Return to Focus on Physiologic Birth Introduction

A Focus on Physiologic Birth

Physiologic Childbirth

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 Physiologic Childbearing

The following recommendations arise from results synthesized in Hormonal Physiology of Childbearing:


  • Educate all maternity care providers in the hormonal physiology of childbearing.


  • Use effective policies and quality improvement strategies to foster consistent access to physiologic childbearing.

  • Strengthen and increase access to care models that promote physiologic childbearing and safely limit use of maternity care interventions.

Engaging and Supporting Childbearing Women

  • Use effective consumer engagement strategies to inform women about physiologic childbearing and involve them in related aspects of their care.

Maternity Care Practice, Whenever Safely Possible

  • Provide prenatal care that reduces stress and anxiety in pregnant women.

  • Foster the physiologic onset of labor at term.

  • With hospital birth, encourage admission in active labor.

  • Support privacy and reduce anxiety and stress in labor.

  • Make nonpharmacologic comfort measures for pain relief routinely available, and use analgesic medications sparingly.

  • Make nonpharmacologic methods of fostering labor progress routinely available, and use pharmacologic methods sparingly.

  • Promote continuous support during labor.

  • Foster spontaneous vaginal birth, and avoid unneeded cesareans.

  • Support early and unrestricted skin-to-skin contact after birth between mother and newborn.

  • Support early, frequent, and ongoing breastfeeding after birth.


  • Identify and carry out priority research into hormonal physiology of childbearing, and routinely incorporate this perspective in childbearing research.

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].

Childbirth Connection, 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.


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