For the Love of Oxytocin

There is a hidden world inside hospitals that rarely sees the spotlight: Labor and  Delivery. The majority of pregnant people in the United States give birth in a hospital setting,  where people are treated as sick patients and not healthy birthers. According to a study conducted by the Commonwealth Fund, the United States has one of the highest maternal and infant death rates in developed countries.  

When a low-risk, healthy pregnant individual is treated as such, the need for interventions during labor and birth is often unnecessary. The birth team is there to support and love the birthing person so they feel comfortable and safe. This safe feeling allows oxytocin to flow. Oxytocin is the love hormone and is arguably the most important hormone for labor and birth. When oxytocin is uninterrupted, labor progresses at the body’s natural pace.  

Hospital environments slow the body’s natural oxytocin production in a multitude of  ways, including but not limited to: 

- Bright lights 

- Frequent interruptions 

- Restricted movement 

- Nonconsensual interventions and routines 

- Continuous Electronic Fetal Monitoring  

Obstetricians and midwives in hospitals have different guidelines for when a low-risk pregnant person should make their way to the hospital. Typically, the birthing person will labor at home until contractions are 3-5 minutes apart, cannot talk through contractions, or when the water breaks with or without contractions.  

It is not uncommon for labor to slow or pause when arriving at the hospital. Adrenaline takes over while oxytocin sits back. Erica Chidi Cohen, cofounder and CEO of LOOM, states that to keep oxytocin flowing, the birthing person must continue to feel safe and comfortable.  Once oxytocin increases, labor progresses once more. Pauses can happen frequently throughout labor, not only upon arrival. For instance, labor is going smoothly and a nurse comes in to do a consensual cervical check, the person is at 8 centimeters, so the nurse calls the doctor into the room because it is almost time to push. There is a chance the person in labor only met this doctor once arriving to the hospital, not the person who they were seeing for prenatal appointments throughout pregnancy. Birth is an incredibly vulnerable moment, so the body may react by closing the cervix once the doctor walks in to again check the dilation  (openness) and effacement (thinness) of the cervix, which now measures at 5 centimeters based on the doctor’s findings. This regression is the body’s way of protecting itself. 

Depending on the hospital, if labor stalls or slows, the obstetrician may say labor is failing to progress and call for Pitocin to pick labor back up. Pitocin is the synthetic form of oxytocin that causes the uterus to contract. Birthing people often describe Pitocin contractions as jagged and sudden, unlike the gentle wave of intensity from unmedicated contractions. Once Pitocin is introduced to the system, a cascade of interventions sometimes seems unavoidable. The contractions are so intense, the birthing person cannot stand it and asks for an epidural, the most common pain relief during labor in the United States. Epidurals block the pain by numbing the lower half of the body, but the birthing person can still feel pressure. It is not uncommon for epidurals to slow labor down dramatically and lower the fetus’  heart rate. If the fetus is in distress, a cesarean may be deemed necessary.  

It is clear that if the labor was progressing normally before arriving at the hospital, but goes awry, then it is the hospital that needs to make some changes to how a birthing person is treated. Hospitals can support the natural flow of oxytocin by: 

- Dimming lights 

- Limit interruptions from staff 

- Quiet voices 

- Encourage movement and various birthing positions 

- Allow doula support 

- Intermittent fetal monitoring 

- Educate birthing person fully on all options, benefits, and costs before proceeding with any  intervention 

Births out of the hospital, at home or in a freestanding birth center, with a midwife present are the norm in many counties around the world. As stated by Karen R. Kleinman, MSW, LCSW and Valerie Davis Raskin, MD in "This Isn’t What I Expected," those who birth outside of the hospital are more likely to claim a positive experience, while some birthing in a hospital express feelings of trauma. It is time the United States sees birth as a natural, physiological process that when left undisturbed, will result in healthy a parent and baby.