#216 | The Mystery of Functional Birthing Explained with Author Sarah Thompson

June 7, 2023

With the right knowledge and education about the intricacies of our own health, we have the potential to influence how our body gives birth. Did you know that by twenty-eight weeks of pregnancy your body is already making physiological and functional shifts to prepare for labor? Or that your baby's adrenal glands are the biggest factor in the initiation of labor? Have you ever heard that sub-clincal hypothyroidism is associated with a significantly higher rate of postpartum hemorrhage or that if you are magnesium deficient, your oxytocin receptors may not be as readily available?  Are you curious about the role of CoQ-10 in the prevention of pre-eclampsia or how hylauronic acid influences cervical readiness for labor?  Author Sarah Thompson of @functionalmaternity gets into all the fascinating details of the functional birth process and gives us practical tips on what we can do to optimize our bodies for birth.  We're sure you've never heard physiologic details like this before. Grab a pen, a pad of paper, and your thinking cap for this one!

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View Episode Transcript

How do we prevent complications? Well, we don't prevent them in the moment, just like preeclampsia, we gotta go backwards, we gotta go back to when these processes first start. If you can't make oxytocin receptors, you're not going to be able to attach oxytocin to the uterus. And that happens weeks before we actually go into labor. If we can't build our oxytocin receptors, because we are vitamin A deficient or we are sub clinically hypothyroid. Well, again, we can give them Pitocin. All day long, it's not going to do anything. There's no receptors for them to grab on to functional birth experience. To me, the physiological birth experience to me is that the steps happened is is the body functioning or the processes happening? Right? Is the mother able to gently go through that experience without having trauma.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hi, there, I'm Sarah Thompson. I'm a certified functional medicine practitioner who specializes in maternity care. And I'm also the author of the book functional maternity. And today we're going to talk about preparing for the functional childbirth experience.

What is the functional childbirth experience? So that's kind of a new term. Can you tell us a little bit about what a functional birth experiences we talk a lot on our podcast about physiologic birth? But I get the sense that they're a little bit different.

Yeah, the terms can be interchangeable. Absolutely. We're talking about what is the natural physiology of childbirth? And how does that physiological response expand outside of just hormones that go into causing contractions? How does it affect the overall physiology of the body? And how does the physiology of the body affects the birth experience?

Is the term functional used in the same way? It's used in functional medicine overall? Exactly. And how is that what is the meaning of functional medicine overall?

So the meaning of functional medicine is the how does the body function? Right? So the physiology, and how do those different functions play into one another? So versus just looking at what's the physiology of the ovaries and the uterus and how they function? We go into how do the adrenal glands also play into this reproductive response? How does the pituitary gland and the thyroid hormones also play into this physiological response? And then of course, with functional medicine, one of our big focuses is diet and lifestyle. So how did those experiences also affect the physiological responses?

Okay, I think it would, I think it'd be safe to say that most of modern obstetrical and maternity care doesn't put a lot of emphasis on the functional part of pregnancy and birth do they know, I mean, they definitely understand the physiological side. But most of their, their training, and most of what they do is on the management and control of those physiological responses, instead of the support the natural physiological response. And childbirth is one of those great, great examples of that because physiologically, the body is preparing for childbirth, all the way back at 28 weeks, the body is already making changes to prepare the mother for the birth experience. And in conventional medicine, the birth experience is this small window in which we make changes to the physiology. But there's a whole lead up, you know, 10 to 12 weeks of lead up of physiological changes in the maternal body that set this person up for birth success, or birth complications.

So what what is that process where we're right before that process begins? What's going on? And that what triggers the process to begin and prepare the body for birth? Yeah, the biggest trigger of all of this is the baby itself. So most people don't realize that the primary driver of all the hormonal changes in pregnancy is the actual baby. Right? The the fetal adrenal glands are 90%, bigger in the womb, then they are weeks after delivery, they immediately shrink after birth. And it's the fetal adrenal glands that produce majority of these hormones with the help of the placenta. So you can start to see that the fetal adrenal glands are producing these hormones as early as 16 to 18 weeks. But we see the biggest surge in these hormones starting at around 28 weeks, and the primary hormone that these fetal adrenal glands are producing is cortisol.

I think of that as a stress hormone. I mean, it is a stress hormone. What's the I know it can also serve a purpose for us like we get a flight of it in the morning, it helps to wake us up and make us feel energized in the morning. It's essential to function. What's the what's the purpose of it at 28 weeks? What does it start to do in the body?

So at 28 weeks, cortisol starts to send signals from the placenta to the mom, and the mom's body starts to produce a little bit more cortisol. And we do have two different types of stress hormones, we have cortisol, and we have cortisone, right? Think of cortisol as our driver of life. It's, there's a receptor for cortisol and literally every cell of the body, every nerve cell, skin cell, cartilage cell, has a receptor for cortisol. And cortisol regulates neurotransmitters, it's been known to regulate things like peristalsis, heart rate, blood pressure, all of these different functions in the body, then you have cortisone, which think hydrocortisone cream, right. It's a natural anti inflammatory. And everything about pregnancy. And everything about childbirth is an inflammatory experience. And it's this natural inflammation to some degree that helps to trigger these little changes that we see. And from 28 weeks on, it's like a little stair step of change that happens. Hormones in pregnancy, do this little increase, right, we see the steady increase in hormones throughout the beginning of pregnancy. And then at about 28 weeks, they literally skyrocket. And we see this almost doubling every week of these hormones. Right, they peak at about 34 weeks, certain ones start to come down like progesterone, cortisol tends to stay elevated. And we see these different changes as we lead to labor and delivery. But this all happens so much further back. And this cortisol that we're getting from the baby goes into the placenta gets into the mother's bloodstream, and starts to make changes in her system to trigger these different changes in preparation for labor and delivery, one of the biggest changes changes to the cervix. So at the onset of pregnancy, the collagen fibers of the cervix, the cervix is just one big old chunk of collagen, right, just like the finger nose and your ears, it's a collagen base, the fibers of the cervix winded themselves together to become like this nested bowl of inter entertain intertangled fibers, because we do not want those fibers to come apart. What we see in microscopic studies of the cervix is that cortisol stimulates a remodeling of the cervix. And this happens all the way at the beginning of the third trimester, and sometimes at the end of the second trimester. And what we start to see is an unwinding of the cervical fibres. So then all that they can become parallel. We don't want them soft, we still want them hard, we want them firm. But we have to start making that change so that we don't get to 40 weeks, and we have a couple of fibers that are still intertwined. If we have that that's gonna be harder to open that cervix.

That's amazing. Isn't that cool? What we've afford to continue? What is this the science of who knows this? was discovered that study this what field of work? What field of scientists have done this work? What is this called this study?

It's a study of obstetrics, how do you know it's out there? By finding the research looking for it?

So interesting? Why are we never why are we never talking about influencing cortisol levels in late pregnancy as a method for induction, let's say I have seen a couple of clinical trials pop up recently, in which they are looking to change cortisol levels. But mostly because I think cortisol is such a hormone that's not as understood in pregnancy. We don't do a ton of research on cortisol outside of a couple of different fields. And and there's a lot that goes into it. Right?

I continue influencing parts of the body. Yeah.

And it's and it's an interplay, there's not just one hormone or not just one system that triggers all of this, right? So if we go back to the cortisol side, right, we've got this little remodeling thing that's happening. Some of this cortisol is actually going back to baby to stimulate the maturation of the lungs and the digestive system. Right. And then the more mature baby gets, the more cortisol and all these hormones get produced, and then more cortisol for mom gets to baby and we see this lovely cycle happening. And in the end, we I think we're all pretty aware at this point, that it's the maturation of the lungs themselves, that stimulates the onset of the active labor process. And so it's all actually starting way back at this 28 week mark. The other hormone that's getting produced by the baby is DHEA. And the placenta converts DHEA into estrogen. estrogen levels also skyrocket starting at that 28 week mark. estrogens are responsible for the production of things like prostaglandins. Right, I think we're all familiar with prostaglandin Because that's one of our induction methods.

Why don't you explain prostaglandins anyway? You never know who's listening who's newly Brighton. And let's just explain everything. Yeah.

So there's different types of prostaglandins, the ones I'm talking about in in this, this context are what we call series to prostaglandins. So we have PGF, two alpha PG, e twos. And there's these different types of prostaglandins that do different things. We've also got our one series prostaglandins that work on the coagulation aspect of things like pasta, cyclins, Thrall box and a two, there's all these other different prostaglandins that get produced closer to the onset of delivery so that we can clot, right? We don't want to bleed out. Right? There's a balance that has to happen. prostaglandins are have have a bad reputation because they are associated with inflammation. They are also made from a compound called arachidonic acid. arachidonic acid is made from omega six fatty acids in the diet. Right? So we have kind of fear of omega six fatty acids in our world, but we need them, we absolutely need them for the labor and delivery experience.

I thought they were I always think of them as a good thing, because they are what ripens the cervix. Yes, but you're saying that it's not the only function in this biofeedback system between the body, the placenta, the baby, you're saying the prostaglandins are also responsible for allowing coagulation to prevent postpartum hemorrhage?

Yes, and more. So we'll keep going down this journey, because prostaglandins do so much. So when we're talking about those prostaglandin. So going back to that cervical fiber aspect, right? While cortisol is making those fibers work that parallel as we kind of stair step our way each week with a little bit more progression in the maturation of our baby, and a little bit more hormone production. We need those prostaglandins to soften the fibers, we need to give them flexibility. Again, we still don't want them to open. But we need to start making them softer and squishier so that when we ask them to open, we can do that. The other thing we start to see is that estrogen, prostaglandins, these hormones coming together, start to make oxytocin production on the inside of the uterus. Now we're getting the Braxton Hicks contractions. And when we get this oxytocin production on the inside of the uterus, it stimulates the development of prostaglandin receptors in the cervix itself. And so now we've got another cyclical action happening down here, right, between oxytocin and these little minut contractions and prostaglandin production and estrogen who stimulates the actual genetic expression of your oxytocin. Estrogen does other things in the body during this timeframe to up regulates magnesium transport and absorption, because we need that to make things like nitric oxide. Right. Nitric oxide is a they though dilator and basal relaxant. And we see studies that talk about low estrogen levels, and low low nitric oxide production being associated with preeclampsia. With later on in pregnancy, we also need magnesium to help with the transport of thyroid hormones, which we see that there is upwards of a 50% increase in the need for thyroid hormones in the third trimester, you have to have thyroid hormones to make oxytocin receptors. Seems like estrogen is a really important variable in this picture. And thyroid clearly is also very important. So two things to think about maybe in preconception or in pregnancies, you know, like how does one control their healthy estrogen is that just by having a healthy liver, it's not her so it's not her, it's the placenta.

The placental production makes estrogen, it's not mom's estrogen, the s the placenta is taking the DHEA that the baby is producing and converting it into estrogen. So the more mature baby gets thanks to those cortisol levels, the more DHEA their adrenal glands produce and the more estrogen the placenta can produce. It's just converting it.

So there's really you don't really have a lot of control over that side as much, what goes into making those happy, healthy estrogen levels as a happy healthy placenta. So things like reducing oxidative stress in the placenta, lots of antioxidants. The the placenta itself is prone to oxidative stress conditions. And for those who aren't familiar with oxidative stress as a term, it's it's like our medical term for pollution, internal biological pollution. And every time we do a function in the body, we make a hormone. We make a neurotransmitter we burn calories for energy. We make pollution every single day you and I were all making pollution. And in pregnancy. It's a very polluting process. And we'll see that there is an up regulation in the production of certain antioxidants in the body Kokyu tin defiance superoxide dismutase these are found very heavily in the placenta. And protecting the placenta is often protecting it by removing the pollution. Because, you know, if you, those of us, you know, if you go and live in the country versus living in LA the pollution aspect, right, we see differences in people's health outcomes based off of some of those things, because pollution is toxic, or unnatural pollution that we produce every single day can become toxic. And pregnancy is prone to higher rates of pollution, because the whole process is very inflammatory.

And really want to get back to this. This process you were describing, it's genuinely fascinating. And I was already forming the big takeaway, in my own mind that this is such an incredibly complex process. I mean, I think humans have barely scratched the surface on really understanding and having a reverence for pregnancy and childbirth. But it's just so interesting how every little action in the body is critical for the subsequent action. So my thinking is, if any of this is disrupted, it's going to have downstream effects. Absolutely. And so that that's where this is really getting interesting, because we always view it as isolated like you're pregnant, and then suddenly, you're in labor boom, that's not at all what's going on. So let me interject one question before you proceed with explaining that. Maybe it's too big of a question for this point of the conversation. How does one most easily remove toxins and pollutants? Yeah, that's what everyone's gonna be thinking about now.

Sure. And again, a lot of it is happening, the placental development side of things is happening really early in pregnancy, the trophoblast cells that become the placenta, you have a placenta by 10 weeks. Right, that person is already functioning and doing things by 10 weeks. And you'll actually see some cases a very, very early onset preeclampsia, like 12, week, preeclampsia cases. And that placenta support really begins preconception early. So the best thing you can do is work on reducing this oxidative stress pre conceptionally, making sure you're getting the antioxidants in the diet, doing your best to avoid pollutants as best you can. There's a lot that goes into making superoxide dismutase glutathione. Some people with, you know, certain methylation and you know, if it means cycling issues can't make as much glutathione there's a genetic component there. So really, things like that help reducing your mental stress load, right? Sleep is probably the most important thing that you can do. Sleep is when we detox sleep is when we go and we clean out this pollution. And there are so many studies that talk about sleep deprivation, sleep apnea, sleep breathing problems, insomnia patterns, with more complications in pregnancy, really associated with this internal pollution.

And we don't just mean then difficulty sleeping in pregnancy, insomnia of pregnancy, you're talking about sleep problems leading up to pregnancy. So three months, six months a year before conceiving, making sure that you have really healthy good sleep habits, so that you have the healthiest development of a placenta.

Yeah, those are the best things once you are pregnant, it does get harder. I mean, everything is so rapidly changing in pregnancy. And it's it's one of the things I tell the midwives and people who I consult with, I consult with midwives and physicians all over. And it's one of the things we talk about a lot is 90% of the time when we get these patients, we're already in acute crisis management, right? We don't have time for prevention for a lot of these people. And it becomes using sometimes antioxidant therapy and there's some really cool studies out there there that were were researchers are looking into using these innate antioxidants in supplemental form and, and medication form to prevent and treat these complications, like alpha lipoic acid is one that we've seen a lot of research on. And you know, so far safety studies on that look good. But you'll see studies talking about using alpha lipoic acid to treat preeclampsia, and to treat gestational diabetes and and preterm labor. subchorionic hematoma has all these different complications that we see throughout pregnancy by giving this interesting. Antioxidant, right same thing with in acetyl cysteine. Right. There's a little bit of research coming out on in this little cysteine and the prevention and the treatment of some of these conditions. And again, these are all early studies, but it's promising and it's based off of understanding this unique functional physiology of of the pregnancy experience.

Are these in pill form? Are we talking very high doses in liquid intravenous form?

Um, The research so far is in pill form that I've seen.

So is that something that you would recommend that women looking to conceive are taking these supplements in advance of pregnancy?

Depending on the individual, I don't I don't believe in generic supplementation. The one that has the most research backing on it right now is CO q 10. We see a lot of research in the prevention of preeclampsia and the support of mostly like advanced maternal age moms, simply because we see that CO q 10. levels drop as we age, and supplementing with that has been shown to help support the body, the cardiovascular system and the metabolic systems.

So that may be one explanation for the higher rates sometimes of hypertensive issues and pregnancy.

Yeah, as we age, we are more prone to oxidative stress because oxidative stress is a part of aging, we naturally produce less of our innate antioxidants. So those glutathione bones superoxide dismutase Kokyu, Tim. And so we're already set up for slightly more inflammation as we age in the pregnancy experience.

Where did we leave off on that, um, I'd love to get back to your saying about the physiologic process, you know,

I have to I write my notes as I go. And so I have my lovely little, little diagram to keep us on track. Okay, so estrogen is kind of where I left off talking about the upregulation of magnesium, and then how some things like the magnesium helps with transporting thyroid hormones. Estrogen is also responsible for the making of the oxytocin side and the oxytocin receptors, we see the that being a big part. The other interesting thing we see estrogen doing is it makes what we call gap junctions. gap junctions are connections to the nerve cells within the endometrial and the uterine tissues, because we need a lot of neurotransmitter function for the actual birth experience. And we have to set the foundation for that. We have to make all these little connections as we build up that staircase. So that when somebody goes into labor, everything's in place, we've got all the nerves we can send those signals. At in labor, we have all sorts of different different neurological signals that are happening, everything from the communication to control the actual contractions, right, which we need more magnesium and calcium and all those great electrolytes to make that happen. But we also need to be able to do things like make the catecholamines surge. Right. The catecholamines surge is huge. And at what point does that show up? The catecholamines? When do we need catecholamines to show up? Yes. Because, yeah, it's always been my understanding that we don't want catecholamines while we're dilating. So when do we and then of course, it's a different experience when she's 10 centimeters, and we need that energy. Exactly. Yeah. Is that the point we're talking about? Yeah. So if we look at again, now we can go into the natural physiology of childbirth. Right? So let's just say everything happened the way it's supposed to, we had all the cervical changes all these great things. prostaglandins made everything nice and soft and squishy? Well, there's this really cool thing that happens at the onset of labor. And it has to do with a cool chemical. Nobody ever talks about called hyaluronic acid. Evergraze hear about hyaluronic acid and labor and delivery?

No, just you just use it for the face. Well use it on our skin right to prevent wrinkles. Hyaluronic Acid, your skin. Your skin.

Yes. It's like a liquid. What is it? In theory?

Yeah, it's a carbohydrate based chemical. That is it's a lubricant of skin and cartilage is what it is. And what it tends to do is basically suspend suspend fluid and animation in a way in between, in between cells to give them plumpness. Right. It is an extremely important part of the labor and delivery experience. So remember, we went back we made our we made our structure of the cervix parallel, we gave it flexibility. And now we're going to face it. And we have faced it with hyaluronic acid. Hyaluronic Acid comes in and fill the interstitial spaces. Oh, look, we're getting some squishy vector, right? And then it starts to stretch. And then oh my gosh, now we're super squeegee in there because we put so much fluid in it.

Can you talk about a basement for those who don't understand a basement? It's funny, my my, my niece listen to listen to this podcast. She's in her early 20s. And she's nowhere near ready for this. And she she's like I love when you guys stop and explain things. And I know we have followers who do too, so forgive me for interjecting with that but please explain a basement.

Yeah, a basement is literally this. It's the softening of the cervix and this descending or is it just a softening, it's attending as well. But in order to then it has to say the softening and then it kind of visually, you know, like as we're plumping up those fibers it softens and squishes and then like narrows out so that the tissue around the cervix is thick. And defacement is the process in late pregnancy in which that thick tissue Around the cervix becomes ultimately paper thin and then it's in a position to draw back easily as we're dilate, then there's less tissue for the uterus to draw back.

But it's not really the tissue around the cervix is is what is the cervix is the tissue, right? Your cervix is like a tube, think of it as like a tube. It's long, it's usually several centimeters, four centimeters long. It's long. And then the effacement is the shrinking of that the thinning of it out.

The tissue is the structure is literally changing. Right? That's what we're seeing here is the structure literally changed. So this is earlier when you said it's changing the structure of the cervix, that is what you meant. Yeah.

And the actual face met part we see is literally the flooding of this hyaluronic acid into the cervix. To make it gooey. Right, we're melting the cervix by adding fluid to it, which makes it easier to dilate later to get that tissue to drop back into the uterus later. That's why this step is happening. Yes, which really gives you a respect for allowing labor to start on its own. Because when you take a woman who hasn't been through that process, and we flood her with Pitocin, you can start to imagine all the risks involved. A body just isn't there yet, the steps haven't taken place yet. Well, that's prostaglandins, and cervical dilators. And to be happy, you can't just go in and start contracting the uterus with a without a, what they refer to as a ripened cervix, which, but then I forget what year the study was. But there was a study that compared induction methods. And it's when we started moving away from just using Pitocin for inductions, adding in the cervical ripening agents, there was a really cool component of that study where they use hyaluronic acid for labor induction. And they injected the cervix with hyaluronic acid every three hours, I'm pretty sure is what that was. And it had better labor outcomes, with less complications, less cesarean delivery, but it was deemed unusable because nobody liked being injected in the cervix. It's a horrible method of delivery. Right? But really, what some other way, can you just use like a suppository.

One of the things we see is that oh, and that'd be good. I mean, I think there's some other studies that are coming out, or they're like clinical trials looking into that now. And prior to that there was a lot of research basically going into these different ways we can we can try to change hyaluronic acid, how do we support natural hyaluronic acid and understanding the physiology of hyaluronic acid in these scenarios. But you see, again, in this physiology, right before the onset of labor, you can measure Hi, Ilan, I hyaluronidase in the bloodstream, and it just skyrockets literally right before the onset of delivery, and then drops because the body fills the bloodstream with it. And then it all goes down to the tissues.

And this is exactly the kind of thing I was thinking about because of the conversation you're bringing here. Because even if Okay, so they used to just induce women with Pitocin until they said, That's a terrible and dangerous idea. So then they said, well, let's just go the step before and start her off with prostaglandins. And now the Pitocin won't have this, the same risk. But I can't help but wonder because of this conversation won't. If you just start with prostaglandins, you're you're still interrupting the process of what was happening before? And as my mind was? Considering that, you said, Well, yeah, it's not just happening at the cervix, it floods your whole bloodstream. So when we do say, Oh, well, we're ahead of this, we're now going to inject it into her cervix, you're still you're still intervening in the process that must happen throughout her entire body, her brain, her placenta and her baby. You can't just like, you know, stick this process with, oh, here's an injection now we're good. This really gives us such an appreciation for to every extent possible. not interrupting this process, because you're you're what led up to it, I don't know, I'm, it just gives me an appreciation for not interrupting this process more than ever, especially because it really is initiated by the baby. So just injecting the mother with something is in a baby who's not ready. Yeah, that's really overriding the system. But what you said about the it was so interesting about it coming from the lungs and the cortisol because we know that, you know, we we do give moms cortisol to, to rapidly develop the infant lungs in preterm labor. So we know it works. Yeah. So I just wonder if that was ever used in like postdates pregnancy, somebody who's 42 weeks and hasn't gone into labor. And you know, they're talking about induction now and C section have we never tried the cortisol method? I haven't seen any studies on it. But that's not to say somebody hasn't done them. Right. Maybe there maybe there are studies and I just haven't seen them. I have never heard anything about them using it outside of using it with preterm deliveries, knowing that we need to try to get baby's lungs to mature a little faster.

Yeah, just an interesting thought. Yeah, it is an interesting thought. And that's, those are the type of conversations that I hope to elicit in the people who do the research, right. Let's look into this. Why are we not looking into this? How do we use this physiology earlier than acute crisis management in the actual labor and delivery experience, because by the time we get there, sometimes it's too late. Right? These processes take weeks, months to do if we allow natural physiology to do its job. And, you know, my job I feel like as a provider of maternity care, is to help my clients hug their physiology throughout their pregnancy experience so that we can encourage the functional birth experience, right, the physiological birth aspect, how do we encourage that leader starting now? How do we prevent complications? Well, we don't prevent them in the moment. Just like preeclampsia prevention happens pre conceptionally. Right? How do we prevent anything in a childbirth experience? We gotta go backwards. We gotta go back to when these processes first start. And that's the beginning of the third trimester. And throughout the third trimester, you know, there's there's these great studies that talk about things like subclinical hypothyroidism, and poor labor and delivery outcomes, because thyroid hormone is so important for things like beta carotene conversion to retinol. And Retinol is important for how you make and use your oxytocin receptors. If you can't make oxytocin receptors, you're not going to be able to attach oxytocin to the uterus. And that happens weeks before we actually go into labor. And I don't know if you're familiar with the study, the consortium of safe labor, great study done, it was done between 2000 to 2008. It was it was done by 12 different centers, 19 hospitals, they did over 220,000 births in this study, and they were looking at how do we create safe labor? How do we affect the labor and delivery outcomes? And one of the big takeaways from this had to do with this idea of subclinical hypothyroidism being an associated factor with some of these labor and delivery outcome complications and what they found with subclinical hypo and subclinical hypothyroidism. Let's, let's talk about that for a hot second. Right? We're not talking clinical, we're not talking with people with a TSH of 456789 10. We're talking people with a a TSH level of 2.5 to three and a just over that. Right.

What is still considered normal when normal unless you report exactly unless you're familiar with the recommendations of the Endocrine Society in the American thyroid Association, who say a TSH over 2.5 or two or three in pregnancy is not okay. And it's based off of these interesting studies we've seen where we see more complications in women with a TSH greater than three, even if it's within the normal ranges. But what they found was that women who had the subclinical hypothyroidism patterns had lower odds of spontaneous labor, higher rates of induction, higher diagnosis of failure to progress in labor, higher C section rates and higher hemorrhaging rates. Right there was another study in 2019 that found that people with subclinical hyperthyroidism at a 38.8% chance of hemorrhaging. Wow. And this has to do a lot with this natural physiology as we lead up to that labor and delivery experience building the oxytocin receptors, right? If we can't build our oxytocin receptors, because we are vitamin A deficient or we are sub clinically hypothyroid. Well, again, we can give them Pitocin. All day long, it's not going to do anything. There's no receptors for them to grab onto. Oh, it'll do something. It's Labor going.

I don't think TSH is even a part of the standard obstetric panel, and it's certainly not at 28 weeks now. So nobody's even looking at this. Now.

Very rarely do they get run. Most people who have had their thyroid diagnosis in pregnancy, it's through IVF, or fertility clinics, the reproductive endocrinologist do a lot of thyroid testing prior to transfers prior to IU eyes because we see this pattern associated with recurrent miscarriages. Yeah, so as we get to like the progression of labor and delivery, you know, it's all stair stepping. And we have thresholds in these hormones. You hit a threshold in cortisol and we see this trigger, you see a threshold and estrogen and we see these triggers, you hit a threshold in the prostaglandins. It's the prostaglandins. So it's PGF to Alpha specifically, that triggers this hyaluronic acid production. Okay. And then with that hyaluronic acid we see you know, like I was saying the effacement with cortisol, like we were saying before, it triggers the maturation of the lungs. As babies grow their lungs and they breathe of the amniotic fluid they produce these chemicals called surfactants and surfactants are super inflammatory And I always joke, it's like, you know, we've all gotten soap in our eye, right? These surfactants are like soapy little chemicals that irritate the inside of the uterus in the placenta. And eventually it gets so irritating and so toxic in there that the placenta signals the brain to produce oxytocin, the reject the ejection reflex, right? This baby is too toxic, we have to get it out of here. It's becoming dangerously toxic at this point.

Bad labor is supposed to begin with this process is that really, it's really?

Yeah, poison out.

conquers I can't do any of that. So the baby or they it starts producing essentially toxins. And then then the oxytocin is produced to inject everything. That's why we say everything in labor in lottery, the whole process is highly inflammatory. There's a 500% increase in cortisol production in pregnancy 500% in the labor and delivery experience, right? In birth itself, there's a 50% increase in norepinephrine and a one or another 500% increase in adrenaline. It's stressful, right? So let's say the brain produces oxytocin. Oxytocin comes down and binds to the receptors. Well, let's go back to oxytocin binding aspects. In order for oxytocin to bind to the receptor. Let's just say we made all the receptors we were supposed to because we had six fold the amount of vitamin A in our diet that we were supposed to have in the third trimester to do that. For oxytocin to bind to its receptor, you have to have magnesium. And most people have such a deficiency, right?

60% of Americans aren't consuming the minimums of both. There's no m&a there's magnesium. Well, yeah. 50% for vitamin A 60%. For magnesium as of what was it the 2016 National Health Report. I'm sure it's gotten different at this point, we it's been a couple years, but they haven't updated it. And so we have to have that magnesium to bind to that aspect. Once we get that oxytocin triggers more prostaglandin production, which then triggers that hyaluronic acid aspect, so becomes this lovely cycle. And the more contractions, we put baby's head down, and then eventually we have a lovely baby, right. And we could spend probably another 30 minutes going over the physiological aspect of what happens once we get that initiation. But to me, it's, it's the prep work, right? If we can do all this prep work, then everything that happens in that physiological birth experience is functional. It's doing what it's supposed to do the way nature intended it. That's the goal. And when we say you have a functional birth experience, it doesn't mean you have a three hour birth and, you know, you push for two minutes, like that's not necessarily functional for everybody. Functional birth experience. To me, the physiological birth experience to me is that the steps happened the way they were supposed to we have somebody else involved here, right? There's a whole other person going through this experience, and they are also affecting this right? To where baby stays high, we might might not get baby to come down as quickly as we should. And that's okay. That's still physiologically normal. Right? Is is the body functioning? Are the processes happening? Right? Is the mother able to gently go through that experience without having trauma? Right? There's all these different things that go into physiological functional birth and somebody's functional birth, maybe an hour, eight hour birth and somebody else's functional birth, maybe a 24 hour birth, and that's okay.

And just as Cynthia said a little while ago, anytime we intervene in this process, we are interfering with the body's ability to go through this functional process. And we don't know how much we're interfering with that. We don't know how, how off course we're taking the natural process. Yeah, even even minimal interventions.

Yeah. And it affects babies, right? We don't think of these things necessarily as interventions is always making changes to the baby, the baby comes out, right? But the catecholamine surge is a big example of that. That catecholamines surge happens after we've gone through transition. And right before we push a baby out, and the catecholamines surge is that big surge in adrenaline that I was talking about that 500% Oh, and you know, you guys, you guys have been to birth, the fetal ejection reflex. Yeah. Well, there's Yes. And so what you'll see is that catecholamines surge gets to the baby, and that baby needs that to handle that big push through the birth canal. And take that big first breath. Right? They need those hormones, they need that adrenaline because it's attractive. It's, it's protective. And again, I can go into a hole, you know, this is what's happened at each step. You know, and everybody's progression in that physiological process of birth is very different. I use a Grand Canyon analogy for that because I hiked the Grand Canyon a few years ago, and I remember getting to the top and we're like, oh my god, that was just like having a baby. Everything about that was like having a baby. Did you My baby. I have to, I have to, but it was just like having a baby. Yeah, it was just I hiked the trail with my mom. And I remember at one point we look each other like, I feel like I'm giving birth again, like this is just mentally and physically the all of the emotions are there. Right. And it was it's become my analogy,

the relief at the end is really something I think every woman understands.

Absolutely. It's kind of like, yeah, yeah. So, you know, that's, that's the the pregame, you know, how do we how do we hug this? How do we hug this physiology? Right? Like hugging it, we're, we're supporting those natural function, we have to support that natural functions. As practitioners, our job is to help our clients through that by by making sure we we find if there's any issues along the way, addressing things like stress responses, right? Are you sleeping? Like if you're, if you're somebody out there listening right now, what's your sleep like? Right? are we supporting our cortisol levels, if you're having insomnia, maybe you're there is a little bit more information than there should be or you're not managing that inflammation correctly. Right, antioxidants become a big part of preventing things like preterm labor, we also need to make sure we're hitting up some of these nutrients that nobody ever talks about things like vitamin A six fold increase in the need for vitamin A, in the third trimester, and that goes into mostly oxytocin receptor and oxytocin formation, making sure you're eating a balanced diet, right? Hyaluronic acid is a carbohydrate based, you have to have carbohydrates in order to make hyaluronic acid. So balanced diets, right, reducing and managing stress as best we can. Those are things that we can do in that preconception phase in order to support these systems. And as practitioners, I feel like our job is to help guide our clients through this process. And that's one of the things that I love to do. I know it's one of the things that you guys are passionate about. And I'm sure there's a lot of midwives out there, who are also very passionate about supporting their clients through this process. And part of making the change is all of us coming together to vocalize and to share this knowledge. And it's one of the reasons I wrote the book, I think everybody needs to know that this is a process that needs a hug. And then for those who want to learn more about this process, chapter 12 of my book goes into this and so much more detail. And then I have a download off of my website that is basically chapter 12 expanded, that goes into even more of this and it's a patient guide. So it's designed for patients that walks them through this process and then show them nutritionally and lifestyle what they can do at home to support this process. There is an element of control. This is this is something that we can encourage we have we have the potential to change pregnancy and childbirth outcomes by focusing on how the body functions, how childbirth functions, and diet and lifestyle and with the right knowledge with the education you have the potential to create a beautiful birth experience.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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