After 25 years as a midwife, it saddens me to hear of a woman’s negative first experiences with childbirth, oftentimes resulting from insensitive and neglectful care. As a midwife, one of my early memories of research on labor and birth were the doula studies in the USA in the late 1970’s. The implications of this research were remarkable – if women received continuous labor support, the risk of caesarean section was reduced. Having trained as a midwife in a large metropolitan hospital where the medicalization of childbirth was a daily reality, it was so refreshing to know that just being supported by another person had such profound effects.
Since that time, the body of knowledge around relational support for childbearing women has increased exponentially to cover a range of midwifery care models, including caseload practice, midwifery group practices and midwifery teams. These models of midwifery cause a reduction in drugs and medical procedures in labor. Why were these models so effective in reducing the medicalization of childbirth? Could it be as simple as providing an encouraging presence to women, especially those experiencing childbirth for the first time? Could being kind make such a difference?
A couple of decades after the doula studies, a clearer understanding of labor and the complex interactions among women’s hormones that occur during labor began to explain the profound effect of human caring. The hormone adrenaline, which elicits our fright and flight response, undermines the hormone oxytocin. During labor, oxytocin is responsible for uterine contractions. Too much adrenaline can slow contractions, cause them to have an erratic pattern or stop the labor altogether. We now know that when a woman in labor receives support and is enabled to stay calm, comfortable and confident, her adrenaline levels stay normal and work with the body during labor. Being scared and fearful inhibits and prolongs labor, while also increasing pain perception. Therefore, any form of care that encourages, soothes and relaxes women will bring benefit.
The significance of reducing stress in labor has since been demonstrated by a range of other environmental and physical therapies. These include providing a homely ambiance and offering water immersion. Hence the growth in birth centers with water birth facilities. We now also know that oxytocin is stimulated by touch, which is why massage is so commonly used by birth partners, midwives and doulas.
In recent years, psychologists have combined research from neuro-endocrinology and evolutionary biology to highlight the importance of compassion for human healing and well-being. Compassion acts on a center in the brain responsible for building affiliative bonds and soothing feelings. Empirical research is beginning to show that compassionate caring facilitates healing faster than non-attentive contact. The findings of this ground-breaking integration of several research streams are published in The Compassionate Mind by Paul Gilbert.
Compassion has always been a hallmark of good midwifery practice and now we know that it is not only welcomed by women but that it also has healing, restorative properties. When compassion is combined with the continuous presence of birth companions and a homely environment, the optimum conditions are in place for labor and birth to progress physiologically without the need for drugs or other medical procedures.
So why aren’t these elemental human behaviors available to and experienced by all women whenever and wherever they give birth? After all, the caring gene is common to all humanity. The tales of birth trauma generally occur in large maternity hospitals that are short staffed and caring for all levels of risk. These are staffed by kind midwives, but they are looking after two or three women at once and working in a medicalized setting, where the technology and high patient number distracts them from the core purpose of caring. This has to be challenged if the international epidemic of childbirth interventions is to be halted and reversed. Please spread the word that women deserve compassionate and kind care when they go through childbirth. In fact we believe it is a woman’s right.
Dr. Denis Walsh and Dr. Kerri Schuiling are Co-Editors-In-Chief of the International Journal of Childbirth. To learn more about their work and to find similar articles on midwifery and childbirth, check out a free sample issue on springerpub.com.