Back to basics and into the dark….

When working in busy fragmented models of care with pressure on time, workload and an increasing amount of paperwork and so on – it can be easy to be pulled along in the current. Get to work, get handover, get a handle on the scene. Building rapport with a family, assessing the situation and going over notes and results. Heaven forbid you slow down for a moment in case you miss some vital piece of information that could potentially lead to the doom of all involved. Yes, it feels like that. What have I missed, what documents guide me on this, how do I find them? Who do I ask?

And then we slow down for a second, we properly meet the woman and her support crew. We truly see them and their baby (in the womb) and realise – all the lights are on and there is not a scrap of privacy in the room for this woman. With the hustle and bustle of midwives and doctors in and out of the room sometimes the absolute fundamentals of holistic midwifery practice get missed. Creating a space that feels, looks and sounds safe and private.

I particularly see this on weekday inductions of labour. Maternity units are in a state of constant flux as their ”business as usual”. Inductions are booked daily, starting the process morning and evening with oxytocin infusions starting and ending all the time. In this almost robotic method of bringing about birth it can become so process focussed and time trapped that it pulls away from the very nature of how birth unfolds. It is still birth! The very things we know about promotion of natural oxytocin are still every bit as relevant for the successful use of synthetic oxytocin. Some would argue even more so to increase the chance for endogenous oxytocin production to catch up and decrease interruption to bonding and the breastfeeding relationship immediately after birth beyond 3 months^2,3. We don’t know a lot about the long term effects of high dose synthetic oxytocin on mothers or babies but a common sense approach applies, the less we need the better. I am not arguing for or against induction of labour in this blog that is a very different subject which someone else has covered well. I align with the thoughts of Dr Rachel Reed on ‘Why Induction Matters’ ¹ which you can find more info in the resources. But back to my point – THE LIGHTS PEOPLE!! TURN OFF THE FRIGGING LIGHTS!!!

As a midwife you learn in detail about the physiology of labour and birth. Fear and adrenaline have an inhibitory effect on endogenous oxytocin production. Being on display when at our most primal, feeling out of control is something that the overwhelming majority of women are NOT comfortable with. Our mammalian brains seek quiet, private space for us to give birth so that we can keep ourselves and our babies safe. But often hospital-based birth spaces are not dark, at best they can be dimly lit. We as midwives NEED to be aware that such a simple act is one which can be incredibly powerful. We need to advocate for relative darkness, promoting a sense of safety and privacy but also creating an environment to enhance the natural flow of melatonin and oxytocin and the cascade of helpful hormones will follow.

What is less known is the importance of the hormone melatonin in labour. Melatonin is the hormone of darkness, released from the pineal gland and works synergistically with oxytocin. In fact melatonin and oxytocin receptors are collocated in the central nervous system⁴. The functional triad of oxytocin-GABA-melatonin inhibits neocortical activity⁵ which in turn enhances potential for contractility of uterine muscle.  This hormone usually begins synthesis and secretion from the onset of darkness, reaching its peak between 2 and 4am⁵. It is one of the reasons women usually go into labour at night or in the early hours of the morning.  What we know about the release of melatonin is that it is affected by the sense of sight and is inhibited by intensity and length of exposure to light via increased neocortical activity⁶ (coherence, talking, problem solving state etc). Think about how much women are surrounded by light and look into there phones in labour – hello inhibition! This is not a matter of completely eliminating light and taking away a communication device but rather – having the conversation about the impact on labour and having someone else communicate on their behalf. It is about education for women. And der -turning off as much light as possible! There is even speculation about the impact of blue light on the ‘birth preparation’ phase and that women are constantly in a state of being overstimulated by blue light⁷, information and technology which could in turn be leading to longer gestations and higher rates on induction. And as our light sources become more sophisticated, the wave lengths and intensity change as does its potential for impacting on the body’s natural rhythms.

Yes women are in hospital to have a baby and sometimes people even prepare them to “throw their dignity out the window” before they come in to have a baby. Which I will just add, is so wrong. Midwives try exceptionally hard to maintain and preserve each and every persons dignity – and there are no open windows, your dignity is staying here – with you. Women expect there will be things that may feel odd but accept that we are the care providers and that how we care for them is all part of the process. But having bright lights (outside of an operating theatre) are not a part of promoting normal birth. It’s kind of like you going to work and having to go to the toilet with the lights on and the door open and maybe a person or two coming in to check on you… regularly. Now I ask you, would you –

1. be able to go to the toilet?

2. prefer the lights on or off?

We are in a very interesting time, the very lights we have surrounding us day in day out are evolving too. In an age of constantly changing evidence and of rich and diverse information at our fingertips – let us take a moment to focus on what we have always known anecdotally. That darkness provides women with a level of privacy that a bright space will not. Darkness also has physical benefits and supports the normal progress of labour.

For the love of birth – turn off those bloody lights!

Resources:

1. Olza Fernández, I., Marín Gabriel, M., Malalana Martínez, A., et al (2012), Newborn feeding behaviour depressed by intrapartum oxytocin: a pilot study. Acta Paediatrica, 101: 749-754. doi:10.1111/j.1651-2227.2012.02668.x
2. Aleeca F. Bell, Rosemary White-Traut, Kristin Rankin. (2013). Fetal exposure to synthetic oxytocin and the relationship with prefeeding cues within one hour postbirth. Early Human Development. 89(3)137-143. ISSN 0378-3782. doi.org/10.1016/j.earlhumdev.2012.09.017.
3. Dr Rachel Reed. Midwife Thinking https://midwifethinking.com/why-induction-matters/
4. Wu YH, Zhou JN, Balesar R, et al (2006). Distribution of MT1 melatonin resceptor immunoreactivity in the human hypothalamus and pituitary gland: colocalization of MT1 with vasopressin, oxytocin and CRH. Journal of Comparative Neurology. 499(6):879-910.
5. Sabihi S, Dong SM, Maurer SD, et al. (2017). Oxytocin in the medial prefrontal cortex attenuates anxiety: Anatomical and receptor specificity and mechanisms of action. Neuropharmacology 125:1-2. Doi: 10.2170/physiolosci.RP006208.
6. Kozaki T, Koga S, Toda N, et al (2008). Effects of short wavelength control in polychromatic light sources on nocturnal melatonin secretion. Neuroscience Lett. 439(3):255-259.
7. Odent, M. (2019). The Future of Homo: The Future of Candles. Pp 25-32. World Scientific: Singapore.