Protecting Mothers - before, During, & After birth (Part 1 of 3)
It’s the 26th hour. I am 9cm dilated give or take but the right side of my cervix is still thick, hanging on, not letting up. The peanut ball is between my legs (if you know you know), and I’m not happy. But I don’t have a choice, we must move forward. Then my water broke. Unlike what pop culture would have you believe, your “water breaking” isn’t necessarily a sign of labor beginning. Mine didn’t break until I was about “ready to push” another silly step we’ve tried to find a place for in childbirth. When my water did break, my midwives gave me the choice to go to my preferred hospital right away or deliver my daughter then have her be taken via ambulance to the closer hospital (one with a less equipped nicu) because she had already passed meconium and she would need medical assistance after birth.
This is a glimpse into my first experience with childbirth. I had prenatal care with an OBGYN at a hospital and Midwives at a birth center. I wanted to give birth at the birth center rather than at home or the hospital but given the opportunity would have chosen a private island with a cave and no other human beings in sight.
Birth is not something I spent any time thinking about prior to becoming pregnant myself. My approach despite having sourced many professionals from varying backgrounds to give me education and guidance was to remain as unattached and flexible to an outcome as possible. I just wanted “to feel connected to her and not have any medical intervention”. Though a water birth with my daughter “en caul” or born within her completely intact, fluid filled amniotic sac as I catch her without any assistance had a nice ring to it.
Part 1: how we protect mothers During Birth.
First of all, protecting them from what? What does it even mean to protect a mother at these various stages of experience? How a woman perceives her childbirth experience holds lasting powerful impact on a biological, psychological, and spiritual level. So let’s move one step past what birth is at a physiological level and talk about the nuances of the mind body and soul experiencing birth that need to be taken into consideration. No two mothers will need the same protection.
TO PROTECT MEANS TO UNDERSTAND: Realities that shape Birth
What are epigenetics and how do they impact birth?
Epigenetics is the study of how life experience can flip certain genes "on" or "off" without changing your actual DNA. Lehrner and Yehuda describe it as the way environmental influences "'get under the skin,' directing transcriptional activity and influencing the expression or suppression of genes" (1763) — in plain terms, stress, trauma, or safety don't just affect how you feel; they can leave a chemical mark on which genes get used. That matters for birth because maternal stress and high cortisol during pregnancy have been linked to changes in the gene for the oxytocin receptor, the same gene that controls the hormone driving labor contractions, pain tolerance, and bonding (Unternaehrer et al. 1460).
So a woman's biology for birth can start being shaped before she's even born.
That priming shows up again during labor itself, in what's called the fear-tension-pain cycle: oxytocin "plays a key role in regulating and controlling processes that ensure a safe birth," but stress "can have negative effects on the progress of labor" (Walter et al.) — meaning fear during labor isn't just in a woman's head, it can chemically work against her body's ability to labor smoothly. One study backs this up directly: among women without an epidural, "[p]ain and cortisol increased throughout labor," and "[f]ear and pain correlated" at every stage (Alehagen et al. 153) — the more afraid a woman felt, the more pain she reported, in a real physiological feedback loop.
This pattern can even reach back a generation. Lehrner and Yehuda point to "putative epigenetic mechanisms for transmission of trauma effects . . . through social, intrauterine, and gametic pathways" (1763) — meaning a mother's or grandmother's unprocessed trauma may leave a biological trace that shapes a woman's own stress response before she ever goes into labor. But that's not a life sentence. The same research emphasizes "the possibilities of resilience and adaptivity" (1763), which is the encouraging part: epigenetic marks respond to environment, so a calm, safe, well-supported birth space may be one of the most powerful tools available for interrupting an inherited pattern in real time.
Your Beliefs matter: the partner factor.
What you believe about your ability to give birth actually changes how your body does it. Researchers who reviewed decades of studies on "childbirth self-efficacy" — basically, how confident a woman feels about handling labor — found that "increased childbirth self-efficacy is associated with a wide variety of improved perinatal outcomes," and, encouragingly, that this kind of confidence "can be modified through various efficacy-enhancing interventions" (Tilden et al. 465). In plain terms: believing you can do this isn't just a mindset trick — it's tied to real differences in how labor unfolds, and it's a belief that can be built up ahead of time. That's because confidence and fear run through the same hormonal system that drives labor itself. A team of childbirth researchers found that a mother's "wellbeing and feelings of safety" directly shape "an optimized process of labor," largely because oxytocin — the hormone behind contractions and natural pain relief
— only flows freely when a woman feels safe (Olza et al.). Feeling scared or unsupported doesn't just feel bad emotionally; it can chemically interrupt the process her body is trying to run.
This is where a partner's role gets complicated. Feeling safe in labor depends heavily on having steady, one-on-one support: a major review of 26 clinical trials found that continuous support during labor led to more spontaneous vaginal births, shorter labors, and fewer negative feelings about the birth experience overall (Bohren et al.). But that support only works if the mother actually believes it's there for her. If she walks into labor already convinced her partner won't know what to do, won't stay calm, or won't be able to give her what she needs, that doubt becomes its own stressor — the same kind of fear that spikes cortisol and blocks oxytocin in Olza et al.'s model of birth as a "neuro-psycho-social event." In other words, it's not enough for a partner to simply be in the room;
the mother's belief in that person's ability to show up for her is part of what her nervous system is reading as "safe" or "unsafe" in real time — regardless of whether the doubt turns out to be true.
The Biological Blueprint for a Safe Birth Environment
Long before hospitals designed labor and delivery wards, a woman's body already had a blueprint for where and how she needed to give birth — one written by evolution, not architecture. Labor runs on what researchers describe as "innate hormonally mediated physiologic processes in women and fetuses/newborns during childbearing," a finely tuned system of oxytocin, endorphins, and stress hormones that "optimize labor and birth" when they're allowed to function undisturbed (Buckley 145). In plain terms: labor is a hormonal event, and the hormones driving it are notoriously shy — they flow best in low light, quiet, and privacy, and they shut down fast under threat, exposure, or the sense of being watched. That's not superstition; it's physiology inherited from every other mammal that seeks out a dark, hidden den to give birth. The same research warns that "common maternity care interventions may disturb hormonal processes, reduce their benefits, and create new challenges" (Buckley 145) — meaning bright lights, frequent exams, monitors, and unfamiliar faces, all standard in modern obstetric settings, can work directly against the biology birth was designed to run on.
Privacy alone wasn't enough, though — evolution also wired women to seek a specific kind of company. Human childbirth became unusually difficult once our ancestors evolved to walk upright and grow large brains, a trade-off researchers call the "obstetrical dilemma": "adaptation to bipedal locomotion decreased the size of the bony birth-canal at the same time that the exigencies of tool use selected for larger brains," and this "obstetrical dilemma was solved by delivery of the fetus at a much earlier stage of development" (Rosenberg and Trevathan 161). In plain terms, human babies are born more helpless and human birth is harder than in almost any other primate — which is likely why humans evolved a near-universal instinct to seek out experienced, trusted companions during labor rather than going it alone.
Before obstetric care centralized birth into hospitals, that instinct simply looked like being surrounded, at home, by a small circle of known and trusted women.
What a physiologically safe birth environment biologically requires hasn't changed: privacy, dim and quiet surroundings, and people the mother already trusts. What's changed is how far modern maternity care, with its bright rooms, rotating strangers, and near-constant observation, has drifted from that blueprint.
The Hill I Will Die On: You Don’t need Science to know these realities
It did not take science to tell us these realities of childbirth but it helps for those of us who like to think our way through feelings, emotions, and our traumas. The truth is pain, suffering, and trauma cannot be perfectly understood from one person to the next but simultaneously we have all experienced it. The important part about empathy is not needing to measure the severity of what a person is experiencing in contrast to our own experiences to respect it’s presence but to merely witness it and treat the other as you would if you were in pain. This can be tricky. Many of us, if not all, struggle with the ability to show ourselves compassion when we hold shame around the “why” we feel the pain we feel. If we struggle to hold that compassion for ourselves, it will feel nearly impossible to show someone else compassion especially if we lack understanding of the “why” they are in pain to begin with.
Pain in childbirth has been distorted to create fear to sell you services, products, and policy that creates more pain.
I preface most of my discussion posts with science to enforce the reality that I regularly walk through both science and traditional wisdom to form my opinions. The great, not just good science that has been applied to the research of childbirth variables is endless. I would bore you trying to cite the basics and trust you will visit my other discussion posts or have done research on your own should you be interested in reading those. I am going to challenge you for a moment to sit back and feel this part with me. You will not find statistics backing the idea that in a low-risk pregnancy a stereotypical hospital birth will leave any of the parties involved in the birthing experience with the best possible outcome in contrast to birth experienced outside of the hospital. The points I made above largely describe nuances that will have to be explored with each mother to best understand their specific birth needs. No matter what those variables are the most probable needs to protect the birth experience will align with anything BUT a hospital environment. Why does this matter? Because many women are not exposed to the information necessary to understand these realities and/ or don’t have access to birth support outside of the hospital environment. The more you fear childbirth the more money the hospitals, investors, pharmaceutical companies, and their share holders make. This doesn’t mean your OBGYN or other hospital staff are out to take your money… this means that the responsibility is on YOU to understand who trained the professional giving you their opinion and what is that information bias towards. Science is valuable, great science is invaluable to the birth experience of many families. But when science is weaponized to create fear to try and create a certain pattern of behavior to protect the bottom line… that’s where we draw the line.
Questions To Think About:
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This has been Part 1 of 3 for my discussion on Protecting Mothers Before During & After Birth. Listen to the companion podcast to this discussion here.WORKS CITED
Alehagen, Siw, et al. "Fear, Pain and Stress Hormones during Childbirth." Journal of Psychosomatic Obstetrics & Gynecology, vol. 26, no. 3, Sept. 2005, pp. 153–65, doi:10.1080/01443610400023072.
Lehrner, Amy, and Rachel Yehuda. "Cultural Trauma and Epigenetic Inheritance." Development and Psychopathology, vol. 30, no. 5, Dec. 2018, pp. 1763–77, doi:10.1017/S0954579418001153.
Unternaehrer, Eva, et al. "Maternal Adversities during Pregnancy and Cord Blood Oxytocin Receptor (OXTR) DNA Methylation." Social Cognitive and Affective Neuroscience, vol. 11, no. 9, Sept. 2016, pp. 1460–70, doi:10.1093/scan/nsw051.
Walter, Michael H., et al. "The Role of Oxytocin and the Effect of Stress During Childbirth: Neurobiological Basics and Implications for Mother and Child." Frontiers in Endocrinology, vol. 12, 27 Oct. 2021, article 742236, doi:10.3389/fendo.2021.742236.
Bohren, Meghan A., et al. "Continuous Support for Women during Childbirth." Cochrane Database of Systematic Reviews, vol. 7, 2017, art. CD003766, doi:10.1002/14651858.CD003766.pub6.Olza, Ibone, et al. "Birth as a Neuro-Psycho-Social Event: An Integrative Model of Maternal Experiences and Their Relation to Neurohormonal Events during Childbirth." PLOS ONE, vol. 15, no. 7, 28 July 2020, e0230992, doi:10.1371/journal.pone.0230992.
Tilden, Ellen L., et al. "The Effect of Childbirth Self-Efficacy on Perinatal Outcomes." Journal of Obstetric, Gynecologic & Neonatal Nursing, vol. 45, no. 4, 2016, pp. 465–80, doi:10.1016/j.jogn.2016.06.003.
Buckley, Sarah J. "Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care." Journal of Perinatal Education, vol. 24, no. 3, 2015, pp. 145–53, doi:10.1891/1058-1243.24.3.145.
Rosenberg, Karen, and Wenda Trevathan. "Bipedalism and Human Birth: The Obstetrical Dilemma Revisited." Evolutionary Anthropology: Issues, News, and Reviews, vol. 4, no. 5, 1995, pp. 161–68, doi:10.1002/evan.1360040506.