Episode 149 - 5 Strategies to help you get a vaginal birth in hospital
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host,
[0:03] Dr. Melanie Jackson. I'm a clinical and research midwife with my PhD. And each episode, I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth, and postpartum journey.
[0:25] Welcome to today's episode of the Great Birth Rebellion podcast. I'm your host Dr. Melanie Jackson and today we're talking about how to have a natural birth in hospital. Now this is a great one for you care providers to share with the women that you're looking after and if you're a great friend and you have a pregnant friend this is something they are going to want to hear. Just by sharing this you could change their whole birth experience for the better. Why wouldn't you do that? And if you're out there listening and someone shared this with you, you've got people who love you and who want the best for you and who are an ally in your journey. So many of you won't have any other choice but to go to your local hospital to give birth, and many of you want that and you're happy with that and but some don't really want to accept that option but you don't really have another choice. So this is for you if you want to have a low intervention birth where the baby comes out of your vagina without a vacuum, without forceps or episiotomy where you haven't required medication and it's for you who wants the most natural birth possible in a hospital setting. So I've been a private midwife for 16 years. I know what the secret sauce is to support women to have vaginal births with as little intervention as possible.
[1:54] And my whole career, I've been able to build this unique skill set as a midwife to help women put all of the ingredients together, and for me to stay out of the way as much as possible to ensure that they get the low intervention birth that they're after. And this is what I'm going to share with you today. How to have a natural vaginal birth with low intervention, even if you're going into hospital to have your baby. My clients mostly choose to give birth at home, but you don't have to be planning a home birth to have a low intervention vaginal birth. This can be possible in hospital. You just have to plan it a little bit differently for it to work. You do have to work a little bit harder for it, more preparation for it, because the hospital environment itself is working against you a bit here. But there are ways around it, and that's what I'm here to explain. So if this is you and you have hopes to just arrive at hospital, do what you need to do in labor, give birth without unnecessary interruptions, you're in the right place. I'm going to give you so many strategies that you can implement to increase the chances of you having a vaginal birth in hospital. And the truth is that low intervention vaginal births are becoming less common. Fewer women are having them, and I refuse to believe that this is the fault of women. Women aren't asking for more intervention.
[3:24] They're actually being groomed to accept it. But if you ask the majority of them, they don't truly actually want it. And we'll talk about the research behind that as we go.
[3:35] So today I'll start by explaining what your body does and needs during labour and birth and this is where you'll understand the function and physiology of your body and mind in labour and birth. Then I'll explain what choices you can make to optimise your physiology in order to maximise the chance that you will have a vaginal birth. So when our bodies are functioning at an optimum capacity this reduces the chance of things going wrong in inverted commas during your labor and birth. So there are some things that are out of your control completely but there's a huge raft of controllable factors that you can take responsibility for to curate a great birth for yourself. If you apply everything that I'm going to share today you give yourself the best possible chance at having a vaginal birth because your body and mind will have what they need to give birth in an optimum state.
[4:38] But please don't hear this as a guarantee. You may still need interventions. Our bodies are not perfect and they don't always function as they should. But when you give your body what you know it needs to function properly, you increase your chances of this physiological function working. So not everything is within your control or anyone's control, but some things are. And those controllable factors are your responsibility if you want to have a vaginal birth in hospital. All right.
[5:11] Let's get into it. My first point is to remind you that hospital births are geared towards intervention. For women who say they have a plan to go with the flow and do whatever is suggested on the day, you have to know that the flow is medical. If you want a medicalised birth, then going with the flow is the path of least resistance. But if you want a low intervention birth, you're going to have to put some effort and do some swimming upstream because you're going against the flow.
[5:44] So you might be fortunate enough to have a midwife or obstetrician that aligns with your philosophy to have a low intervention birth. But if you don't know who's going to be looking after you when you get to hospital like so many women, it's best to be overprepared just in case you find yourself with a care provider who has a particularly interventive approach to birth care. Now, I know it might seem like I'm poo-pooing hospitals straight up here, and I'm not, but just know that the statistics here in Australia particularly.
[6:17] And if you check the stats in your country too, wherever you're listening from, I feel sure that the medicalization of childbirth is trending around the world and causing fewer women to have low intervention vaginal births. Here in Australia, our most recent statistics show that 49% of women had a non-instrumental vaginal birth, which means that 49% of women didn't have a cesarean, vacuum, forceps, or an episiotomy. So 12% of women had a vaginal birth that was assisted by vacuum or forceps, and 39% of women had a cesarean section. So overall just under less than half of women are giving birth through their vagina without some kind of surgical technique so I don't feel like I'm overreacting when I say that we've over medicalized childbirth because now just one percent more than half are having births that are not unassisted spontaneous vaginal births so yes this conversation is important I'm not making it up normal birth rates are dropping and if you want.
[7:28] A low intervention vaginal birth you're going to have to work for it. So let's find out what you can do. What are the controllable factors that you can choose to implement that will increase your chance of having a low intervention vaginal birth? So firstly if you can if you've got this option to choose a birth location that is geared towards you having a low intervention birth but that also meets your particular needs that will increase your chance and there are ways to work out which location is going to increase or decrease your chance of a vaginal birth. One way is by just looking at research papers which will give you a general idea of which direction to go and which places to avoid and that's what I can help with you today.
[8:15] But it is also essential that you understand the statistics in your particular location. Have a look at the birth places that are specifically available to you. You may only have one and you can go and find out the spontaneous vaginal birth rates in that facility. So it's all well and good to know that your chances of vaginal birth overall are 49% but that could be different at the hospital that you've got access to. It may be more or less. It's also really good to know that your chance of vaginal birth increases at home or in a birth center or at a public hospital versus a private hospital but if you don't have access to these what do you do next? So I completely understand that most women don't have the luxury of choosing from a full menu of options you'll probably need to make the best of what you've got.
[9:12] But if you are in that privileged proportion of women who have less barriers in their choice about where to birth, we can have a very quick look about which birth locations are going to give you the best chance of a low intervention vaginal birth. So first, let's look at some big studies. These are available as full text papers for you to read in detail in the resource folder. As always, if you're on the mailing list for this podcast, you can access the resource folder, which has all of the research that we use to create every single podcast episode, the details of how to join you in the show notes. So for today's purposes, I've focused on the data from these specific studies that pertain to mode of birth, so vaginal, cesarean, forceps, vacuum, because we're talking about how to increase your chances of vaginal birth. So I'm not going to go through all the stats, just the ones that relate to our topic today.
[10:08] So in both the studies below, they talk about normal labor and birth and there's a little bit of controversy around using the word normal birth because actually these days it's normal to have a high intervention birth either having your baby removed for you from you via cesarean vacuum or forceps or through episiotomy so it's actually no longer normal to have a spontaneous vaginal birth with low intervention but these studies are talking about normal labor and birth and these relate to spontaneous labor so it hasn't started with an induction, no epidural or general anesthesia, no forceps, vacuum, episiotomy or cesarean section. So that's how we define normal labor and birth from these studies.
[10:56] So the first one is the birthplace in England study and this was replicated here in Australia. So the proportion of women with a normal birth varied depending on the location that they gave birth at. So if the women in this study plan to give birth in an obstetric unit, so it's led by doctors, there was a 58% chance of a normal vaginal birth. If you were in a midwifery unit, 76% chance. If you're in a midwifery-led freestanding unit, so more like a birth center, you had an 83% chance. And for a planned home birth, it was 88%. So women who planned births at home or in freestanding or alongside midwifery units were significantly less likely than those who planned to give birth with doctors in an obstetric unit. They were less likely to have an instrumental or operative birth or receive medical interventions.
[12:00] So they're significantly more likely to have a normal birth. And this was mimicked in the birthplace in Australia study. So a planned birth at home or birth center was associated with normal labor and birth more often than a planned hospital birth. The women who were planning a birth center birth were three times more likely to have a normal vaginal birth compared to at a hospital. Women planning home birth were six times as likely to have a normal vaginal birth compared to a hospital so it's clear that a hospital setting has an impact on the chances of you having a vaginal birth and also people would be saying now oh but the women who gave birth in hospital were more high risk that's why they had more intervention no both these studies were done on low risk populations.
[12:50] So what we know is that the birthplace does make a difference and so now we've got to know knowing that we need to employ strategies to try and manufacture a vaginal birth in a setting that doesn't automatically gear you or have a flow
[13:08] towards low intervention birth. So your first step is to find out which hospitals are available to you in your area. You might only have one option, You might have two options and then look at that hospital's spontaneous vaginal birth rates and you can contact them and directly ask them what their stats are. You might need to speak to the right person. Not everybody on the phone has got access to this kind of information, but you could ask to speak to an educator or a midwifery unit manager who can have access to the stats for their hospital so that you understand what you're dealing with. And if you've got an option of two hospitals, you might choose the one that's going to give you a better chance of spontaneous vaginal birth.
[13:52] Sometimes you can be lucky enough that if you just Google around, the stats might be made public somewhere on the web. And here in Australia, we do have a mothers and babies report that's done every two years. And the New South Wales mothers and babies report breaks it down per hospital. So that is very, very handy. And actually, I've put that document in the resource folder. If you're a mother from New South Wales here in Australia, the other states didn't have it broken down so easily, which was very frustrating. I did try and find them for you all.
[14:26] But you can find out your individual hospital spontaneous vaginal birth, right? Find out what you're after. So now let's see what you can do to improve your chances of being one of those women to have a spontaneous vaginal birth. And I'm going to start by talking about how your body works during labor and birth and what optimum function looks like so that you can employ as many elements as possible to support these physiological functions when giving birth in hospital.
[14:53] So firstly, your body needs to be ready. There is an interaction between the readiness of your body and the readiness of your baby as it, you know, your baby's got to finish developing and your uterus has to be ready to go into labor. There's this complex web of interactions and hormone actions that will occur in your brain and in your body and in your baby's body to start ripening your cervix and start acting on your uterus. So I can't stress enough the importance of readiness.
[15:25] In the age of induction where 33% of women and 43% of first-time mums have their labor induced, that means that many women and babies are asking their bodies to labor prematurely before they're ready and their babies are being born before they're fully developed but if you do go into labor yourself when your body and baby decides then you know that your body your hormones the baby's body are all functioning in an optimum state that will translate into optimal function of your body throughout labor and birth wait till your body is ready and I'm speaking in general terms here because there's no doubt there are some of you sitting out there thinking that well hang on my labor started on its own and it still got complicated yes that can definitely happen I'm not denying that a fundamental part of labor and birth as a physiological function means it sometimes doesn't go right we are not perfect like all other things in life we can do our best to get the best outcome but there are still uncontrollable factors.
[16:36] So the first one, waiting till your body is ready, not having an induction unless you absolutely need it. And similarly, there will be women out there listening, thinking, well, I had an induction, it went completely fine. That's also absolutely possible. But as we will see in a minute.
[16:53] By being induced, you reduce your chances of normal vaginal birth. So there was a great study done in 2021, which looked at the outcomes of non-medically indicated induction of labor. So these are women who didn't have medical reason to be induced, but they were induced. This is happening. Don't assume that every induction is a medical induction. So these are well women and babies who are being induced for no medical reason. And there's lots of reasons, including things like being induced just at 39 weeks, because you're 39 weeks. If women are over 35, if they've been pregnant through IVF, if they're over 41 weeks, if you've got gestational diabetes, whether it's well controlled or not. But most women are not being induced because they're sick or because their baby's in danger. So this study looked at inductions for well women and babies compared to outcomes for women and babies whose labors started spontaneously on their own. So this study had 474,000 births and 15% of those, so nearly 70,000 of those women had an induction for non-medical reasons, 15% of the whole birth population of this study.
[18:09] And the result showed that for first-time mums, their chances of a spontaneous birth where their baby came out without an episiotomy, vacuum, forceps, or cesarean, if they had an induction, was 42.7%. So less than half pushed their babies out without them being cut or pulled out. And when they compared that to women whose labor started on their own, the women who had a spontaneous labor, they had a 62.3% chance of having a spontaneous vaginal birth. So 42% versus 62% in favor of spontaneous labor. Instrumental birth rates, so vacuum or forceps, were also different. 28% if you had an induction versus 24% if you had spontaneous labor. Having a cesarean section during labor that you hadn't initially planned, 29.3% if you have an induction versus 13.8% if you start labor spontaneously. That's more than twice the number of cesareans for women having inductions. Remembering these were not unwell women or babies before they started their induction. These are healthy women and babies and one in three of them required a cesarean section versus one in seven if they went into labor spontaneously.
[19:27] Similarly epidural use if you had an induction was 71% compared to 41.3%. Now there was a similar trend for outcomes for women who'd had babies before or except their cesarean section rates were correspondingly lower in each group. So what this shows is that starting labour on your own and not opting for an induction if you don't need it, overall improves the outcomes of your labour and birth for you and your baby. But it's a number one element to increase your chances of a spontaneous vaginal birth without needing vacuum, forceps, episiotomy or a cesarean section.
[20:05] So again, some women need induction for their individual circumstance, and there should be a risk analysis benefit, of course, before you decide whether or not you're going to take one. But on the whole, your body will function better if you wait for labor to start on its own, because you're more likely, your body and your baby's body is more likely to be ready, and normal, natural labor without medication works better.
[20:31] And that shows in the spontaneous vaginal birth rates for women who start labor on their own. The next way that your body works in labor is to have an optimum cocktail of hormones and I'm going to focus on three in particular oxytocin, melatonin and adrenaline.
[20:49] Oxytocin is the hormone of love, bonding, joy.
[20:55] Orgasms, childbirth and breastfeeding and in addition to acting on the brain to make us fall in love and enjoy the people around us, it acts on our muscles to cause them to act and contract. And that's the physical commotion that occurs when we orgasm. Oxytocin is the reason our uterus contracts and the reason why milk is released from our breasts when we feed our babies. So without oxytocin, your uterus is not going to function correctly in labor and without your uterus being ready to receive oxytocin it doesn't matter how much oxytocin your brain releases your uterus won't contract efficiently and this is another point of waiting until your body's ready because earlier in pregnancy our uterus doesn't have many oxytocin receptors on it but as you get further along in your pregnancy the receptors on your uterus increase in volume, they become ready to receive and respond to oxytocin for labor. But if you get induced at 38 weeks, for example, when your body wasn't going to be ready until maybe 41 weeks or even maybe 42 weeks, there's a reduction in the chance that your body will respond to that induction because your uterus isn't functionally ready to act under the influence of oxytocin. So the release of oxytocin in your brain acts on your brain and your uterus and flows through to your baby.
[22:24] And when I think of the type of care that I try and give women as a home birth midwife, I'm always thinking, how can I make sure the oxytocin flow keeps going? How can I give care that centers around enhancing the activity of oxytocin? So what is it that enhances as the flow of oxytocin.
[22:47] Firstly, it's being with people who you love, trust, and know. So our oxytocin is immediately challenged if we are in the presence of somebody that we don't know or perhaps that we're suspicious of. So it's important that my relationship with my clients is such that they trust me and that they know me. They know I'm on their side. And relationship-based care enhances those feelings of safety and trust and means that the presence of the midwife or care provider is not going to interfere with the flow of oxytocin. So there was a lovely French obstetrician by the name of Michelle O'Daunt who advocated for the presence of the quiet midwife knitting in the corner as the ideal birth companion for women. And this is the idea. Do not interrupt the flow of oxytocin because if you interrupt oxytocin, you interrupt labor and birth. And I know some people will say that the presence of the midwife in the room is an intervention and that may be so in care models that aren't relationship-based because potentially that triggers off some fear in the woman and some suspicion and potentially...
[24:04] Interrupts the flow of oxytocin. But in a relationship-based model where the woman has chosen, loves and trusts the midwife and the midwife doesn't intrude upon the woman's labor process, then this could actually enhance the activity of oxytocin and improve labor outcomes.
[24:25] So again, it's about what's going on around you to enhance oxytocin flow and who's in that space. So given the right environment it's warm private unobserved quiet with only trusted people in the space this will reduce the possibility of adrenaline being released into your body so adrenaline will directly challenge oxytocin they don't coexist you can't be in a state of joy of oxytocin while also having feelings of fear and fright because of adrenaline so adrenaline Melatonin makes us hypervigilant, which is opposite to the state you want to be in when you're in labor. And we'll revisit this in a moment. But the next hormone that determines the flow of labor is melatonin.
[25:15] And melatonin is the sleep hormone that gets released when the sun goes down. And there's some research that shows that the presence of melatonin alongside oxytocin makes oxytocin a hundred times more potent than without melatonin. So that's why women will more likely than not go into labor at nighttime if their body's given the option because melatonin potentiates, it makes more the power and capacity of oxytocin. And oxytocin is responsible for smooth and efficient flow of labor and your uterine contractions. And we'll circle back again to why this is important let me examine what might happen to you in hospital.
[26:01] And also ask questions about the exposure of artificial blue light during labor and what effect that has on melatonin because artificial lights can mimic to our eyes some daytime light and that can impact the flow of melatonin. And also ask questions as to why all inductions are started during the daytime when we know that melatonin makes oxytocin 100 times more effective than just oxytocin on its own. Yet the hospital system is set up to induce women during the day. Maybe that's got something to do with the changes of spontaneous vaginal birth rates if you choose to wait to counter labour. Now, although I said just earlier that adrenaline competes with the action of oxytocin, There is still a place for adrenaline in your labor where it actually enhances labor function instead of impeding it. But it's not until the very end when you are getting ready to push out your baby. So there's a point in your labor where you will naturally get adrenaline. Your body will release it.
[27:09] But at this point, oxytocin is too influential to be completely overcome by adrenaline. and what this looks like, this labour phase or stage, we often refer to it as transition. And you might have experienced transition as a bit of a reputation for women freaking out during transition and feeling like they can't do it anymore.
[27:32] But women in that state, when they get.
[27:37] Adrenaline released may subconsciously be responding to adrenaline as if something is wrong you know we might be feeling as if we have to run or fight but if we can understand and rationalize that in this circumstance adrenaline has a different purpose so when we're transitioning we're transitioning in from labor into the pushing phase of our labor and birth and we can transition there more confidently knowing that your labor is flowing efficiently and that the introduction of adrenaline is going to flood your bloodstream with nutrients, make your body more capable of not only pushing out your baby with superhuman strength, but more importantly, give you the strength, energy, nourishment to protect, watch, feed, and parent your baby the minute it comes out. So the adrenaline that you get to push your baby out turns you into this fierce mama bear. it's really purposeful. It's the reason why after you give birth, you just feel like you can't sleep and you want to keep an eye on your newborn the whole time. Your body is primed to protect your baby and adrenaline is part of that.
[28:47] But it does also space out your contractions. So the contractions of pushing are a bit further apart than the contractions of labor. And that's normal and okay and probably a necessary part to help the baby recover between pushing efforts and in hospitals sometimes clinicians will see that your contractions have spaced out towards the end of labor and they'll offer you what's called an augmentation they'll want to speed your labor back up you know oh your contractions have spaced apart well yeah they're supposed to we just got the adrenaline and that's needed for the pushing phase. So oxytocin's a little bit dampened, but not completely. But this is a normal part of end-stage labour.
[29:35] And so you might be offered the opportunity to have some artificial oxytocin. So it's like an induction, same medicine, but it's called an augmentation. They're trying to augment, make more contractions with artificial oxytocin because they've just witnessed that the contractions are spacing out. But you can resist that at that moment. Your body's doing what it's supposed to do. allow the power of this adrenaline to have its effect on these later stages of labor, so those are the three hormones that are imperative for proper function of labor oxytocin melatonin and adrenaline so we've spoken about those two things so far waiting for labor to start hormones of labor now the next element for optimizing birth physiology.
[30:24] Is to appreciate intuitive movement and positioning during labor and birth. So we've already talked about the parts of labor that are related to our mind, location, who's there, the hormones, but part of labor is a mechanical experience as well. So the baby is presented with a passageway, the bony and muscular parts of its mother's body, and the baby must navigate and position itself through its mother's pelvis in a particular way to traverse it effectively. Your pelvis is not a straight tube that the baby gets squished down into. It's a curve with rocky edges and outcrops and organs and muscles that are all part of that space. And so your baby will meet the curves of your pelvis and of your pelvic floor muscles, and it's required to contort its body and twist and turn in a way to ensure that it comes out without getting stuck and in an ideal position. So just as your baby needs to move in order to do this.
[31:27] You need to move in order to allow it to happen. And your pelvis is a series of moving parts and it becomes more movable and adaptable through your pregnancy to ensure that there's adequate space for the baby to be born. So during labor, your tailbone and the whole bony structure can move about in response to the position of the baby. And women will often feel where their baby is in the pelvis and experience it as pressure in certain areas of their back and pelvis and they intuitively respond to that with positions that enhance their own comfort and they'll try and do things to move the baby from that spot and in this scenario women will very rarely choose to lay on their back or sit still during a contraction but during these difficult times this is also when women might opt for things like an epidural and then we compound the issue and reduce the chance of the baby being able to move through your pelvis efficiently because you can't move with your baby the baby's got to do all the work so labor and birth eventuate they come to an end in the baby moving from inside to outside and so while the baby's doing its movements to do that so too are you?
[32:49] So anything that interrupts this movement also interrupts the baby's capacity to get out without assistance. So in this scenario just move however feels comfortable. There's no need to prescribe particular positions or movements. Just avoid anything that will limit your movement. Things like epidurals, laying on the bed, taking medications that will sedate you, continuous CTG monitoring, so heart rate monitoring where the straps are on and you can't move away, having IV fluids restrict your movement. You can choose to do things like labor in a bath or in the shower, have a birth stool, chairs, floor mats, a birth ball, a birth sling, all kinds of things. Anything that will facilitate, just move however feels comfortable. There's no prescription for what's best.
[33:40] The next thing, number four, stay in the zone. What am I talking about, the zone? So when you go into labor, the activity of your brain changes along with the complex hormonal cocktail that takes over that we just spoke about.
[33:58] The front part of your brain that's responsible for communication and decision-making, it shuts down and your limbic system, which is the automatic, involuntary, intuitive, non-thinking part of your brain, takes over and it dictates the function of your body without your conscious effort. So when this change happens in women's brains, you can see it change outwardly in the woman's behavior. So not only does their brain activity become more internal, but their behavior becomes more internal. And midwives or people watching the birth will describe this as the woman going into herself. She's going into labor land and you will cease to interact with the outside world. You won't want to come out of that. You want to stay in it. Often women will close their eyes and try and shut off the things that are happening around them. And they need to disappear into this internal land and not be pulled away from it that is, physiology of labor and birth your body will function more efficiently without interruptions and if you can stay in that limbic system that part of your brain that you have no control over except that you can control the things that will drag you out of that space one of the purposes.
[35:17] Of having other people in your birth space is to protect the birth space. So when we say protecting the birth space, you know, sometimes doulas will say I'm there to protect the birth space. We mean that we want to make sure nothing gets to the woman that is going to break her engagement with the internal labor land that she's gone into. Your body will function more efficiently without interruptions so any circumstances that make you feel safe to disengage from the outside world and go fully into this inside world would enhance the activity of your body and labor but this relies on you knowing the people who are in your space and knowing and trusting that they're not going to do anything to you that you don't agree with.
[36:03] So anything that requires you to communicate, make a decision, anything that you feel like you need to protect yourself from, all of this will bring you away and out of your limbic system and back into your frontal brain. And this interrupts the birth process. Now, the other thing that interrupts this flow and this process is the constant interruption of medical examinations in labor, in hospitals. A constant stream of checks for blood pressure temperature your baby's heart rate vaginal examinations checking the contraction strength and frequency that will be monitoring and measuring everything and the interruptions are constant now more experienced clinicians can do this far more subtly than clinicians who are still learning but know that this interrupts your flow over and over again. So perhaps only accept those things that you believe are absolutely necessary for the well-being of you and your baby and ask to be left undisturbed unless it's required and that only a minimum number of people are admitted into the room. No extras that don't need to be there.
[37:18] And I'm going to take a chance to talk about this weird practice that I've seen so many hospitals where the doctor on the ward that day, they take it upon themselves to come in and introduce themselves to every single laboring woman just in case they're needed later. Can I tell you this is not for the benefit of the woman. I don't know who benefits from this, but it's not for her benefit.
[37:44] She does not want to meet new people in the throes of labor or have a conversation. She will not remember your name in that moment and I would it would honestly be better if you just stayed out just come in if there's an emergency it might make you feel better to think I introduced myself to everybody today they've all seen my face but she doesn't need to meet you first you've just interrupted her birth process think about that whenever you enter a birth space am I adding or taking from the labor process probably if you don't know her you are taking from it so So, how do we optimize the function of our body in labor when we're in a hospital setting? So, we spoke about the three hormones, oxytocin, melatonin, and adrenaline.
[38:31] And the good news is that you can optimize the function of oxytocin and melatonin. And if you do those, the optimization of adrenaline will naturally flow. So, that's one less thing to do. And as I've already said, oxytocin function is optimized when you feel safe. So feelings of safety come from being in a familiar, warm, quiet, comfortable space with people that you know and trust.
[38:57] In strange and new environments, that requires hypervigilance from you.
[39:02] That requires decision making and interaction because you've got to quickly assess the safety of this new space. So when you move into hospital and labour, you enter into this new unfamiliar space with new unfamiliar people. And this creates a place of hypervigilance while you're working out if this is a safe place or not. And then after you've familiarized yourselves hopefully you've met your midwife who you feel safe with it's a whole other story if you meet the midwife who's been allocated to your care and you immediately don't feel safe with them that is a clue as to the impact that that clinician is going to have on the function of your oxytocin in labor you can ask for a new one okay so you can mention to them I really want to have a low intervention vaginal birth can you find me a midwife who's going to be able to help me with that in and actually before you even move into hospital when you phone the hospital to let them know that you're coming in say to them I really want to have a low intervention vaginal birth I'm planning on using the room to move around. I want to labor in water.
[40:14] Please can you allocate me a room and a midwife who's going to help facilitate that. That's something that you can set up early on and the team leader can pick and choose from whichever midwife is available that might best cater to your needs. So that is a way of potentially having someone in the space that suits your intended purposes.
[40:35] So moving into hospital does dampen oxytocin because it increases adrenaline. And this is because it requires you to come out of your limbic labor brain and come back into your decision-making frontal cortex outside of the labor zone. And this is why some women report that their labor slows down when they move into hospital and it can take some time to settle in and get back into the flow once you feel safe again. So this transition to hospital represents an interruption in the hormonal flow of labour. So how can you optimise hormonal function as you make this transition? There are things that you can do to mitigate the impact of moving into hospital.
[41:19] So firstly, you could purposely disengage from the transfer experience. Okay, try wear some nice warm clothes. You don't feel the big temperature changes. Wear an eye mask. You'll have to be guided through into cars and out of cars, of course. Headphones that are playing music to block out noise, external noise. And try and reduce the stimulation that gets through to you during the transfer. So on arrival, you're kind of forcing your body to remain internal and you're blocking out external stimuli. You're trying not to engage that frontal cortex. And when your care provider sees that you're intentionally kind of blocking things out, then it's up to the team around you, the people that you've chosen to take with you to hospital to give birth, to be your advocate and communicate on your behalf. So they can say, look, she's really trying hard to stay focused on her labor. us. So let's just go through to the room and we can talk there. Turn down the lights when you get to the room. Make sure there's only one person in there. Make sure that everyone's speaking quite low. You know, really set the standard for the expected behavior is around you by sending this quite strong message that you're blocking as much as you possibly can out.
[42:38] So you've got to have people in your space and with you who will advocate for you in your absence. So ensure that no one burst that bubble this could be a partner who's really capable and prepared a robust support person a friend your mother whoever it is or you could hire a doula who's kind of a professional at these things if you're if the people around you don't feel they're prepared to do that then hiring a doula is a great option.
[43:07] And there are things that you can take from home that you can put in the birth space that will facilitate this feeling of familiarity and comfort. And so when you see them, you just feel warm and fuzzy and you feel like you're in a familiar place. And then move the birth space around and claim it as your own. So when you arrive at the hospital, you'll see that all the rooms are set up in their own particular way. And this is for the benefit of the people who work there. They've set it up so that they have greatest access to the equipment and to you but they haven't really thought about your needs in this scenario so it's okay to do things like take the brakes off the bed and move it to the side ask to have equipment like birth balls and birth mats and some extra pillows and blankets around some chairs and a birth stool that you can use you can hang a birth sling from the door some places have a place to hang them from the roof turn the lights down all these things that you can do just to take ownership of the space and make it more functional for your purposes that's okay to do so those are some things that you can do to mitigate the impact of the transfer to hospital on your labor flow now melatonin function as I said is optimized during the evening and when you're not exposed to artificial light and blue light.
[44:30] So automatically by waiting to go into labor without induction, you're optimizing melatonin function because your body will most likely go into labor at night when melatonin is highest.
[44:42] But the things that you can do during labour to enhance and facilitate melatonin flow is avoiding any screens. Computer, TV, mobile phones during labour. Reduce your exposure to artificial light. If you can't wear an eye mask and completely block it out, wearing red glasses, so blue light blocking glasses, can be another option.
[45:06] Turn off all the fluorescent lights in the birth space and you can buy these little, handheld or like transportable orange light lamps we've got them all around our house we're reading at night time but these don't emit the blue light waves that send messages to your brain that it's daytime and so you can still have some light in the space but they don't impact your melatonin so melatonin is your night time sleepy hormone so anything that sends a message to your body that it's daylight will reduce melatonin now the problem is is that hospitals are full of blue light all the time so managing to reduce this will help avoid melatonin interruptions and you know the local hospital that we transferred to has got these automatic lights every time you move in and out of a space they just turn on and off women can't labor in the bathroom without a full light experience it's quite it definitely interferes the birth process so you've got to factor in how you're going to limit exposure to that.
[46:12] Now adrenaline is triggered where you perceive risk or in times of stress so although it's a powerful end of labor tool you want to see in early labor if you can try and reduce it and the way that you can do that when you're vulnerable labor is to manufacture a safe and protected environment with safe people ahead of time. So this means really curating your care team because you might arrive at hospital and find that you don't know the people who are looking after you. That's the majority of women will not know ahead of time who's going to be looking after them and that's stressful. So how can we reduce the impact of adrenaline on your labour?
[46:53] The first thing you can do is stay at home as long as possible. The less time you spend in hospital, the more chance you have of a spontaneous vaginal birth.
[47:06] And the impact of adrenaline in early labor is more so than the impact of adrenaline in later labor. So this means that you need to be preparing to labor at home for as long as possible. And the best way to do that is to have a robust team of people who are confident to help you. And also a collection of pain management tools and comfort tools that are going to mean that you can stay at home longer comfortably. Birth balls, mats, a TENS machine, somebody who knows how to massage you, somewhere comfortable to sit, a doula. So again, hiring a private doula or a private midwife who will be with you from the beginning to the end, including when you are laboring at home.
[47:54] So what we know is that one-to-one continuous care is the most important thing here. Having as much cohesiveness and continuity in your support team as possible and making sure they're always with you is a way to help you stay at home longer, but also ensure that you've got a more likely chance of a spontaneous vaginal birth when you arrive at hospital. So this could be a great partner who is on your side, who believes in your ability, who feels confident to advocate for you and is educated enough to help with decision-making during labour and so that's a great ally to have at home but also in hospital. You might have a friend that embodies all of that or you can defer that to some hired help like a doula or a private midwife.
[48:45] I've got a lot of strategies here. What did we cover so far? So a little summary of what you can do to increase the chances of a spontaneous vaginal birth in hospital. So firstly, aim to start labor on your own. Only accept an induction if it's medically necessary. Stay at home as long as you can. The longer you're in hospital, the less likely you are of having a spontaneous birth. Have a robust support team who's capable of helping you stay at home comfortably and confidently. This could include your partner, friend, doula or private midwife. Support your physiology during transfer to hospital by blocking out external stimulation. Avoid artificial lights during labour, so make it dim, orange lights, blue light blocking glasses.
[49:39] Allow yourself to use instinctual movement and avoid anything that will limit your movement that includes an epidural lying on the bed sedation continuous heart rate monitoring of the baby you'll need to move the room around to make it more comfortable for you it's not designed for your comfort so you need to manufacture that make efforts to protect your birth space to sustain your limbic system in your internal labor zone tell people not to talk to you and not to bother you unless it's medically indicated and having continuous support from a doula or private midwife or robust support team is another way to facilitate all of these strategies that you're going to employ to improve your chances of having a spontaneous vaginal birth.
[50:29] Oh there's so much more that I could share but this will definitely give you lots to work with on your journey towards a vaginal birth. So remember team that there are things you can control and things that you can't. These things that I spoke about today are some controllable factors that will
[50:48] improve your chances of vaginal birth but not guarantee it. But just know that you've done all you can if you applied everything you learned today and this episode is a great one for you care providers and doulas to be sharing with women that you're looking after or if you have a great friend who shared this with you if you are a great friend share this with your pregnant friends this is something they're going to want to hear just by sharing this you could change their whole birth experience for the better there's no reason not to share this information and if you if someone shared this with you you've got Pete you've got the right people on your side who want the best for you and who are an ally in your journey I'm Dr Melanie Jackson and this is the Great Birth Rebellion podcast we would love to hear your stories of spontaneous vaginal births that you achieved because you applied this information.
[51:46] Get in touch. I love receiving emails and social media messages from women who tell me that they use what they learned on this podcast and that it resulted in a great birth that they were really satisfied with. Can't wait to hear what you do with this. Bye for now.
[52:06] To get access to the resources for each podcast episode, join the mailing list at melanie the midwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch atthegreatbirthrebellion.com follow me mel @melaniethemidwife on socials and the show @thegreatbirthrebellion all the details are in the show notes.
This transcript was produced by ai technology and may contain errors.
©2025 Melanie The Midwife
