What Your Nervous System Has To Do With Birth
I want to paint a picture of a common scenario I see as a birth doula. I’ve been working with a family for some time, preparing for the birth of their baby. Maybe they’re a little bit nervous for the challenges that lie ahead, but mostly, they’re excited. They’ve done the research, they’ve planned for what they want and don’t want to happen during their birth experience. The expectations are set. And then early labour happens. For people labouring for the first time, early labour can come as a bit of a surprise. We expect for it to start slow and gradually build, but its not unusual for people to feel surprised at the intensity they feel in early labour while their body is just getting the hang of contractions. Sometimes, this phase of early labour lingers for a while, stretching out over a couple of days and nights. It’s perfectly natural for this early stage of labour to take some time. But it’s also true that this difference between what someone expects and the reality they are facing can trigger anxiety and worry. Then, that anxiety and worry can actually disrupt the process at a time when we really want things to be moving steadily forward. This is one of the main reasons I decided to open up the option of a third prenatal visit in my standard birth package – I want to give families an opportunity to practice the skills they need to help regulate their nervous system during labour and birth so that things can progress as smoothly as possible.
An intricate model of the human body with its arms raised toward the sky.
There’s a lot of talk these days about nervous system regulation, and it seems increasingly that people are understanding how the way their nervous system is responding to their environment not only affects how they feel, but the way they are able to respond to whatever situation they are encountering in their life. For some, talking about the nervous system in relation to birth will make perfect sense. For others, it might not seem so obvious. What does the nervous system have to do with it anyway? This blog post will unpack the connection between the nervous system and the labour process so that you can plan ahead to develop skills and tools that will help you stay in a supportive frame of mind when your baby is on their way.
At one point in your life, you probably learned about the two branches of the nervous system. The sympathetic nervous system is the one we associate with the fight, flight, freeze, or fawn response. This branch of your nervous system is activated during times of stress and it causes your body to shunt blood flow away from non-essential organs and to produce particular hormones and neurotransmitters so that you can face the situation at hand. Classic example: if you are suddenly faced with a bear on your hike in the mountains, your ovaries don’t need a lot of blood flow. Your muscles and your heart, on the other hand, are going to need quite a bit so that you can react quickly. The hormones and neurotransmitters in your system help to mobilize sugar for your muscles to use and sharpen your senses. It’s an incredible thing. The problem comes when that system becomes activated during times where we need those other bodily processes to stay online. During labour, the body experiences quite a lot of physical challenge. Contractions can be very intense and its normal for the mind to interpret intensity of this nature as pain that is threatening, when it’s actually working for you and your baby. When we perceive that we are under threat – which can also be triggered by other things happening around you – we shift into this sympathetic branch of our nervous system. Now, before you start thinking that all sympathetic nervous system activation in labour is bad, it’s important to know that it can also help to serve you during your labour. For example, the surge of adrenaline generated through transition and into the pushing stage can help birthing people experience a “second wind” of energy that helps them gather their resources to finish birthing their baby. Adrenaline can also increase one’s pain tolerance temporarily to help manage the intense sensations of birth. So while some activation is normal and helpful in labour, we also want to make sure that it doesn’t override the other things that need to happen in our bodies for a baby to be born.
A pregnant person works hard to manage the sensation of contractions while laouring in a hospital.
The second branch of the nervous system is the parasympathetic nervous system, which we associate with resting and digesting our food. In this state, our body is relaxed and feels safe. This allows our system to maintain blood flow to all our organs – including our digestive and reproductive organs – and to experience a state of calm. While people don’t typically associate labour and birth with a state of calm, it’s actually really important, so we’re going to unpack it further.
Olza and colleagues (2020) describe birth as a neuroendocrinological event. That’s a mouthful, but what it means is that birth is an event that is coordinated by both our nervous system and our hormones working together. When we are in labour, we experience a neurochemical cascade that organizes the flow of labour, reduces the pain and stress to the birthing person, and facilitates the adaptation of the newly born infant. The uterus is actually innervated with nerve fibres that are connected to both the sympathetic and parasympathetic nervous systems. The main hormone of birth is oxytocin, which is released by the brain and works to both stimulate labour to progress (causing contractions) and reduce fear and pain (by stimulating feel-good feelings). Because oxytocin is largely associated with the activation of the parasympathetic nervous system, our body has a much easier time producing the oxytocin that is going to move our labour forward when we are in that parasympathetic state – resting, feeling calm, and knowing we are well supported. When we experience strong uterine contractions, this activates sensory fibres of the sympathetic nervous system, which is why we experience intense and even painful sensations. This stimulation of the sympathetic nervous system causes the release of stress hormones like cortisol and adrenaline.
What’s important to remember is that these two systems operate independently of one another – they’re both working at the same time in labour! But they can also work against one another, creating hold-ups for you. When our sympathetic nervous system is too activated – because we don’t have the tools we need to manage the sensations of labour, because the environment we are labouring in feels unsafe, or because we don’t feel adequately supported – it can reduce the amount of oxytocin our body is producing to progress labour and help us manage our feelings. So the trick, as I’ve alluded to earlier, is to develop strategies and tools that can be used all throughout labour to stay in your calm zone as much as possible.
A pregnant person relaxes over the side of a birth pool, finding a moment of calm in labour.
But how do we do this? How do we reduce the amount of stress we are feeling so that we can enhance our parasympathetic nervous system and oxytocin release?
1. We can use calming physical touch to activate sensory nerve fibres in the skin which, in turn can support the production of oxytocin. Gentle massage or a calm hand on your shoulder during contractions can be grounding. Wherever we can produce feelings of pleasure and comfort, oxytocin will follow. Ina May Gaskin (2002), a world-renowned midwife, recommends the loving touch of a partner through kisses and caresses to help labour progress.
2. We can work together to create a safe and supportive environment, which can increase our feelings of safety – this might look like being surrounded by supportive people, having comfort items from home, reducing stressful stimuli, and even making the birthing space feel like a special, sacred place to have a baby.
3. We can also work to ensure there is lots of reassurance and encouragement provided to the birthing person to help counteract the effects of pain and tension on the nervous system. Even though labour is intense, it can help to know that you’re doing a great job, that everything is working as it should, that you’ll meet your baby soon and you have people who love you to stay by your side the whole time you need them.
4. We can use the breath. Our connection to our breath is a powerful way to help shift the nervous system in the direction we want it to go. When we are able to breathe deeply and slowly, we send a signal to the body that all is well and it is okay to relax.
If there is one thing I hope you take away from this blog post, it’s that the birthing person’s mental and emotional state during labour is not a ‘bonus’ or extraneous feature of the physiological process of birth. It’s actually an integral part of the process. When things happen in labour that create undue stress or fear, we can dampen the natural flow of labour facilitated by oxytocin, which in turn sets us up to experience more interventions than may be necessary otherwise. As doulas and medical care providers, the work we do to respect a birthing person’s mental and emotional state matters. This doesn’t just go out the window if medical interventions become necessary – it’s a tool we can use no matter what is happening in a birth to help people feel as safe and supported as possible
And if you’re currently pregnant and planning for the birth of your baby, this is helpful information too! It means that you have from now until your labour starts to start practicing coping tools that you can use in labour to help yourself stay calm. You can start thinking about ways you can make your birthing space as safe as possible, including what kinds of support you might want or need to make that possible for you. As a Calgary birth doula, this is always something on my mind when working with my birth clients and is something I’d love to support you with if you are looking for a doula.
Citations:
Gaskin, I.M. (2002). Spiritual midwifery (4th Ed.). Summertown: Book Publishing Company (BPC).
Olza I., Uvnas-Moberg, K., Ekström-Bergström, A., Leahy-Warren, P., Karlsdottir, S.I., Nieuwenhuijze, M., Villarmea, S., Hadjigeorgiou, E., Kazmierczak, M., Spyridou, A., Buckley, S. (2020). Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth. PLoS One, 15(7):e0230992. doi: 10.1371/journal.pone.0230992.