Episode 155 - Optimising the function of your body in labour
[0:00] Welcome to the Great Birth Rebellion podcast. I'm your host, 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. Hello and welcome to today's episode of the Great Birth Rebellion podcast. I'm your host Dr Melanie Jackson and if you've been following along the podcast for a while and you're up to date with the episodes you'll sense that we've been really focusing on the strategies behind a great birth and enhancing and optimizing the function of your body in labor there is a reason for this a lot of our podcast episodes are really topical and super specific So I'm spending just a few episodes honing in on the bigger picture strategies of setting yourself up for a great birth experience. And this doesn't always mean that you're planning a vaginal birth or that you're planning a low intervention birth. A great birth is bigger than that.
[1:10] But there are some things that you can do to optimize the function of your body to get the best chance at also optimizing the outcomes of your birth. So if you have friends or clients who are pregnant this is the episode to share this gives some of the hidden strategies that women don't necessarily consider when they're making plans for their birth and also I'll give you this tip for free one of the key factors in a great birth is that your partner and your birth support team are also on board so if you're listening to all this and thinking oh I really want my birth team to hear this send them this episode to listen to and if you are one of those support people or birth workers listening to this episode then you're already 50% on the way to being an incredible birth partner because you're willing to put the time and effort into listening to this so welcome to the great birth rebellion I've also listed some other episodes in the show notes for you to listen to if there are parts of this episode that you want to explore further.
[2:20] And if you are new here, new to the podcast, this episode is an excellent start to your Great Birth Rebellion journey. The things I'm talking about here are a bit of a launch pad to the rest of the episodes. So you're in the right place.
[2:34] And today I'm sharing my tips for optimizing the function of your body during labor. This is just the tip of an iceberg. It's just one single episode. There is so much more to say. So we'll get into it. And today I'm covering, firstly, how your body and mind work during labor and what optimum function looks like. And this is something really great for birth supporters to know because you play an integral role in protecting the external environment to make space for optimal functioning of the woman's body. Then we'll move to talking about movement and positioning during labor to optimize your labor and birth and also what it means to be in the zone.
[3:17] And I'll talk about the challenges of modern maternity care in relation to the optimal functioning of your body in labor and how to mitigate some of the challenges that you'll be faced with in order to give your birth the best chance of working well, even if you're in a sub-optimal environment. So in this episode, it might feel like I'm focusing a lot on all the problems, but hang in there because towards the end, I talk all about the solutions to some of the problems that might get in the way of your body functioning optimally during your labour.
[3:52] I've been a home birth midwife for 17 years and also an academic researcher for that time. My PhD explored the maternity care system and how it impacts upon women's birth decisions. And I have an intimate understanding on how birth works and what women need in order for their body to function optimally during labor and birth through my work as a midwife and as I witness birth unfold at home you gain all this kind of knowledge so this encapsulates all of that previous experience first I want to explain what your body does and what it needs during labor and birth and in this section this is where we'll understand the function and physiology of your body and your mind in labor and birth.
[4:42] Then I'll describe what the mainstream maternity care system will offer you during your labor and birth. And I realize I'm speaking to an international audience here, but I'm very convinced that although there are some differences from country to country, that the general structure and delivery of maternity care services around the world are hinged on a few fundamental principles that are the same the world over. After that, I'll explain what choices you can make to optimize your labor and birth experience so that you can maximize the chance that you will have a great birth and a vaginal birth, if that's what you want, where your body and your mind have what they need to function at an optimal level. And when we're functioning optimally, this reduces the chances of things going wrong during your birth. There are some things that are out of your control, but there are a huge raft of controllable factors that you can take responsibility for and that you can use to curate a great birth for yourself. Remembering that a great birth is not always about a vaginal birth. It's about feeling respected as the authority of your pregnancy and birth and feeling loved, supported and cared for without someone trying to take your choices away.
[6:04] So a great birth isn't always about great outcomes. It's about maintaining control over the decisions that you've made and about what happens to you and your baby. And if you apply everything I'm going to share, you give yourself the best possible chance at a great birth because your body and mind will have what they need to give birth in an optimum state and have your preferences respected. So let's get into it. I'm starting with how your body works during labour and birth and what optimum functioning looks like. So firstly, your body needs to be ready.
[6:41] There is an interaction between the readiness of your baby and the readiness of your body. There is a connection in your body that tells you when the baby's finished developing and when it's time for your uterus to start getting ready to have the baby. Now, I can't stress enough the importance of readiness.
[7:00] In this age of induction, where 33% of women and 43% of first-time mums have their labor induced, this means that their bodies are being asked to labor prematurely before they're ready their babies are being born before they're fully developed so if you go into labor yourself then you know that your body and hormones are functioning at an optimum state and that'll translate into optimum function of your body throughout labor and birth i am speaking in general terms because there are no doubts that many of you are sitting and watching and thinking well my labor started on its own but it still ended up being complicated and that can definitely happen and I'm not denying that a fundamental part of labor and birth as a physiological function means that sometimes it doesn't work like with all other things in life all we can do is our best to get the best outcome but there are uncontrollable factors so what I'm offering to you today are controllable factors that will increase your chance of a great birth. Now, there was a study done in 2021, which looked at the outcomes of non-medically indicated induction of labor. So that's when well women and babies are being induced for no medical reason. Now, there are lots of reasons that women get induced when there's no medical reason.
[8:25] Lots of clinicians are encouraging induction at 39 weeks, particularly if women are over 35 who've gotten pregnant through IVF, if they're over 41 weeks pregnant, if they have gestational diabetes, whether or not it's well controlled, if your waters break and you don't go into labor. But there's lots of other reasons, but most women are not being induced because they are sick or their baby is in danger. So this particular study looked at inductions for well women and babies, and they compared that to the outcomes for women and babies whose labors started spontaneously on their own. So of the 474,000 births included in the study, about 15% of them had an induction for non-medical reasons and the results showed that for first-time mums their chances of a spontaneous vaginal birth where the baby comes out without episiotomy, vacuum, forceps or cesarean, if they had an induction, that was 42.7%. Less than half of them push their babies out without being cut or pulled out. Compared to when labor starts on its own, that goes up to 62.3% chance of a spontaneous birth. So 42% versus 62%, still not great, but massive difference. Instrumental birth rates, which is like a vacuum or forcep extraction, was 28% versus 23.9%.
[9:50] A cesarean section during labor, where it wasn't initially planned, was 29.3% if you have an induction versus 13.8% if labor starts on its own. That's less than half a chance if you wait for labor. So more than twice the number of cesareans for women who are having inductions. Remembering that these were not unwell women or babies before they started their induction. They weren't high risk. These are healthy women and babies and one in three of them required a cesarean section versus one in seven if they go into spontaneous labor.
[10:24] Epidural use for women who had an induction, 71% compared to 41.3% and 41.2% of women who had an induction also had an episiotomy compared to 30% of women. Don't get me started both those stats are way too high regardless of which birth option you choose but it makes the point and finally if you have an induction you double your chance of a postpartum hemorrhage so it was 2.4 percent if you got induced versus 1.5 percent if you don't and there was a similar trend for women who'd had babies before except their cesarean section levels rates were lower than women having the first baby. So following induction, the incidences of neonatal birth trauma, needing to resuscitate the baby, respiratory disorders, admissions to neonatal intensive care and to hospital for up to 16 years later were increased across all of those factors for women whose labors were induced. So what this shows is that starting labor on your own and not opting for an induction if you don't need it overall improves the outcomes of your labor and birth for you and your baby in the short and long term because spontaneous labor works better than induced labor and some women need an induction for the individual circumstance and there should be a risk benefit analysis in this to decide but on the whole.
[11:53] Your body will function better if you wait for labor to start on its own. The next way your body works in labor is to have the optimum cocktail of hormones. And I'm going to focus on three in particular. Oxytocin, melatonin, and adrenaline. So oxytocin is the hormone of love and bonding, joy, orgasms, childbirth, and breastfeeding. So in addition to acting on the brain to make us fall in love and enjoy the people around us, it acts on our muscles and causes 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.
[12:41] 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 is releasing, your uterus won't contract properly. And this is another point of waiting till your body is ready because earlier in pregnancy, your uterus doesn't have as many oxytocin receptors on it. But as you get further along in your pregnancy, the receptors on your uterus increase in volume, ready to receive and respond to the oxytocin for labor. But if you get induced at 38 weeks, for example, when your body wasn't going to be ready till 41 weeks, there is 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 it flows through to the baby by the placenta. And when I think of the type of care I try and give as a home birth midwife, I'm always thinking, how can I make sure the oxytocin keeps flowing? How can I give care that centers around oxytocin? So what enhances the flow of oxytocin?
[14:04] The first thing is being with people who you love, trust, and know. So our oxytocin is immediately challenged if we're in the presence of somebody 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 and know me. So relationship-based care enhances feelings of safety and trust and means that the presence of the midwife or the care provider is not going to interfere with the flow of oxytocin. And there's this lovely French obstetrician by the name of Michelle Audente who advocated for the presence of a quiet midwife knitting in the corner as the ideal birth companion for women. And it's this idea, do not interrupt the flow of oxytocin because if you interrupt oxytocin, you interrupt labor and birth. So given the right environment, warm, private, unobserved, quiet, with only trusted people in the space, will reduce the possibility of adrenaline being released in the woman's body, in your body.
[15:10] And adrenaline directly challenges oxytocin. They cannot coexist. You can't be in a joy state of oxytocin while also having feelings of fear and fright because of adrenaline because adrenaline makes us hypervigilant. So the next hormone that determines the flow of your labor is melatonin, the sleep hormone that's released when the sun goes down. So there is some research that shows that the presence of melatonin potentiates oxytocin by a hundred times. So oxytocin is a hundred times more potent than without melatonin and that's why more women will go into labor at night because melatonin potentiates oxytocin and oxytocin is responsible for smooth efficient flow of labor. Now we'll circle back to why that is important when we examine the hospital environment and ask questions about exposure to artificial light and blue light during labor and why are all inductions started during the daytime. So I said earlier that adrenaline competes with the action of oxytocin, but there is a place for adrenaline where it enhances your labor function instead of impeding it. But it's not until the end when you're getting ready to push your baby out. So there is a natural point in your labor where adrenaline is required.
[16:33] But at this point, oxytocin is too influential to be completely overcome by adrenaline. And what this looks like in labor is that this is what sometimes people will refer as transition, this transition of hormones actually.
[16:48] You might have experienced transition and it has a bit of a reputation for when women freak out during transition and they say they can't do it and want to escape the process. We are subconsciously responding to adrenaline as if something is wrong as if we're going to have to run or fight sometimes we feel scared but if we can understand and rationalize that in this circumstance adrenaline has a different purpose then we can transition to the pushing phase of your birth more confidently knowing that your labor is flowing efficiently and that the introduction of adrenaline at this time is actually going to help you become have superhuman strength as you push your baby out but more importantly give you strength energy nourishment to protect watch feed and parent your baby the minute it comes out that adrenaline that you get to push your baby out turns you into a fierce mama bear it really is purposeful but what it also does is space out your contractions. So the contractions of pushing your baby out become a bit further apart than the contractions of labor, but that's normal and okay and probably necessary to help your baby recover between pushing efforts.
[18:10] So those are the three hormones that are imperative for proper function of labor, oxytocin, melatonin, and adrenaline. So we've spoken about these two things so far, waiting for labor to start and the hormones of labor. So now let's start talking about intuitive movement and positioning.
[18:31] So part of labor is a mechanical experience. 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 the mother's pelvis in a particular way to traverse it. So your pelvis is not a straight tube it's sort of up and down journey that the baby just gets squished down it's a curve and it has rocky edges and outcrops and organs and muscles that are all part of this space.
[19:02] So your baby will meet the curves of your pelvis and your pelvic floor muscles and it's required to contort and twist its body and turn it in a way to ensure it comes out without getting stuck. So just as your baby needs to move in order to do this, 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. And during your labor, your tailbone and the whole bony structure can get moved about in response to the position of the baby. Women will often feel where their baby is in their pelvis and experience it as pressure in certain areas of their back and pelvis. And then they'll intuitively respond to that with positions that enhance their own comfort and they'll try and move the baby from that spot with their own movements. Women will very rarely choose to lay on their back or sit still during contractions if they're truly intuitively listening to their body. So labor and birth eventuate in the baby moving from inside to outside and while the baby is moving so too are you. So anything that interrupts this movement also interrupts the baby's capacity to get out. Now, the final thing you need in regards to physiology is staying in the zone.
[20:29] So when you go into labor, the activity of your brain changes along with the complex hormonal cocktail.
[20:37] The front part of your brain that is responsible for communication and decision making shuts down. And your limbic system, the more internal part, is an automatic, involuntary, intuitive sort of non-thinking part of your brain. And it takes over and dictates the function of your body without your conscious effort involuntary. And you can see when a woman's gone inside her limbic space during labor. Not only does her brain activity become more internal, but her behavior becomes more internal.
[21:08] And midwives describe this as women going into themselves or going into labor land. They cease to interact with the outside world and need to disappear into this internal land and not be pulled away from it 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 internal world will enhance the activity of your body and labor and one of the purposes of other people in your birth space is to protect the birth space and when we say protecting the birth space we mean make sure that nothing gets to the woman that's going to break her engagement with her internal labor world anything that requires her to communicate make a decision anything that she feels she needs to protect herself from brings her away from that limbic system and back into her frontal brain and that interrupts the birth process.
[22:08] So those are the four things that our bodies need in order to optimise birth outcomes. They are to start labour on our own, facilitate the three major hormones of labour, oxytocin, melatonin and adrenaline, intuitive movement for you as the woman and staying in the zone. So now let's have a look at the care that is offered through modern maternity care systems and how this relates to birth outcomes and these four elements
[22:38] we've just spoken about. I just want to take this opportunity here to offer something more than what I can cover in this episode. If what you are hearing is the type of information that you want to go deeper into and you really want to set yourself up for a great birth, I have something else for you. On June 27th, 2025, I'm running a free live online masterclass, which goes further into the idea of what it means to have a great birth and how to get one.
[23:08] If you are listening to this episode as a back catalogue and June 27th has already passed, don't worry. We will record the session and you can go back and watch it at my website, melanethemidwife.com. But if you're one of the fortunate people to be listening before the 27th of June, the masterclass is live and interactive and you'll get a chance to sit in a digital room with me as I offer up what I know about what a great birth means and how to increase the chances of you getting one for yourself. So this is just not for women planning an all-natural birth with no interventions. This is for any type of birth.
[23:47] Your birth can be great even if it doesn't go to plan or even if you're planning every medical intervention on offer. Having a great birth is bigger than the individual elements. Now you can sign up for the masterclass at melanymidwife.com slash great. I'll link it in the show notes as well. And even if you can't attend live, I'll send you the recording afterwards. I've never done a live session like this before and I opened it for enrollments last week and already 2,000 people have signed up to come. You are in good company, everyone wants a great birth, and I've got some information to share on how you can increase your chances of getting one. So sign up to the masterclass. The link is in the show notes. I'll remind you again at the end in case you forget. Western style maternity care systems are what we call medicalized. So the process of pregnancy and childbirth are considered medical events. And for this reason care centers around hospitals and medical facilities under the supervision of medically trained people.
[24:51] So again I'm being very general here but the fundamental underlying philosophy behind how maternity care is delivered around the world assumes that birth is a risky medical event and so the priority is to ensure that women give birth in a place with access to medical care. So not saying this is right or wrong at this point, it's just how it is. So if birth is a medical event, then hospital and medical facilities are established to service birthing women. And these facilities are filled with medical personnel and care providers who are there to keep you safe. This is the prevailing message that birth can be dangerous and come here, we will keep you safe. So the system was built on the principle that birth can go wrong at any minute and that the best place to keep you safe is at these purpose-built facilities with purpose-trained care providers. So women believe this to be true. We go to hospital to have our babies and these hospitals are staffed by people who have human limitations. So they are rostered on in shifts they come and go from the hospital and the hospitals have policies procedures and guidelines that govern practice so that everyone knows and follows these rules of care.
[26:09] At a large scale like this where so many women are being managed and staff are coming, and going in rotational shifts like this they need to have a system of care that ensures everything runs smoothly so one practitioner can hand over to the next so that the care is uniform and largely the same for the comfort and benefit of the staff and the facility. And their insurance relies on this too. Insurance companies will ensure that these facilities will ensure the facilities on the proviso that everyone follows the due process and sticks to the rules. And there was an author who's since now passed, her name's Sheila Kitzinger, and she referred to this way of caring for women in a centralized locations like this en masse as a factory style approach to birth care. It functions like a factory with a production line and women and their babies are the product. So these institutions are tasked with getting women in, caring for them along the production line using a systematic one-size-fits-all approach. So I call it birth by numbers. And then they'll send them all out the other end with the end goal of everyone being alive.
[27:27] Now, noble as it is, it minimizes the experience of women as they move through this factory care approach, and it minimizes the birth experience to a merely mechanical process, which is typical of the industrial approach and the production line mentality. So when we centralise maternity care like this, it becomes mechanised and cold.
[27:51] And these centralised systems, warmness and kindness and humanness is not built in. And that's why there's such a push for what's called woman-centred care. There's a whole body of research that's developed around advocacy for woman-centred care. But why do we need to advocate for women to be the centre of maternity care decisions? Well that's because they're currently not the center of their care modern maternity care is system-centric not woman-centric so a fundamental element of the factory floor is also the fragmentation of the production line so one part of the production line does one thing and that the product is moved down the line to the next point of care and so on so we call this fragmented care where care of the individual woman is broken up and provided through a number of different stages through different care providers and modern maternity care lacks what we call continuity with one care provider and it therefore lacks relationship these people often don't know each other so these are the fundamentals of maternity care and there are boutique services that have been hard fought for that are more woman-centred and more focused on relationship-based care. So midwife-led birth centres, home birth services, private home birth midwives.
[29:19] Midwifery group practices, these services are, Often behind an access wall though, you can only access them if you manage to run a gauntlet or if you're in a position of privilege and you have to be in the right location with the right risk status and with the right amount of money at the right time if you want to get access to a maternity service of your own choosing that offers you continuity of care with a provider that you choose. So it's not what the majority of women will be able to access.
[29:51] The majority of women will only have access to fragmented maternity care in their local public hospital and they'll be cared for by a different person at each appointment. They'll see lots of different strangers during their labour and birth and be offered a few mere days of postnatal care, again with different care providers. That will be different where you live but what is universal is that the maternity care system does not favour continuity of care or out of hospital models. These are usually hard-fought boutique models and the first to go if the system is ever under stress. So financial stress, workflow and staffing issues, change of management or big world events like COVID, the maternity care system will cull woman-centered services first.
[30:40] The maternity care system is being set up as a centralised, fragmented model and accessing anything outside of that requires a level of forethought,
[30:50] privilege and luck if that's available at all. Now some of you will be thinking, but it's all set up in this way because birth is dangerous and we do all need to be in the central locations full of experts because that's how we will keep ourselves safe during this dangerous time. And yes it's true birth can be dangerous it does come with some risks but not for all women all the time the risks of birth have been overstated and I could and am writing a whole book on risk and safety in childbirth so I can't fully unpack this idea in this short session but when we look at research behind for example home birth outcomes compared with hospital outcomes and see that the babies are in just as good condition whether they're born at home or in hospital.
[31:43] No difference in outcomes. So that's good. Your baby will have as much chance of surviving and as much chance of health in a hospital as it would at home if you have care providers with you. And because of this research people will say well home birth is just as safe as hospital of birth but that is because they haven't considered the mother in their conclusions. And what we see in this research is actually mothers do undoubtedly, without question, in extreme excess, better at home than if they give birth in hospital. Here I'm about to talk about a particular study and some of the statistics. So for those watching on Spotify or on YouTube, you'll see the video for this podcast and you'll see that there are some images and slides that will help explain the statistics visually. Okay. So if you're listening on this on just the audio platform, I'll do my very best to explain it verbally. But if you need the visuals, be sure to watch the video on Spotify or go to the Melanie the Midwife YouTube page where you can watch the Great Birth Rebellion episodes as videos.
[32:50] So let's have a look at how do women do? Is this message of birth being so dangerous that we need to do it in hospital? Is this an accurate message? And there was this huge study involved 1.2 million births. It was done here in Australia, but this study has been mimicked in other countries as well. And it's called Maternal and Perinatal Outcomes by Planned Place of Birth in Australia. And it's a linked population data study. So basically, they look back at all the information.
[33:19] Again, as I said, in other countries, they've done this and they had very similar results. So they're fairly universal. This study looked at women with uncomplicated pregnancies who gave birth within a study period to a single baby that was head down between 37 weeks and 41 weeks gestation.
[33:36] 93% of the women in the study were in hospitals, 5.7% were in birth centres and 0.7% were at home, which was about 8,000 home births, a bit more than 8,000 home births. Now when they looked at those three they they broke it up in place of birth and we have home birth with a care provider birth center with midwives versus if they gave birth in hospital so let's have a look at the outcomes again these are all low-risk women so no one's got any complications theoretically these would be the women who were going to do well anywhere because they're well healthy women with well healthy babies. So the factors that are going to influence their birth outcomes are their care provider and their birth location.
[34:25] So what is the likelihood of a normal labor and birth by location for low-risk women? So normal means just the baby, you go into labor and you push your baby out without a vacuum, forceps or an apeliotomy. If you're at home, if you're laboring at home, your chances of staying there, just having a normal birth without any interruptions or interventions is 95.2%. 95.2%. If you go to a birth center, it's 89.2%. So again, you've left your home, but you're still with midwives and you're not in a hospital. If you have your baby in a hospital, according to this study, you will have a normal labor and birth, if you're a low-risk woman, 78.6% of the time. So home 95.2 hospital 78.6 very similar groups of women.
[35:16] So postpartum hemorrhage, so over 1,000 mils. This is something that people are worried about. Oh, if you stay at home, aren't you going to bleed? The rates are actually pretty similar regardless of where you give birth. Birth centers seem to be the least likelihood of bleeding, but again, it's not in a hospital. So overall, still women will be fine in a postpartum hemorrhage and in terms of the rates, very similar. Okay, an in-labor cesarean section. So if you have an already planned cesarean section, you're in labor and then you move on to having a cesarean section that you didn't plan. If you're at home, there's a 2.4% chance that would happen. If you're in a birth center, there's a 4% chance. And if you're in hospital, 7.8% chance. So already we're seeing that the outcomes for women are significantly better outside of a hospital. So vacuum and forceps statistics is where the big jump happens. If you are planning a home birth, your chance of needing vacuum or forceps is
[36:20] 2%. If you're at a birth center, it's 6%. Obviously, we don't do these at home or at the birth center. It requires transfer, but these are the stats on women who had planned home births and birth centers. If you're in a hospital, 11.8%. It's significant. Remembering the hospital did not improve outcomes for babies.
[36:41] So far, we've got a lot more intervention for women without a corresponding improvement in the outcomes for the baby. Next, let's have a look at augmentation of labor with oxytocin. So this is a big thing in hospital. If your labor is not progressing in the time frame they believe it should, they will augment your labor with artificial oxytocin called syntocinon, or if you're in the US or elsewhere, they call it pitocin, but it's artificial oxytocin. So if you're at home, this is required or it occurs 3.4% of the time. In a birth center, 8.1%. In hospitals, 16.5%. Again, no improvement in outcome. It didn't make a difference to the baby, but boy, does it make a difference to the woman. So if you're at home, you've got a lot less chance of this intervention occurring. And if we look back at the four things that help your body work optimally, that makes sense because a home environment facilitates a lot of the optimal functioning of your body during labour.
[37:44] Let's have a look at how many women had no tears after their birth. So, you know, there are a lot of factors that come into play when we think about what causes, what increases your risk of having a tear while giving birth. So if you're at home, 47.2% of women had no tears completely intact after birth. Birth center, 30%. Hospital, a quarter of the women, 26.3%. So you've got more chance of tearing if you give birth in hospital as a low-risk woman. Actually, almost double the chance of tearing if you give birth in hospital with no differing outcome for your baby. So this is an improvement on the woman's outcomes.
[38:31] Or episiotomies. So here is where they will actually cut your vulva, a surgical cut to your vulva or perineum, to get your baby out at the point of crowning so your baby is already visible at this point. If you're at home, there's a 2.6% chance of that happening. A birth centre, 8.3%. Hospital, 17.3%. This depends where you are. Rates vary wildly across the world. But for this study, 17.3% compared to 2.6% if you're at home. So you can see how women would have better outcomes having birthed away from a hospital.
[39:14] So compared with planned hospital births, the odds of normal labour and birth without intervention were over twice as high in a planned birth centre, nearly six times as high as planned home births. Remembering that there were no statistically significant differences in stillbirths for the babies during labour, neonatal deaths, or anything relating to newborn outcomes in these three planned places of birth. Wherever you choose to birth as a low-risk woman, there are studies on higher-risk women, but this is the one I've looked at today, your baby will have very similar outcomes. The difference will be in your own health and well-being, and a hospital needs to give you way more interventions in order to get the same outcomes that can be achieved at a home birth. And that's possibly because when they interrupt the labour process, they have to intervene to bring it back and that translates into more interventions in your labor and birth. So what is it about hospital settings that creates all this intervention?
[40:19] And the simple answer is that the maternity care system is not centered around the woman's needs in labor and birth. The system is system-centric, not woman-centric. So all the needs of the laboring women have not been factored into the environment and the care strategies and the policies. These are all centered around the needs of the factory. So the simple fact is that modern maternity care is generally, simply owing to the way that it's set up, it cannot support birth physiology it's the antidote to women's bodies working properly so now they have to heavily intervene in order to get the babies out safely and this is to the detriment of women and I know I've poo-pooed the maternity care system so I need to offer a caveat here to say that there are certainly heroes within the maternity care system who make every effort to protect women from the detrimental parts of modern maternity care, and there are a proportion of women who absolutely need high intervention care in order to be safe. However, the system has over-medicalized and over-managed childbirth largely, and this is the problem. Too much medicine where it's not needed.
[41:36] Again, there are boutique services such as home birth services, private midwives, private obstetricians, birth centers, midwifery care programs that seek to provide alternatives to these mainstream fragmented models. So if that has been your experience, know that these services can counteract some of the downfalls of the maternity care system that I've just described. So what can you do to optimize your birth experience and give your body the best chance of functioning properly so that you and your baby can experience as few complications and as few interventions as possible during your labour and birth.
[42:16] So the short answer is that you need to support the physiology that I mentioned in the first part of the talk. So starting labour on your own, only accept induction of labour if the benefits outweigh the risks. In some circumstances, an induction is a treatment for a serious problem, such as preeclampsia. There's lots of possible serious problems. But for the most part, induction is given for non-medical reasons. In fact, here in Australia, our recent stats are that 43% of first-time mothers in Australia are induced, and the three top reasons for induction are being beyond 41 weeks, prolonged rupture of membrane, so your waters are broken for longer than 24 hours, and gestational diabetes, but all of which are not medically necessary reasons for induction. Sometimes they're required, but mostly they're not if there's no complications. So support your physiology by waiting for your body to go into labor on its own unless there is a clear and convincing medical reason to do otherwise.
[43:25] And you're far less likely to be offered an induction if you choose a midwifery model of care or if you choose to give birth outside of a hospital. So you can increase your chances of labour starting spontaneously just by choosing a midwife as your care provider and planning a birth that's outside of hospital. The next thing is to optimise your hormonal function in labour. So we spoke about the three hormones, oxytocin, melatonin and adrenaline. And the good news is that if you optimize the function of the oxytocin and melatonin, the optimization of adrenaline will naturally follow.
[44:03] So oxytocin function is optimized when you are feeling safe. And feelings of safety come from being in a familiar, warm, quiet, comfortable space with people that you know and trust. Strange and new environments require hypervigilance from us. They require decision-making and interaction because we have to very quickly assess the safety of this new space. So when women move into hospital, for example, when they're in labor, they enter into a new unfamiliar space with new unfamiliar people. And this creates a place of hypervigilance where they have to work out, is this a safe place or not, while they familiarize themselves with the new environment. So this dampens oxytocin because it increases adrenaline and also because this requires women to come out of the limbic labor part of their brain and back into the decision-making frontal cortex so now they're also out of the labor zone and this is why women report their labor slowing down when they move into hospital and it can take some time for them to settle in feel safe, get back into the flow again, if they feel safe in that space. So this transition into hospital represents an interruption in the hormonal flow of labor.
[45:27] So ways that you can optimize your hormonal functioning labor is to give birth in a space that feels familiar and comfortable to you. So this might be a hospital that might be where you feel safe, a birth center or a home birth. But if you know that you're giving birth in a place that doesn't feel familiar and comfortable, then there are still some things you could do to mitigate this circumstance. We might not all get the choice. So you can purposely disengage from the transfer experience by wearing an eye mask and headphones with your chosen music playing. So try and reduce the input stimulation during your transfer to hospital and upon arrival to hospital. Force your body to remain internal and block out external stimuli so you've got to have people obviously in your space that will advocate for you in your absence and ensure that no one bursts that bubble.
[46:22] So you could hire a doula or build a team that's on your side, which could include your partner if they're capable of that. Take things to the hospital from home that enhance your feelings of familiarity and comfort and move the birth space around to claim it as your own. Now, melatonin function is optimized during the evening and when not exposed to artificial light and blue light waves. So automatically by waiting to go into labor without an induction, you're optimizing your melatonin function because your body will most likely go into labor at night when melatonin is highest as opposed to being induced in the daytime at a time that suits the facility and it suits the staffing, but in no way benefits your hormonal cocktail.
[47:11] The other things you can do to support your melatonin are to avoid a computer screen, TV, mobile screens during labour and reduce your exposure to artificial light by wearing the blue light blocking glasses. Turn off the fluorescent lights in the bird space and you can take with you sort of little orange light lamps, mobile ones, to help. You could wear an eye mask in labour if you can't avoid the artificial light.
[47:40] So melatonin is our nighttime sleepy hormone so anything that sends a message to your body that it's daytime reduces melatonin and the problem is is that hospitals are full of blue light all the time so managing and reducing this will help avoid melatonin interruptions now adrenaline is triggered where you perceive a risk or in times of stress or as a powerful end of labor tool to push your baby out and care for it as a hypervigilant mama bear. So adrenaline is also the antidote to oxytocin in labor. So you can modulate your adrenaline response by being very picky about who's in your space. Choose your birth care team and your care provider. Someone who you trust and who doesn't frighten you and then choose a birth venue that you feel safe and comfortable with. You are going to be vulnerable in labour so you have to manufacture a safe and protected environment with safe people ahead of time and if you feel safe and in a low adrenaline state during labour that's going to potentiate the behaviours of your body.
[48:51] So today you've learned about how your body works in labor how modern modern maternity care systems work to care for women in labor and some some of the ways that you can optimize your body's function many of which will require you to mitigate the impact of modern birth facilities and how their practices impact upon your labor and birth flow so choosing who is with you and where you give birth are the two major factors that contribute to how your labor will unfold. And not just across physical safety measures, but across all measures of safety,
[49:29] the physical, emotional, social, cultural, and psychological spectrum. That has been today's episode of the Great Birth Rebellion podcast. If this is the type of information that you want to go deeper into and really want to set yourself up for a great birth, I have something else for you. On June 27th, 2025, I'm running a free live online masterclass which goes further into the idea of what it means to have a great birth and how to get one for yourself. If you're listening to this episode as a back catalogue and June 27th has already passed, don't worry, we will record the session and you can go and watch it at my website, melanethemidwife.com.
[50:12] But if you are one of the fortunate people who just happened to be listening to this before the 27th of June, the masterclass is live and interactive. So you'll get a chance to sit in a digital room with me as I offer up information about what I know of what it means to have a great birth and how you can increase your chances of getting one. Now, if you're listening to this as a back catalogue and June 27th is well and truly passed, don't worry. you can go to my website melaniethemidwife.com and have a listen to the recording. We will record it and we'll make sure that we post it up there for people to go back and listen to. This masterclass is not just for women who are playing in an all-natural low intervention birth. This is for everyone. Any birth can be great. A great birth is not always about getting everything that you planned. Even when things don't go to plan, your birth can still be great because there are a few specific elements that can lead to that and I'm going to show you what they are at the masterclass so go ahead you can sign up for the masterclass at melaniethemidwife.com slash great the link is in the show notes for you just click on through and I will see you there.
[51:22] To get access to the resources for each podcast episode join the mailing list at melaniethemidwife.com and to support the work of this podcast wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.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
