A philosophy of birth: if you want to change the world, change the conversation.

This essay is about why and how we should introduce birth into the canon of subjects explored by philosophy. Birth care brings to the fore fascinating philosophical questions: is a woman in labour a subject with full rights in practice as well as in theory? Can a labouring woman exercise her autonomy in a situation of maximum vulnerability but also maximum lucidity and awareness, as characterises the work of giving birth? What is the relationship between agency, capacity, and pain during and between contractions? Birth care proposes key questions relating to knowledge, freedom, and what it means to be a human being. Nonetheless, giving birth continues to be a blind spot in contemporary prevailing philosophy. My approach to a philosophy of birth aligns with one of the aims of contemporary philosophy; I explore the relationship between knowledge and emancipatory action in the relatively unchartered waters of birth and delivery, to create an epistemology that is sensitive to feminism and embodiment. What I propose to achieve through a philosophy of birth is a new logos for genos -a radically new meditation on origin and birth. How we understand our origin and the practices that bring us into being reveals our humanity. The lived experiences of women and their  situated knowledge challenge widely-held assumptions about rationality, about what it is to be a birthing woman and what it is to have agency and capacity in the delivery suite. A philosophy of birth enables us to navigate the stormy waters of contemporary obstetric practice towards a new and radical  logos for  genos -an embodied genealogy which not only redresses imbalances of gender, but also addresses life and happiness.

Barriers to establishing shared decision-making in childbirth: Unveiling epistemic stereotypes about women in labour.

RATIONALE, AIMS, AND OBJECTIVES: The benefits for shared decision-making (SDM) in delivery of high-quality and personalized care are undisputed, but what is it about the dynamics of the delivery room that leads some to doubt that true SDM is possible? How difficult can it be to establish SDM as the norm when caring for a woman in labour? The discussion around SDM, autonomy, and rationality is timely and highly relevant to wider practice. METHOD: The concept of a person's autonomy in decision-making about their body and health is generally accepted and is indeed enshrined in law in many countries. This ought to lay the foundation for SDM in obstetrics. Yet, women's experience speaks to an uncomfortable truth, namely, that it is far from commonplace. We are interested in exploring this tension between the law and the practice. RESULTS: We examine a theory of female rationality and its application to women in labour, and juxtapose this with the view from the front line of care delivery. Is a woman in labour able to fully engage in an SDM process? In answering this question, associations in the discourses and practises around women's capacity during labour are revealed, which act as barriers, consciously or unconsciously, to establishing SDM as the norm in obstetrics and midwifery. CONCLUSION(S): The recent UN report advocating a human rights-based approach to end mistreatment and violence against women in reproductive health services has a particular focus on childbirth and obstetric violence. This paper contributes to the recognition of obstetric violence as a human rights violation. It offers conceptual tools to diagnose the impact of gender stereotypes during childbirth and to eliminate women's discrimination in the field of reproductive health.

Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth.

BACKGROUND: Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. METHODOLOGY: In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. FINDINGS: The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. CONCLUSION: By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.

Maternal plasma levels of oxytocin during breastfeeding-A systematic review.

INTRODUCTION: Oxytocin is a key hormone in breastfeeding. No recent review on plasma levels of oxytocin in response to breastfeeding is available. MATERIALS AND METHODS: Systematic literature searches on breastfeeding induced oxytocin levels were conducted 2017 and 2019 in PubMed, Scopus, CINAHL, and PsycINFO. Data on oxytocin linked effects and effects of medical interventions were included if available. RESULTS: We found 29 articles that met the inclusion criteria. All studies had an exploratory design and included 601 women. Data were extracted from the articles and summarised in tables. Breastfeeding induced an immediate and short lasting (20 minutes) release of oxytocin. The release was pulsatile early postpartum (5 pulses/10 minutes) and coalesced into a more protracted rise as lactation proceeded. Oxytocin levels were higher in multiparous versus primiparous women. The number of oxytocin pulses during early breastfeeding was associated with greater milk yield and longer duration of lactation and was reduced by stress. Breastfeeding-induced oxytocin release was associated with elevated prolactin levels; lowered ACTH and cortisol (stress hormones) and somatostatin (a gastrointestinal hormone) levels; enhanced sociability; and reduced anxiety, suggesting that oxytocin induces physiological and psychological adaptations in the mother. Mechanical breast pumping, but not bottle-feeding was associated with oxytocin and prolactin release and decreased stress levels. Emergency caesarean section reduced oxytocin and prolactin release in response to breastfeeding and also maternal mental adaptations. Epidural analgesia reduced prolactin and mental adaptation, whereas infusions of synthetic oxytocin increased prolactin and mental adaptation. Oxytocin infusion also restored negative effects induced by caesarean section and epidural analgesia. CONCLUSIONS: Oxytocin is released in response to breastfeeding to cause milk ejection, and to induce physiological changes to promote milk production and psychological adaptations to facilitate motherhood. Stress and medical interventions during birth may influence these effects and thereby adversely affect the initiation of breastfeeding.