Bonni Hall: Endorphins, Labour, Pain and Bonding

One of my favourite parenting-related websites is The Natural Child Project. I was over there, dredging around for articles about natural childbirth for a friend who’s expecting a baby soon. Out here in South Africa, planned Caesarians are all the rage, and you hear pregnant women nervously telling you they’ll “try for a natural” as though it’s a hole in one or something that requires an equal measure of exceptional skill and good fortune. Private healthcare is the norm here, and there are some obstetricians who will not even consider taking on patients that refuse an elective Caesarian. Among those that do plan for natural childbirth, there is almost an unspoken assumption that vast quantities of drugs of will be necessary in order to survive the experience. It saddens me to think that so many healthy, capable women, who have little or no reason to fear childbirth, will be talked out of one of the most phenomenal experiences of their lives on the basis of fear and popular myth.

Anyway, the following article was written by a woman called Bonni Hall, who used to run a website called Evaluated Childbirth. Sadly, the website is no longer up, but Bonni kindly passed on two very inspiring articles and agreed to give me permission to post them here. The first of these follows below.

Endorphins, Labor, Pain, and Bonding
by Bonni Elizabeth Hall

I’ve always wondered why women in childbirth should experience pain. I do realize that pain can be lessened by various perfectly natural means (change of position, lessening of anxiety, and more), but what I mean is that for the majority of women (as well as other mammals), birth involves pain. Why?

The human body produces various hormones in response to different situations. To pain (and some other stimuli), the hormonal response is to release endorphins, which are natural pain relievers. They not only suppress pain, they give the person a sense of well-being and sometimes a “high”. Atheletes often rave about the wonders of an endorphin high, as well as the effects of epinephrine (also known as adrenaline). Both of these naturally produced chemicals come into play when a woman is in labor.

To put it mildly, the mother’s endorphin level affects the level of endorphins the baby is receiving. This makes the labor more tolerable for the mother, but may well affect the baby even more. It’s entirely possible that a tiny baby can’t produce the level of endorphin (and epinephrine) necessary to really be able to get any relief from the pain of birth, and considering that the baby’s skull bones actually overlap in order to allow the birth, it’s very likely that there is some level of pain involved for the child.

In addition, there is an experience known as “birth euphoria” experienced by mothers who labor and deliver medication-free. This euphoria is specifically related to the mother’s levels of endorphins and epinephrine. It is believed that this euphoria is an important part of the bonding process.

Recent studies have shown that certain kinds of anesthesia (notably epidurals) severely reduce the levels of endorphins in the mother’s body. No pain, no endorphins. What, then, does this do to the baby’s level of pain relief? Naturally, if the mother has had narcotics, the baby will have received some, but then there are the issues with negative side effects (notably depressed respiration) of those drugs. And while the drugs used in epidurals can and do cross the placenta, they certainly don’t have the same pain-relieving result on the baby, since the mother received the drugs in the epidural space of the spine and the baby is receiving them on a more system-wide level.

According to a study done in Europe on the psychological effects of epidurals (Khrebiel, et al., 1987), ewes given epidural anesthesia during labor and birth all eventually rejected their lambs. The full implications of this are not entirely known, and certainly human intelligence can and does affect the relationship between mother and child beyond the primal mammalian responses, but given other tests with human mothers and babies which point to bonding problems (Sepkoski CM, Lester BM, Ostheimer GW, Brazelton TB; Dev Med Child Neurol 1992 Dec;34(12):1072-80), it seems likely that the physical sensations of labor and birth may affect the mother’s response to her infant by inducing hormonal and neurological changes to make her more able to nurture her offspring, and that interfering with those sensations may well cause bonding problems between mothers and babies.

Wrote Ronnie Falcoa, LM, MS (homebirth midwife, labor coach, prenatal hypnotherapist, and maintainer of The Midwife Archives):

Most of us with extensive natural birth experience have found that a natural birth is an overall more positive birth experience for both the mom and the baby. A woman who is relaxed and receiving adequate support and has a normal pregnancy and labor will generate endorphins to provide her own natural pain relief.

These endorphins are passed through to the baby because they are carried in the mother’s bloodstream. The anesthetics administered through an epidural are carried through the tissues by gravity, rather than through the bloodstream, and they don’t do much to relieve the baby’s experience of discomfort caused by the contractions, the periodic oxygen deprivation during the contractions, and the molding of the head in order to pass through the pelvis.

In addition to providing the baby with pain relief, the natural secondary hormones of labor (endorphins and adrenalines) are crucial in priming the baby for extrauterine life. They are important in the incredible physiological changes that happen at the moment of birth; in particular, they help facilitate the changeover to extrauterine breathing – an exquisitely complicated process involving a rerouting of the baby’s circulatory system to include the lungs and exclude the placenta. This process requires a heightened neurological response to the changing blood gas levels in order for three ducts in the baby’s body to close completely and complete the changeover. An absence of these hormones does indeed put the baby in greater danger. Some babies require heart surgery to close the duct that should have closed naturally at birth.

In addition, these endorphins are absolutely required for the best possible bonding between mother and baby, and they are important in the baby’s physical and emotional development.

So in summary, it seems that not only is the mother’s pain (which can, as mentioned, be managed effectively in the majority of cases with proper prenatal education, training, and support during labor) instrumental in lowering the pain for the baby, it may actually set the stage for bonding and nurturing, due to the levels of hormones involved, hormones which are certainly reduced and may be absent when drugs are routinely introduced into labor. At the time of birth, an unmedicated woman’s level of endorphins, the body’s natural pain killers, are thirty times higher than those in non-pregnant women. Endorphins create feelings of pleasure and joy, and of euphoria. Since endorphins are secreted in response to pain, it seems likely that by eliminating pain, epidurals would also lower the endorphin response, and in fact, recent studies (cited above) have shown this to be true.

However, the reduction in endorphins and adrenaline is only true for drugs or any type of pain relief that prevents the pain signals from reaching the brain. So while an epidural would prevent the natural and desirable buildup of endorphins and other narcotics would inhibit this buildup, other methods of pain relief that work by over-riding or re-programming those signals (hypnosis, massage, water, movement in labor, meditation, etc.) relieve the perception of suffering while still allowing the endorphins to build, producing not only pain relief for the mother but also for the baby and also producing the birth euphoria which is so vital to strong maternal-infant bonding.

Prepared, unmedicated birth is not only low-risk and high-benefit, it is an intricate part of Nature’s plan for bonding mother and child, and for laying the foundation for a secure nurturing relationship. Yet more reason, in my opinion, to learn how to cope with the pain of birth rather than relying on drugs as a “first choice” option for pain management.

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About Lisa

I live in South Africa with my husband and two small children, doing things, thinking about things and sometimes writing about them.
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17 Responses to Bonni Hall: Endorphins, Labour, Pain and Bonding

  1. Sandra says:

    I love this… thank you! As a mom who had 4 pain-free non-intervention natural childbirths, I can definitely agree!

  2. Fascinating reading!

  3. tallstar7 says:

    So glad you’re finding it inspiring. I find the current prevalence of a medicalised view on birth somewhat tyrannical and silencing. The current assumptions seem to be that hospitals are safer environments for birth, that unmedicated deliveries are amazing events that signal either enormous genetic luck or an unnaturally high pain threshold. As a somewhat attention-loving Leo, I don’t mind when people marvel at me, but I do know that the truth is somewhat different: I wasn’t particularly special or brave, I just had access to some very empowering information, and I was prepared to trust my body to do what it needed to do.

  4. Pingback: Bonni Hall: Endorphins, Labour, Pain and Bonding « Relentless … | Manifest My Desire

  5. Evelyn says:

    Have you read Naomi Wolff’s “Misconceptions”? – all about as you put it, the “medicalised” approach to birth.

  6. Lisa says:

    Hi, I don’t remember if I’ve commented on your blog before, but I have read a few posts…I think you put a link on the CC forum? Anyway, I love this article, thank you for sharing it. I found it powerful and inspiring. I can agree from the other side that the bonding thing is true. By no choice of mine, I had to have a medicalized birth and it was very traumatizing for me. I was in so much shock that even though I knew I loved and wanted my baby, I hadn’t bonded appropriately with him. He had to stay in the ICU for three days and I had to go home without him for one night. I confided to my husband that I felt like I wouldn’t be sad if our baby never came home (even though a few hours earlier I was crying that I had to leave him at the hospital). That’s how much shock I was in! Of course I wanted him, and everything was fine when he came home. But I still lament not having a normal birthing (to me “normal” equals “natural). And when I think of how awful it must have been for my baby, I feel so sad.

  7. tallstar7 says:

    Hi all
    Thanks for taking the time to leave a comment – it’s always great to know that there are people reading this stuff and gaining something from it!

    Lisa – Welcome to the blog, and I am sorry to hear you had a traumatic time at your baby’s birth. From my own experience, I am convinced that natural birth is a tremendously powerful bonding experience – my “birth euphoria” took weeks to wear off (to my relief, as I was expecting to be top of the postnatal depression party list, as I was relatively isolated in a foreign country at the time). Nonetheless, even if your birth didn’t allow for that bonding experience, evolution has been kind to us, and there are a million more opportunities that follow, as you’ve no doubt found.

  8. RaiulBaztepo says:

    Hello!
    Very Interesting post! Thank you for such interesting resource!
    PS: Sorry for my bad english, I’v just started to learn this language ;)
    See you!
    Your, Raiul Baztepo

  9. Eleanor says:

    Hi. I gave birth this morning to my first child. The only pain relief I had was that which my own body produced and my husband’s continuous support.. I was pretty much off my face like id smoked an entire den of opium, and very very zen. It was still painful, but my baby came out alert, I’m not drugged up, and the sense of accomplishment that we achieved is terrific! Thank you for this fascinating article. Natural childbirth IS doable!

  10. Lisa says:

    Eleanor – congratulations!! That is wonderful, and I’m delighted you found the article useful. Brilliant description of the weird combination of drugged out and fully alert… I found that the aftereffects took, literally, months to wear off; I was on a birth-induced high for weeks and weeks after K was born. L

  11. Hello Lisa, My name is Iga Czarnawska-Iliev and I am the director of a childbirth preparation school in London called “Gaia”. I was myself born through a traumatic forced caesarian and, now the happy mum of two naturally born sons, I am passionate about educating women about the true face of childbirth. This is the first time I stumbled across your blog – thank you for posting! – and I am writing to ask your permission to quote (~ 2, 3 sentences) of this post in an article I am writing now for Polish press in London about the myths leading to elective C-sections.
    Also, what Bonnie wrote is fascinating! I would be so grateful for a contact to her.
    And thank you for this great blog again. I plan on visiting you more in the future :)

    Iga.

  12. Kate says:

    My son got badly stuck – shoulder dystocia – during his home waterbirth. In the process of getting him out, the nerves to his left arm were torn so badly that the nerves never fully recovered.

    BUT if I had given birth in a hospital, with an epidural, statistically the time he would have spent navigating the birth canal would have been longer, so he would have been more stressed and traumatized even before he got stuck on my pubic bone… and he would not have had the benefit of my hormones to provide him pain relief during the most traumatizing event of his life.

    I wasn’t able to get pregnant again, but if I had, it would have been a difficult decision whether to give birth vaginally or have a C-section (due to the high probability of having a repeat shoulder dystocia birth). But one thing I WOULD NEVER CONSIDER would be a medicated vaginal birth. The infant doesn’t get the other benefits of the mothers birthing hormones (many of which have probably not even been discovered yet). But at least they are not subjected to unnecessary pain all so the mother doesn’t need to feel any herself.

    It is so shocking and depressing that the very same mothers who get up in arms about their little boys getting circumcized without anesthesia would subject their child to something SO MUCH MORE traumatic (childbirth) without the benefit of painkillers. I think if moms only stopped to think just how traumatic childbirth is FOR THE CHILD they would not think twice about going through it naturally. Most women would throw themselves under a moving car to spare their child…

  13. Sandra says:

    Kate, these too are the mothers that thought even smelling a cup of coffee while pregnant would hurt the baby; that eating a can of tuna or sleeping on their right side would be fatal to their unborn child; that they were virtually invalids during the pregnancy… They didn’t research those myths, so they wouldn’t research the poisons in medicated births and the risks of those either.

    9 months of walking on eggshells, thrown out the window because the doctors treat medicated births as normal and expected.

    Thank you again for a great blog. I hope that in my lifetime we see medicated, intervention-laden births as the exception, not the rule.

  14. Thank you for this great post! I linked to it in my blog post. http://www.myfemininemind.com/2011/06/disempowerment-of-women.html

  15. Lisa says:

    Thanks :-) Always surprises me how many people chance on that post and find it as useful as I did. So glad Bonnie agreed to let me publish it here!

  16. rebecca says:

    Be very careful……. labour can be excruciating especially if you are induced..I was twice… This happens to a lot of women… Your virgina dilates very quickly in this occasion. I felt I was being ripped apart. The father stood at the end of the bed saying I was not to have pain relief. The nurses had to get my Mum to come in from her home… She managed to talk me into having the epidural which took away the pain instantly. My baby had been in fetal distress.
    I had to defy my partners wishes he would probably have let my baby die….ignorance or religion or health all bun cum…… Get pain relief for God’s sake….

  17. Lisa says:

    Hi Rebecca
    Induction interrupts the normal progression of contractions, so, yes, I can’t imagine it’s reasonable to expect to get through an induced birth process without pain relief. I don’t think anyone’s arguing that women should be denied pain relief. I think Bonni just argues that in a normal labour, pain is normal and can, in many cases (though not all), be endured, and has some productive benefits. If you need it, you need it. But pain is not necessarily unendurable in all cases, and it’s important that pregnant women hear this and gain confidence from it.

    I find it strange that you talk about your partner’s wishes, and your mother “talking you into” an epidural, but not your own wishes or views. Did you want pain relief or not? In retrospect, it sounds like you certainly did. But I don’t see why this leads to the conclusion “Get pain relief for God’s sake”. Sure, if you must, get pain relief for your own sake or the baby’s sake. Not God or your partner or your mum!

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