In This Issue—The Impact of Birth Physiology on the Transition to Motherhood

Abstract

In this column, the associate editor of The Journal of Perinatal Education discusses the impact of birth physiology on the transition to motherhood. The associate editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

In the last year, in the midst of the Covid-19 pandemic, keeping birth as normal as possible has certainly been a challenge. Restrictions on support, moving in and out of the hospital quickly, and separation of mother and baby became “what to expect.” Alarm bells went off right from the start (Lothian, 2020). Buckley (2015), in her landmark work on the hormonal orchestration of labor and birth, provides evidence for the importance of support in reducing fear and anxiety and in helping women manage increasingly strong contractions as labor progresses. Without support, the potential to disrupt the hormonal physiology of labor increases. There is substantial evidence that labor support plays a critical role in the process of labor and birth and sets the stage for breastfeeding success (Green & Hotelling, 2019; Bohren et al., 2017). We have yet to evaluate the outcomes of restricting support, early discharge and separation of mother and baby and outcomes related to complications during and after the birth. But we do know that labor support, an essential component of safe and satisfying birth and early mothering, in many hospitals, was in short supply.

So, I was interested to read a newly published article, Birth as a neuro-psych-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth (Olza et al., 2020). The research integrated findings of two systematic reviews: maternal plasma levels of oxytocin during physiologic childbirth (Uvnas-Moberg et al., 2019) and a meta-synthesis of women's subjective experiences of physiologic birth (Olza et al., 2018).

The findings highlight the role of oxytocin in labor and the relationship between support and oxytocin levels. The levels of oxytocin at birth are 3 to 4 times higher than at the start of labor. Oxytocin released in the brain during labor and birth induces pain relief, decreases fear and stress levels, and stimulates social interactive behaviors. If pain and stress are too great this positive effect disappears, and oxytocin levels decrease. Support and touch can further activate the oxytocin system and decrease levels of fears, stress and pain.

The findings that extend our knowledge substantially relate to the effect of the endogenous oxytocin during labor on the psychological experience of labor and postpartum. For women who experience physiologic birth, in early labor, women engage in social interactions, nest building, and caring behaviors. As labor advances there is an increasingly inner focus and need for support. As labor becomes more intense, there is an altered state of consciousness. During pushing women become more active. They are in some senses “back to the world” and experience higher levels of pain and fear just before the birth. Right after birth women experience joy and pride and describe the feeling of being enveloped by baby and family. There is a heightened need for peace and touch. During the postpartum period there are lower levels of anxiety and higher levels of social, interactive behaviors.

The researchers suggest, based on these findings, that the experience of physiologic birth appears to result in a transformative personality change. The personality change appears to be induced by oxytocin and facilitates attachment and mothering. The researchers conclude that the neurobiological processes induced by the release of endogenous oxytocin influence maternal behavior and feelings to facilitate birth. The psychological experience during birth may promote an optimal transition to motherhood and the altered state of consciousness that women experience may be a hallmark of physiologic birth. The research also highlights the importance of support and touch to reduce labor stress and fear and pain.

The researchers conclude that “Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor” (Olza et al., 2020, p. 2). They also stress the importance of women knowing what interferes in powerful ways with oxytocin driven physiologic birth and the crucial importance of social support. This has important implications for childbirth education.

This research deepens our understanding of both the physiologic process of labor and birth and its foundational importance for the transition to motherhood and makes a major contribution to the literature. I highly recommend reading the entire article.

IN THIS ISSUE

Our feature article, “Re-Imagining Postpartum,” is by Sally Placksin, author of Mothering the New Mother: Women's Feelings & Needs After Childbirth, first published in 1994. This article describes Ms. Placksin's journey, decades later, as she looks again at the postpartum period, talking to childbirth educators, birth advocates, and women. Her journey has brought her to a deeper understanding of the postpartum period, women's needs, and the critical importance of postpartum support.

Also, in this issue co-authors Thepha, Marais, Bell, and Muangpina describe the development and evaluation of a three-year six-month intervention model to address the reduction of the six months exclusive breastfeeding rate in Northeast Thailand. Their aim was to assess the feasibility of the training intervention and its potential to improve six-month exclusive breastfeeding knowledge. For the health-care professionals and community leaders who participated, the mean six-month exclusive breastfeeding knowledge scores improved significantly. Authors recommended that this workshop could be duplicated and scaled up in other regions across Thailand to standardize care.

Recognizing that new fathers experience a variety of stressors, including identity and role transitions, changing relationships, and developing caregiving skills, Rayburn and Coatsworth developed, implemented, and evaluated a support program for new fathers. The five-week group intervention used a combination of mindfulness practices and skill-building for parenting and partner communication. Results indicated reductions in stress and depressive symptoms and increases in mindfulness constructs of nonjudgment and nonreactivity. This program holds promise as an avenue for supporting families across the transition to parenthood.

Cheryl Beck shares findings from her innovative secondary qualitative analysis designed to identify metaphorical expressions mothers of twins used to describe their first year caring for their infants. Data from the primary grounded theory study were reanalyzed using metaphor identification procedure and revealed eight metaphors: blur, life on hold, being an orchestrator, being a juggler, being an equalizer, being a quick-change artist, being a milk factory, and open invitation. Beck explains that these metaphors give clinicians an insider's view of the struggles mothers of twins experience during the first year after birth. The author suggests that childbirth educators are in a perfect position to provide anticipatory guidance for couples in classes who are expecting multiple infants.

Pilkington and Bedford-Dyer share results of their qualitative investigation of mothers' worries during pregnancy. Their analysis consisted of a content analysis of posts on Reddit. Most worries related to infant factors, individual factors, and antenatal care factors, such as medical procedures. The remaining worries related to situational factors and the partner relationship. These findings support calls for antenatal education to address women's psychosocial concerns more adequately.

Finally, in this issue, Steketee and Harden describe the implementation of a perinatal health fair called Mom Expo, intended to connect local women to holistic resources. These researchers used participatory strategies to develop the health fair with local women and perinatal educators and evaluated the health fair using pragmatic measures based on the RE-AIM framework. Feedback indicated strong enthusiasm for future similar events. Overall, this project provides practical and empirical information to inform the planning, implementation, and evaluation of perinatal health fairs that establish meaningful connection between local women, perinatal educators, and health researchers.

Biography

JUDITH A. LOTHIAN is a maternal child nurse and childbirth educator. She is a Professor at the College of Nursing at Seton Hall University. Dr. Lothian is the Associate Editor of The Journal of Perinatal Education and the co-author of Giving Birth with Confidence: The Official Lamaze Guide.

DISCLOSURE

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.