ļ»æEpisode 197 - Having a vaginal birth in hospital
[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. In 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.
[0:24] Hello, and 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 improve your chances of having a vaginal birth in hospital. And I mean a spontaneous vaginal birth, no episiotomy, not a vacuum, forceps. This episode is about cesarean prevention as well, but it's about how to improve your chances of having a vaginal birth in hospital. So this is for you if you want a low intervention birth where your baby comes out of your vagina and it's for you if you want an as natural birth as possible in a hospital setting. But before I say anything, you're probably here because you're having your baby in hospital.
[1:11] But if you're having a home birth, these tips that I'm going to give you are also going to be incredibly helpful. But because you're at home, you've already increased your chances of vaginal birth just by avoiding a hospital. So I realized that home birth is not possible for everyone. There are lots of barriers to accessing that option. And I see you mamas who would love to have a home birth, but just can't get access to something like that. But you still want to have a low intervention birth. So I'm going to talk about how to do that in hospital. Through this episode, you'll hear me talking about the avoidance of pain medication. And this is because when you accept pain medication in labor, especially something as strong as an epidural, you reduce your chances of a vaginal birth. That's not my opinion, but when you interrupt physiology, your body doesn't work as efficiently and you reduce the chances of your baby coming out of your vagina spontaneously just by having an epidural. And because of this, I've actually, I've created a short, It's all facts, no fluff guide to giving birth without pain medication because it's not enough to suggest to somebody, to you, to avoid an epidural. That's not enough information.
[2:28] Because I want to give you some guidance as to what else you can do to work through the pain of labor. So I released a guide to giving birth without pain medication. I released it four months ago and already since then a thousand women have bought the guide. And if you want to avoid pain medication in labor you have to have a plan for other strategies to manage labor pain. You've got to have a prepared set of tools that you can use to replace something like an epidural. So you can grab the guide. There's a link below in the show notes. It's got all those tools in it. And I've been a home birth midwife for 18 years. All of the things that are in the guide are all the things that I've seen work, particularly for women who are giving birth at home who don't have the option of paying medication. So go ahead, scroll down to the show notes if you want to. you can pause this episode straight away, scroll down to the show notes, click the guide to give birth without pain medication and get access to that yourself.
[3:29] And today's podcast episode has been generously sponsored by Poppy Child from Pop That Mama. Poppy is the creator of the birth box and in it has the bonus oxytocin bubble, which is an online resource designed to help build the strategies that you will need to work through labor, birth and beyond without feeling overwhelmed. Poppy is a hypnobirthing practitioner and through the birth box, she walks you through the hypnobirthing and breathing techniques that you'll need to use to work through labor, especially if you want to optimize the chances of you having a vaginal birth. You'll also love the oxytocin bubble, which is a set of audio tracks that are designed to help you stay in the zone in labor and birth. And in this episode, I'll be telling you all about the zone. Poppy is giving Great Birth Rebellion listeners 25% off at the checkout. So click the link in the show notes, get the birth box for yourself and take advantage of that discount.
[4:29] Okay, let's get into this episode. How can you increase your chances of having a vaginal birth in hospital? And there are some really clear strategies here that you can enact to improve your chances and curate a situation for yourself that tips the odds in your favor of having a vaginal birth in hospital. So you can sit back and listen to this one because I've also created a quick checklist of all the things that I'm going to speak about in this episode. I've made it into this handy little PDF downloadable document. It's completely free to you. You can have access to that. If you're already on the mailing list for the podcast, it will be in the podcast resource folder. So you'll know that each week you get access to all of the podcast resources, including all the back catalog. But if you aren't on the mailing list and you want access to all the podcast resources, just join the mailing list. You'll get access. the mailing list is at melanethemidwife.com but it's in the show notes down below or if you just want the checklist for this podcast episode you're not interested in the rest again go down the show notes and you'll see the little handy pdf downloadable that goes with this podcast episode so now you don't have to make notes you can just download the pdf and tick off all of the elements so that you know that you've optimized your chances of a vaginal birth in hospital So I've been a private midwife for 18 years.
[5:57] Because of that, I know the secret sauce to supporting women to have vaginal births with as little intervention as possible. And that's what I'm going to be talking about today. My clients do 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 a little bit differently for it to work. And you have to work a little bit harder because the hospital environment itself,
[6:27] is most likely going to be working against you. So we already know that the hospital approach to birth and the environment itself doesn't lend itself to preference vaginal birth. So you need to invest, personally invest some time, effort, maybe some money to improve your own chances of this. The fact is, is that you will have to take responsibility of this because you can't guarantee that the people caring for you have an interest in you having a vaginal birth as much as I would like to say that they do. It's unfortunately not the case. Many locations have cesarean sections over 50%. Physiological birth and vaginal birth statistics are reducing. They're not in your favor. So you have to take responsibility for this, unfortunately.
[7:21] So today I'll start by explaining what your body does and needs during labour and birth and this is where you'll start to understand the function and physiology of your body and mind in labour and birth and then I'll explain what choices you can make to optimise your physiology in order to maximise the chance that you'll have a vaginal birth. So when we are functioning at optimal capacity, this reduces the chances of things going wrong in your labor of birth and therefore increases the chances of you having a spontaneous vaginal birth without intervention.
[7:54] There are some things that are out of your control but there is a huge raft of controllable factors that you can take responsibility for and curate a great birth for yourself through these strategies. And 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 function optimally. So having said that, please don't hear this as a guarantee. You may still need intervention. Our bodies don't always work perfectly, even if everything has been set up and organized to the nth degree. But when you give your body what you know it needs to function properly, you increase the chances of you having the birth that you're planning. Not everything is within your or anybody else's control. Some things are, and that's what we're going to talk about today. So let's get into it. So my first point is to remind you that hospital births are geared towards intervention.
[9:01] Overall, the governance and system behind institutionalized birth favors a medical approach and it automatically reduces the chances of you having a vaginal birth. So for women who say that they're going to just go with the flow as their birth plan, you have to know that the flow is medical. If you want a medicalized birth and you plan to follow the recommendations of your care provider at each decision point, then going with the flow is the path of least resistance. But the flow is medical so your birth will follow a more medical path but if you want a low intervention birth you're going to have to put some effort in you're going to be swimming a little bit upstream because you will be going against the flow so you might be fortunate, enough to have a midwife or an 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 at your birth when you get to hospital, 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, they might be heavy handed and coercive and you need to be ready and prepared to navigate that. Just assume you'll be going against the flow and you need to have some information and strategies around that.
[10:24] Now I know it might seem like I'm poo-pooing hospitals here but when you look at the statistics particularly here in Australia, and if you check the statistics in your country too, barring a few very unique situations where the caesarean section is not rising, in most countries, the caesarean section is rising, caesarean section rate is rising, and physiological birth is decreasing. So wherever you're listening, I feel sure that the medicalization of childbirth is trending around the world and causing fewer women to have low intervention vaginal births. And here in Australia, our most recent statistics show that 49% of women are having non-instrumental vaginal births, so slightly less than half. 12% of women had a vaginal birth assisted by vacuum or forceps.
[11:17] 39%, in fact, it's closer to 41 now since these statistics were released, 41% of women had a cesarean section. But this does vary widely depending on where you're giving birth, if it's your first baby or subsequent baby, who your care provider is. So some practitioners and hospitals have a cesarean rate upwards of 50%. It just really depends on where you go. And this is a great time to mention that public hospitals have lower cesarean section rates. They hover around the 30% to 50% mark.
[11:53] And private hospitals have a higher cesarean section rate, more likely to be between the 50 to 70% mark for cesarean sections. Where you give birth makes a massive difference to the amount of intervention that you'll have. So if you want a low intervention birth, you've got to choose a location that
[12:14] favours low intervention birth. So let's go 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. The first thing, which I've already alluded to, is choose a birth location that is geared towards you having a low intervention vaginal birth and that also meets your unique needs. So there are ways to work out which location is going to increase or decrease your chance of vaginal birth. And I completely understand that most women don't have the luxury of choosing from the full menu of options there are so many options for what you could choose where you could choose to have your baby and who you can choose to have your baby with but there's inequity in access to maternity care and so not all women have access to all the options so you will probably need to make the best choice with what you've got.
[13:11] But if you're in a privileged position to be one of those women who have less barriers to their choice, you'll have an option of more places to birth and more people to choose from. So if we're thinking about birthplaces that optimize your chance of having a vaginal birth, I'm going to have a look at some big studies here, some big research papers. They're all available full text in the podcast resource folder. So you can have a look at this if you want to read through them in details. And for today's purpose, I haven't extracted all the information from these papers. I've just focused on the data that specifically pertains to the mode of birth because we're talking about how to increase your chance of vaginal birth. So in the studies below, we're going to be talking about normal vaginal birth. And when I say the words normal vaginal birth, it means spontaneous labor. So the women weren't induced. They went into labor on their own. No epidural or spinal medication for pain relief, no general anesthesia, so no anesthetics, no forceps, no vacuum, episiotomy, or caesarean section. It's spontaneous vaginal birth without a woman who's been induced. So this first study is called the Birthplace in England study. That's its slang. That's the way we refer to it. The proportion of women with a normal birth in this study.
[14:34] Varied in percentages from 58% of women had a normal birth in an obstetric unit, so run led by doctors. Then they looked at statistics for women who gave birth in a midwifery-led unit, which was 76% spontaneous vaginal birth rate.
[14:56] If you went to a freestanding unit, like an external birth center, wasn't attached to a hospital, freestanding midwifery unit, 83% chance of a spontaneous vaginal birth. And if you're planning a home birth, it was an 88% chance. So women who planned births at home or in a freestanding birth center or midwifery unit were significantly less likely than those who planned obstetric unit births to have an instrumental birth or an operative birth or receive medical interventions such as induction, epidural, anesthesia, episiotomy. So you were more significantly likely to have a normal birth without intervention, spontaneous vaginal birth if you were cared for by midwives and if you were further away from the hospital. So these are your first top tips. Where do you give birth? Preferably in midwife-led units, possibly if you have access to it outside of a hospital, but if you don't, midwifery care is your best option. The least likely chance of a spontaneous vaginal birth is in an obstetric-led unit where doctors are in charge, and potentially, and this we'll see later, in private hospitals. With private obstetricians, again, your chances of a vaginal birth is lower.
[16:19] So the further away you move from a medicalized model of birth and into models that favor physiology, which midwives are supposed to be the experts in physiological birth, the expert carers, women are the experts. You already increase your chances of vaginal birth by favoring those options that increase the chances of vaginal birth. It just, it makes a lot of sense, but I'm going to say it over and over again because I've lost count of the number of women who say, hey, I'm giving birth with a private obstetrician in a private hospital, but I don't want a cesarean and I don't want this and I don't want that. My first question is, why did you book the place where you're most likely to get all of those things and all of those interventions if you don't want them? You've inadvertently or consciously put yourself in a situation that does not favor your preferences.
[17:12] Now this birthplace in England study, we actually replicated it here in Australia and they found that planned birth at home or in a birth center was associated with normal labor and birth more often than planned hospital birth. We already know that from the birthplace in England study and that women planning a birth center birth were almost three times as likely to have a spontaneous vaginal birth. Women planning a home birth were almost six times as likely. Those are the findings when we replicated that same study here in Australia. So my point is to understand that when you go into the hospital, you have to know that you're not in the most ideal location if the outcome that you're after is a vaginal birth without intervention. So how you can improve your chances of getting this is if you are planning of going to hospital, you need to know you've got to have specific strategies. So the first thing you can do is find out which hospitals are available to you in your area. Map out your individual menu options. You might not have option of birth center or home birth. You might only have the option of one single hospital, but you could look into your options, scope out all the possible options that are available specifically to you in your area.
[18:30] Then have a look at those hospitals' spontaneous vaginal birth rates. You can contact them and ask them directly what their rates are or you can Google them. Sometimes their statistics are available online. Here in Australia, we have the Mothers and Babies Report which comes out every two years and they have got little sections where you can whittle down the individual hospital statistics for vaginal births.
[18:56] And the next thing that you can do is once you discover what services are available to you in your area and you've started to understand what their spontaneous vaginal birth rates are, then it's about how do you get access to the services that have the highest rates of spontaneous vaginal birth. And the most likely location for that will be in a midwifery continuity of care model. So if those hospitals have something called MGP, midwifery group practice, or some Sometimes they have all kinds of different names, but basically you want to get yourself onto the midwifery program where you have the same midwife or team of midwives who cares for you from your pregnancy, birth, and postpartum. Now be aware there are other hybrid programs like MAPS, a midwifery internat or postnatal service, where you'll only have the same midwife for your pregnancy and postpartum care, but you still have a stranger with you at birth. I've got a lot to say about those programs, but be aware that they're not the same. You want full continuity with the same midwife that you had care with for your antenatal care. These models have got the highest rates of spontaneous vaginal birth, but also the least chance of having a disappointing or traumatic birth experience with continuity of care.
[20:17] So straight away, you can see that the choice of birth location and care provider make an impact on the outcome of your birth. If you want a low intervention vaginal birth, you would be wise to steer clear of a private obstetrician and private hospitals unless you have a particular need for one. So if you are not choosing a private doctor because you have a specific medical need and you're just choosing them because that's what your friend did, that's what everybody around you did. That's what somebody on social media said to do, or maybe you have private health insurance and you want to use it, you are inadvertently or consciously setting yourself up for a cesarean or surgical birth. Your chances of a spontaneous vaginal birth are significantly less in that scenario with a private obstetrician at a private hospital than they are in a public hospital with a midwifery care program, or even with a hospital doctor.
[21:14] Your chances of a cesarean section are way higher in a private hospital. So give yourself the best chance and make a choice that will favor a vaginal birth if that's what you want. And a private hospital is not that.
[21:28] So now that we know that location matters, let's see what you can do to improve the chances of you being one of those women who have a spontaneous birth in hospital. So I'm going to start with how your body works during labour and birth and what optimum function looks like so that you can employ as many of these elements as possible to support the physiological function of your body when you're giving birth in hospital. So firstly, your body needs to be ready. There is an interaction between the readiness of your baby and the readiness of your body. And when it's ready, your baby has finished developing and your uterus is ready to get started with the complex web of interactions and the hormone actions that will occur in your brain and body to start ripening your cervix and acting on your uterus.
[22:19] The take-home message is that your body works best when your body's ready to go into labor and when your baby is ready to be born. Bringing labor on prematurely is going to reduce the chances of you having a spontaneous vaginal birth. And I can't stress enough the importance of readiness. And in the age of induction, where over 35% of women overall and over 45% of first-time mums have their labor induced this means that their bodies are being asked to labor prematurely before they're ready and their babies are being born before they're fully developed. If you go into labor yourself when your body and baby decides you know that your body and hormones are functioning at an optimal level that your baby is at a state of development where it can cope with the stress of labor and this will translate into the optimal function of your body throughout labor and birth. Now, speaking in general terms, because there's no doubt that there are many of you sitting out there watching and thinking, well, my labor started on its own, but it still ended up being complicated. And this can definitely happen. I'm not denying that. But a fundamental part of labor and birth as a physiological function is that sometimes it doesn't go the way you were expecting.
[23:39] That's physiology. It can be unpredictable. And like all things in life, we do our best to get the best outcome, but there are uncontrollable factors. But what I'm offering you here today are some controllable factors that will increase your chance of achievement.
[23:53] And there was a great study done in 2021, now that we're still talking about readiness. It was done in 2021, which looked at the outcomes of non-medically indicated inductions of labor. So that is well women and babies who were being induced for no medical reason. Those were the subjects of this study. People sometimes, when I talk about this study, they're like, oh yeah, but if they were being induced, it's because they had a need. No, in this study, no one had a medical need. The study was called Intrapartum Interventions and Outcomes for Women and Children Following Induction of Labor at full term in Uncomplicated Pregnancies. And it's in the resource folder. So you can have a look at it. You can read it full text. And actually, the resource folder is very full of papers for this episode for you to read. So please do go ahead and check my work. If you don't believe me on any of this, you can read the papers in full. I'm not hiding behind anything. And there are lots of reasons that women get induced for no medical reason and lots of clinicians are encouraging induction from 39 weeks for things that are not medical conditions. Things like if you're over 35, if you're pregnant through IVF, if you're over 41 weeks, if you have gestational diabetes, even if it's well controlled.
[25:13] So many women are being induced not because they're sick and not because they are in danger. There's just some random criteria that some hospitals or clinicians use. So this study looked at inductions for well women and babies compared to outcomes for women whose labor started spontaneously. So well women who had a spontaneous vaginal birth versus well women who had an induced labor. This was a huge study.
[25:44] They had about 70,000 women had an induction of labor for non-medical reasons. And the results showed that for first-time mums, the chances of a spontaneous vaginal birth where the baby comes out without episiotomy, vacuum, forceps or cesarean, if they had an induction, the spontaneous vaginal birth rate was 42.7%. These are well women with a spontaneous vaginal birth rate of 42.7%.
[26:18] Well women should not, only 42% of well women should not be, what I'm saying is, is these aren't sick women with sick babies. And the fact that only 42% of them could have a vaginal, spontaneous vaginal birth is absurd. But anyway, that's what they found in this study. Less than half of the women push their babies out without the baby being cut or pulled out. This was compared to women who started labor on their own and they had a 62.3% chance of a spontaneous vaginal birth. So that's 42% versus 62% in favor of spontaneous labor. I mean, it's still low stats in my opinion. But anyway, that's the comparison. It makes the point. If you're ready to have your baby, you've got an increased chance of spontaneous vaginal birth if you opt not to have an induction. Now, the instrumental birth rates, which is vacuumed forceps, were 28% versus 23%, so less chance of having a vacuum of forceps if you're going to labour spontaneously.
[27:28] And if we look at the intrapartum cesarean section rates where the woman was in labor and then went for a cesarean section during labor, if you have an induction, there was a 29% chance that they'd start your induction and then race you off for an emergency cesarean section during labor. If you weren't induced, it was 14% if your labor started spontaneously. So that's about twice the number of cesarean sections during labor for women who have had inductions. Remembering that these weren't unwell women or babies before they started the induction. These are healthy women and babies and one in three of them required a cesarean section if they had an induction versus one in seven if they go into spontaneous labor. So avoiding a non-medically indicated induction will significantly increase your chances of having a non-surgical birth. So epidural use for women who had an induction was 71%. When you introduce an epidural, you immediately introduce medical complexity compared to 41% of women who had a spontaneous vaginal, who had a spontaneous labor. So significant reduction in the need for epidurals if you don't have an induction.
[28:45] And similarly, if you had an induction, your chances of an episiotomy is 42%. And in this study, if you didn't have an induction, it's 30%, which is still way too high. But already, if you avoid induction, you've reduced your episiotomy rates and, And there was a similar trend for women who had babies before, except the cesarean section rate is much lower because you're more likely to have a cesarean for your first baby than your second.
[29:13] So what this shows is that starting labour on your own and not opting for an induction if you don't absolutely need it increases your chance of vaginal birth just on its own. Because spontaneous labour works better than induced labour and produces fewer complications. It's just what the research says. Some women need an induction for individual circumstances and so there should be a risk benefit analysis for sure to decide but on the whole your body will function better if you wait for labour to start on its own and you're more likely to have a spontaneous vaginal birth, 62% chance versus 42% chance if you have an induction.
[29:55] Okay, so that was letting labour start on its own. The next way that your body works in labour is to have an optimum cocktail of hormones. Labour is really governed by a lot of hormones. And I'm going to focus on three in particular.
[30:13] Oxytocin, adrenaline and melatonin. So oxytocin is the hormone of love and bonding and joy and orgasms and childbirth and breastfeeding. So in addition to acting on the brain, oxytocin makes us fall in love and it makes us enjoy the people around us. Oxytocin is released when you eat chocolate, but it also acts on your muscles to cause them to contract. So it acts on your uterine muscles and on the muscles in your breasts during breastfeeding to release milk. So that physical commotion that occurs as well when you orgasm, oxytocin is the reason our uterus contracts. It's the reason for the contraction of our vulva during orgasms. It's the reason why milk is released. 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 or how much artificial oxytocin is introduced into your body, your uterus won't contract. And this is another point of waiting until your body is ready.
[31:30] Because earlier in your pregnancy, in the earlier weeks of your pregnancy, even from 37, 38, 39 weeks, your uterus doesn't have many oxytocin receptors on it. But as you get further along in your pregnancy, the receptors on your uterus to receive oxytocin increase in volume. And so when I talk about your body readiness for labor, one of the elements is that the further along you are in your pregnancy, the more oxytocin receptors are on your uterus. So that when it is time to go into labor and your brain starts to release oxytocin to start off contractions, your uterus has so many receptors on it that the oxytocin has somewhere to go, links into your uterus and creates contractions. But if you get induced at 38 weeks, for example, when your body wasn't ready to go into labor yet, maybe your body was going to go into labor at 41 or 42 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, either your own or artificial.
[32:46] So the release of oxytocin in your brain acts on your brain but also on your uterus and it flows through to your baby through the placenta so when i think about the type of care i try to give to women 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 the protection of oxytocin? Because oxytocin is the important hormone that's going to determine how your uterus reacts to labor and birth and how efficient your labor and birth is.
[33:24] So how can you do this in hospital? How can you enhance the flow of oxytocin if you're in hospital and you're not in your beautiful safe bubble at home with people you know and trust? So have a listen to this. Being with people who you love, trust, and know. Your oxytocin is going to be immediately enhanced if you feel safe with familiar people. But oxytocin will be immediately challenged and potentially suppressed if you're in the presence of someone that you don't know or perhaps that you're suspicious of. This is why relationship-based care, so knowing the person who's caring for you, I mean, it makes so much sense. I just can't even believe we have to talk about it. But anyway.
[34:14] Relationship-based care enhances feeling of safety and trust. And it means that the presence of a known midwife or care provider doesn't challenge the flow of oxytocin because you already trust them and feel safe with them. And there was this lovely French obstetrician by the name of Michel O'Don. I did a whole episode on him because of how amazing I think he is. It's episode 166, the Ode to Odon. And he advocated for the presence of a quiet midwife knitting in the corner as the ideal birth companion for women. And I know it sounds idealistic, but the idea is do not interrupt the flow of oxytocin because if you interrupt oxytocin and insert yourself into a birth space and it reduces the woman's sense of safety, you've interrupted labor and birth. You've interrupted the flow of oxytocin. So if you can do anything about it, see that you can favor a care plan and care team that you know. Midwifery care where the midwife has seen you all through your pregnancy will be with you at birth and postpartum. That's going to enhance oxytocin flow, your sense of safety, reduce chances of trauma and increase your chances of a vaginal birth.
[35:35] So that's the first thing to protecting oxytocin. The next thing is given the right environment, if you feel warm, private, unobserved, thank you Dr. Sarah Buckley, and the environment is quiet with only trusted people in the space, you will reduce the possibility of adrenaline being released into your body. Now, adrenaline directly challenges oxytocin. Sometimes they do coexist at some points in labor and birth, but during labor and birth where you're trying to aim for efficiency and extra contractions and cervical dilation and the movement of the baby down.
[36:17] If the environment doesn't lend itself to a feeling of safety and privacy and quiet and low lights, then this is a challenge to your oxytocin state. So if you have feelings of fear or fright, you've got increased adrenaline. And adrenaline makes you hypervigilant. And this doesn't have a beneficial effect in labor. In ideal circumstances, oxytocin is flowing because adrenaline is low. So the next thing you can do is prepare an environment that feels safe and then you will also increase your chances of having an efficient labour and birth and your body functioning more optimally, which increases your chances of a spontaneous vaginal birth. If you're going to hospital, you may need to bring things with you that make the space feel safer. And this can include support people who make you feel safe and who you know will keep you protected and a care team that you recognise. In those scenarios, if you've got a few other elements in the birth room, a birth ball or a pool or a birth stool, some quiet light, some music, you can make the environment more comfortable. But making a comfortable environment is not going to serve you if the people in your environment aren't serving you.
[37:38] So while the environment is important, as a priority, choose people who make you feel safe and then you can work on the right environment. Okay, so the next hormone that determines the flow of your labor is melatonin. We already talked about oxytocin and I'm going to circle back around to adrenaline in a minute. But the next important hormone in your labor is melatonin. And melatonin is the sleep hormone. That's why you might have heard of it before. It's released when the sun goes down and there is some research that shows that in the presence of melatonin, oxytocin is 100 times more potent than without melatonin.
[38:22] Actually, this is why women will be more likely to go into labor at night if you go into labor spontaneously because melatonin potentiates oxytocin and oxytocin is responsible for the smooth and efficient flow of labor. So we will come back to why this is important when we examine the hospital environment and ask questions about the exposure to artificial light, which directly reduces melatonin. So we wonder why the hospital environment is not facilitating spontaneous vaginal birth. But then women are giving birth under these bright blue fluorescent lights that we already know. Blue light and fluorescent light and bright light reduces melatonin and therefore Or if melatonin is reduced, then oxytocin is less potent as well, 100 times less potent. We'll circle back to that, but I'm going to leave that there for a minute.
[39:26] And although I said that adrenaline sometimes, well, in early labor, adrenaline competes with the action of oxytocin, there is a place for adrenaline in labor and birth where it actually enhances the labor function instead of impeding it. But that's again that's physiology and already if there are things that are challenging oxytocin there are things that are challenging physiology and you can't necessarily rely on adrenaline to function in a physiological way if the hormonal soup of labor has already been disturbed by various things. So the place of adrenaline in your labor and birth is towards the end when you need to.
[40:06] Gather your strength to push your baby out and more importantly to feed and care for your baby. We need to be hypervigilant when the baby is born because we're its mother and we've got to protect and feed it and make sure it's okay. So we get a generous offering of adrenaline towards the end of labor that doesn't impact oxytocin so much that it stops our labor because the oxytocin flow is already happening.
[40:31] Adrenaline gets added. The contractions do space out a little bit which is also a generous offering to your baby because once you start pushing your baby out that's an additional stress on your baby and it needs more time between contractions to recover, to re-oxygenate, to gather its energy, to clear lactic acid, to get ready for the stress of the next push. This is just the natural normal stress of labor and birth. So adrenaline at the end stages of labor and birth is normal and physiological and it's okay. It can be what contributes to that overwhelming feeling when you're in transition but just remember if you can rationalize, if you get to the end of your labor and birth and you think whoa this is so big I can't do it and you're starting to feel fearful. Consider that this is just your body giving you the adrenaline that you need for this last and final stage of labor and birth. Tell yourself this is my body functioning perfectly giving me adrenaline so that I can push out my baby and care for it at the end because when you're in the labor zone you're feeling a bit woozy and drowsy and towards the end your body will give you adrenaline so you get superhuman strength, but more importantly, give you the strength and energy to nourish, protect, watch, feed, and parent your baby when it comes out.
[41:55] So the adrenaline that you get to push your baby out turns you into a fierce mama bear. It's purposeful and it's necessary and it's physiology. So these are the basic three hormones that are imperative for proper function of labor and birth.
[42:10] Oxytocin, melatonin and adrenaline.
[42:14] So we've spoken about those things so far, waiting for labor to start and the hormones of labor. Now, the final element to optimizing your birth physiology and increasing your chances of having a spontaneous vaginal birth is intuitive movement and positioning during labor and birth. And I will say here, if you've got an epidural, you immediately take out your ability to move intuitively and position your body effectively during labor and birth.
[42:43] So labor is partly a hormonal experience. It's a human experience. it's a relational and social experience but it's also a mechanical experience the baby is presented with a passageway your pelvis your vagina your vulva all of that pelvic bowl and musculature the bony parts and all of the organs that occupy that space your baby has to traverse all of that in order to be born your pelvis is not a straight tube the baby doesn't get squished down into just a straight downpipe if we're thinking mechanically, it's a curve. Your pelvis is a curve with rocky edges and outcrops and organs and muscles that are all part of this space. So your baby will meet the curves of your pelvis, of your pelvic floor muscles, and it's required to contort its body and twist and turn it in a way to ensure that it can come out without getting stuck. And so just Just as your baby needs to move in order to do this and rotate and come down and alter the shape of their body, you also need to move in order to allow this to happen.
[43:54] Part of labor is that it's a mechanical experience. Your baby is navigating your pelvis and you need to move to help your baby do that. Your pelvis is a series of moving parts and it becomes more movable and adaptable throughout your pregnancy and in labor and birth. And this is to ensure that there's adequate space for your baby to be born. So during labor, your tailbone and the whole bony structure can get moved about. In response to the position of your baby and in response to your own positioning and women will often feel where their baby is in the pelvis and experience pressure on of the baby on certain bony structures especially if it's poorly positioned you'll be able to feel that on your bones and on your structures you can intuitively tell that there's something not quite right And then women are also perfectly capable of responding intuitively with positions that will enhance your comfort and that will try and move the baby from that spot. You won't necessarily be visualizing where your baby might be caught up or what it's trying to do, but you will naturally move in positions that feel better. And that means that the baby is moving off those little outcrops and bony structures.
[45:19] This means labor and birth is an active process you need to actively move it's a marathon you can't just lie there and hope that all of this will go well very rarely will a woman actually choose to lay on her back or sit still during contractions you immediately when you get a contraction you want to move so anything that interrupts your movement is going to interrupt the movement for the baby.
[45:51] So the strategy here is to go with instinctual movement. There's no tricks and tips. Just go with what feels good and avoid anything that will limit your movement. That includes an epidural, laying on the bed, if you've had any sedation, continuous CTG, so continuous fetal heart rate monitoring will reduce your movement. And we know that women who have continuous CTG, their movement is limited. They also have an increased risk of cesarean section, vacuum and forceps without an improvement in the outcomes for their baby, by the way. CTG has not been proven to be effective in keeping you and your baby safe. So avoiding the things that prevent movement and then ask for things that will facilitate movement. A bath, a birth stool, the shower, chairs, a floor mat, a birth sling, a birth ball, all All of these things, a chair, a couch, pillows on the floor, get your support person to keep you comfortable moving.
[46:52] All these things are going to facilitate movement. So avoid things that will limit your movement and ask and plan for things that are going to allow for movement. And you can also change the hospital room around a little bit. Take the brakes off the bed, move it out of the way so that you've got more room in the birth room. You can also raise the bed right up high and use it to lean on. This will prevent you from, you know, accidentally ending up on the bed. And this happens all the time because the bed is the center of the room. Your care providers will gravitate towards it and they will courage you onto it. So if you can take the bed out of the equation, you are automatically going to stay way more active.
[47:34] All right, so that was the third point. The next one is staying in the zone, in the labor zone. There's that song with the danger zone. This is the labor zone. So when you go into labor, the activity of your brain changes along with the complex hormonal cocktail that takes over. I talked about the hormonal cocktail. We talked about the mechanics of the whole thing. now your brain activity changes as well so the frontal part of your brain that's responsible for communication and decision making it kind of shuts down a little bit it goes to sleep it's not quite as necessary and your limbic system in your brain fires up this is the automatic involuntary intuitive non-thinking part of your brain and it takes over and it dictates the function of your body without your conscious effort so when this happens you can actually visually see what happens to a woman when their frontal part of their brain shuts down and they move into their limbic system the woman becomes more inward you can see it you can see her closing her eyes shutting herself off to the outside world she does not want to interact she's gone into herself she's gone into labour land.
[48:59] She is now in the zone. She's disappeared into her internal land.
[49:07] And she's not to be pulled away from it. She needs to go in there in order for her body to function properly. So your body will function more efficiently without interruptions. So any circumstance that takes you out of labor land and shocks you awake, brings you back into your frontal part of your brain where you're not supposed to be while you're labor and birthing, any interruptions are going to interrupt the flow of labor. So the purpose of other people in your birth space is to protect that labor zone to protect the birth space so that nothing gets to you nothing gets to the woman that's going to break your engagement with your internal labor world that's the requirement of everyone around you is to keep you in the zone. So anything or anyone that challenges that is going to reduce and change the function of your body and reduce your chances of a spontaneous maternal birth. And when I think of the hospital birth environment, there is constant, nonstop interruption into your birth space. I'm not joking. It's, I reckon, how often, I have not timed it.
[50:31] But think about routine medical examinations, blood pressure, temperature, baby's heart rate, vaginal examinations. They check the strength and frequency. They invite somebody else to check all of those things. Maybe you've got a CTG on and somebody's coming in to say hello. There's just constant interruption and new people. And there's this other weird practice. I'm going to take this opportunity to have a rant. There is this weird practice that happens in many hospitals where the doctors, when there are the new round of doctors who are coming on the ward, they take it upon themselves to go into every single laboring woman and introduce themselves. Hi, I'm such and such the doctor for today. I'm on shift. You know, they do this. I'm sure they're well-meaning. They do this so that you see their face and you know their name in case they need to come in later. But can I tell you, this is not for the benefit of the woman. This is for the benefit of the clinician in some weird world where they think that maybe you would love to meet them.
[51:37] She does not want to meet you. She does not want to meet new people in the throes of labor or have a conversation. She won't remember your name in that moment. Honestly, it would be better if you stayed out of the room, just come in if there's an emergency and we actually need you. She doesn't need to meet you in labor and birth. It represents an interruption and it's unwelcome. That is the end of my rant. All right. What have we done so far? We spoke about three hormones, oxytocin, melatonin, and adrenaline. We spoke about the appropriate location, the appropriate care providers, staying in the zone, staying moving. So the next thing I want to talk about is the transition from home into hospital. Because when women move into hospital and labor, they enter into this new unfamiliar space. Their labor is interrupted and they might feel like they need to be hypervigilant while they get in the car and transition to hospital and then go to this new location at the hospital, meet new people, and it's bright and it's noisy and it smells weird. This all dampens the oxytocin because it increases adrenaline, takes you out of the zone.
[52:51] So how can you reduce the impact of the transition to hospital and,
[52:58] and reduce the impact and the interruption of the hormonal flowing labor. I will, at this point, refer you to episode 195 of the Great Birth Rebellion podcast, which is called the High Powered Hospital Bag. That's the High Powered Hospital Bag episode.
[53:13] And in that episode, I talk all about strategies and tools to optimize your transition from home to hospital and everything you will need to take with you in the car in order to try and stay in the zone. So I'll summarize it here for you in a few points, but you need to purposely disengage from the transfer experience by wearing eye mask, headphones, have music playing. You want to reduce the input of stimulation during transfer. If you can just only hear the noises that you want to hear and see the type of light and visual and images that you want to see by covering up your eyes, if you can block out external stimulation you're going to reduce the chances of you getting interrupted have people with you who will advocate for you and and who are focused on your comfort and won't burst that bubble and here is where having building a team who's on your side and who is competent and robust I cannot stress the importance of a competent and robust support team in you having a spontaneous is vaginal birth. Major, major key players. So don't skirt around who you choose to have with you. If you feel your team is not confident and robust, this is the time to hire someone like a doula who can assist with this.
[54:39] And then you're going to take things from home that enhance your feeling of familiarity and comfort and that are going to help you work through the labour contractions in the car but also in hospital. And all of those things are in the High Powered Hospital Bag episode which also has a great checklist and printout. Actually, I'll put that in the show notes for you. And then when you do get to hospital, you need to move into the birth space and claim it as your own. You can hear all about those tips in the High Powered Hospital Bag episode. That's where it's a great additional listen with this one.
[55:15] And the final thing I'm going to recommend to you, if you want to enhance your chances of having a spontaneous vaginal birth in hospital, would be to stay at home as long as possible. And just go into hospital at the time where you feel like you're close to having the baby. The less time you spend in hospital, the more chance you have of a vaginal birth. So this means preparing to labor at home for as long as possible. And as I said the best way to do that is to have a robust team of people who are confident who can help you and also listen to episode 195 for the hospital bag tools because that's got advice for your care team of how to care for you at home and during the transition but we know that the longer you're at hospital the the the time if you look at it on a graph the more time equals more intervention and therefore less chance of a spontaneous vaginal birth. Staying at home as long as possible with a robust team and prepared group of people, including yourself, increases your chances of spontaneous vaginal birth.
[56:25] So what did we cover today? And also you don't have to take notes. Just click below. There's the full checklist of everything I spoke about today. But what can you do to increase your chances of having spontaneous birth in hospital? Understand the vaginal birth rates at the hospital that you are going to be giving birth at and understand the flow of that hospital, what you're going to have to do to fight against that. Aim to start labor on your own, only accept an induction if there is a medical necessity. Stay at home as long as you can. Have a robust and capable support team. Support your physiology during labour and birth by blocking out external stimulation to try and enhance the activity of oxytocin and melatonin. Avoid artificial light during labour. Use instinctual movement. Avoid anything that will limit your movement. Make efforts to protect your birth space, to stay in the zone and in your limbic system and have the continuous support of a robust support team, doula or private midwife. if you can. And if you can get continuity of mid-roofery care, this is the most likely chance of a spontaneous vaginal birth.
[57:39] There is so much more that I can share, but this will definitely give you lots to work with on your journey towards a vaginal birth. And remember, there are things that you can control and there are things that you can't. The things that I spoke about today are some controllable factors that will improve your chances of a vaginal birth by not guaranteed. But just know that you've done all you can if you've applied what you learned today. Now remember to scroll down in the show notes access the resources for this podcast episode where you will find the downloadable checklist for the main points in this episode and if you're keen for that you'll probably also love the high powered hospital bag checklist from episode 195 and you'll also see that in the show notes and if you want to avoid an epidural and prepare your partner and support people to help you and support you through labor and birth don't forget to grab The Guide to Giving Birth Without Pain Medication. All the details for that are in the show notes.
[58:42] This has been today's episode of the Great Birth Rebellion podcast and I will see you in the next episode. 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.
Ā©2026 Melanie The Midwife
