Doula Training Class 3: Hormones in Labor & Childbirth

• Doula Training & Mentorship, Class 3 is about Labor & Childbirth

The Role of Hormones

• Estrogen levels steadily increase throughout pregnancy
• Progesterone levels steadily increase throughout pregnancy
• HCG levels peak around 10 weeks of pregnancy
• Prolactin levels steadily increase throughout pregnancy
• Relaxin levels peak around 10 weeks of pregnancy
• Oxytocin levels spike at labor

Human Chorionic Gonadotropin

• hCG is produced by the placenta post-implantation
• This hormone supports the corpus luteum function, a temporary ovarian structure essential in early pregnancy
• Pregnancy tests detect this hormone

Progesterone

• Helps establish the placenta, stimulating growth of blood vessels to supply the womb
• Inhibits uterus contraction as it grows with the baby
• Also strengthens pelvic wall muscles for labor

Oestrogen

• Helps the uterus grow, maintains its lining, and aids fetal organ development
• Activates and regulates the production of other hormones
• Stimulates breast growth and milk duct development with progesterone

Prolactin

• Needed to produce breast milk and aids mammary glands enlargment in preparation for milk production
• Progesterone inhibits lactation during pregnancy

Relaxin

• Inhibits uterus contraction to prevent premature birth
• It relaxes blood vessels, increasing blood flow to the placenta and kidneys
• It relaxes the joints of the pelvis and softens and lengthens the cervix during birth

Oxytocin

• Levels rise at labor, stimulating uterine contractions which triggers prostaglandin production, further increasing contractions
• Used to induce labor if it doesn't start naturally

Cervical Effacement

• The cervix must be ripened first
• The cervix begins to thin and fade away
• At first, the consistency is like the tip of your nose, then it becomes like jelly
• Measured by percentage
• Usually happens before or in tandem with dilation

Cervical Dilation

• Measurement of the opening of the cervix
• Active labor begins at 6cm
• A full 10cm is required to begin pushing
• In rare cases it is possible to push prior to the 10cm
• Dilation typically happens gradually, from 6-10cm takes average of 8 hours
• Very slow early dilation can occur

Pelvic Station

• Conveys how low the baby has descended into the pelvis, measured from -3 to +3
• There can often be correlation between the dilation and the station.
• The station can regress or change
• Laboring down is when pushing is postposed until the baby is fully descended

Fetal Positioning

• There are Seven cardinal movements of labor
• Baby rotates with select contractions or external rotational assistance
• Ideally the baby should be born face down
• Babies can be born OA/"sunny side up", which causes intense and prolonged back labor

Stages of Labor

Pre-Labor

Physiological

• Relaxin is at work
• More consistent Braxton Hicks contractions
• Flu-like symptoms (nausea, diarrhea, loss of appetite)
• Period-like cramps
• More consistent aches and pains

Psychological

• Final nesting surge occurs
• Excitement and/or anxiety are high
• Mood changes

Early Labor

Physiological

• Rupture of water (not common)
• Onset of contractions begin
• Bloody show/mucus plug release
• Contractions are spread far apart
• Can continue normal daily activities and can talk through contractions

Psychological

• Excited

• Nervous

• Planning

• Overthinking

• Clients should rest during this stage to conserve energy

Active Labor

Physiological

• 6+ cm of dilation
• Should transition to the delivery location
• Contractions intensify gradually
• Contractions get closer together to approx. 5 minutes apart
• Becomes more physically uncomfortable

Psychological

• Begin to have doubts
• Continuing regular activities become difficult
• Inability to converse through contractions

Transition

Physiological/Hormonal

• 8-9cm of dilation
• Contractions are 2-3 minutes apart
• Last large surge of oxytocin
• Preparing body for pushing

Psychological

• Initial shakiness
• Crying, visible display of emotions
• Letting guard/wall down
• Can be trance-like
• Common Phrases: "I can't do this," "I want an epidural"

Pushing (1 hour)

Physiological

• Full effaced and fully dilated
• Recurring contractions 1-2 minutes apart
• Ring of fire
• Synchronizing pushing with contractions
• May experience fatigue
• Upright positions are best
• Should not take longer than one hour!

Psychological

• Metally tired but excited
• Tapping into unknown strength
• Motivated

Immediate Postpartum (1-2 hours)

Physiological

• The umbilical cord is cut, standard, delayed, or a lotus
• The placenta is born
• Tearing stitching is common only for 2nd/3rd
• The golden hour/first breastfeeding latch

Psychological/Hormonal

• Uncontrolled shaking/chills
• Feeling cold
• Feelings of euphoria/elation
• A rush of energy
• Inability to sleep immediately

Assignments

• How to decide ones arrival time when attending births.
• Memorize the seven cardinal rotations of childbirth.
• Need to research 1st, 2nd, 3rd and 4th degree perineal tears.
• There is also need to research the difference between Braxton Hicks contractions and true labor.

Class 3 of the Doula Training & Mentorship program focuses on Labor & Childbirth, specifically the role of hormones. It discusses the function of Estrogen, Progesterone, HCG, Prolactin, Relaxin, and Oxytocin, and how their levels change throughout pregnancy and labor.