1. CHILDBIRTH
Supporting the
Physiological Process

2. What is physiologic?
The Study of normal biological function as
opposed to pathologic . . . as well as how the
organism as a whole accomplishes particular
tasks essential to life.

3. What is pathologic?
A specialty concerned with the nature and cause
of disease as expressed by changes in cellular
or tissue structure and function caused by the
disease process

5. What is Physiologic Birth?
• Starts on it’s own
– Baby is mature (brown fat, mature brain and
lungs), transfer of maternal antibodies, fetal
descent
• Progresses on it’s own
– Optimal neuro-endocrine function allows for
natural hormonal cascade
• Results in vaginal delivery
– Baby transitions normally, successful
breastfeeding (AWHONN 2012)

6. CONSENSUS STATEMENT
“Normal Physiologic labor and birth is one that is
powered by the innate human capacity of the
woman and fetus. This birth is more likely to be safe
and healthy because there is no unnecessary
intervention that disrupts the physiologic processes.
Some women/babies will develop complications,
however, supporting the normal physiologic process,
even in the presence of complications, has the
potential to enhance best outcomes for the mother
and infant”
(ACNM, MANA, and NACPM*)

7. What Drives the Physiologic Process of
Birth?
“The main lesson of modern physiology is
that the process of parturition is an
involuntary process related to the
activity of archaic brain structures”
(Odent 2007)

9. The Thinking Brain
The cerebral cortex is the part of the brain that
functions to make human beings unique from
other mammals. Distinctly human traits
including higher thought, language and
human consciousness as well as the ability to
think, reason and imagine all originate in the
cerebral cortex.

10. IT’S ALL HAPPENING IN THE BRAIN
we want to decrease activation of the ‘thinking’ brain

11. and optimize the activity of the ‘non-thinking’ brain
(the archaic structure)

12. HOW DO WE DO THIS?
Optimize Neuro-Endocrine Function!
Laboring women mostly need “protection against
any factor that might increase the levels of
adrenaline or stimulate the neocortex.”
(Odent 2007)

13. The Relaxation Response
Take a Deep Breath

14. HORMONES of BIRTH
• Produced primarily in the limbic system – the
area of the brain that regulates instinctual
behavior – the hypothalamus and pituitary
• Optimal function of this system facilitates the
progress of labor, boosts both mom and baby’s
ability to cope with the process, and enhances
attachment and breastfeeding success

15. THE MAJOR PLAYERS
oxytocin
endorphines
catecholamines

16. OXYTOCIN
“whatever the facet
of love we
consider….
…OXYTOCIN
is involved.”
(Beckley, 2002)

17. THE HORMONE OF LOVE
• Made in the hypothalamus, stored in the
pituitary and released in pulses.
• Responsible for the ‘ejection reflexes’ of
reproduction: orgasm, fetal ejection reflex,
placental ejection, milk ejection and let down
reflex.
• Secreted in social situations such as friendly
gatherings, sharing meals, etc.
• In other words: ENHANCES HUMAN BONDING

18. OXYTOCIN – before birth
• Secreted during pregnancy and breastfeeding period to
enhance nutrient absorption – helps formulation of
intestinal villi.
• Plays a role in the inhibition of the brain regions associated
with behavioral control, fear, and anxiety; thereby
decreasing stress and enhancing relaxation.
• Also produced by baby – this secretion may play role in
initiation of labor.
• Baby’s head pushes on cervix creating a positive feedback
loop.

19. POSITIVE FEEDBACK LOOP

20. HOW CAN WE HELP… DURING LABOR
Help mom stay calm,
comfortable and confident
oxytocin

21. HOW CAN WE HELP?…
Advocate to
avoid
disturbances such
as unwelcome
people or noise
and
uncomfortable
procedures
(these will
stimulate the
neo-cortex)

22. POSITIONING
Encourage upright and
forward leaning positions
that help baby’s head push
against cervix

23. POSITIONING

24. POSITIONING
Maximize pelvic
diameter as
much as
possible. Side-
lying is good for
pushing and
delivery if pt has
an epidural

25. OXYTOCIN – after delivery
• Levels remain high after birth as the baby nuzzles
and licks the breast, which helps the uterus contract.
• Immediate and uninterrupted skin to skin contact
helps facilitate this process, secreted by both mom
and babe, bathing both in an ‘ecstatic cocktail’ of
love and bonding… also enhanced by eye contact.
• Evokes feelings of contentment, reduces anxiety, and
increases feelings of calmness and security.
• Protects against stress and promotes wound healing.

26. POSITIVE FEEDBACK LOOP

27. HOW CAN WE HELP… After Delivery
Provide opportunity
for skin-to-skin and
eye-to-eye contact,
nipple stimulation and
privacy

28. HOW CAN WE HELP …AFTER DELIVERY
PROVIDE PRIVACY FOR FAMILY BONDING

29. Inhale… Exhale…

30. ENDORPHINES

31. ENDORPHINES IN LABOR
• CREATE FEELINGS OF EUPHORIA AND PLEASURE… increase
tolerance to pain.
• Levels increase during labor, peaking at the time of birth and
subsiding slowly over 1-3 days.
• Endorphins can create a ‘hazy’ effect (just like opiates),
which help soften the memory of the pain of labor.
• The body produces endorphines in relationship to length of
labor.

32. HOW CAN WE HELP?
Help mom stay calm, comfortable
and confident
endorphines

33. HOW CAN WE HELP?…
Advocate to avoid
disturbances such
as unwelcome
people or noise
and
uncomfortable
procedures

34. HOW CAN WE HELP?
Encourage mom’s natural efforts!
You Can Do It!
Good Job!
Keep it up!
You’re doing Awesome

35. ENDORPHINES
“Birth is not only about making babies. Birth is
about making mothers – strong, competent,
capable mothers who trust themselves and
know their inner strength.”
~Barbara Katz Rothman, PhD

37. CATECHOLAMINES

38. CATECHOLAMINES before birth
• Stimulate the nervous system for fight or flight. High
levels during the active phase of labor can block
oxytocin (a protective mechanism so that labor can
be halted temporarily if danger is present).
• When birth is imminent, an increase in adrenaline
activates the ‘fetal ejection reflex’ (urge to push),
which facilitates quick delivery.
• Emotional response is varied and can produce
excitement, fear, anger, and anxiety, nausea, panic –
even if pt has an epidural.

39. HOW CAN WE HELP?
Help mom stay calm, comfortable
and relaxed

40. HOW CAN WE HELP?…
Advocate to avoid
disturbances such
as unwelcome
people or noise
and
uncomfortable
procedures
(these will
stimulate the
stress response)

41. HOW CAN WE HELP?
Educate and explain – proven to
decrease anxiety
Promote feelings of trust and
confidence in her ability to give
birth – and in yourself as caregiver
– feelings of trust and confidence
decrease the stress response

42. Avoid the turtle on it’s back position
as much as possible

44. HOW CAN WE HELP?
Take advantage of
the fetal ejection
reflex by allowing
physiologic second
stage (laboring down,
waiting for an urge
to push, allowing mom
to push as she
wants).

45. DO NOT DISTURB!!
• Like all mammals, humans need to feel safe and
protected for labor to proceed. When catecholamine
levels rise, labor slows or stops.
• Hospital environment (bright lights, invasive procedures,
interruptions by strangers, etc) provokes the release of
catecholamines (stress response).
• Stress response interferes with oxytocin and endorphine
release leading to prolonged labor, increased fear and
pain.

46. CATECHOLAMINES after delivery
• Levels drop quickly which contribute to a cold, ‘shocky’
feeling (shivering).
• Important to keep mom warm (skin to skin also helps
regulate maternal temp) because cold stress can keep
catecholamine levels high, which inhibits oxytocin
production.
• The fetus also secretes these hormones which helps it’s
response to the stress of labor (intermittent decreases in
oxygen) and adaptation at birth.
• Keeps mom and baby alert after birth for feeding and
bonding.

47. HOW CAN WE HELP?
We don’t want this! We want this!
Do whatever you can to decrease the stress response

48. HOW CAN WE HELP?
Promote immediate skin-to-skin,
cover mom with warm blankets
after delivery, if she is having
pain with placenta or repair,
speak reassuringly, bring
attention to baby
SUPPORTING OXYTOCIN AND ENDORPHINE RELEASE WILL
INHIBIT CATECHOLAMINE RELEASE

49. Breathing in… Breathing out…

50. BREATH AND RELAXATION
• Slow deep breathing
• Inhaling through nose, exhaling through
mouth
• Adapt techniques as needed – each labor is
unique
• Encourage relaxation in the shoulders and
pelvis/hips/thighs

52. VOCALIZATION AND RELAXATION
• Same concept as breath patterns: promotes
relaxation and provides distraction
• Keep tone low: moans, groans, humming,
deep breathing, chanting or sighing. Low
tones come from relaxed throat and jaw
• High pitched screeching, does not come from
a relaxed body, nor does it create a relaxing
environment for mother or baby…

53. …or the nurse!

54. HOW CAN WE HELP?
• Encourage her own spontaneous vocalizations
as long as they’re conducive to relaxation
• Keep your own voice calm and relaxed
• Direct mom in between contractions, not
during them

55. IN SUMMARY – HOW CAN WE HELP the
PHYSIOLOGIC PROCESS OF BIRTH?
• Optimize function of birth hormones
– Positioning
– Support and encouragement – create a trusting
relationship, reinforce her ability to give birth
– Education and explanation – especially before any
procedures
– Relaxation techniques – soft, calm demeanor
– Allow/support bonding after birth

56. CREATE A BUBBLE OF PRIVACY
“…continuously supported, protected and cared
for, but not disturbed the laboring woman can let
go of fear…within this bubble, privacy is
protected: Strangers are kept away, information
is filtered, questions interruptions and intrusions
are kept to a minimum” (Beckley 2002)
Give the body a chance to do it’s job of birthing!

59. RESOURCES
Calais-Germain, B. (2003). The female pelvis: anatomy and exercises. Eastland Press, Inc.
Gaskin, I. (2011). Birth matters: a midwife’s manifesta. Seven Stories Press.
Hansen, R. (2009). Buddha's brain; the practical neuroscience of happiness, love and wisdom. (1st ed.). New
Harbinger Publications.
Kabat-Zinn, J. (2013). Full catastrophe living: using the wisdom of your body and mind to face stress, pain and
illness. (2nd ed.). Bantam.
Odent, M. (2008). Birth and breastfeeding: rediscovering the needs of women during pregnancy and childbirth.
(2nd
ed.). Rudolph Steiner
Simpson, K. (2013). Awhonn's Perinatal Nursing. (4th
Ed.). Lippincott, Williams and Wilkins.
Walsh, D. (2013). Evidence and skills for normal labour and birth: a guide for midwives. (2nd
ed.) Routledge.
Buckley, S. (2003). Undisturbed birth: nature's blueprint for ease and ecstasy. Journal of Perinatal Psychology
and Health, 17(4),
Simpkin, P. (2007). How to use comfort measures to manage pain and prevent suffering in labor.
AWHONN 2012 Position Statement. Nursing support of laboring women.
AWHONN 2012 Webinar. The importance of physiologic birth
AWHONN 2013 Women’s Health and Perinatal Nursing Care Quality Draft Measures Specifications
acnm, mana, and nacpm*, (2012). Supporting healthy and normal physiologic childbirth - a consensus
statement.
Normal Birth: A Thing of the Past? JOGNN examines a trend toward high-tech, high-intervention birth; suggests care prac