Angel-Ecstatic Birth: The Hormonal Blueprint of Labor

[Guest guest]

Ecstatic Birth: The Hormonal Blueprint of Labor

Issue 111, March/April 2002

By Sarah J. Buckley

 

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 orchestration unfolds optimally when birth is undisturbed,

enhancing safety for both mother and baby. Science is also

increasingly discovering what we realize as mothers- that our way of

birth affects us life-long, mother and child, and that an ecstatic

birth, a birth that takes us beyond our Self, is the gift of a

lifetime.

Four major hormonal systems are active during labor and birth. These

involve oxytocin, the hormone of love; endorphins, hormones of

pleasure and transcendence; epinephrine and norepinephrine, hormones

of excitement; and prolactin, the mothering hormone. These systems

are common to all mammals and originate in our mammalian or middle

brain, also known as the limbic system. 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

laboring woman. Under such conditions a woman intuitively will 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 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, caesarean surgery,

and separation of mother and baby after birth.

Hormones in Birth

Oxytocin

Perhaps the best-known birth hormone is 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, the " master gland " deep in our

brains, and stored in the posterior pituitary, 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 contractions at the

end of an undisturbed labor, 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 in pregnancy, when it acts to enhance

nutrient absorption, reduce stress, and conserve energy by making us

more sleepy.3 Oxytocin also causes the rhythmic uterine contractions

of labor, and levels peak at birth through stimulation of stretch

receptors in a woman's lower vagina 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 also produces oxytocin during labor, perhaps even initiating

labor;6 so, 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 suckling. Good levels of oxytocin

also protect against postpartum hemorrhage by ensuring good uterine

contractions.7 In 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 keep the mother

relaxed and well nourished. One researcher calls it " a very efficient

antistress situation which prevents a lot of disease later on. " In

her study, mothers who breastfed for more than seven weeks were

calmer than mothers who did not.8 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 may mediate the antidepressant effect of drugs such as

Prozac.14

Beta-endorphin

As a naturally occurring opiate, beta-endorphin has properties

similar to meperidine (pethidine, Demerol), morphine, and heroin, and

has been shown to work on the same receptors of the brain. Like

oxytocin, beta-endorphin is secreted from the pituitary gland, and

high levels are present during sex, pregnancy, birth, and

breastfeeding. Beta-endorphin is also a stress hormone, released

under conditions of duress and pain, when it acts as an analgesic

and, like other stress hormones, suppresses the immune system. This

effect may 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-endorphin induces feelings of

pleasure, euphoria, and dependency or, with a partner, mutual

dependency. Beta-endorphin levels are high in pregnancy and increase

throughout labor,15 when levels of beta-endorphin and corticotrophin

(another stress hormone) reach those found in male endurance athletes

during maximal exercise on a treadmill.16 Such high levels help the

laboring woman to transmute pain and enter the altered state of

consciousness that characterizes an undisturbed birth.

Beta-endorphin has complex and incompletely understood relationships

with other hormonal systems.17 In labor, high levels will inhibit

oxytocin release. It makes sense that when pain or stress levels are

very high, contractions will slow, thus " rationing labour according

to both physiological and psychological stress. " 18 Beta-endorphin

also facilitates the release of prolactin during labor,19 which

prepares the mother's breasts for lactation and also aids in the

final stages of lung maturation for the baby.20 Beta-endorphin is

also important in breastfeeding. Levels peak in the mother at 20

minutes,21 and beta-endorphin is present as well in breastmilk,22

inducing pleasure and mutual dependency for both mother and baby in

their ongoing relationship.

Fight-or-Flight Hormones

The hormones epinephrine and norepinephrine (adrenaline and

noradrenaline) are also known as the fight-or-flight hormones or,

collectively, as catecholamines (CAs). They 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.

In the first stage of labor, high CA levels inhibit oxytocin

production, therefore slowing or inhibiting labor. 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 this sympathetic response,

inhibiting labor and diverting blood to the major muscle groups so

that the mother can flee to safety.

In humans, high levels of CAs have been associated with longer labor

and adverse fetal heart rate patterns.23 After an undisturbed labor,

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 may express fear, anger, or excitement, and the CA

rush will cause several very strong contractions, which will birth

the baby quickly and easily.

Some birth attendants have made good use of this reflex when a woman

is having difficulties in the second stage of labor. For example, an

anthropologist working with an indigenous Canadian tribe recorded

that when a woman was having difficulty in 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.24

After the birth, CA levels drop steeply. The new mother may feel

shaky or cold as a consequence. A warm atmosphere is important, as

ongoing high CA levels will inhibit oxytocin and therefore increase

the risk of postpartum hemorrhage.25

Noradrenaline, as part of the ecstatic cocktail, is also implicated

in instinctive mothering behavior. Mice bred to be deficient in

noradrenaline will not care for their young after birth unless

noradrenaline is injected back into their system.26

For the baby also, birth is an exciting and stressful event,

reflected in high CA levels.27 These assist the baby during birth by

protecting against the effects of hypoxia (lack of oxygen) and

subsequent acidosis. High CA levels at birth ensure that the baby is

wide-eyed and alert at first contact with the mother. The baby's CA

levels 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

breastmilk synthesis and breastfeeding. Traditionally it has been

thought to produce aggressively protective behavior (the " mother

tiger " effect) in lactating females.28 Levels of prolactin increase

in pregnancy, although milk production is inhibited hormonally until

the placenta is delivered. Levels further increase in labor and peak

at birth. Prolactin is also a hormone of submission or surrender (in

primate troops, the dominant male has the lowest prolactin level) and

produces some degree of anxiety. In the breastfeeding relationship,

these effects activate the mother's vigilance and help her to put her

baby's needs first.29 The baby also produces prolactin while in the

womb, and high levels are found in amniotic fluid, possibly of

uterine or placental origin.30 The function of prolactin in the baby

is unknown.

Undisturbed Birth

Undisturbed birth is exceedingly rare in our culture, even in birth

centers and homebirths. 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 thus seem to be

fundamental. Yet the entire system of Western obstetrics is devoted

to observation of pregnant and birthing women, by both people and

machines; when birth isn't going smoothly, obstetricians respond with

yet more intense observation. It is indeed amazing that any woman can

give birth under such conditions. Some writers have observed that,

for a woman, having a baby has a lot of parallels with making a baby:

same hormones, same parts of the body, 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?

For birthing Maia Rose, my fourth baby, I arranged a situation where

I felt very safe and very private, and I had my shortest, easiest,

and most ecstatic labor and birth--one and a half hours with an 8-

pound, unexpectedly breech baby. I believe this birth proceeded

optimally because I was totally free to follow my instincts, and

because I felt safe and private. Each woman must labor where, and

with whom, she feels safest, and my situation would not suit

everyone. But it underscores the huge gap between what was ideal for

me and my baby, physiologically and hormonally, and the standard care

offered in most hospitals.

Impact of Drugs and Procedures

Induction and Augmentation

In Australia, approximately 20 percent of women have induced labor,

and another 20 percent have an augmentation--stimulation or speeding

up of labor--with synthetic oxytocin (Syntocinon, Pitocin).31 In the

US, these rates are 19.8 percent and 17.9 percent,32 adding up in

both countries to around 40 percent of birthing women being

administered synthetic oxytocin by IV during labor.

Synthetic oxytocin administered in labor does not act like the body's

own oxytocin. First, Syntocinon-induced contractions are different

from natural contractions, and these differences can cause reduced

blood flow to the baby. For example, waves can occur almost on top of

each other when too high a dose of synthetic oxytocin is given, and

it also causes the resting tone of the uterus to increase.33

Second, oxytocin, synthetic or not, cannot cross from the body to the

brain through the blood-brain barrier. This means that Syntocinon,

introduced into the body by injection or drip, does not act as the

hormone of love. However, it does provide the hormonal system with

negative feedback--that is, oxytocin receptors in the laboring

woman's body detect high levels of oxytocin and signal the brain to

reduce production. We know that women with Syntocinon infusions are

at higher risk of bleeding after the birth, because their own

oxytocin production has been shut down. But we do not know the

psychological effects of giving birth without the peak levels of

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. " 34 Michel Odent speaks passionately

about our society's deficits in our capacity to love self and others,

and he traces these problems back to the time around birth,

particularly to interference with the oxytocin system.

Opiate Painkillers

The most commonly used drug in Australian labor wards today is

pethidine (meperidine, Demerol). In one state, 34 percent of laboring

women in 1998 were given this drug.35 In the US, several opiate-like

drugs have been traditionally used in labor, including meperidine

nalbuphine (Nubain), butorphanol (Stadol), alphaprodine (Nisentil),

hydromorphone (Dilaudid), and fentanyl citrate (Sublimaze). The use

of simple opiates in the labor room has declined in recent years,

with most women now opting for epidurals, which may also contain

these drugs (see below).36 As with oxytocin, use of opiate drugs will

reduce a woman's own hormone production,37 which may be helpful if

levels are excessive and inhibiting labor. The use of pethidine,

however, has been shown to slow labor, more so with higher doses.38

Again we must ask: What are the psychological effects for mother and

baby of laboring and birthing without peak levels of these hormones

of pleasure and mutual 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.39 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 birthrates 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. When the

mothers had received opiates, barbiturates, and/or nitrous oxide gas

during labor, 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.40

This study was recently replicated with a US population, with very

similar results.41 The authors of the first study suggest an

imprinting mechanism, but I wonder whether it may 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 that may not be obvious until young adulthood.42-45 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. " 46

Epidural Drugs

Epidural drugs are administered over several hours via a tube into

the space around the spinal cord. Such drugs include local

anaesthetics (all cocaine derivatives, e.g., bupivicaine/marcaine),

more recently combined with low-dose opiates. Spinal pain relief

involves a single dose of the same drugs injected through the

coverings of the spinal cord and is usually short-acting unless given

as a combined spinal-epidural (CSE). Epidural pain relief has major

effects on all of the previously mentioned hormones of labor.

Epidurals inhibit beta-endorphin production47 and therefore also

inhibit the shift in consciousness that is part of a normal labor.

(This may be one reason why epidurals are so acceptable to hospital

birth attendants, who are not prepared, practically or

professionally, to deal with the irrationality, directness, and

physicality of a woman laboring on her own terms.) When an epidural

is in place, the oxytocin peak that occurs at birth is also inhibited

because the stretch receptors of a birthing woman's lower vagina,

which trigger this peak, are numbed. This effect probably persists

even when the epidural has worn off and sensation has returned,

because the nerve fibers involved are smaller than the sensory nerves

and therefore more sensitive to drug effects.48

A woman giving birth with an epidural will thus miss out on the fetal

ejection reflex, with its 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 labor and the extra need for forceps when an

epidural is used.49 Use of epidurals also inhibits catecholamine

release,50 which may be advantageous in the first stage of labor;

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 helps to make a laboring woman's uterus

contractible, and levels increase when women labor without epidurals.

In one study, women with epidurals experienced a decrease in PGF2

alpha, and average labor times were increased from 4.7 to 7.8

hours.51 Drugs administered by epidural enter the mother's

bloodstream immediately and go straight to the baby at equal, and

sometimes greater, levels.52,53 Some drugs will be preferentially

taken up into the baby's brain,54 and almost all will take longer to

be eliminated from the baby's immature system after the cord is cut.

One researcher found bupivacaine and its breakdown products in the

circulation of babies for the first three days.55

Another indication of the effects of epidurals on mother and baby

comes from French researchers who gave epidurals to laboring sheep.56

The ewes failed to display their normal mothering behavior; this

effect was especially marked for the ewes in their first lambing that

were given epidurals early in labor. Seven out of eight of these

mothers showed no interest in their offspring for at least 30

minutes.

Some studies indicate that this disturbance may apply to humans also.

Mothers given epidurals in one study 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 labor.57 In another

study, mothers who had epidurals described their babies as more

difficult to care for one month later.58 Such subtle shifts in

relationship and reciprocity may reflect hormonal dysfunctions and/or

drug toxicity and/or the less-than-optimal circumstances that often

accompany epidural births--long labors, forceps, and cesareans.

Incredibly, there have been no good studies of the effects of

epidurals on breastfeeding, although there is evidence that babies

born after epidural have a diminished suckling reflexes and

capacity.59,60

Cesarean Surgery

Cesarean section involves major abdominal surgery and increases the

risk of maternal death by about four times,61 as well as possibly

affecting mother and baby's health in subsequent pregnancies.62

Cesarean rates are currently 21.1 percent in Australia63 and 22.9

percent--the highest level on record--in the US.64 Obviously there is

a shorter or absent labor with cesarean birth, and the peaks of

oxytocin, endorphins, catecholamines, and prolactin are absent.

Furthermore, mothers and babies are usually separated for some hours

after birth, so breastfeeding is usually delayed. Both will also be

affected to some extent by the drugs used in the procedure (epidural,

spinal, or general anaesthetic) and for postoperative 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

percent of women who had given spontaneous vaginal birth experienced

a marked improvement in mood and an elevation of self-esteem after

delivery. By contrast, the 17 percent 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.65

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 average for

cesarean babies, and 75 minutes average for babies vaginally born.

Duration of breastfeeding was not significantly different for the

mothers, and the authors conclude that " other factors " can compensate

for deficient hormonal release. " 66 Other research has shown that

early and frequent suckling positively influences milk production and

the duration of breastfeeding.67,68 The authors of the hormonal study

above add, " These data indicate that early breastfeeding and physical

closeness may be associated not only with more interaction between

mother and child, but also with endocrine [hormonal] changes in the

mother. " 69

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 mother and 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. And enhanced self-

esteem after a natural birth--a lifelong effect, in my experience--is

a solid base from which to begin our mothering.

The connections between events at birth and long-term health

certainly deserve more study. (See Michel Odent's Primal Health

Database, www.birthworks.org/primalhealth, for a summary of current

research.) 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 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 a baby to

remain in his 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 mother

and 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, " 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. " 70

For the mother also, " A major block of dormant intelligences is

activated " the mother then knows exactly what to do and can

communicate with her baby on an intuitive level. " 71 This awakening of

maternal capabilities is well known among animal researchers, who

link it to the action of pregnancy and birth hormones on the brains

of mothers who have recently delivered.72 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.

According to Joseph Chilton Pearce (see Note 70), when these

activations do not occur within about 45 minutes of birth, " cut off

from his 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. " The damage caused by separation, Pearce

writes, is " massive and past the point of repair. " 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 Evolution's End: Reclaiming the Potential of Our

Intelligence is compelling.

Optimizing the Ecstasy

The following suggestions will help a woman use her hormonal

blueprint and so optimize the experience and safety for herself and

her baby.

Take responsibility for your health, healing, and wholeness

throughout the childbearing years.

Choose a model of care that enhances the chance of a natural and

undisturbed birth (eg, homebirth, birth center, one-on-one midwifery

care).

Arrange support according to an individual woman's needs; trust, a

loving relationship, and continuity of care with support people are

important.

Consider having an advocate at a hospital birth, e.g., a private

midwife or doula.

Ensure an atmosphere where the laboring woman feels safe, unobserved,

and free to follow her own instincts.

Reduce neocortical stimulation by keeping lighting soft and reducing

words to a minimum.

Cover the clock and any other technical equipment.

Avoid drugs unless absolutely necessary.

Avoid procedures (including obvious observations) unless absolutely

necessary.

Avoid cesarean surgery unless absolutely necessary.

Don't separate mother and baby for any reason, including

resuscitation, which can be done with the cord still attached.

Breastfeed and enjoy it!

One way to ensure minimum interference in the third stage is to

practice Lotus Birth, or nonseverance of the cord. This is only

compatible with a physiological third stage, and also keeps mother

and baby together and secluded in the hours and days after birth. It

is the subject of a new book and, having had three Lotus-born babies

myself, I highly recommend both the practice and the book.73.

Giving birth is an act of love, and each birth is unique to the

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 that

requires, especially in these times, that we each trust, honor, 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 hospital

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].74

Notes

1. M. Odent, The Scientification of Love (London: Free Association

Press, 1999).

2. M. Odent, " The Fetus Ejection Reflex, " in The Nature of Birth and

Breastfeeding (Westport, CT: Bergin and Garvey, 1992).

3. K. Uvnas Moberg, quoted in report of Australian Lactation

Consultant's Conference, Gold Coast, Australia 1998, published in

Australian Doctor (July 8, 1998): 38.

4. M. Y. Dawood et al., " Oxytocin in Human Pregnancy and

Parturition, " Obstetrics and Gynecology 51 (1978): 138-143.

5. E. Nissen et al., " Elevation of Oxytocin Levels Early Post-partum

in Women, " Acta Obstetricia et Gynecologica Scandanavica 74, no. 7

(1998): 530-533.

6. T. Chard et al., " Release of Oxytocin and Vasopressin by the Human

Fetus during Labour, " Nature 234 (1971): 352-354.

7. M. Odent, " Don't Manage the Third Stage of Labour! " Practising

Midwife 1, no. 9 (1998): 31-33.

8. See Note 3.

9. J. G. Verbalis et al., " Oxytocin Secretion in Response to

Cholecystokinin and Food: Differentiation of Nausea from Satiety, "

Science 232 (1986): 1417-1419.

10. P. Feifal and T. Raza, " Oxytocin Modulates Psychomimetic-induced

Deficits in Sensorimotor Gating, " Psychopharmacology 141, no. 1

(1999): 93-98

11. T. R. Insel, " Vasopressin and Autism: Is There a Connection? "

Biological Psychiatry 45, no. 2 (1999): 145-147.

12. S. Knox et al., " Social Isolation and Cardiovascular Disease: An

Atherosclerotic Pathway, " Psychoneuroendocrinology 23, no. 8 (1998):

877-890.

13. S. Sarnyai and G. L. Kovacs, " Role of Oxytocin in the

Neuroadaptation to Drugs of Abuse, " Psychoneuroendocrinology 19, no.

1 (1994): 85-117.

14. K. Uvnas Moberg et al., " Oxytocin as a Possible Mediator of SSRI-

induced Antidepressant Effect, " Psychopharmacology 142, no. 1 (1999):

954-1001.

15. M. Brinsmead et al., " Peripartum Concentrations of Beta Endorphin

and Cortisol and Maternal Mood States, " Australian and New Zealand

Journal of Obstetrics and Gynaecology 25 (1985): 194-197.

16. R. S. Goland et al., " Biologically Active Corticotrophin-

releasing Hormone in Maternal and Fetal Plasma during Pregnancy, "

American Journal of Obstetrics and Gynecology 159 (1984): 884-890.

17. T. Laatikainen, " Corticotrophin Releasing Hormone and Opioid

Peptides in Reproduction and Stress, " Annals of Medicine 23, no. 5

(1991): 489-496.

18. M. Jowitt, " Beta-endorphin and Stress in Pregnancy and Labour, "

Midwifery Matters 56 (1993): 3-4.

19. C. Rivier et al., " Stimulation in Vivo of the Secretion of

Prolactin and Growth Hormone by Beta-endorphin, " Endocrinology 100

(1976): 238-241.

20. C. R. Mendelsen, " Prolactin May Be Stimulus in Fetal Lung

Development, " Ob-Gyn News, July 1, 1978.

21. R. Franceschini et al., " Plasma Beta-endorphin Concentrations

during Suckling in Lactating Women, " British Journal of Obstetrics

and Gynaecology 96, no. 6 (1989): 711-713.

22. V. Zanardo et al., " Beta Endorphin Concentrations in Human Milk, "

Journal of Pediatric Gastroenterology and Nutrition 33, no. 2 (2001):

160-164.

23. R. Lederman, E. Lederman et al., " Anxiety and Epinephrine in

Multiparous Women in Labor: Relationship to Duration of Labor and

Fetal Heart Rate Patterns, " American Journal of Obstetrics and

Gynecology 153, no. 8 (1985): 870-877.

24. This incident is described by Michel Odent in " The Fetus Ejection

Reflex, " in The Nature of Birth and Breastfeeding (Westport, CT:

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28. M. Odent, The Nature of Birth and Breastfeeding (Westport, CT:

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29. Ibid.

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32. National Center for Health Statistics, www.cdc.gov/nchs,

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33. See Note 15.

34. See Note 28.

35. Queensland Health Perinatal Statistics 1998,

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46. See Note 44.

47. See Note 15.

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56. D. P. Krehbiel et al., " Peridural Anesthesia Disturbs Maternal

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60. A. B. Ransjo-Arvidson et al., " Maternal Analgesia during Labor

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63. See Note 31.

64. See Note 32.

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69. See Note 66.

70. J. C. Pearce, Evolution's End: Reclaiming the Potential of Our

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71. Ibid.

72. J. A. Russell et al., " Brain Preparations for Maternity- Adaptive

Changes in Behavioral and Neuroendocrine Systems during Pregnancy and

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73. Shivam Rachana, ed., Lotus Birth (Melbourne, Australia: Greenwood

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74. G. J. Kloosterman, " Universal Aspects of Birth: Human Birth as a

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(Note: A similar version of this article was presented at the Circle

of Life Conference of the National Association of Childbirth

Educators, Queensland, Australia, April 2001.)

Sarah J. Buckley trained as a family MD and GP-obstetrician in New

Zealand. Giving birth to her children Emma (11), Zoe (8), Jacob (6),

and Maia Rose (1), all born ecstatically at home, has fueled her

passion for birth and motherhood, and she is currently fully occupied

in mothering, writing, and lecturing. She lives in Brisbane,

Australia, with Nicholas, the love of her life, and can be reached at

sarahjbuckley.