A Focus on Physiologic Birth
A new report, Hormonal
Physiology of Childbearing: Evidence and Implications for Women, Babies, and
Maternity Care (2015),
produced by Childbirth Connection and authored by Dr. Sarah J. Buckley, synthesizes
a large literature about innate hormonally-mediated processes in women and
fetuses/newborns from pregnancy through the postpartum/newborn periods. The report,
which focuses on four hormone systems that are consequential for childbearing,
also examines possible impacts of common maternity care practices and
interventions on these hormonally-mediated processes. Core hormonal physiology
principles reveal profound interconnections between mothers and babies, among
hormone systems, and from pregnancy through to the postpartum and newborn
periods. Overall, consistent and coherent evidence from physiologic
understandings and human and animal studies finds that the innate hormonal
physiology of childbearing has significant benefits for mothers and babies.
Such hormonally-mediated benefits may extend into the future through
optimization of breastfeeding and maternal-infant attachment. A growing body of
research finds that common maternity care interventions may disturb hormonal
processes, reduce their benefits, and create new challenges. Developmental and
epigenetic effects are biologically plausible but poorly studied. The
perspective of hormonal physiology adds new considerations for benefit-harm
assessments in maternity care, and suggests new research priorities, including
consistently measuring crucial hormonally-mediated outcomes that are frequently
overlooked. Promoting, supporting, and protecting physiologic childbearing, as
far as safely possible in each situation, is a low-technology health and wellness
approach to the care of childbearing women and their fetuses/newborns that is
applicable in almost all maternity care settings.
Hormonal Physiology of Childbearing: Topline Recommendations to Promote, Support, and Protect
The following recommendations arise from results synthesized in Hormonal Physiology of Childbearing:
Use effective policies and
quality improvement strategies to foster consistent access to physiologic
increase access to care models that promote physiologic childbearing and safely
limit use of maternity care interventions.
Engaging and Supporting Childbearing Women
Care Practice, Whenever Safely Possible
Provide prenatal care
that reduces stress and anxiety in pregnant women.
physiologic onset of labor at term.
With hospital birth,
encourage admission in active labor.
Support privacy and
reduce anxiety and stress in labor.
comfort measures for pain relief routinely available, and use analgesic
methods of fostering labor progress routinely available, and use pharmacologic
support during labor.
vaginal birth, and avoid unneeded cesareans.
Support early and
unrestricted skin-to-skin contact after birth between mother and newborn.
frequent, and ongoing breastfeeding after birth.
The report and related resources are freely
available online from Childbirth
Connection Programs at the National Partnership for Women & Families.
Related resources include infographics for clinicians and for women; a consumer
booklet; fact sheets; and separate files of the executive summary, abstract and
topline recommendations, and full recommendations. Many related resources are
being developed over time to make results accessible to diverse audiences.
Childbirth Connection is developing a program agenda to educate the relevant
stakeholders about results and address implications for the maternity care
system. To learn more and become involved in this work, please contact
Childbirth Connection Programs at 202.986.2600 or [email protected].
which is now a core program of the National Partnership for Women &
Families, commissioned the new report, with support from DONA International and
Lamaze International. The author, Dr. Sarah J. Buckley, is a medical writer
with a longstanding interest in the subject of the report. Referees from
diverse disciplinary perspectives provided comments on earlier drafts that were
used to strengthen the report.