THE PSYCHOSENSORY LABOR - Why You Should Not Wear Red Lipstick to a Birth

Something as innocent as wearing bright red lipstick to attend a birth can stall labor. The laboring brain is primal, and the unexpected splotch of red can register as blood, a sign that you’ve been hurt, which means a predator is nearby. When feeling threatened, the best course of action for the mother is to hold off contractions and escape. Deer have been known to do that when hunters approach.

Here is an actual case of my client Emma, who had been laboring all day and was leaning over her kitchen counter, breathing and focusing, when her husband burst through the door. He had rushed home from filming at a campsite several hours away. As soon as she saw him, she screamed at him to get away, surprising herself. As she explained later, she had a violent, visceral reaction to his red shirt and the smell of smoke on him. Emma was reacting to the visual cues of blood on her husband and the smell of smoke, perhaps a sign of a forest fire nearby.

Our senses are exponentially heightened in labor because we are most vulnerable to predation at that time. We are experiencing powerful uterine contractions. Our pelvic bones pull apart as a tiny human being tries to come through, rendering our gait unstable for a quick escape. When that little human arrives, it will likely emanate a loud, piercing cry, garnering unwanted attention from hungry animals. We will have lost blood as a natural part of giving birth, and it would take time for vessels to constrict and re-route oxygen back to our brains. Emma wasn’t being irrational; laboring women’s unusual responses have to do with a mismatch between their primal sensory perception and modern circumstances.

Momentarily, Emma’s labor slowed down but resumed when her husband showered and joined her in the birth pool in their living room, where she gave birth to their son. What we may call the Lipstick Conundrum was short-lived for her, but for many others, a chain of similar events can significantly impact their oxytocin release.

Oxytocin, most known for human bonding, switches its function during labor to become fuel for contractions. It is delivered in constant pulses from the pituitary gland—think of a slow dripping faucet. The molecules attach themselves to oxytocin receptors on the uterine muscle wall like keys on locks, activating repeated waves of tightening. Hundreds of these waves then expel the baby from our body. Oxytocin has a short half-life and dissipates from the blood circulation in minutes if not constantly supplied. The advantage of this delivery system is the ability of the brain to control supply and to immediately shut off when the laboring human is threatened so she can regain the physicality needed for fight, flight, or other survival actions.

I was at dinner with an obstetrician friend one evening when she unexpectedly asked me, “How do women labor at home without pitocin?” Kelsey and I both attend births, but our experiences are entirely different. She couldn’t do her work without pitocin, the synthetic form of oxytocin, while I rarely use it in my births. We are also positioned on opposite sides of a political divide in maternity care—hospitals versus home births, which is probably why we hardly talk about our work. With some libation in her, her curiosity must have gotten the better of her.

Politics aside, every woman has the right to good care no matter where or how she wants to give birth—a hospital, a birth center, at home, with a doctor, a midwife, or even unassisted for that matter. But inarguably, our system is broken. About one out of three or four women end up with a c-section in this country, and as Kelsey has seen, everyone seems to need pitocin.

In 2008, a movie called The Business of Being Born exposed the overuse of pitocin, and some birthing communities became aware of what is known as the cascade of interventions—one seemingly harmless procedure can lead to another and eventually to an unnecessary c-section. To avoid the cascade, some women took to laboring at home for as long as possible so that contractions would have built enough steam when they arrived and birth could happen quickly. Sometimes, it worked; for others, those hard-earned contractions would slow down or cease altogether as soon as they arrived. As an obstetrician, Kelsey is in the business of addressing the what—when contractions are inadequate, she gives women what their bodies cannot produce. The psychosensory approach seeks to answer the question of why and how.

Imagine a doctor walking into your labor room wearing a mask—a common sight in a post-Covid world. Your primal brain sees a stranger whose facial expression is hidden and, therefore, whose actions you cannot predict. Indeed to some extent, our logical thinking can override this perception. However, the cumulative sensory input in a hospital setting eventually adds up until the threat level becomes high enough to slow or halt the release of oxytocin. Here are just some of the routine procedures that nearly everyone is subjected to—the primal human feels the painful stabbing by a large bore needle, for routine blood tests and IV placement. Straps and cords attach the body to many machines, creating a sense of inescapability. The arm is gripped unnaturally tightly every fifteen minutes as the automatic blood pressure cuff is inflated. You hear the constant digital tapping sound that traces the baby’s heartbeat, creating anticipation. Machines intermittently beep to warn of something wrong, though it always turns out to be a simple IV occlusion or a harmless mechanical malfunction.

Even deeper below our level of awareness, one particular sense is uniquely neuro-wired to detect danger—our olfactory response to something called alarm pheromones. Studies have shown that stress is contagious, and just smelling the odorless, airborne pheromones of a fearful person will mirror the same fear response in your brain.

The nature of hospital care is that the patient will encounter more than a dozen people, from the receptionist to the nurse, the cleaning staff, the social worker, the doctors or midwives, the anesthetist, the students, and so on. The calm person who introduces herself as your nurse might have just had a scary birth outcome in the next room. Her body is releasing alarm pheromones. The intern observing your birth might have just failed an exam, and she is worried about her future. Her body is releasing alarm pheromones. With so many encounters, the chances of contagion from people are high, while the threshold of the primal senses is low.

Home births are not immune either. I am not the only midwife who has asked a nervous bystander to leave so that labor can resume.

Ultimately, however, the psychosensory approach views birth not simply as a matter of predator avoidance. Pre-verbally, touch is how we communicate to say I love you, you are safe, and you can do anything. Labor is hard for anyone, no matter the outcome. We are aiding the human to move into the psychological and even existential depth that is required to birth a child and come into motherhood emotionally intact when she finally places her baby’s heart against her own.

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