The Oxytocin Quandary

I am delighted to host BloodtoBaby's first guest blog by Deborah Neiger (Independent Midwife at Yorkshire Storks).

Off the back of my recent blog 'Oxytocin administration & delayed cord clamping' Deborah discusses the differences between endogenous (natural oxytocin) and synthetic man-made oxytocin (Syntocinon) during labour and birth.

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Super Powers!

Oxytocin is everpresent in midwifery. It thrives within pregnant, birthing and postnatal women, it courses through midwives caring for women, it seemingly permeates the air during physiological births and when mothers connect with their babies. We love it!

Photo courtesy of https://milkandmoon.uk/

We love it so much that it’s molecular structure shows up in the form of tattoos, jewellery, art and all sorts other accessories midwives and mothers covet.

It enables the body to labour, minimises stress, maximises joy and facilitates mothers falling in love with their offspring. It has almost become a symbol of birth physiology, and rightly so.

The Alter Ego!

But there is another side…..the use of synthetic oxytocin, also known as Syntocinon or Pitocin which has now become one of the most common interventions in obstetrics.

It is used to either to induce or augment labour, or to attempt to prevent or stop a postpartum haemorrhage. Please don’t get me wrong…..the judicial use of synthetic oxytocin can make sense during some births and be occasionally lifesaving.

However, the vast majority of women in this country will have synthetic oxytocin injected into their bodies, either intravenously or intramuscularly at some point during her labour and birth.

Well, is this a bad thing, seeing as oxytocin is so amazing? Maybe, yes.

While the use of synthetic oxytocin is often framed as ‘simply adding the exact same hormone that the body is already producing, so we are just helping you along’, it really is not quite so simple.

Synthetic vs endogenous oxytocin

We have plenty of research to show how endogenous oxytocin facilitates the physiological pathways that influence mothers’ birthing and bonding behaviours and their ability to regulate stress and emotions.

We do NOT however have the same research pertaining to the use of synthetic oxytocin, and furthermore, we know that synthetic oxytocin can actually influence those pathways detrimentally, probably in a dose specific way. In the very interesting article ‘Beyond Labor: the role of natural and synthetic oxytocin in the transition to motherhood’ (Bell, 2014) this is explored in depth.

To summarise, and very simply, the more synthetic oxytocin we administer, the more inhibition of oxytocin receptors in the maternal body (and perhaps the fetal one) takes place, on a molecular, physiological and epigenetic level.

This down regulation is likely to change the behaviours facilitated by endogenous oxytocin. Endogenous oxytocin buffers stress experienced due to fear and pain (as might be experienced during birth), therefore optimising well being and survival of mother and baby.

The pulsing system of endogenous oxytocin release is also protective against anxiety and depressive feeling. We know less about the influence of synthetic oxytocin on this mechanism. Especially in the context of current birth practices and the fact that births induced or augmented may also be less satisfying to mothers and subsequently lead to low mood after birth. This could be because synthetic oxytocin does not act on the brain in the same way as natural oxytocin which promotes the release of beta-endorphins (pain relieving hormones) during birth (Uvnäs-Moberg, 2016). This is understanding of course, the likelihood of developing depressive feelings after birth is hugely multifactorial.

The impact of synthetic oxytocin on mothering behaviours has been studied mostly in animals. The outcomes of these studies are interesting but frustratingly inconclusive.

For example, in a type of vole, low dose synthetic oxytocin exposure increased the ability to form close bonds, while high dose exposure diminished the ability to bond.

In sheep and cows, optimal maternal behaviour is suppressed if endogenous oxytocin secretion is suboptimal due to regional anaesthesia, whereas in sheep, administering synthetic oxytocin can help them accept lambs that are not their own.

Human research generally seems to show that abnormal blood oxytocin levels are correlated with less optimal mothering behaviours (optimal for the purpose of research being continued breastfeeding, eye contact, positive affect and affectionate touch and language).

So. We still don’t REALLY know how exactly synthetic oxytocin differs from endogenous oxytocin. I am left pondering if synthetic oxytocin administration and its influence on birthing and mothering is simply an issue of ‘oxytocin overdose’, a definite difference in molecular effects of endogenous and synthetic oxytocin, or simply a reflection of birth intervention and its effects.

What we DO know is that manipulation of the oxytocin system around childbirth has long term effects and synthetic supplementation is certainly manipulation.

NICE (2014) guidelines currently recommend that all birthing women have some synthetic oxytocin to prevent post partum haemorrhage, so the vast majority of women are subject to this manipulation.

And personally, I certainly feel swayed that there IS a big difference between naturally produced oxytocin and synthetic oxytocin.

Photo courtesy of Carla Mastroianni founder of the super MaMas Club

If you have ever seen the subtle and not so subtle changes of a woman moving through her labour; the flushed cheeks, the gradual movement from analytical chattiness to the altered level of consciousness and focus in deep labour and the purpose and power followed by relief and elation, and the second wave of relief after the birth of the placenta. It often (by no means always) feels quite different to a birth that was induced before its time and augmented to the point of fear and agony, leading to regional anaesthesia. This is not a value judgement, simply an observation.

I would very much welcome more research and less eagerness to use synthetic oxytocin while doing everything to support the endogenous system of oxytocin release.

Deborah Neiger