“We are the only species that can doubt its capacity to give birth”
Liliana Lammers, Dr. Melodie de Jager, Cozette Laubser and Dr. Michel Odent in Highgate London, 2018.
UNDERSTANDING THE SIMILARITIES
Humans are grouped with other mammals whom are warm blooded, develop a neocortex, grow their young in a placenta, birth their live young, and breastfeed them. Another fascinating similarity between humans and other animals is the presence of the love and bonding hormone called Oxytocin. In The Oxytocin Factor, author Kerstin Uvnäs Moberg explains when researchers first became aware of the hormone. It was in 1906 when the English teacher Sir Henry Dale discovered the substance in the pituitary gland that could speed up the birthing process. He named it Oxytocin, from the Greek words for “quick” and “childbirth labor”. Later, he found that it also promoted the expulsion of breastmilk. Now it appears that Oxytocin plays a much larger physiological role than previously recognized, since under many circumstances it has the ability to produce the effects that we associate with the state of calm and connection. (Moberg, 2011: 3) Moberg goes on to say that oxytocin is found, entirely unchanged chemically, in all species of mammals. (Moberg, 2011: 4).
UNDERSTANDING THE DIFFERENCES
Although all mammals possess a neocortex, the human brain has a highly developed neocortex. It is this part of the brain that makes our ability to think, reason, talk and analyse possible. But, can our neocortical function, or simply put, our critical thoughts, hinder an instinctive natural birth?
We are the only species that can doubt its capacity to give birth. Think about that.
Ina May Gaskin
THE NEOCORTEX - THE HUMAN BIRTH HANDICAP
“…The important point is that when the ‘fetus ejection reflex’ is initiated, women are obviously losing neocortical control – control by the thinking brain, the brain for intellect, the part of the brain that is highly developed only among humans. Women may suddenly talk nonsense. They can behave in a way that usually would be considered inacceptable for a civilised woman, for example screaming, swearing, and biting the midwife… They can find themselves in the most unexpected, bizarre, often mammalian, quadrupedal (on all fours) postures. They seem to be ‘on another planet’. A reduced neocortical control is obviously a prerequisite for an easy birth among humans. In other words, the main reason for human handicap during such a physiological process is the inhibitory effect of an active, powerful neocortex. It is easy to explain why the concept of the fetus ejection reflex is not understood after thousands of years of socialisation of childbirth. It is precisely when birth seems to be imminent that the birth attendant has a tendency to become even more intrusive. If, for example, the labouring woman says ‘Am I going to die?’ ‘Kill me!’ or ‘Let me die…’, instead of keeping a low profile. The well-intentioned birth attendant usually interferes, at least with reassuring, rational words. These rational words can interrupt progress towards the fetus ejection reflex. The reflex does not occur if there is a birth attendant who behaves like a coach, or an observer, or a helper, or a guide, or a support person. And it is exceptionally rare when the baby’s father participates in the birth. The fetus ejection reflex can also be inhibited by eye-to-eye contact or the imposition of a change of environment, as would happen, in our modern world, when a woman is transferred to a delivery room. It is inhibited when the intellect of the labouring woman is stimulated by any rational language, for example if the birth attendant says: ‘Now you are at complete dilation. It’s time to push’. During an authentic reflex, the mother is in a quasi-ecstatic state and does not even realise that the baby is coming. Any interference tends to bring her back ‘down to Earth’, and tends to transform the fetus ejection reflex into a second stage of labour, which involves voluntary movements.” (Odent, 2016:20)
To be a good mom, you need to feel a lot (and think a little) to stay in contact with your mommy brain. Your hormones are willing assistants to keep you relaxed and functioning from your instinctive brain, more than functioning from your thinking brain. That is why new moms often feel slow and a little out of control. It is exactly how you should feel to be able to get to know your baby.
Dr. Melodie de Jager
EVOLUTION OF THE HUMAN CAPACITY TO GIVE BIRTH
“… There are inescapable questions to be faced about the probable evolution of the human capacity to give birth, even without referring specifically to the laws of natural selection. Today, with the help of epigenetics, it is understood that when a physiological function is underused it has a tendency to become weaker and weaker from generation to generation. In an age of pharmacological assistance during labour and simplified techniques of cesarean-section, the Oxytocin system is an example of a physiological function that has suddenly become underused: until recently, it was possible to give birth to babies and placentas without an intense activation of this system. From another perspective, practitioners who routinely ask how a pregnant woman was herself born have come to the conclusion that there is a correlation between the way a woman was born and how she gives birth to her own children.” (Odent, 2016:27)
PRE-LABOUR VERSUS IN-LABOUR CESAREAN-SECTIONS
“When the cesarean-section is accepted as a ‘normal’ way to be born, the focus is different. The main questions are about the timing of the operation. When is the best time to perform the operation. From that perspective there are three kinds of cesareans: pre-labour cesarean-section, in-labour non-emergency cesarean-section, and in-labour emergency cesarean-section. We must consider the usual classifications, which confuse the terms ‘pre-labour’ and ‘elective’, and also ‘in-labour’ and ‘emergency’:it is possible to plan an in-labour cesarean-section, and an in-labour operation can be decided on and performed before the birth becomes an emergency.
It is easy to anticipate differences between babies born pre-labour and those born by the other routes. In particular we know that there are increased risks of respiratory difficulties after pre-labour birth, which makes sense since we now understand that the fetal lungs themselves provide a signal to initiate labour: surfactant, a protein within the lungs, serves as a labour hormone that indicates to the mother’s uterus that the fetal lungs are mature enough to withstand the critical transition from life in fluid to air breathing. Furthermore, the well-known role of maternal and fetal stress hormones in the maturation of the baby’s lungs is relevant. Everybody knows that when a premature birth is considered imminent the mother is given analogues of stress hormones (corticosteroids) to mature the baby’s lungs. The stress of labour is associated with the release of endorphins, which induce the release of prolactin. One of the many effects of prolactin is to participate in lung maturation. We must also take into consideration the effect of the fetal stress hormone noradrenaline, which is released during labour. Fetal noradrenaline has multiple roles to play, including protection against lack of oxygen during uterine contractions and lung maturation.
This is an important point: the multiple negative effects of stress deprivation among babies born by pre-labour cesarean-section have been underestimated until recently. For example, it has been demonstrated that, under the effect of noradrenaline, the sense of smell has reached a high degree of maturity at birth among babies born by in-labour cesarean-section. We must emphasise the paramount role of the sense of smell immediately after birth. I mentioned in the 1970’s that the sense of smell is the main guide towards the nipple during the hour following birth. It has been demonstrated that it is mostly through the sense of smell that a newborn baby can identify his mother (and, to a certain extent, that the mother can identify her baby). There has recently been an accumulation of data to support the practice of waiting, whenever possible, for the onset of labour before performing a cesarean.” (Odent, 2016:29)
NEWBORN GUT FLORA AND ADULT OBESITY
“It appears that, apart from the route of birth and exposure to antibiotics, a shortened duration of pregnancy tends to delay the maturation of the gut flora: one week more or less in the duration of pregnancy is associated with highly significant differences. A pre-labour cesarean implies the association of all the known factors that can delay the maturation of the gut flora. This study is all the more important as it also reveals that delayed maturation of the gut flora is a risk factor for increased adiposity at the age of 18 months.” (Odent, 2016:31)
THE STRESS OF LABOUR AND BRAIN DEVELOPMENT
“In spite of possible interspecies differences, we must seriously consider animal experiments suggesting that the stress of labour influences brain development. Studies have demonstrated that the birth process in mice triggers the expression of a protein (uncoupled protein 2) that is important for hippocampus development. In humans, the hippocampus is a major component of the limbic system. It has been compared to the ‘conductor of an orchestra’ directing brain activity. It has also been presented as a kind of GPS system, helping us navigate while also storing memories in space and time.” (Odent, 2016:32)
I think we are amidst the largest experiment in human history, and we are not running the controlled studies to need to know what the consequences are. I think that is unethical, I don’t think it’s acceptable. I am not saying we shouldn’t use the procedures and medical advances we have. I am saying we owe it to the children that we are producing to know everything we can about what the consequences for that child, or those procedures are.
Sue Carter, Biologist & Behavioural Neurobiologist
THE WORLD HEALTH ORGANISATIONS STATEMENT ON CESAREAN-SECTION RATES
Since 1985, the international healthcare community has considered the ideal rate for cesarean-sections to be between 10% and 15%. Since then, cesarean-sections have become increasingly common in both developed and developing countries. When medically justified, a cesarean-section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of cesarean delivery for women or infants who do not require the procedure. As with any surgery, cesarean sections are associated with short and long-term risk which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies. These risks are higher in women with limited access to comprehensive obstetric care. In recent years, governments and clinicians have expressed concern about the rise in the numbers of cesarean-section births and the potential negative consequences for maternal and infant health.
URBANISATION, CULTURAL CHANGES AND MEDICAL ADVANCES THAT HAVE INFLUENCED OUR MODERN BIRTH CULTURE
• In 1846 dentist T.G. Morton experimentally used dietyl ether as anaesthesia. Once anaesthesia, antisepsis, and asepsis were firmly established obstetricians were able to concentrate on improving the techniques employed in cesarean-section.
• In 1928 Alexander Fleming had discovered Penicillin. It was purified as a drug in 1940 and is today known as modern antibiotics.
• In addition to surgical advances, the development of cesarean-section was influenced by the continued growth in number of hospitals, by significant demographic changes, and by numerous other factors, including religion. Religion has affected medicine throughout recorded history and, as noted earlier, both Jewish and Roman law helped shape early medical practice.
• As the rate of urbanization rapidly increased in Britain, throughout Europe, and the United States there arose at the turn of the century an increased need for cesarean-sections. Cut off from agricultural produce and exposed to too little sunlight, city children experienced a sharply elevated rate of the nutritional disease rickets. In women where improper bone growth had resulted, malformed pelvises often prohibited normal delivery. As a result the rate of cesarean-section went up markedly.
• In urban centers large numbers of uprooted working class women gave birth in hospitals because they could not rely on the support of family and friends, as they could in the countryside. Special hospitals for women sprang up throughout the United States.
• Since 1940, the trend toward medically managed pregnancy and childbirth has steadily accelerated. Many new hospitals were built in which women gave birth and in which obstetrical operations were performed. By 1938, approximately half of U.S. births were taking place in hospitals. By 1955, this had risen to ninety-nine percent.
• In the late 1940’s and 1950’s ultrasound made it possible to measure fetal growth and fetal skull width in relation to mother’s pelvic dimension’s and now has become a routine diagnostic advice. While this type of visualization provided medical personnel with valuable information, it also influenced attitude toward the fetus. The fetus then became a patient.
Several factors have contributed to the rise in cesarean-sections. Some of the factors are technological, some cultural, some professional, others legal. The growth in malpractice suites no doubt promoted surgical intervention, but there were many other influences at work.
SHOULD WE RELOOK THE WAY WE VIEW BIRTH?
In Penny Simkin’s ‘The Birth Partner’ she starts off with this important truth: ‘How a woman is cared for and supported during birth is a major influence, not only in how she gives birth but also in how she feels about it. Yet, medical care before and during childbirth focuses almost exclusively on the physical safety of the baby and mother. This medical care places little emphasis on the mother’s emotional well-being, her relationship with her partner, and her readiness to parent.’ (Simkin 2013; 9)
Knowing that an unhindered birth is important is not enough. We need to ask for, and create, a birth environment that will assist a birthing mother to access her primitive state, allowing her natural instincts to work, to labour.
People don’t realise how easy it is to make a birth difficult.
Liliana Lammers
POSITIVE BIRTH ENVIRONMENT
• Feeling safe and secure
• Privacy
• Warm and comfortable room temperature
• Silence
• Darkness or dimmed lights
• Active birth, moving around and finding the position that feels the most comfortable.
DIFFCULT BIRTH ENVIRONMENT
• Feeling threatened
• Feeling observed
• Feeling cold
• Questions and talking (stimulation of the Neocortex) • Bright lights
• Coached birth, instructed to breathe in a certain way, instructed to push, confined to a bed etc.
As an interdisciplinary student of human nature, I am aware of the dangers of being the prisoner of one particular perspective. After reviewing the knowledge provided by a certain number of scientific disciplines and considering the limits of each of them, we must build as many bridges as possible between different ways of thinking. The point is to learn from a combination of data provided by a great variety of scientific teams. In an age of extreme scientific specialisation, it is more useful than ever to recall that ‘The whole is greater than the sum of its parts’.
Dr. Michel Odent
