Gentle and Natural Birth Induction – the ultimate guide

Dr Tina Berkovits PhD.jpg

As with conventional interventions there has to be a certain readiness of mother and fetus and good timing for the natural and gentle induction technique to work efficiently.
To appreciate the gentle and natural birth induction it is important to understand the role of the different hormones that are released by the fetus, stimulated glands, placenta and the brain of the mother before, during and after birth. It is also imperative to comprehend the movement of the fetus and the role of the muscles involved during childbirth to fully grasp the technique. The treatment may include manual stimulation, oral intake, breathing techniques, coaching and guided imagery. 
Assuming the reader is informed with the birthing process, this article starts with the techniques themselves and ends with some additional relevant background informations. 

The evaluation is usually done by an experienced therapist together with the treating physician, midwife, and/or other conservative methods. Only then is the method of gentle and natural induction treatment decided upon and performed according to the presented condition. 

Disclaimer 
The information provided in this paper on gentle and natural birth induction is purely for informational purposes and is not intended as a substitute for advice from a physician or other health care professional.   
No information in this paper “Gentle and Natural Birth Induction” is intended for the diagnosis or treatment of any health problem, for health assessment, for prescription of any medication, or for any other health treatment. Consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you suspect you might have a serious health problem. You should never stop taking any medication without first consulting your physician. 
Dr Tina Berkovits PhD. 


The Treatment 

Having an understanding of the importance of the psoas muscle, the role of hormones, the cardinal movements of the fetus, the movement of the head through the pelvis, the treatment obviously concentrates on facilitating optimal conditions for all of the above.  
Most of the times the birthing mother’s state of mind ensures the physical, mental and emotional environment needed to facilitate a safe birth and is an intricate part of the evaluation and thereafter the treatment. 
So how do we set about to create this optimal environment: Obviously the therapist cannot relax a client and neither can she/he change the 
hormonal secretions or move the baby into the right position. All the above have to be done by the mother and the fetus.  
The therapist can only help facilitate relaxation of the mother, facilitate a gentle birth process, facilitate a relaxed state of mind by ensuring a safe and comfortable environment. The mother has to relax, feel safe, feel comfortable and thereafter secrete the hormones necessary to facilitate the birth of the baby. 
Manipulations of the body can help the mother relax the psoas muscle. Soothing touch can help the mother release hormones that are beneficial for the birth experience. A good talk and cry before birth can help ease fear and release tightened ligaments and muscles. 
One of the manual treatments that help induce the optimal environment for a natural birth experience is reflexology.     

Reflexology  
The method of reflexology treatment depends on the week the mother arrives and is slightly different for either preparation towards induction or gentle and natural induction of birth at the due date of after.  
There are some points that are stimulated after the baby is full-term or overdue.  
The Reflexology treatments for preparation done in the 36th week include:

  • hormonal balance with special attention on reflex points of the pituitary gland and ovaries
  • massage of the uterus reflex point
  • stimulation of the lower spine reflex point
  • stimulation of the symphysis pubis reflex point
  • stimulation of the hip joint reflex point
  • stimulation of the sacral plexus reflex point
  • stimulation of the colon reflex points
  • relaxation techniques

When the baby is overdue and the contractions have not yet started use deep pressure technique and add acupressure to reflex points (also acupuncture) in synchronization with the above. 
The relevant meridians are:

  • SP 
  • LI 
  • KI 
  • UB 
  • GB 
  • GV 

Use deep pressure techniquse on the uterus reflex points and simultaneously stimulate or massage the pituitary gland reflex points. Strongly pulling the heel and pushing back of toes can also be applied. 
The points are manually stimulated for about 30-45 minutes after massaging the feet till they are warm and flexible. The points can be needled with acupuncture needles before or after the reflexology treatment. Make sure the feet are warm and stay warm – also after the treatment. 
 
A short note for the reflexology therapist: the reflex points listed above are according to the original works of E. Ingham. Another aspect of the reflexology mapping would be to superimpose the female reproductive organs (cervix, uterus, Fallopian tubes and ovaries) onto both feet as a 
whole and then use these as focal points for the treatment. 
 
After gentle induction through reflexology: 
After and during the reflexology treatment contractions often start, though it may sometimes take about 3 sessions in a row to get things going. If the client has come in for treatments a week before the due date, the induction is done even more gently and gradually increased in strength according to the condition of fetus and mother. 
 
Rocking: 

After the Reflexology treatment “Rocking” induces tranquillity and relaxation of all muscles. This is done with the client lying first on the right, then on the left side (or first on the left, then on the right). Each individual vertebra, (especially at the areas of the insertion of the psoas muscle T12 and L4) then muscles and joints of shoulders and pelvis should be released until the whole length of the spine, shoulder and pelvic girdles are completely relaxed and move smoothly in synchronization. 
An over-the-thumb rule is: Only when the tip of the nose quivers when gently rocking the body, the mother is completely relaxed.  
At the end of the rocking treatment the body should be fully supported by the therapist and gently moved back and forth (as in a cradle) to induce a kind of sleepy hypnotic state.  
The client feels either very light or heavy depending on stress, fatigue, tension and general energy, but always comfortable and relaxed and “right”. During contractions the “Rocking” is continued and can be accompanied by Guided Imagery that has been introduced to the client at the beginning of the sessions. 
1-3 treatments are usually enough to induce contractions. They also help reduce pain to about 50% or more – sometimes less – during active labour.  
Clients have reported they would still feel the contractions, but not the full force of the pain. The contractions were not being experienced as intolerable and it was easier to ride them out.

Manipulation of the psoas muscle: 
Manipulation of the psoas is done by holding the foot and gently rotating the leg outward or inward. The manipulation is first done on the leg which is rotated slightly outward, a sign of a less tight psoas. Working on the “healthy” side, will help the mother relax, since it is a completely painless and gentle manipulation. Often the mother will drift into a sleepy state of mind during the rotation, which in turn will help in the manipulation of the tight psoas on the other side. 
After completing the rotation of the “healthy” leg, attention is now given to the tight psoas of the other leg at the hip joint. The manipulation has to be firm but gentle. If too much pressure is exerted it can be painful and cause more tightening of the muscle. Great care has to be taken not to rotate the calf only which will then harm the knee. Manipulation of the psoas muscle is first done through the rotation of the leg affecting the hip joint and then at the hip itself. At the same time the hip joint and pelvis is manipulated, the buttock (gluteus) and back muscles relax and eventual back pain is relieved.  
As a therapist one has to remember that the area of the psoas muscle at the groin is one of the points where emotions are physically expressed and held in the body. Stretching and strengthening exercises will hardly release tension in the psoas muscle. Since the brain controls tension and relaxation of the muscle, the brain has to be addressed through the manipulation and a different kind of movement has to be induced. The area is usually tight and because of the postural strain during pregnancy can become tighter and cause pain in the back and groins. When manipulating the hip and pelvis to relax the psoas muscles, it can cause a confrontation of the mother with her fears, anger and bring about tears. This in itself can sometimes be confusing and painful for the mother and cause the psoas to become tight again. Gentle encouragement, soft words and tranquillity is needed at that stage of treatment. 
Try to swing the leg – bent at the knee, foot flat on the table – back and forth. The leg has to be well supported by the therapist to give the mother the feeling of confidence. 
The tightness and tension is felt immediately by the therapist and mother; now great patience is needed to overcome the psoas muscle tension. No amount of prodding will help – only patience and giving confidence on an emotional level will release the muscle and joint. 
If the treatment is done in the right environment and gently, the psoas and tight ligaments will relax and the pelvis will be free to move and facilitate the lightening and descend of the fetus.

Breathing exercise: 
A great part of the gentle and natural induction method is learning to breathe into the lower abdomen – all the way down to the bikini line. Every woman responds to a different instruction/image for this kind of breathing. Note: This is not the breathing exercises studied in childbirth education classes, but is a more specifically controlled breathing method. 
While the therapist places her/his hand right above the bikini line (with the permission of the mother) the mother is instructed to 

  • breathe into the cervix
  • breathe into the hand placed on to the lower abdomen
  • breathe for the baby 
  • breathe in and out through the vagina
  • open the lungs to the side while breathing
  • open the nostrils while breathing
  • breath out towards the perineum

While breathing into the lower abdomen, a lot of concentration is needed. The mother turns inward and learns to centre herself, which is a great help, also, for later, when contractions are stronger. The therapist should pay attention not to hyperventilate the mother (expiration has to be at least 2x longer than inspiration). The centred breathing exercise together with the relaxation of the psoas at the hip joint will again help free the pelvis of tight muscles and ligaments facilitating the downward movement of the fetus.  
 
Home Remedies: 
Together with the manual treatments, above, there are some things the mother can do at home. Here are some remedies that are very beneficial and helpful when the due date has passed and the mother is scheduled for conventional induction in the hospital.

Sex  
Sex has long been a method of inducing labour, making use of the prostaglandins found in the semen and cervix during orgasm, stimulating contraction. It is generally more relaxing and enjoyable than being induced with medication in a hospital. It will not harm the baby, and can open the cervix up to 2cm.  
 
Nipple stimulation 
 
Nipple stimulation is a safe and gentle induction method by following the protocol below 

  • roll nipples between thumb and forefingers for 2 minutes 
  • rest for 3 minutes 
  • repeat rolling/resting for 20 minutes* 

*increase rolling to 3 minutes and decrease resting to 2 minutes for 20 minutes, if inadequate contractions occur after initial 20 mins. 

Enemas
Enemas have been used by experienced midwives, for ages, with great success and are relatively safe. They cause the bowels to contract also affecting the uterus. Use with caution if you are not used to laxatives, or by experience if you know you react with violent diarrhea.

Exercise 
Walking, swinging in a swing and general exercise contracts the uterus. Squatting for short periods is helpful. Hula or belly dancing works great, as does washing the floor on all fours or weeding the garden. Climbing stairs and skipping down again is a great exercise to get the pelvis moving and helping the fetus rotate downwards. Make sure not to overexert yourself – strength is still needed for the birth.
A bumpy car ride works well and is more restful for the mother, since she can lie down or sit in the back seat.

Pineapple. 
Eating lots of pineapple is reputed to begin labour and ripen the cervix. It probably has to do with the enzyme bromelain found in the fruit. Make sure it doesn’t give you heartburn and drink it in small sips first to find out. Preferably not on the day of birth!

Cumin Tea
This is used by midwives in Latino cultures. Traditionally, a raw cube of potato is added to the tea which absorbs the bitterness of the cumin. Some sugar or honey will make this drink more palatable. 1 Tbsp. cumin seed to one cup of boiling water; allow to steep for 5 minutes; then drink. No more than 1 cup per day. 

Castor Oil  
three teaspoons of castor oil is about right; try mixing it with some juice or pour it over a salad (tuna salad is a good alternative). Note: castor oil can give you cramps and diarrhea; if you know how you react to laxatives (strong ones) then you will know if you want to use this method for the induction of labour. 

Water
The role of water is to give energy to the mother, prevent abortion, help keep amniotic fluid at the desired levels and relieve pain during labour.  

Homeopathy and Childbirth Related Issues:
Pulsatilla  
This remedy corrects the inability of the uterus to expand and enables the child to turn and descend head first into the birth canal prior to delivery. During the 33rd week (the seventh month), the mother can take Pulsatilla 30 CH, once a day for a few weeks (initially in granules), but after that, in energized liquid form.  
From weeks 33 to 36 there is still time for the child to turn without stress. If the child has still not descended by week 36, one dose of Pulsatilla 200 CH can be taken – again start with granules and repeat in the liquid energized form 10 days later. In this way, Pulsatilla will help avoid breech and other abnormal presentations. These time guidelines generally apply to the first pregnancy. In subsequent pregnancies the child may not descend and engage until later, but Pulsatilla can still facilitate proper positioning of the infant prior to birth.  
Pulsatilla: when contractions are irregular and weak, the cervix is slow to dilate and the mother feels miserable, clingy and tearful; she may talk about wanting to give up and go home! 

Natrum muriaticum 

Natrum muriaticum can help to induce labour or strengthen ineffective contractions. It can be helpful with postpartum bleeding and a reluctant placenta.  

Black cohosh
  
Black cohosh often used to relieve irregular contractions and encourage stronger contractions (If this causes nausea and/or lightheadedness, discontinue.)  

Blue cohosh   

This remedy helps to increase uterine tone; (can also cause nausea/light-headedness). Mothers should discontinue use of this herb if they experience any of these side effects.

Chamomile  

Chamomile encourages relaxation and promotes sleep; some experts feel that this herb as a tea is gentle enough to use in moderation anytime after the first trimester.   

The role of hormones: 

Oxytocin 
Oxytocin is also called the “love-hormone”. The hormone is best known for its role in inducing labour and its influence on the ability to bond with others, according to researchers at the University of California, San Francisco. When the newborn is placed on the mother “skin to skin” after the birth, oxytocin levels increase and facilitate bonding with the infant. 
Oxytocin stimulates milk ejection during lactation, uterine contraction during birth and is released during sexual orgasm in both men and women. Receptor cells allowing a woman’s body to respond to oxytocin increase gradually in pregnancy and then sharply in labor. Oxytocin is a potent stimulator of contractions, which help dilate the cervix, move the baby down and out of her body, give birth to her placenta and limit bleeding at the site of the placenta. During labor and birth, the pressure of the baby against the cervix and then against tissues in the pelvic floor stimulates oxytocin and contractions.  
Oxytocin levels gradually increase and peak around birth, saturating the mother and baby with love. Nipple stimulation during labor, massage or any other touch therapy and suckling of the newborn can increase the level of oxytocin. 
Oxytocin release during breastfeeding causes mild but often painful uterine contractions during the first few weeks of lactation and helps in the “let down” of the milk from the mammary glands. 
It is also released during orgasm in both sexes. In the brain, oxytocin is involved in social recognition and bonding, and is said to be involved in the formation of trust between people, and bonding between mother and baby. 
Oxytocin can contribute to an incapacitated mind, as can endorphins and high level of estrogens. 
Low levels of oxytocin during labor and birth can cause problems by:

  • causing contractions to stop or slow, and lengthening labor 
  • resulting in excessive bleeding at the placenta site after birth 
  • leading providers to respond to these problems with interventions

A woman can promote her body’s production of oxytocin during labour and birth by:

  •  staying calm, comfortable, and confident 
  •  avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures 
  • staying upright and using gravity to apply pressure of her baby against her cervix and then, as the baby is born
  • engaging in nipple or clitoral stimulation activities before birth and giving her baby a chance to suckle shortly after birth  

Endorphins 
Endorphins are brain chemicals known as neurotransmitters, which transmit electrical signals within the nervous system.  
Stress and pain are the two most common factors leading to the release of endorphins and are similar to opiates in their action as painkillers and inducing a feeling of “high”. 
In addition to decreased feelings of pain, the secretion of endorphins leads to feelings of euphoria, modulation of appetite, release of sex hormones, and enhancement of the immune response.  
They are also responsible for the spatial memory loss and forgetfulness during pregnancy and after birth. With high endorphin levels, we feel less pain and fewer negative effects of stress. It is known that the body produces endorphins in response to prolonged, continuous physical exercise or exertion, such as birth for example. 
The level of this natural morphine-like substance may rise toward the end of pregnancy, and then rises steadily and steeply during un-medicated labour. (Most studies have found a sharp drop in endorphin levels with use of epidural or opioid pain medication.)  
High endorphin levels during labour and birth can produce an altered state of consciousness that helps women flow with the process, even when it is long and arduous.  
Despite the hard work of labour and birth, a woman with high endorphin levels can feel alert, attentive, and even euphoric as she begins to get to know and care for her baby after birth.  
Endorphins too may play a role in strengthening the mother-infant relationship at this time.  
A drop in endorphin levels in the days after birth may contribute to the “blues” that some women experience at this time.  
 
Low levels of endorphin can cause problems in labour and birth by:

  • causing labour to be excessively painful 
  • a feeling of  the pain being intolerable 
  • leading providers to respond to this problem with interventions

A woman can enhance her body’s production of endorphins during labour and birth by:

  • staying calm, comfortable, and confident  
  • avoiding disturbances, such as unwelcome people or noise and uncomfortableprocedures 
  • delaying or avoiding epidural or opioids as a pain relief method

 
Interesting: Certain foods, such as chocolate or chilli peppers can also lead to enhanced secretion of endorphins. In the case of chilli peppers, the spicier the pepper, the more endorphins are secreted. The release of endorphins upon ingestion of chocolate likely explains the comforting feelings that many people associate with this food and the craving for chocolate in times of stress. 
 
Adrenalin  
Adrenalin is the hormone of excitement and it can also stimulate the “fight or flight” response in the sympathetic nervous system. Adrenaline, the “fight or flight” hormone, helps ensure survival. Women who feel threatened during labour (for example by fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labour or stop it altogether. Earlier in human evolution, this disruption helped birthing women move to a place of greater safety.  
During transition, adrenalin levels increase to trigger the fetal ejection reflex and supply the mother with a rush of energy to come out of her altered state of awareness. Together with high levels of oxytocin, this will bring on strong contractions that urge the mother to bear down and birth her baby easily and quickly. This hormone, too, assists with the bonding of mother and child. 
 
A woman can keep adrenaline down during labour and birth by staying calm, comfortable, and relaxed. The following can help:

  • being informed and prepared 
  • having trust and confidence in her body and her capabilities as a birthing woman 
  • having trust and confidence in her caregivers and birth setting 
  • being in a calm, peaceful, and private environment and avoiding conflict 
  • being with people who help her with comfort measures, good information, positive words, and other support 
  • avoiding intrusive, painful and disruptive procedures

Too much adrenaline can cause problems in labour and birth by:

  • causing distress to the unborn baby 
  • causing contractions to stop, slow, or have an erratic pattern, and lengthening labour, creating a sense of panic and increasing pain in the mother leading providers to respond to this problem with caesareans and other interventions.

Interesting: The fact that adrenaline and oxytocin are antagonistic explains the basic need of all mammals when giving birth to feel secure. In a wild environment a female cannot give birth as long as there is a possible danger, for example the presence of a predator around. In that case it is an advantage to release adrenaline, which brings more blood to the skeletal muscles and gives more energy to fight or to run away; it is also an advantage to stop releasing oxytocin and to postpone the birth process. There is in fact a great diversity of situations associated with a release of adrenaline.  
Mammals release adrenaline when they feel observed. It is noticeable that they all rely on a specific strategy not to feel observed when giving birth: privacy is obviously another basic need.  
This emergency hormone is also involved in thermo-regulation. In a cold environment, one of the well-known roles of adrenaline is to induce the process of vasoconstriction. This explains that, for the act of birthing, mammals must be in a place that is warm enough. 
 
Prolactin 

Prolactin is the hormone of mothering and it peaks at the time of birth. It prepares the woman for motherhood and helps her to feel loving and tender towards her baby. Prolactin is the hormone of breast milk and is considered to be imperative for optimal brain development in the new born baby. During pregnancy, high circulating concentrations of estrogen promote prolactin production. The resulting high levels of prolactin secretion cause further maturation of the mammary glands, preparing them for lactation. 
Another effect, recently discovered by the University of Paisley and the “Technische Hochschule, Zürich”, is to provide the body with sexual gratification after sexual acts. This hormone represses the effect of dopamine, which is responsible for sexual arousal, thus inducing the male’s refractory period. The amount of prolactin can be an indicator for the amount of sexual satisfaction and relaxation. After childbirth, prolactin levels fall as the internal stimulus for them is removed.  
Sucking by the baby on the nipple then promotes further prolactin release, maintaining the ability to lactate. The sucking activates mechano-receptors in and around the nipple. These signals are carried by nerve fibres to the pituitary gland, which causes increased prolactin secretion. The suckling stimulus also triggers the release of oxytocin from the posterior pituitary gland, which triggers milk let-down: prolactin controls milk 
production (lactogenesis) but not the milk-ejection reflex; the rise in prolactin fills the breast with milk in preparation for the next feed. 
 
Estrogen  
Estrogen regulates progesterone, a hormone that protects the continuation of pregnancy. Estrogen also kick-starts one of the major processes of fetal maturation; without it, a fetus, lungs, liver and other organs and tissues cannot mature. During pregnancy there is an increased level of progesterone which prevents the uterus from contracting, which helps in the gestation of the fetus.  
When the woman approaches her due date, estrogen levels increase and create top progesterone levels. The uterus becomes more receptive towards circulating oxytocin which both the baby and the mother produce in response to each other. 
Also, prostaglandins are active towards the due date, which help soften the cervix and ligaments to facilitate birth. Estrogens increase throughout pregnancy and are produced primarily by the placenta. Among other functions, estrogens increase uterine blood flow. The production of prolactin is thought to be stimulated by increasing levels of estrogens. 

Prostaglandins 
Prostaglandins were first discovered and isolated from human semen in the 1930s by Ulf von Euler of Sweden. Thinking they had come from the prostate gland, he named them prostaglandins. Prostaglandins are highly potent substances that are not stored but are produced as needed by cell membranes in virtually every body tissue. Prostaglandins, are like hormones in that they act as chemical messengers, but do not move to other sites, but work right within the cells where they are synthesized. 
Different prostaglandins have been found to raise or lower blood pressure and regulate smooth muscle activity and glandular secretion. Several prostaglandins have been shown to induce fever, possibly by participating in the temperature-regulating mechanisms in the hypothalamus. 
Prostaglandins are involved in the activation of the inflammatory response, production of pain and fever. When tissues are damaged, white blood cells flood to the site to try to minimize tissue destruction. Prostaglandins are produced as a result. 
Blood clots form when a blood vessel is damaged. A type of prostaglandin called thromboxane stimulates constriction and clotting of platelets. Conversely, PGI2, is produced to have the opposite effect on the walls of blood vessels where clots should not be forming. 
Certain prostaglandins are involved with the induction of labor and other reproductive processes. PGE2 causes uterine contractions and has been used to induce labor.  
Prostaglandins are involved in several other organs such as the gastrointestinal tract (inhibit acid synthesis and increase secretion of protective mucus), increase blood flow in kidneys and leukotriens promote constriction of bronchi associated with asthma.  

The relevant parts of the brain are the following: 
1. Neocortex, (neopallium): rational, intellectual part of brain 
2. Intermediated brain, limbic system (paleopallium): emotional part of brain 
3. Primitive brain (archipallium): self preservation and aggression instinctual reactions.  

The primal brain and the Neocortex balance 
The primal brain is an ancient structure responsible for:

  • Automatic functions
  • Symbols (e.g. stories)
  • Emotions
  • Senses
  • Hormones
  • Safety & protection 

It can override the neo-cortex; its development was completed long before the Neocortex, the thinking, newer part of the brain, was developed.   
The primal brain is the main player in labour and must take precedence over the neocortex in order to ensure the whole process is as safe as possible for the mother and her baby. During labour the primal brain has the ability to release hormones to ensure a safe birth. The hormones include oxytocin, endorphin, adrenalin and prolactin.

  • Oxytocin is secreted by the posterior pituitary gland but produced in the primal brain.
  • Endorphins are secreted by the anterior pituitary gland. 
  • Adrenalin is secreted by the adrenal which is stimulated by the anterior pituitary gland and also the placenta. 
  • Prolactin is secreted by the anterior pituitary 
  • Estrogen is secreted by the gonads which in turn are stimulated by the anterior pituitary gland 
  • Prostaglandin  

 
*The hormones secreted by the posterior pituitary (like oxytocin) are actually produced in the brain and carried to the pituitary gland through nerves. They are stored in the pituitary gland. 
During labor the primal brain sends out endorphins to calm the woman and switch off her neo-cortex. When the birthing woman ignores this or “fights” against it by talking, trying to maintain a social presence, or tensing up with each surge, worries excessively and becomes frightened, the primal brain picks up on this as a danger and gets very alert and agitated. It then reduces the secretion of endorphins and increases the stimulation of adrenalin secretion to activate the FFF response.  
Adrenalin is also called the emergency hormone whose effect is to stop the release of oxytocin particular when there is a possible danger. This interferes with the process of birth and tends to slow it down and prolong it, often stopping it altogether. It can also reduce the blood supply to the uterus, putting the baby at risk and into distress, which often results in a forceps delivery or emergency caesarean. 
Odent describes the importance of creating an environment that reduces activity to the neocortex and enhances the ability of the primitive brain to take over the process of birth. Like other primitive functions such as sleeping and sexual intercourse, the primitive brain controls birth. Activities such as talking, bright lights and being observed, all stimulate the neocortex. This, in turn, inhibits the ability of the woman’s body to produce the hormonal levels she needs for a normal birth. 
The aim of any birth induction is to subdue the neo-cortex and reassure the primal brain that all is well, that there is no danger and to help the mother surrender to the birthing process and just let go. A birthing mother needs to feel private, safe and undisturbed so she can enter into an altered state of awareness and allow her birthing instincts to effortlessly unfold. 
A doula can do a lot to help the neo-cortex switch off by using touch, music, aroma therapy, warmth, and security to send messages of calm and safety to the primal brain. A woman who feels safe and comfortable is then able to “let go”. Quiet, peaceful music or sounds and a darkened room will provide optimum conditions under which the primal brain will allow labor to start and continue. 
Touch is one of the best approaches a doula can use to subdue the neo-cortex and communicate to the primal brain that all is well. When touch is used appropriately, endorphins are released which enhance the birthing woman’s ability to relax. Feeling warm and nurtured also plays a key role in the quality of the birthing process. Having access to warm socks and blankets is of utmost importance, as shivering from feeling cold releases adrenalin.  
It is vital that the mother drinks regularly and if she feels hungry, she needs to be able to eat.  
Smells also play an important part in the birthing process. Smells that are comforting such as essential oils, or familiar, such as pillows or blankets from home, are important when a woman is birthing in a hospital situation. It’s all about creating a safe nest for the mother to birth in. 
Though it is important to keep quiet and talk as little as possible in order to help keep the neo-cortex subdued, we sometimes have to talk to the birthing woman.  
This is not a problem, as long as we keep it simple and brief and don’t get into long-winded discussions. It is advisable not to talk during a surge, except to give simple encouragement in a soothing tone.
   
The Limbic System 
Buried within the depths of the cerebrum are several aggregates of the limbic structures and nuclei which control and mediate memory, emotion, learning, dreaming, attention, arousal and the perception and expression of emotional, motivational, sexual and social behaviour including the formation of loving attachments.  
The limbic system not only controls the capacity to experience love and sorrow, but it governs and monitors internal homeostasis and basic needs such as hunger and thirst. 
Over the course of evolution a layer of neocortex began to develop and enshroud the limbic system, to maximize the survival of the organism, and to more efficiently, effectively and safely satisfy limbic needs and impulses.  
In consequence, the frontal, temporal, parietal and occipital lobes evolved, covered with a neocortical cover, associated with the conscious, rational mind.  
The hypothalamus could be considered the most “primitive” aspect of the limbic system. The hypothalamus regulates internal homeostasis, including the experience of hunger and thirst, which can trigger rudimentary sexual behaviors or generate feelings of extreme rage or pleasure.  
In conjunction with the pituitary, the hypothalamus is a major manufacturer/secretor of hormones and other bodily secretions, including those involved in the stress response and feelings of depression. 
 
Cardinal Movements in Labor:
The mechanisms of labor, also known as the cardinal movements, refer to the changes in position of fetal head during its passage through the birth canal. Because of the asymmetry of the shape of both the fetal head and the maternal bony pelvis, such rotations are required for the fetus to successfully negotiate the birth canal. Although labor and birth is a continuous process, seven discrete cardinal movements of the fetus are described: engagement, descent, flexion, internal rotation, extension, external rotation or restitution and expulsion. 
 
Descent 
The baby’s head moves deep into the pelvic cavity. This movement, commonly called lightening, is preceded by Engagement or the entering of the biparietal diameter (measuring ear tip to ear tip across the top of the baby’s head) into the pelvic inlet. The baby’s head becomes markedly molded when these distances are closely the same. When the occiput is at the level of the ischial spines, it can be assumed that the biparietal diameter is engaged and then descends into the pelvic inlet.
 
Flexion 
This movement occurs during descent and is brought about by the resistance felt by the baby’s head against the soft tissues of the pelvis. The resistance brings about a flexion in the baby’s head so that the chin meets the chest. The smallest diameter of the baby’s head (or suboccipitobregmatic plane) presents into the pelvis. 
 
Internal rotation 
As the head reaches the pelvic floor, it typically rotates to accommodate for the change in diameters of the pelvis. At the pelvic inlet, the diameter of the pelvis is widest from right to left. At the pelvic outlet, the diameter is widest from front to back. So the baby must move from a sideways position to one where the sagittal suture is in the anteroposterior diameter of the outlet (where the face of the baby is against the back of the laboring woman and the back of the baby’s head is against the front of the pelvis). If anterior rotation does not occur, the occiput (or head) rotates to the occipitoposterior position. The ocipitoposterior position is also called persistent occipitoposterior and is the common cause for true back labor. 
 
Extension 

After internal rotation is complete and the head passes through the pelvis at the nape of the neck, a rest occurs as the neck is under the pubic arch. Extension occurs as the head, face and chin are born. 
 
External rotation 
After the head of the baby is born, there is a slight pause in the action of labor. During this pause, the baby must rotate so that his/her face moves from face-down to facing either of the laboring woman’s inner thighs. This movement, also called restitution, is necessary as the shoulders must fit around and under the pubic arch. 

Expulsion 
Almost immediately after external rotation, the anterior shoulder moves out from under the pubic bone (or symphisis pubis). The perineum becomes distended by the posterior shoulder which is then also born. The rest of the baby’s body is then born, with an upward motion of the baby’s body by the care provider. 
  
The Importance of the Psoas Muscle 
Anatomically, the psoas is a large muscle, measuring 16 inches in length and basically anchors the leg to the trunk. It starts at the front of the spinal vertebra T12. It attaches along the respiratory diaphragm and lumbar vertebrae from L1 to L5. It meets up with the iliacus muscle of the pelvic bowl. It dives under the groin to finally insert on the inner thighbone, thus influencing the movement and rotation of the pelvis. Essentially, all the organs are in contact, either directly or indirectly, with the diaphragm and psoas.  
 
Function:
The psoas bends the hip and leg towards the chest when going up and down stairs and helps propel the leg forward when walking or running. It flexes the trunk forward when squatting or bending over. Fundamentally, it acts like a guide wire to stabilize the trunk and spine during movement and sitting. It correctly balances the abdominal and low back muscles ensuring erect posture. The psoas supports the internal organs and functions as a hydraulic pump. Its movement allows for fluids to be pushed in and out of cells, such as blood and lymph.  
When the fear reflex gets activated, the psoas flexes the hip. This can be observed when an infant becomes startled, the legs fly up towards its face instinctively to protect itself. As the child grows into adulthood, this reflex gets integrated. Instead of legs moving towards the face, now the trunk flexes toward the legs. During times of stress when in self-protection mode, the psoas is under a state of constant contraction. Imagine how a tightened psoas will affect the birth process! 
 
Impact of a shortened psoas:  
The length of the psoas determines whether the pelvis is free to move or not. It becomes shortened from prolonged sitting, excessive running/ walking, sleeping in the fetal position and even stress, as noted above. A shortened psoas muscles affects posture in the following ways: 
 
1. The hips thrust forward creating rotation of the pelvis and an internal rotation of the affected leg. The opposite leg will rotate externally to counter-balance the asymmetry. To the body, the affected leg is now longer, and every time the person steps, it drives the leg up into the hip 
socket, creating further imbalance, leading to a functional leg length discrepancy. 
 
2. The pelvis and thigh draw closer, thus limiting space and movement in the hip socket. In essence, the femoral head is locked into the socket and instead of rotation occurring at the hip joint; it produces a torque at the knee and at L4-L5. 

3. Spinal segments compress, creating a lordotic posture of the low back and pelvis. The network of lumbar nerves and blood vessels passes through and around the psoas,so tightness here will impede the flow of blood and nerves impulses to the pelvic organs and legs, potentially affecting sexual and elimination functions and creating numbness and tingling in the legs and feet. 
 
4. It is responsible for menstrual cramps as it puts added pressure in the reproductive organs. 
 
5. It creates a thrusting forward of the ribcage and encourages chest breathing, which limits the amount of oxygen taken in and encourages over usage of the neck muscles. The trunk shortens and the space for the internal organs is decreased, which affects food absorption and elimination, contributing to constipation. 
 
Disclaimer 
The information provided in the paper on birth induction is purely for informational purposes and is not intended as a substitute for advice from a physician or other health care professional.   
No information in this paper on birth induction is intended for the diagnosis or treatment of any health problem, for health assessment, for prescription of any medication, or for any other health treatment. 
Consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you suspect you might have a serious health problem. You should never stop taking any medication without first consulting your physician.  

by Dr. Tina Berkovits, RCP, PhD., Master Therapist, Naturopathy, Homeopathy, Acupuncture, Doula, Childbirth Education, Postpartum Group Coacher, tel: 0544-381491, mobile: +972-544 381491, tinabster@gmail.com, http://tina.ein-hod.info
in Ein Hod, Tel Aviv, Israel.  (D.N. Hof Hacarmel 30890, P.O.Box 75)