Thursday, August 9, 2012

Radical Change #35: Shift Focus of Early Prenatal Care: Teach Mothers to Reduce Stress to Reduce Preterm Labor and other problems

Hello Birth Peeps,
A growing number of studies are confirming there is truth in an old wives’ tale that says pregnant women should be protected from stress or a sudden shock to avoid premature labor (Ahhh, high fives to the power of observation by the old ones who did know!). 
     Most of us think we should help mothers reduce their stress and rest more in the third trimester, or after she develops symptoms such as early contractions or hypertension. But research is showing an ounce of prevention in the first trimester is worth pounds of cure in the third. 

 Recent research is showing a correlation between stress in the first trimester and early miscarriage, pre-term labor, low birth weight, and influences on the baby’s temperament.1 One in ten babies is born prematurely in the U.S., as we know, and have sympathy for these little babies who struggle with many health problems. If you could do something to reduce this suffering, you probably would… read on!

After the Northridge Earthquake in California, it was observed that women who were in their first trimester when it happened had shorter gestations than women who were in second or third trimester. Why would stress in the first trimester increase preterm labor and low birth weight?:   
When a pregnant woman perceives a stressor, her brain releases a hormone called CRH (corticotrophin-releasing hormone)—a hormone that signals the body to release other stress hormones (e.g. adrenalin and cortisol, among many others) needed to generate the complex fight-flight-freeze response. When the threat or stressor is resolved, the stress hormones return to baseline, and all is well.

Stress hormones cannot return to baseline whenever pressure and tension is unrelenting; when she is in a constant state of anxiety and worry because she doesn’t know what to do, or she believes there is “no back door,” no way out. Her stress might be related to work, or not having a job, not having enough money, racial discrimination, a pregnancy-related concern, among other stressors.

Persistently high levels of maternal stress hormones signal the baby’s placenta to increase production of CRH (as much as twenty times normal level), which cross the placental barrier and circulate in the mother’s blood. The developing baby is also stressed and begins producing its own stress hormones. 

Did you know that elevated CRH levels measured in the mother’s blood between 16 and 20 weeks gestation can predict whether she is likely to deliver prematurely (the risk is three times higher).2 Thus, CHR levels have been referred to as the “placenta clock.” 

Here's where it starts to get interesting because there is something we can do:
In addition to external stressors, the mother’s coping style also influences her level of CHR and stress hormones. It makes sense that when the mother reduces her stress by taking action toward solving the problem, stress hormones can return to baseline. 

   On the other hand, when she does not or cannot make a decision or take action on her behalf, the problem or "threat" (whether real or imagined) continues to loom over her. If her coping style is to disengage, to try to ignore the problem, or hope that someone or something “out there” will intervene on her behalf, she will probably have higher levels of CHR and stress hormones.3

We can’t hold this information or responsibility solely over mothers’ heads as another thing she “should” do (unless we want to risk increasing her stress and guilt). We know it is not possible for mothers in the first trimester, in this socially obtuse birth culture, to make this radical change on their own--independent of the support of their families, work place, birth attendants (who may "order" rest), and culture as a whole.

This important change, Change #35, will be realized when birth attendants collectively and radically shift their focus—from enrolling pregnant women in their first trimester in prenatal care primarily to gather a medical history, estimate the due date, and take lab tests—to using early prenatal visits to teach each mother how to assess and reduce stress, and how to rest. Again, we must stop thinking that there is nothing we can really do in the first trimester and call for "Early Prenatal Education" classes.

     How the Huntress Warrior Lowers Stress:  

Track your daily rhythm and level of stress.
Pay attention to what is happening around you and in you.
Ask yourself, “What needs to happen next?”
Dare to act deliberately and decisively.
Do what needs to be done, but nothing extra.
Don’t look back, second guess, or judge yourself;
just reassess the new moment
and do what needs to be done next—
without an attachment to outcome.

Stalk early signs of tension, dread, or stress,
notice when you start to feel pressured by daily hassles—
do something different—and lower stress early.

Eat well, eat mindfully, avoid fast food.
Organize your week to do fewer errands, less driving.
Greet the sun with a poem, a dance, or a meditation.
See the humor in life, laugh, watch funny movies.
Practice guided imagery, following your bliss,
yoga, tai chi, and take long walks in nature.
(excerpted from upcoming book, Birth as a Hero’s Journey copyright 2012 Pam England)


P.S.  Are you still wondering why stress in the second and third trimester is less problematic? Here’s another mini-physiology lesson:
CRH levels normally increase in the second trimester, and increase even more in the third, even when pregnancy is not particularly stressful. Ordinarily, this surge of CRH would stimulate an overproduction of stress hormones in the mother, but this does not happen because simultaneously her body begins producing large quantities of a CRH-binding protein that prevents CRH from being recognized or utilized by her body.4

 Citations and Resources:
1  Retrieved July 2012 from:, “Stress Management for Health Course: The Fight or Flight Response.” <<Johntel, no author given anywhere. Since these are facts and not creative material, let’s not spend a lot of time on permissions>>

3  Latendress, Gwen, Ruiz, Roberta J.  (2010). “Maternal Coping Style and Perceived Adequacy of Income Predict CRH Levels at 14–20 Weeks of Gestation”
4  Dewar, Gwen Pregnancy stress hormones: How a natural rise in hormone levels may benefit baby…and re-program mom’s brain Copyright © 2008 by Gwen Dewar
retrieved July 2012: www.

Hobel, Calvin, Goldstein, A. and Barrett, Emily S. “Psychosocial Stress and Pregnancy Outcome”
Clinical Obstetrics and Gynecology. Volume 51, Number 2, 333–348 r 2008, Lippincott Williams & Wilkins


  1. This is wonderful Pam, giving me some solid evidence for what I already felt to be true.

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