in the protection and safety of birthing our babies. Hormones act as chemical messengers that tell a particular part of the body what to do.

Science is also increasingly discovering what we realise as mothers: that, for both mother and baby, our way of birth affects us life-long and that an ecstatic birth – a birth that takes us beyond our self – is the gift of a lifetime.

Four of the major hormonal systems are active during labour and birth. They are: oxytocin, the hormone of love; endorphins, the hormones of pleasure and transcendence; adrenaline and noradrenaline (epinephrine and norepinephrine), hormones of excitement; and prolactin, the mothering hormone. These systems are common to all mammals and originate deep in our mammalian or middle brain.

For birth to proceed optimally, this part of the brain must take precedence over the neocortex, or rational brain. This shift can be helped by an atmosphere of quiet and privacy with, for example, dim lighting and little conversation and no expectation of rationality from the labouring woman.

Under such conditions a woman will intuitively choose the movements, sounds, breathing, and positions that will birth her baby most easily. This is her genetic and hormonal blueprint.

All of these systems are adversely affected by current birth practices. Hospital environments and routines are not generally conducive to the shift in consciousness that giving birth naturally requires.

A woman’s hormonal physiology is further disturbed by practices such as induction, the use of painkillers and epidurals, cesarean surgery and the separation of mother and baby after birth.

Hormones in labour and birth

Oxytocin

Perhaps the best-known is the birth hormone, oxytocin, the hormone of love, which is secreted during sexual activity, male and female orgasm, birth and breastfeeding. Oxytocin engenders feelings of love and altruism; as Michel Odent says, ‘Whatever the facet of love we consider, oxytocin is involved’ (1).

Oxytocin is made in the hypothalamus, deep in our brains, and stored in the posterior pituitary, the master gland, from where it is released in pulses.

It is a crucial hormone in reproduction and mediates what have been called the ejection reflexes: the sperm ejection reflex with male orgasm and the corresponding sperm introjection reflex with female orgasm; the fetal ejection reflex at birth – a phrase coined by Odent for the powerful uterine contractions at the end of an undisturbed labour, which birth the baby quickly and easily (2); and, postpartum, the placental ejection reflex and the milk ejection, or let-down reflex, in breastfeeding.

As well as reaching peak levels in each of these situations, oxytocin is secreted in large amounts by pregnant women. During pregnancy, oxytocin acts to enhance nutrient absorption in the mother’s body, reduces stress, and conserves energy by making us more sleepy (3).

Oxytocin also causes the rhythmic uterine contractions of labour; levels peak at birth through stimulation of stretch receptors in a woman’s lower vagina or birth canal, as the baby descends (4). The high levels continue after birth, culminating with the birth of the placenta, and then gradually subside (5).

The baby has also been producing increasing amounts of the hormone oxytocin during labour (6) (7); therefore, in the minutes after birth, both mother and baby are bathed in an ecstatic cocktail of hormones.

At this time, ongoing oxytocin production is enhanced by skin-to-skin and eye-to-eye contact and by the baby’s first attempts at suckling (8). Good levels of oxytocin will also protect against postpartum haemorrhage by ensuring good uterine contractions.

During breastfeeding, oxytocin mediates the let-down reflex and is released in pulses as the baby suckles. During the months and years of lactation, oxytocin continues to act, to keep the mother relaxed and well nourished.

Oxytocin expert and researcher, Professor Kerstin Uvnas Moberg, calls it ‘…a very efficient anti-stress system, which prevents a lot of disease later on’ (3). In her study, mothers who breastfed for more than seven weeks were calmer, when their babies were six months old, than mothers who did not breastfeed.

Outside its role in reproduction, oxytocin is secreted in other situations of love and altruism – for example, sharing a meal (9). Researchers have implicated malfunctions of the oxytocin system in conditions such as schizophrenia (10), autism (11), cardiovascular disease (12) and drug dependency (13) and have suggested that oxytocin might mediate the antidepressant effect of drugs such as Prozac (14).

You can read more about this in BellyBelly’s article 5 Things Oxytocin Does That Pitocin/Syntocinon Doesn’t

Beta endorphins

As naturally occurring opiates, beta endorphins have properties similar to pethidine (meperidine, Demerol), morphine and heroin, and have been shown to work on the same receptors of the brain.

Like oxytocin, beta endorphins are secreted from the pituitary gland, and high levels are present during sex, pregnancy, birth and breastfeeding.

Beta endorphins are also stress hormones, released under conditions of duress and pain, when they acts as a painkiller (analgesic) and, like other related stress hormones, suppress the immune system.

This effect could be important in preventing a pregnant mother’s immune system from acting against her baby, whose genetic material is foreign to hers.

Like the addictive opiates, beta endorphins induce feelings of pleasure, euphoria and dependency or, with a partner, mutual dependency.

Endorphin levels are high in pregnancy and increase throughout labour (15), when levels of beta endorphins and corticotrophin (another stress hormone) reach those found in male endurance athletes during maximal exercise on a treadmill (16).

Such high levels help the labouring woman to transmute pain and enter the altered state of consciousness that characterises an undisturbed birth.

Beta endorphins have complex and incompletely understood relationships with other hormonal systems (17). During labour, high endorphin levels will inhibit oxytocin release.

It makes sense that when pain or stress levels are very high, contractions will slow, thus ‘…rationing labor according to both physiological and psychological stress’ (18).

Beta endorphins also facilitate the release of prolactin during labour (19); prolactin prepares the mother’s breasts for lactation and is thought to be important in preparing the baby’s lungs and heat-regulating systems for life outside the mother’s body (20) (21).

Beta endorphins also play an important role in breastfeeding and breast milk production. Levels peak in the mother at 20 minutes (22) and beta-endorphin is also present in breast milk (23) inducing a pleasurable mutual dependency for both mother and baby in their ongoing relationship.

Fight-or-flight hormones

The hormones adrenaline and noradrenaline (epinephrine and norepinephrine) are also known as the fight-or-flight hormones or, collectively, as catecholamines (CAs).

These stress hormones are secreted from the adrenal gland above the kidney, in response to stresses such as fright, anxiety, hunger or cold, as well as excitement, when they activate the sympathetic nervous system for fight or flight.

During the early stages of labour, too much adrenaline will inhibit oxytocin production, therefore slowing or inhibiting labour. CAs also act to reduce blood flow to the uterus and placenta and, therefore, to the baby.

This makes sense for mammals birthing in the wild, where the presence of danger would activate the fight-or-flight response, inhibiting labour and diverting blood to the major muscle groups so the mother can flee to safety. In human beings, high levels of CAs have been associated with longer labour and adverse fetal heart rate patterns (an indication of stress to the baby) (24).

After an undisturbed, active labour, however, when the moment of birth is imminent, these hormones act in a different way. There is a sudden increase in CA levels, especially noradrenaline, which activates the fetal ejection reflex.

The mother experiences a sudden rush of energy; she will be upright and alert, with a dry mouth and shallow breathing and perhaps the urge to grasp something. She might express fear, anger or excitement, and the CA rush will cause several very strong contractions, encouraging a fast and healthy birth.

The fetal ejection reflex is nature’s way of ensuring a mother will birth her baby quickly and easily (2) (25).

Some birth attendants have made good use of this reflex when a woman is having difficulties in the second stage of labour. For example, one anthropologist working with an indigenous Canadian tribe recorded that when a woman was having difficulty during birth, the young people of the village would gather together to help.

They would suddenly and unexpectedly shout out close to her, with the shock triggering her fetal ejection reflex and a quick birth (2)

After the birth, the mother’s CA levels drop steeply. A warm atmosphere is important; a new mother is very sensitive to temperature and, if she cools down significantly,

the cold stress will keep her CA levels high, inhibiting her natural oxytocin release and therefore increasing her risk of postpartum hemorrhage (26).

Noradrenaline, as part of the ecstatic cocktail, is also implicated in instinctive mothering behaviour. Mice bred to be deficient in noradrenaline will not care for their young after birth unless noradrenaline is injected back into their system (27).

For the baby also, birth is an exciting and stressful event, reflected in high CA levels. They assist the baby during birth by protecting against the effects of hypoxia (lack of oxygen) and subsequent acidosis (28).

High CA levels at birth ensure the new baby is wide-eyed and alert at first contact with the mother. The baby’s CA hormones also drop rapidly after an undisturbed birth, being soothed by contact with the mother.

Prolactin

Known as the mothering hormone, prolactin is the major hormone of breast milk synthesis and breastfeeding. Prolactin production increases in pregnancy, although milk production is inhibited hormonally until the placenta is delivered.

Levels decrease during labour but then rise steeply at the end of labour and peak with birth.

Prolactin is a hormone of submission or surrender and produces some degree of anxiety. In primate troops, the dominant male has the lowest prolactin level.

In the breastfeeding relationship, these effects activate the mother’s vigilance and help her to put her baby’s needs first (29).

Prolactin has been associated with nurturance from fathers as well as mothers, earning it the additional label ‘the hormone of paternity’ (30).

New fathers with higher prolactin levels are more responsive to their babies’ cries (31). Animal studies show that prolactin release is also increased by carrying infants (32).

During pregnancy, the baby also produces prolactin, and high levels are found in amniotic fluid, secreted by the baby’s membranes as well as the mother’s uterine lining (33). Prolactin is also secreted into breast milk, at least in the rat (34).

According to one researcher, ‘…there is evidence that prolactin plays an important role in the development and maturation of the neonatal (newborn) neuroendocrine (brain-hormone) system’ (35).

You can read more about this in BellyBelly’s article – Pain in Labor | How Your Hormones Are Your Helpers

Undisturbed birth

Undisturbed birth is exceedingly rare in our culture, which reflects our ignorance of its importance. Two factors that disturb birth in all mammals are: firstly, being in an unfamiliar place; and, secondly, the presence of an observer.

Feelings of safety and privacy seem to be fundamental, yet the entire system of Western obstetrics and maternity care is devoted to observing pregnant and birthing women, by both people and machines.

When birth isn’t going smoothly, obstetricians respond with even more intense observation. It is indeed amazing that any woman can give birth under such conditions.

Some writers have observed that, for a labouring woman, having a baby has a lot of parallels with making a baby: the same hormones, the same parts of the body, the same sounds and the same needs for feelings of safety and privacy.

How would it be to attempt to make love in the conditions under which we expect women to give birth?

When I gave birth to my fourth baby, Maia Rose, I arranged a situation where I felt very private, safe and undisturbed, and had my easiest and most ecstatic labour and birth: one-and-a-half hours with an unexpectedly breech baby.

I believe that this birth proceeded optimally because of the lack of disturbance and because of my freedom to follow my own instincts.

Undisturbed birth is possible in a variety of settings but must always involve a feeling of emotional security for the birthing woman.

A familiar and supportive companion, such as a midwife or doula, can play an important role in creating and protecting a private space for the labouring woman, especially in a hospital setting.

Impact of drugs and procedures

Induction and augmentation

In Australia in 2002, approximately 26% of women had an induction of labour, and another 19% had an augmentation – stimulation or speeding up of labour – through either artificial rupture of membranes or with synthetic oxytocin (Pitocin, Syntocinon).

In the US in 2002, 53% of women reported that they had Pitocin administered in labour to strengthen or speed up contractions (36).

Synthetic oxytocin, administered during the labour process, does not act like the body’s own oxytocin.

First, Pitocin-induced contractions are different from natural contractions, and these differences can have significant effects on the baby. Pitocin produces labour contractions which are longer, stronger and are associated with greater pain than those experienced from natural oxytocin.

For example, women experience waves that occur almost on top of each other when too high a dose of Pitocin is given, and it also causes the resting tone of the uterus to increase (37).

Such over-stimulation (hyperstimulation) caused by synthetic oxytocin can affect blood flow and deprive the baby of the necessary supplies of blood and oxygen, and so produce abnormal FHR patterns, fetal distress (leading to cesarean section) and even uterine rupture (38).

Birth activist Doris Haire describes the effects of Pitocin on the baby:

‘The situation is analogous to holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air, but not to breathe’ (39).

These effects might be partly due to the high blood levels of oxytocin that are reached when a woman labours with Pitocin. Theobald calculated that, at average levels used for induction or augmentation/acceleration, a woman’s oxytocin levels will be 130 to 570 times higher than she would naturally produce in labour (40).

Direct measurements do not concur, but blood oxytocin levels are difficult to measure (41). Other researchers have suggested that continuous administration of this drug by IV infusion, which is very different from its natural pulsatile release, might also account for some of these problems (42).

Second, oxytocin, synthetic or not, cannot cross from the body to the brain through the blood-brain barrier. This means that Pitocin, introduced into the body by injection or drip, does not act as the hormone of love.

However, it can interfere with oxytocin’s natural effects. For example, we know that women with Pitocin infusions are at higher risk of major bleeding after the birth (43) (44) and that, in this situation, the number of oxytocin receptors in the labouring woman’s uterus actually decreases, and so her uterus becomes unresponsive to the postpartum oxytocin peak that prevents bleeding (45).

We do not know, however, the psychological effects of interfering with the natural oxytocin that nature prescribes for all mammalian species.

As for the baby, ‘Many experts believe that through participating in this initiation of his own birth, the fetus may be training himself to secrete his own love hormone’ (29). Michel Odent speaks passionately about our society’s deficits in the capacity to love self and others, and he traces these problems back to the time around birth, and particularly to interference with the oxytocin system.

Opiate painkillers

The most commonly used drug in Australian labour wards today is pethidine (meperidine, Demerol). In one state in 1998, 38% of labouring women were given this drug (46).

In the US, several opiate-like drugs have been traditionally used in labour, including meperidine nalbuphine (Nubain), butorphanol (Stadol), alphaprodine (Nisentil), hydromorphone (Dilaudid) and fentanyl citrate (Sublimaze).

The use of simple opiates in the labour room has declined in recent years (47), with many women now opting for epidurals, which might also contain these drugs (see below). As with oxytocin, the use of opiate drugs will reduce a woman’s own hormone release (48), which might be helpful if levels are excessive and inhibiting labour.

The use of pethidine, however, has been shown to slow labour, more so with higher doses (49). This is is consistent with the known reduction in oxytocin that natural opiates can cause.

Again we must ask: What are the psychological effects for mother and baby of labouring and birthing without peak levels of these hormones of pleasure and co-dependency?

Some researchers believe that endorphins are the reward we get for performing reproductive functions, such as mating and birthing; that is, the endorphin fix keeps us having sex and having babies (50).

It is interesting to note that most countries that have adopted Western obstetrics, which prizes drugs and interventions in birth above pleasure and empowerment, have experienced steeply declining birth rates in recent years.

Of greater concern is a study that looked at the birth records of 200 opiate addicts born in Stockholm from 1945 to 1966 and compared them with the birth records of their non-addicted siblings (51).

When the mothers had received opiates, barbiturates and/or nitrous oxide gas during labour, especially in multiple doses, the offspring were more likely to become drug addicted.

For example, when a mother received three doses of opiates, her child was 4.7 times more likely to become addicted to opiate drugs in adulthood.

This study was recently replicated in a US population, with very similar results (52). The authors of the first study suggest an imprinting mechanism, but I wonder whether it might be a matter of ecstasy: if we don’t get it at birth, as we expect, we look for it later in life, through drugs. Perhaps this also explains the popularity (and the name) of the drug Ecstasy.

Animal studies suggest a further possibility. It seems that drugs administered chronically in late pregnancy can cause effects in brain structure and function (e.g. chemical and hormonal imbalance) in offspring – effects that might not be obvious until young adulthood (53) (56).

Whether such effects apply to human babies who are exposed for shorter periods around the time of birth is not known but one researcher warns, ‘During this prenatal period of neuronal (brain cell) multiplication, migration and interconnection, the brain is most vulnerable to irreversible damage’ (57).

Epidural drugs

Epidural drugs are administered over several hours via a tube (catheter) into the space around the spinal cord. Such drugs include local anesthetics (all cocaine derivatives – eg. bupivacaine/marcaine), more recently combined with low-dose opiates.

Spinal pain relief involves a single dose, usually of opiate drugs, injected through the coverings of the spinal cord, and is short-acting unless given as a combined spinal-epidural (CSE).

Epidural pain relief has major effects on all of the above-mentioned hormones of labour. Epidurals inhibit beta-endorphin release (15) and, therefore, also inhibit the shift in consciousness that is part of a normal labour.

This might be one reason why epidurals are so acceptable to hospital birth attendants, who might not be experienced or trained in dealing with the irrationality, directness and physicality of a woman labouring on her own terms.

When an epidural is in place, the oxytocin peak that occurs at birth is also inhibited, because the stretch receptors in a labouring woman’s birth canal, which trigger this peak, are numbed (58).

This effect probably persists even when the epidural has worn off and sensation has returned, because the nerve fibres involved are smaller than the sensory nerves and therefore more sensitive to drug effects (58).

A woman giving birth with an epidural will therefore miss out on the strong final contractions designed to birth her baby quickly and safely. She must then use her own effort, often against gravity, to compensate.

This explains the increased length of the second stage of labour and the extra need for forceps when an epidural is used (59). Use of epidurals also inhibits catecholamine release (60), which might be advantageous in the first stage of labour; close to the time of birth, however, a reduction in CA levels will, as with oxytocin, inhibit the fetal ejection reflex and prolong the second stage.

Another hormone also appears to be adversely affected by epidurals. Prostaglandin F2 alpha (PGF2 alpha) helps to make a labouring woman’s uterus contractible, and levels increase when women labour without epidurals.

In one study, women with epidurals actually experienced a decrease in PGF2 alpha, and average labour times were increased from 4.7 to 7.8 hours (61).

Drugs administered by epidural enter the mother’s bloodstream immediately and go straight to the baby at equal, and sometimes effectively greater, levels (62).

Some drugs might be preferentially taken up into the baby’s brain (63) and almost all will take longer to be eliminated from the baby’s immature system after the cord is cut.

For example, with regard to bupivacaine, its half-life (the time it takes to reduce drug levels by 50%) is 2.7 hours in an adult but around 8 hours in a newborn baby.

Another indication of the effects of epidurals on the mother and her baby comes from French researchers, who gave epidurals to labouring sheep (65). The ewes failed to display their normal mothering behaviour; this effect was especially marked for the ewes in their first lambing that were given epidurals early in labour. Seven out of eight of these mothers showed no interest in their offspring for at least 30 minutes.

Some studies indicate that this disturbance might also apply to human beings. In one study, mothers given epidurals spent less time with their babies in hospital, in inverse proportion to the dose of drugs they received and the length of the second stage of labour (66).

In another study, mothers who had epidurals described their babies as more difficult to care for, one month later (67).

Such subtle shifts in relationship and reciprocity might reflect hormonal dysfunctions and/or drug toxicity and/or the less-than-optimal circumstances that often accompany epidural births: long labours, forceps and cesareans.

Incredibly, there have been no large studies of the effects of epidurals on breastfeeding, although there is evidence that babies born after epidural have a diminished suckling reflex and capacity consistent with drug-related effects (68).

One study showed that healthy full-term babies exposed to epidurals during labour were less likely to be fully and successfully breastfed on hospital discharge (69).

Cesarean surgery

Cesarean surgery can be a life-saving operation for mothers and babies but the fact that it involves major abdominal surgery is often overlooked.

Cesarean birth increases the risk of maternal death by about four times (70) (71) and can significantly affect the mother’s and baby’s health in subsequent pregnancies (72). Cesarean rates are currently 27% in Australia (73) and 27.6% – the highest level on record – in the US (74).

Obviously there is a shorter or absent labour with cesarean birth, and the peaks of oxytocin, endorphins, catecholamines and prolactin are reduced or absent.

Furthermore, mothers and babies are usually separated for some hours after birth, so the first breastfeed is delayed. Both will also be affected, to some extent, by the drugs used in the procedure (epidural, spinal or general anaesthetic) and for post-operative pain relief.

The consequences of such radical departures from our hormonal blueprint are suggested in the work of Australian researchers, who interviewed 242 women in late pregnancy and again after birth.

The 50% of women who had given spontaneous vaginal birth were the most likely to experience a marked improvement in mood and an elevation of self-esteem after delivery.

In comparison, the 17% who had cesarean surgery were more likely to experience a decline in mood and self-esteem. The remaining women had forceps or vacuum assistance, and their mood and self-esteem were, on average, unaltered (75).

Another study looked at the breastfeeding hormones prolactin and oxytocin on day two, comparing women who had given birth vaginally with women who had undergone emergency cesarean surgery.

In the cesarean group, prolactin levels did not rise, as expected, with breastfeeding, and the oxytocin pulses were reduced or absent. In this study, first suckling had been at 240 minutes, on average, for cesarean babies and 75 minutes, on average, for babies born vaginally.

The authors commented:

‘This data indicates that early breastfeeding and physical closeness might be associated, not only with more interaction between mother and child, but also with endocrine (hormonal) changes in the mother’ (76).

Other research has shown that early and frequent suckling positively influences milk production and the duration of breastfeeding (77).

The authors of the hormonal study above found that duration of breastfeeding was not affected, and conclude, ‘…other factors…can compensate for deficient hormonal release’ (78).

These studies not only indicate important links between birth and breastfeeding, but also show how an optimal birth experience can influence the long-term health of a mother and her baby.

For example, successful breastfeeding confers advantages, such as reduced risk of breast cancer and osteoporosis for the mother and reduced risk of diabetes and obesity long-term for the child (79).

And enhanced self-esteem after a natural birth — which can be a life-long effect — is a solid base from which to begin our mothering.

The connections between events at birth and long-term health certainly deserve more study (80). But we cannot afford to wait for years for researchers to prove the benefits of an undisturbed birth.

Perhaps the best we can do is to trust our instincts and vote with our birthing bodies, choosing models of care that increase our chances of undisturbed – and ecstatic – birthing.

Early separation

Even in non-interventionist settings, it is uncommon for the baby to remain in the mother’s arms for the first one to two hours. And yet nature’s blueprint for this time includes a specific and genetically encoded activation of the brain and nervous system for both a mother and her baby.

For example, when the newborn baby is in skin-to-skin contact, at the mother’s left breast (which is where new mothers in all cultures instinctively cradle their babies) and in contact with her heart rhythm, according to Joseph Chilton Pearce, ‘A cascade of supportive, confirmative information activates every sense, instinct and intelligence needed for the radical change of environment… thus intelligent learning begins at birth’ (81).

For the mother also, ‘A major block of dormant intelligences is activated and the mother then knows exactly what to do and can communicate with her baby on an intuitive level’ (82).

This awakening of maternal capabilities is well known among animal researchers, who link it to the action of pregnancy and birth hormones on the brain of new mothers.

Such intuitive capacities are sorely needed in our human culture, where we rely so heavily on outside advice from books and experts to tell us how to care for our babies.

When these activations do not occur within about 45 minutes of birth, cut off from a mother’s nurturing and with none of the encoded expectancies met, the newborn’s adrenals continue to release steroids in the face of maximum fear and abandonment. The infant screams for a short time and then silence falls (83).

The damage caused by separation, Pearce writes, is ‘…massive and past the point of repair’ (84). Like Odent, he believes that our current birth practices are psychologically crippling to babies, mothers and society as a whole, and the evidence in his book is compelling.

Optimising the ecstasy

Remember that birth is ‘orgasmic in its essence’ (85) so that conditions for birth are ideally as close as possible to conditions for lovemaking. The following suggestions will help a woman to use her hormonal blueprint and so optimise the experience and safety for herself and her baby:

• Take responsibility for your health, healing and wholeness throughout the child-bearing years
• Choose a model of care and maternity care providers who will enhance the chance of a natural and undisturbed birth (e.g. home birth, birth centre, one-on-one midwifery care)
• Arrange support according to individual needs; trust, a loving relationship and continuity of care with support people are important
• Consider having an advocate at a hospital birth; a private midwife or doula is ideal to help you make informed decisions surrounding your maternity care
• Ensure an atmosphere where a labouring woman feels safe, unobserved and free to follow her own instincts
• Reduce stimulation of the neocortex (rational mind) by keeping lighting and noises soft and reducing words to a minimum
• Cover the clock and any other technical equipment
• Avoid drugs and pain medications, unless absolutely necessary
• Avoid procedures (including obvious observations), unless absolutely necessary
• Avoid cesarean surgery, unless absolutely necessary
• Don’t separate the mother and her baby for any reason, including resuscitation, which can be done with the cord still attached
• Breastfeed and enjoy it!

Giving birth is an act of love and each birth is unique to the individual mother and her baby. Yet we also share the same womanly physiology and the same exquisite orchestration of our birthing hormones.

Our capacity for ecstasy in birth is also both unique and universal – a necessary blessing that is hard-wired into our bodies, but which requires, especially in these times, that we each trust, honour and protect the act of giving birth according to our own instincts and needs.

Dutch Professor of Obstetrics, G. Kloosterman, offers a succinct summary, which would be well placed on the door of every birth room:

‘Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character.

‘The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine – nil nocere (Do no harm) (86).

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