European Journal of Obstetrics & Gynecology and Reproductive Biology
The effect of emotional support on maternal oxytocin levels in labouring women
Introduction
In 150 cultures studied by anthropologists only one culture did not make provision for a family member or friend to be with a woman in labour or delivery (quoted in Ref. [1]).
In Western society the emotional support a labouring woman receives is usually given by her husband or other family member. Technical and professional support is given by midwives and doctors in attendance but the emotional support given by health care professionals may not be optimal in a busy labour ward environment.
There have been a number of studies which have examined the effect of a supportive companion in labour and provide evidence to the efficiency of support on the labour process. In a randomised controlled trial Sosa et al. [1]found that the support of a lay person (`doula') reduced the duration of labour from 19.3 h in the unsupported group to 8.7 h in a supported group. Of 95 unsupported mothers 79% had a problem or intervention in labour (Caesarean birth, meconium stained liquor, oxytocin augmentation, stillbirth, depressed neonate or assisted delivery) compared to only 37% of the supported group. This study was repeated with larger numbers [2](n=249 randomised to no support, n=168 randomised to support) by the same group who found the mean duration of labour was significantly shortened in the supported group (7.7 h SD 3.5 h versus 15.5 h SD 7.0 h, P<0.001) and fewer Caesarean sections were performed in supported patients (7% versus 17% P<0.001). The incidence of oxytocin augmentation in the supported women was 2% versus 13% in the unsupported group. With such large numbers showing that the progress of labour is inhibited and the subsequent use of oxytocin and ultimately Caesarean section in women who did not receive support, it could be postulated that the stressful situation of labour and the subsequent dysfunction may be due to suppression of oxytocin production by the pituitary gland.
Evidence that the pituitary secretion of oxytocin is suppressed by environmental disturbance is seen in animal experiments. Leng et al. [3]found that when conscious chronically catheterised rats were disturbed during parturition, subsequent parturition was prolonged and oxytocin secretion was inhibited. Evidence that the oxytocin secretion was inhibited by endogenous opiates is provided by the finding that naloxone (an opiate antagonist) injections produced an elevation in plasma oxytocin concentrations in both disturbed and undisturbed rats. A similar situation appears to occur in the parturient pig; environmental disturbances resulted in an extended parturition time and when disturbed pigs were given either saline or naloxone injections, the naloxone injected animals had significantly higher oxytocin levels (7.8 versus 38.9 pg ml−1) [4].
In view of animal work suggesting that environmental disturbance reduces oxytocin concentrations by activation of endogenous opioid pathways, and the human studies showing the efficacy of birth support in reducing the duration of labour and the need for oxytocin augmentation, this study was undertaken to investigate the effect of emotional support in labouring women on peripheral maternal oxytocin concentrations.
Section snippets
Patients and methods
The study was approved by the Ethics and Research Committee of the University of Cape Town. All patients who participated gave informed written consent to participation in the study. Women who were having their first labour or trial of scar and who were in spontaneous active labour were asked to help with this study. The women had no evidence of maternal or fetal compromise, a normal cardiotocograph on admission, a normal haemoglobin and were not accompanied by a companion during the labour
Oxytocin assay
Whole blood samples were aspirated into chilled syringes, centrifuged and the plasma aspirated and frozen in liquid nitrogen. Extraction of the oxytocin from the plasma was performed within 24 h and ultimately radioimmunoassay of oxytocin was performed. Enzyme inhibition with phenanthrolene was used and the assay technique has been described in detail elsewhere [5]. The assays were performed by MSH who had no prior knowledge of the randomisation group. The samples were batched and assayed after
Results
Sixteen patients were enrolled to the study, eight in the support and eight in the no support group and their characteristics are outlined in Table 1. There are no significant differences in the general characteristics. There were four and two women undergoing a trial of scar in the control/support groups, respectively. These women had never had a successful vaginal delivery. In the supported group four women were of the black and four of the coloured race group. There were six and two women,
Discussion
O'Driscoll and Meagher [6]state that the birth of a woman's first baby is the most profound emotional experience for good or ill in a lifetime. In Western societies where virtually every woman will labour with her partner, friend or family member at her side the benefits of birth support may not be readily apparent. The work of Sosa [1]and Klaus [2]in which a decreased intervention rate and shorter duration of labour is apparent when women are supported by a doula in labour has no physiological
References (6)
- et al.
The effect of a supportive companion on perinatal problems, length of labour and mother–infant interaction
New Engl J Med
(1980) - et al.
Effects of social support during parturition on maternal and infant mortality
Br Med J
(1986) - et al.
Endogenous opioid actions and effects of environmental disturbance on parturition and oxytocin secretion in rats
J Reprod Fertil
(1988)
Cited by (9)
The physiology and pharmacology of oxytocin in labor and in the peripartum period
2024, American Journal of Obstetrics and GynecologyProblems with measuring peripheral oxytocin: Can the data on oxytocin and human behavior be trusted?
2013, Neuroscience and Biobehavioral ReviewsCitation Excerpt :According to RIA, basal OT levels for men and women rarely differ (Amico et al., 1981; Grewen et al., 2005; Jokinen et al., 2012). Many studies on the role of OT in human social behavior have focused on its roles in pregnancy, parturition and lactation (Blanks and Thornton, 2003; Chard, 1989; Dawood et al., 1978), and using RIA methods, researchers estimated that pregnant women have values in the range of ∼1–10 pg/ml (Amico et al., 1986; Dawood et al., 1978; Sellers et al., 1981), that they have plasma OT levels ∼7–45 pg/ml during early-stage labor (Dawood et al., 1978; Fuchs et al., 1982; Lindow et al., 1998; Rahm et al., 2002; Sellers et al., 1981), and that those levels might peak ∼9–114 pg/ml during advanced stages of labor (Dawood et al., 1978; Fuchs et al., 1982; Sellers et al., 1981; Thornton et al., 1988). Estimates obtained using RIA methods with extracted plasma likewise indicate that nursing mothers have plasma OT levels ∼2–13 pg/ml prior to breastfeeding sessions (Lucas et al., 1980; Nissen et al., 1996; Yokoyama et al., 1994), and that these values can rise to ∼11–24 pg/ml during breastfeeding (Lucas et al., 1980; Nissen et al., 1996; Yokoyama et al., 1994).
Companion of choice at birth: Factors affecting implementation
2017, BMC Pregnancy and ChildbirthContinuous support for women during childbirth
2017, Cochrane Database of Systematic ReviewsContinuous support for women during childbirth
2013, Cochrane Database of Systematic Reviews