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SNEE Local Maternity & Neonatal Services

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The Latent Stage of Labour   Getting to Know Your Cervix

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Mammalian Birth and how you can influence your hormones.

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SNEE Local Maternity & Neonatal Services

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SNEE Local Maternity & Neonatal Services

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SNEE Local Maternity & Neonatal Services

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SNEE Local Maternity & Neonatal Services

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Reducing your risk of perineal tears | RCOG

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The following animation explains what an OASI is, the four components of the OASI Care Bundle and how women can reduce their risk of sustaining an OASI in childbirth.

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This hub aims to inform about the types of tears that can occur during childbirth, how to minimise your risk of deeper tearing, and what can be done to help your recovery if you do tear.

We also aim to support you to take prompt action if you have any concerns about your recovery, helping you feel better informed when discussing any topics with a healthcare professional.

This information has been developed by the OASI Care Bundle Project Team, the OASI Care Bundle Clinical Champions and perineal specialists.

It is based on the RCOG Green-top Guideline No.29 The Management of Third and Fourth Degree Tears (June 2015) and expert opinion from the above named developers and key stakeholders in line with RCOG due process.

Please give us your feedback

We would like to understand how people are using this resource to help ensure it is relevant and useful. To give us your feedback, please complete our short survey.If you have any questions, please email womensvoices@rcog.org.uk

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Perineal tears and episiotomies in childbirth

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Welcome to our hub for perineal tears and episiotomies in childbirth.

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All4Birth on Instagram: "Resharing a fantastic feel from Sally over @pregnancy.chiropractor , Sally has a selection of fab videos on her instagram 🔗✨

Posted @withregram • @pregnancy.chiropractor The last time I shared this post, it went viral! 1.2 million people viewed it, and over 800 commented! So many women shared their experiences of birthing on their back, sometimes by choice, but often not.
Others shared how much easier they had found birthing in other positions, standing or kneeling, for example. 

Anatomically, upright birth positions allow much better movement of the pelvis (the movement I show in the video is exaggerated for demonstration!). There’s also research to show that contractions are more effective, blood flow to the baby is better, and chance of severe tearing is reduced. 

Pushing on your back can be difficult! But it’s still very much the norm in most places around the world 🌎.

If you’d like to birth in upright positions rather than in your back, have this conversation with your care provider in advance. 

#birthposition
#hospitalbirth
#birthchoices
#birthtips
#thirdtrimester
#birthprep
#pregnancychiropractor 

How was it for you?? What position did you give birth in, or if you’re currently pregnant, what would you like to do?"

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127 likes, 3 comments - all4birth on July 3, 2024: "Resharing a fantastic feel from Sally over @pregnancy.chiropractor , Sally has a selection of fab videos on her instagram 🔗✨

Posted @withregram • @pregnancy.chiropractor The last time I shared this post, it went viral! 1.2 million people viewed it, and over 800 commented! So many women shared their experiences of birthing on their back, sometimes by choice, but often not.
Others shared how much easier they had found birthing in other positions, standing or kneeling, for example. 

Anatomically, upright birth positions allow much better movement of the pelvis (the movement I show in the video is exaggerated for demonstration!). There’s also research to show that contractions are more effective, blood flow to the baby is better, and chance of severe tearing is reduced. 

Pushing on your back can be difficult! But it’s still very much the norm in most places around the world 🌎.

If you’d like to birth in upright positions rather than in your back, have this conversation with your care provider in advance. 

#birthposition
#hospitalbirth
#birthchoices
#birthtips
#thirdtrimester
#birthprep
#pregnancychiropractor 

How was it for you?? What position did you give birth in, or if you’re currently pregnant, what would you like to do?". 

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View this post on Instagram

A post shared by All4Birth (@all4birth)

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SNEE Local Maternity & Neonatal Services

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SNEE Local Maternity & Neonatal Services

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PELVIC HEALTH & JAW TENSION-HOW THEIR CONNECTION WILL MAKE YOUR JAW DROP

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On a visit to my osteopath many years ago, I was amazed when I found out a very valuable insight about the inter-connection between the jaw and the pelvis.   It seems initially surprising that when trying to resolve concerns in the pelvis, an osteopath will often treat the jaw (or vice ver

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On 25th March 1966 SCIENCE, VOL. 151 published Niles Newton’s ‘Parturient Mice: Effect of Environment on Labor’

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On 25th March 1966 SCIENCE, VOL. 151 published Niles Newton’s ‘Parturient Mice: Effect of Environment on Labor’

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This was groundbreaking. Have a read.

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Opening outlet/Opening inlet     Toes OUT – opens inlet/closes outlet                                                  Toes IN – opens outlet/closes inlet

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Opening outlet/Opening inlet     Toes OUT – opens inlet/closes outlet                                                  Toes IN – opens outlet/closes inlet

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Synthetic oxytocin is widely used in maternity care around the world. It is commonly administered to women to induce or to speed up (augment) labour, and to prevent or treat bleeding after birth (postpartum haemorrhage).

Like all maternity-care interventions, synthetic oxytocin may be beneficial, even life-saving, for mothers and babies in some situations. However, because of its widespread use, including in many healthy mothers and babies, it is important to understand the possible risks and side-effects.

This two-part blog explores some important questions, including:

Is synthetic oxytocin harmless, because it mimics the natural oxytocin that women release during labour?

Do high doses of synthetic oxytocin impact the mother's own natural oxytocin release in labour?

In Part 2: (coming in Nov-Dec 2019: make sure to sign up to my newsletter)

Could synthetic oxytocin interfere with the new mother's ability to bond with her baby?

Could synthetic oxytocin impact breastfeeding success?

Could synthetic oxytocin impact the baby's developing oxytocin system, as found in animal studies?

Could synthetic oxytocin even cause autism?

Much of this information comes from a new publication on I s synthetic oxytocin harmless, because it mimics the natural oxytocin that women release during labour? Maternal oxytocin levels during physiological childbirth, which Sarah is a co-author (more details below
It is true that the chemical structure of synthetic oxytocin is identical to the chemical structure of the natural (endogenous) oxytocin that our bodies produce during labour, as shown in this picture.

However, our own natural oxytocin is made in the brain and is released during labour into both the body, where pulses of oxytocin reach the uterus and cause the rhythmic contractions of labour, and also locally into the brain, where it has calming and pain-relieving effects.

As labour progresses, high oxytocin levels in the brain help to counter the stress and pain of the strengthening contractions, which are caused by high levels of oxytocin stimulating the labouring woman's uterus. At the same time, oxytocin is activating her brain's pleasure and reward centres in preparation for bonding with her newborn baby.

In contrast, synthetic oxytocin is administered intravenously (IV), and in constant, high doses rather than in lower-levels and pulses. This can lead to maternal oxytocin levels that are more than double those in a natural (physiological) labour. (See Oxytocin levels during physiological childbirth)

For these reasons, IV synthetic oxytocin causes contractions that are longer, stronger and closer together than the woman's body would naturally produce, especially in early labour.

In addition, synthetic oxytocin does not cross into the brain to help counter the increased stress and pain, as explained in Oxytocin levels during physiological childbirth. Therefore, the stress system may be more activated for women administered high doses of synthetic oxytocin in labour, compared to physiological labour.

Women who are administered synthetic oxytocin also commonly receive epidurals to counter the increased pain, and women with an epidural often require synthetic oxytocin, because epidurals reduce the natural release of oxytocin, as explained below and in this blog.

With this combination, women will miss the natural stress-reducing benefits of their own oxytocin, which also has anti-inflammatory and anti-oxidant effects. (More about this below.) This combination might also explain some of the longer-term effects that have been found for synthetic oxytocin, as discussed in Part 2.

For the baby, the longer, stronger contractions will inevitably reduce blood and oxygen supply to some extent, increasing the risks of hypoxia (low oxygen), which is especially dangerous for the baby's brain at this time. For this reason, women administered synthetic oxytocin in labour always require monitoring of the baby's heart rate to check for indications of hypoxia.
Do high doses of synthetic oxytocin impact the mother's natural oxytocin release in labour?
Some studies suggest extra risks of hypoxia and its possible long-term consequences for babies exposed to synthetic oxytocin in labour, although this area is not well studied. (See studies below.)

Prolonged, high doses of synthetic oxytocin can disrupt the mother's oxytocin system by reducing the number and function of oxytocin receptors in her uterus. This "receptor desensitisation" will reduce her uterine sensitivity to oxytocin, and decrease the effectiveness of oxytocin (natural or synthetic) to cause strong contractions, including after the birth. This explains why women who receive synthetic oxytocin in labour have a higher chance of postpartum haemorrhage and require extra medications to counter this risk.

(For more great articles like this, make sure to sign up to my newsletter)

It is sometimes presumed that administering synthetic oxytocin in labour will reduce the mother's own oxytocin production. This is not true, according to our current understandings.

Oxytocin in labour is not controlled by the usual 'negative feedback' systems, whereby high levels of a biological marker leads to feedback that reduces levels. For example, our blood pressure is controlled such that excessively high blood pressure is detected by our body systems, and leads to changes that bring it back down to what is normal for each of us. This negative feedback is operative in most biological systems, and contributes to homeostasis- the maintaining of physiological stability in the face of external changes.

However, labour is not a homeostatic process! In labour, contractions need to strengthen rather than remain stable, and eventually be strong enough to push the baby from the mother's uterus. This strengthening requires positive, rather than negative, feedback systems, also called 'feed-forward cycles.'

This diagram shows one feed-forward cycle in labour, where the sensations from strong uterine contractions cause feedback in the brain that releases oxytocin, causing even stronger contractions, more sensations and more oxytocin release.

This feed-forward cycle, also known as the Ferguson reflex, provides the high levels of oxytocin (3-4-fold increased at birth) that are needed for the birthing mother to have an effective pushing stage.(See Oxytocin levels during physiological childbirth)

The administration of synthetic oxytocin (without epidurals) will not reduce this cycle, or the labouring woman's natural oxytocin release. In fact, as will be discussed in part 2, synthetic oxytocin may even accelerate this feed-forward cycle (and increase brain oxytocin) by causing stronger contractions with greater sensations.

However, when epidurals are co-administered, the sensations of contractions that fuel this feed-forward cycle are abolished, which slows or even stops the cycle, and consequently slows or stops oxytocin release, as described in this blog.
In summary
The combination of epidurals with high doses of synthetic oxytocin can therefore increase physiological stress in labour, but reduce oxytocin release in the labouring mother's brain, which would usually counteract this stress in labour. (This stress reflects the extra biological stresses in her uterus from the stronger contractions, and can occur even if the labouring woman does not feel the associated pain.)

In addition, we know that prolonged, high doses of synthetic oxytocin can disrupt the oxytocin system by reducing the labouring woman's uterine oxytocin receptors, as explained above.

Note that we do not think that receptor desensitisation occurs in the brain, because oxytocin (or synthetic oxytocin) does not cross into the brain through the 'blood-brain barrier' in significant amounts, as explained in our paper, Oxytocin levels during physiological childbirth.

Synthetic oxytocin is chemically identical to the natural oxytocin released by women in labour and birth. However it has different effects because it is administered IV and does not cross into the labouring woman's brain.

In contrast, natural oxytocin is released from and into her brain, and gives calming, pain relieving effects that counteract labour stress. Within her brain, natural oxytocin also activates reward and pleasure centres in preparation for bonding with her newborn.

While synthetic oxytocin does not directly reduce the mother's own oxytocin release, the common co-intervention of epidural analgesia significantly reduces oxytocin release. This can slow labour and reduce oxytocin's anti-stress, anti-inflammatory and anti-oxidant benefits. This combination might explain some of the longer-term effects that have been found for synthetic oxytocin, which will be discussed further in Part 2.
References and resources
In addition, prolonged, high doses of synthetic oxytocin can disrupt the labouring woman's oxytocin system by reducing her uterine oxytocin receptors. This makes her uterus less responsive to oxytocin and increases her risk of bleeding after birth.
Ecstatic Birth ebook

Could synthetic oxytocin interfere with the new mother's ability to bond with her baby?

Could synthetic oxytocin impact breastfeeding success?

Could synthetic oxytocin impact the baby's developing oxytocin system, as found in animal studies?

Could synthetic oxytocin even cause autism?

(For more great articles like this, make sure to sign up to my newsletter)

Much of this information comes from a new publication on Maternal oxytocin levels during physiological childbirth: A systematic review with implications for uterine contractions and central actions of oxytocin This was written with the good work and dedication of colleagues Kerstin Uvnas Moberg, Anette Ekstrom-Bergstrom, Sarah Buckley and other European co-authors. This work was partly funded by EU COST IS1405 BIRTH: Building intrapartum research through health.
Note that these studies are observational and do not imply causation. However, there is very little high-quality research available in this area.
Hormonal Physiology of Childbearing report Sarah's 2015 report with lots of information about oxytocin (Free download)

Sarah's 2-part blog on epidural effects, including oxytocin

Impacts of synthetic oxytocin in labour:

Bugg 13 : Augmentation with synthetic oxytocin has minimal benefits (Cochrane review)

Rahm 2012 : Epidurals reduce oxytocin

Robinson 2003: Exposure to synthetic oxytocin reduces uterine oxytocin receptors

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Synthetic Oxytocin (Pitocin, Syntocinon): Unpacking the myths and...

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(For more great articles like this, make sure to sign up to my newsletter) References and resources Much of this information comes from a new publication on Maternal oxytocin levels during physiological childbirth: A systematic review with implications for uterine contractions and central...