Misc. thoughts on birth

I’m 9 months and six days pregnant, and oxytocin is on my mind a lot.

Oxytocin causes and is caused by an awful lot of things. It’s been billed as the “cuddle hormone,” but it’s basically involved with every step of baby-making. Skin-to-skin contact, and eye contact, increase oxytocin in adults (perhaps helping them bond). As the body prepares to give birth, it produces more oxytocin that stimulates contractions. After birth, the baby’s suckling stimulates the production of more oxytocin which causes the uterus to contract again and stop bleeding—very useful! First aid for after an emergency delivery is basically “keep the baby warm and stimulate the nipples so you don’t bleed out.” Skin-to-skin contact stimulates lactation and helps mother and baby bond after birth. (Not sure if this one is related, but skin-to-skin contact is also considered effective for pain relief in newborns during things like injections.)

Because oxytocin stimulates contractions, synthetic oxytocin (pitocin) is given to start or speed up labor. The natural birth people are concerned with the side effects, which are contractions that are so strong as to be more painful for mother and possibly dangerous to baby. Pitocin is also used after birth to stop bleeding.

Of all the home remedies to stimulate labor, nipple stimulation and castor oil are the only ones that work.  (For the record, castor oil is not considered worth it because the ensuing nausea and diarrhea dehydates mother and stresses baby.) Sex should help, in theory, because of both prostaglandins from semen and oxytocin from orgasm. But in practice it doesn’t seem to.

Here’s where the idea that “natural” is safe and “medical interventions” are dangerous really breaks down. Too much nipple stimulation basically gives you a large and unknown dose of oxytocin, maybe much more than the dose a doctor would give you. A few studies on high-risk women doing three hours(!) of nipple stimulation each day for three days concluded it was unsafe, because it was more likely than synthethic oxytocin to bring on dangerously strong or quick contractions. Cochrane seems to think it’s ok if you’re not high-risk, though (and presumably it’s safer if you don’t do three hours a day).

…………

Another thing on my mind is what tradeoffs to make around pain relief. Last time I planned to labor in the tub and get out for the actual birth because I was concerned about risk to the baby, but when they offered me the chance to stay in the water I was not eager to get out. Lily was born in the tub at the birth center.

There aren’t many sources that strike any middle ground between rabidly pro-water-birth pieces by midwives and rabidly anti-water-birth pieces by obstetricians, but this is one. Cool fact about babies: they practice breathing in utero, breathing small amounts of amniotic fluid. Shortly before birth they stop doing this. Upon moving from a warm fluid environment to the cooler air of the outside world (maybe also because the chest goes from being compressed to suddenly having space), the baby’s life support system suddenly changes, and it switches from getting oxygen through the umbilical cord to taking its first breaths of air.

The reason water birth normally works fine is that the baby is moving from one warm fluid environment to another, and they don’t start breathing until they hit the air. One danger of water birth is if your baby is compromised and takes a gasp earlier than it normally would, in which case it can inhale water. The other reported danger is from unsanitary conditions, like the cases of Legionnaire’s disease from pools of water kept at 98 F for days at a time – a perfect breeding ground. And some of the reported problems from “water births” are things like “woman accidentally gives birth while in the bath at home with no medical care.” Another danger is an overanxious attendant pulling the baby out of the water so suddenly that the umbilical cord snaps—this is a reason I would be sure to have an attendant who is experienced with water birth.

So how common are these problems? Not very. The UK recommends that all women with uncomplicated pregnancies have the option of water birth, and 6% of births there occur in water. It’s considered safe there.

Water birth usually results in less tearing for the mother, and I found it helped a lot with pain. So how do I balance the risk of serious harm to my child with the near-certainty of less pain for me? At first I thought it was terrible to consider any chance of a really bad outcome for my baby in exchange for my own relief.

But consider a parent with a headache who puts their child in the car and drives to the store for pain relief medication. There’s some risk they’ll be in a car accident and serious harm will come to the child. But we’re okay with people taking that small risk in exchange for near-certain pain relief. I don’t know how the risks of bad outcomes vary between these two situations, but it does at least seem that we shouldn’t immediately condemn any possible tradeoff between parent and child well-being.

…………

If you do any kind of tidying during late pregnancy, people will exclaim, “You’re nesting!” (Most annoying was from the midwife who pushed the exam-room curtain up against the chair where I was supposed to sit and then said I was “nesting” when I moved it out of my face.)

As far as I can tell, there’s plenty of documentation of nesting behavior in pregnant rats, dogs, cats, hamsters, and rabbits but not humans. My mother still talks about her urge to scrub my changing table with Lysol the night before she gave birth, but that’s is the kind of project that doesn’t sound unusual for her anyway.

Part of me wonders if this is just us medicalizing women’s very sensible wish to get things in order while they still have any time.

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