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米歇尔·奥当医生 -- 世界各地的分娩状况

米歇尔·奥当医生 -- 世界各地的分娩状况



Transcript written by Tennelle Sibarani

Translated by …



发言稿撰写:Tennelle Sibarani



I had the pleasure of meeting with Dr. Michel Odent following his talk on “Childbirth Around the World” at the Gallery in Shanghai on April 29th  2011. It was my first experience of hearing this pioneer of childbirth speak. Dr. Odent has published over fifty scientific papers, contributing the first scientific papers on the initiation of lactation in the hour following birth[1], as well as the concepts of water pools and home-like birthing rooms in maternity hospitals[2]. Dr. Odent has authored 12 books that were published in 22 languages. His most recent book “Childbirth in the Age of Plastics” is soon to be released. He has featured in the documentaries “The Business of Being Born” (2008) and “Birth Reborn” (shown in 1982 & 2007). He is the founder of the Primal Health Research Centre (London) and Primal Health Research database.  Dr. Odent‘‘s legacy of wisdom and insight is truly remarkable!


我有幸2011429上海的一家画廊听奥当博士 世界各地的分娩状况的主题演讲之后见到了他。这是我第一次听这位分娩领域医学演讲。奥当博士已经公开发表了超过50篇学术论文,先在论文中科学阐述了分娩后第一时间进行哺乳1,还有水中分娩的概念以及在妇婴保健院中建设家庭式产房2。奥当博士已发表了12本著作,被译成22种语言。他的最新著作,《外科修复时代的生产问题》将于近期出版。他出现在记录出生之事2008年)和《生育重生》(1982年和2007年)原始健康研究中心(伦敦)和“原始健康研究数据库”的创始人。奥当博士确实有着不同寻常的智慧和洞察力。


At the crossroads of childbirth...

The theme of Friday‘‘s talk was childbirth around the world. Dr. Odent began talking about how we are at a critical turning point in the history of childbirth. Technical advances such as caesarian sections, pharmacological drugs, synthetic hormones have pushed childbirth in one direction. We are witnessing in the second part of the 20th century, a push in the opposite direction towards the emergence of data from scientific discoveries.





Dr. Odent shared the findings of three recent scientific studies published in authoritative medical journals to illustrate what is currently happening around the world.

i)          The first study[3] involved a meta-analysis reviewing 12 studies from Western countries reporting on the maternal and newborn safety of planned home versus planned hospital births. It was found that 37% of women who had planned a home birth ended up in hospital.

ii)         The second study[4] looked at 2 groups in the Dutch population: low risk pregnancies (‘‘primary care‘‘ – women in the hands of midwives) and high risk pregnancies (‘‘secondary care‘‘ – women in the hands of an obstetrician). The low risk group under primary care were found to have a 3 times higher risk of perinatal mortality than the high risk group.

iii)        The third study[5] involved three groups from across China: caesarean section on maternal request; assisted vaginal delivery with vacuum or forceps and spontaneous vaginal delivery with no vacuum or forceps. The association between how a baby was born and childhood psychopathology was studied. The psychopathological risks were found to be lower in children born by mothers who had a caesarean, with the highest probability observed with assisted vaginal deliveries.   









3         瓦克斯J.R,卢卡斯F.L,拉蒙特M,皮内蒂 M.GCartin  A和黑石J2010),计划家庭分娩与计划医院分娩的母婴状况的对比分,AJOG,第30界母胎医学会大会出版,芝加哥,IL20102 1-6

4  埃弗斯 AC,布劳威尔斯 HAHukkelhoven CWNikkels PGBoon Jvan Egmond-Linden AHillegersberg J, Snuif YS, Sterken-Hooisma S, Bruinse HW, Kwee A,(2010)荷兰低妊娠风险和高妊娠风险人群的围产期死亡和严重并发症的前瞻性组群研究,BMJ2010112;341:c5639. doi: 10.1136/bmj.c5639

5  Li H-T, Ye R, Achenbach T, Ren A, Pei L, Zheng X, Liu J-M. 中国产妇要求下的剖腹产与儿童精神病理学的回顾性研究。BJOG 2011;118:42–48.


Cocktail of love hormones...

Results of the 3 research studies could easily lead us to draw simplistic interpretations such as “home births are dangerous” or “childbirth with a midwife is dangerous” or “a caesarian lowers the risk of psychopathology in children”. Dr. Odent contests that such simplistic interpretations need to be overcome. It is evident that interventions are quickly replacing the natural release of a “cocktail of love hormones” of which women once relied on. We are lying somewhere at the bottom of the abyss illustrates Dr. Odent, where childbirth is becoming increasingly more difficult. The reason being he explains is that we have forgotten the basic needs of labouring women. We are going to a level where there is no real love; in this abyss there is no need to rely on the power of the “love hormones”. Rather “real love” has been replaced with “plastic love”.





It is important for us to think long-term not just focus on the immediate period of birth. Dr. Odent   explains that an important step in the history of birthing is to understand through scientific data, the behavioural effects of hormones involved in childbirth. Among scientific perspectives today, we see how the capacity to love is involved in the way babies are born in a society. To give birth a flow of hormones: endorphins, prolactin, and vasopressin should be released. A main component of this hormonal mixture states Dr. Odent, is the “love hormone” oxytocin. We are learning that oxytocin is not just the hormone responsible for stimulating contraction of the uterus for the birth of the baby and delivery of the placenta; it is also involved in all episodes of the sexual reproductive life: intercourse, childbirth and lactation. Inspired by the scientist Niles Newton[6], Dr. Odent terms these events: the “sperm ejection reflex”, the “foetus ejection reflex” and the “milk ejection reflex”.




Rediscovering Science...

We can wonder why women can‘‘t easily release and rely on this “cocktail of love hormones” to aid her through the process of childbirth. An array of interventions to “help” her through and out of childbirth have replaced the natural birth process. This “help” argues Dr. Odent, is only a subtle way of control: cultural control! Under cultural control, the birth process has been dramatically disturbed mostly with rituals and beliefs. The transmission of simple beliefs are often accepted as truth yet modern science proves them incorrect. It is the rediscovery of science that will help to reverse cultural conditioning. If we want to rediscover basic needs we cannot rely on any cultural model, we need a universal cross cultural perspective such as that given by physiologists who study the function of the human body. Dr. Odent maintains that physiological perspectives can act as a sort of reference point from which we should try not to deviate from.






Misunderstood natural childbirth...

In past decades there have been many complex and unacceptable theories transmitted through groups of “natural childbirth”. The main reason for pessimism suggests Dr. Odent, is a lack of understanding in natural childbirth movements. Popular trends in natural childbirth circles focus on themes including “active birthing methods”, “a baby‘‘s search for the breast” and “birth in the water”. In speaking further with Dr. Odent on these themes, it was realised that the original message around each of these themes has been misunderstood, distorting the original intention. For example, an “active birth” was used to contrast the “active management” happening in Irish communities. The “rooting reflex” is a “complementary behaviour” between mother and baby. It is unnatural to leave a baby to solely perform the job of finding the breast, latching onto the breast and to feed successfully following birth. The mother and baby are designed to work together to aid this process. The original idea of water births was to offer an alternative to drugs, not necessarily a place to give birth. Occasionally a mother would give birth in water, however this was not the primary objective of water births.



在过去的几十年一直有许多复杂和难以接受的理论被一些自然分娩学派所传播。奥当博士表明悲观的主要原因在于对自然分娩运动的缺乏理解。 大众对自然分娩界的兴趣集中在包括主动分娩方法婴儿寻找乳头水中分娩这些主题上。与奥当博士进一步的交流这些主题,我才意识到围绕每个主题的原始的信息已经被误解了,原有的意图被扭曲了。例如,主动分娩本来是用于对比发生在爱尔兰的主动管理觅食反是一个母亲与婴儿之间的互补行为。让婴儿自己独立去完成寻找乳头,含住,然后成功地得到食物这些任务是不符合自然规律的。母亲和婴儿本应该是共同合作来完成这个过程。水中分娩的原意是提供除了药物以外的另外一个选择,并不一定是提供一个分娩的场所。偶尔母亲会在水中分娩,但这并不是水中分娩的首要目的。


Caesarean sections on the increase...


When we look at statistics and the climbing rates of caesarean sections, the question is often posed “how do we decrease the rate of caesareans?” Dr. Odent explained that this is not the right question or correct way to change births “helped” by technical advances. The point is not to say we must reduce the rate of caesarean asserts Dr. Odent, which can become dangerous. It is already observed that when the primary objective is to reduce the rate of caesarean, the first visible effect is that there are more and more difficult births by the vagina. Everything is tried to avoid a caesarean; leading to situations where babies are born after long difficult labours, after many drugs and after assisted deliveries. This can become dangerous declares Dr. Odent; this should be avoided in the age of safe caesareans.




Today we live in an age where by conventional criteria caesarian sections are safe and acceptable. It is true that in the context of modern large departments of obstetrics most caesarian are in fact necessary and often preferred by many doctors and women. This leads us to another question “so then why aren‘‘t caesarian sections offered to all women?” On an intuitive level, we know there is  something wrong with this conclusion; that the way we are born does have long term consequences[7]. Speaking in the “language of the heart” is not enough states Dr. Odent; rather there is a need to be bilingual using scientific data to transmit intuitive knowledge. There is a need to introduce some new criteria to evaluate the way babies are born.




Optimism in physiology...



Suddenly we have to raise new questions. The rate of women needing a caesarian section or other intervention is increasing because women are not in the right environment. It is urgent for us to rediscover the basic needs of a women in labour and a newborn baby via the perspective of physiologists. Dr. Odent suggests the main reason for optimism lies within the power of modern physiology. From this rediscovery of basic needs we can begin to move out of the abyss and acknowledge the need to shift from “helping” to “protecting” the woman in labour. The key is to be “protected” by avoiding situations that inhibit the birth process. There are many sound concepts that are scientifically well accepted but not easily digested. Dr. Odent discussed some of these concepts, including the adrenalin – oxytocin antagonism; the myth of glucose energy requirements; the neocortex inhibition and maintenance of an empty bladder through the action of a primary hormone: vasopressin.




Digesting the science...


Adrenalin-Oxytocin antagonism:


Adrenalin is released in emergency situations, times of stress, when we are scared, and when we feel observed. The release of adrenalin is highly contagious; in that emotional states are easily transmitted to others. Levels of adrenalin can more easily be reduced, allowing relaxation when there is no one around releasing adrenalin. Its an advantage when a midwife can maintain her adrenalin as low as possible. An experience that came to Dr. Odent‘‘s mind more recently dates back to the Winter of 1953 / 1954, where as a medical student he spent time in a maternity unit in Paris. He remembers the attitude of a midwife towards a woman giving birth. No one was around except a midwife sitting in a corner knitting. Dr. Odent has since realised the value of this traditional attitude (which will be discussed at The Mid-Pacific Conference in Honolulu next year, 2012).




What we have to do today is to rediscover what is simple! The work of scientists from Cambridge university has emerged, where they are studying the physiological response to “repetitive tasks”. The effect of the repetitive task is to maintain levels of adrenalin as low as possible – an important key when a woman is giving birth. When a woman is releasing adrenalin, she cannot release the necessary hormone for childbirth: oxytocin. 


我们今天所要做的就是重新发现什么是最简单的。来自剑桥大学的科学家们已经初有成效,他们正在研究 “重复动作” 对于生理影响。重复动作的影响是要将肾上腺素水平保持得最低——一位女性生产时的关键。当一位产妇释放肾上腺素时,她就不能释放分娩时必须的激素:催产素。


The glucose myth:


It can be mistakenly believed that athletic energy is needed to give birth, that a woman is preparing to run a race. If adrenalin levels are kept very low, the muscles are in a state of relaxation and there is a readiness for sleep. This desired state is interfered with when a woman is asked to walk around or stand upright. The need for sugary drinks and foods to sustain a woman during labour is therefore a useless and counter productive myth! It is well-documented and known for over 30 years in medical circles (1980 publications) that a glucose drip is not to be used during labour. There is a risk of excess insulin in the child and an increased risk of jaundice. 




Inhibition of the neocortex:


The neocortex part of the brain (responsible for logic and rationality) is supposed to be at rest and must not be excessively stimulated when a woman is in labour. This allows the primitive brain structures to more easily release the necessary hormones for childbirth. Giving birth is not a process of the intellect but a primitive response. Bright light stimulation needs to be avoided as intellectual activity is often increased by lights. Consider a dark or dimly lit room facilitating the sleep process, this too can facilitate the birth process. An essential aspect of birth physiology among humans is the inhibition of the neocortex.




Stimulation of this brain region occurs when danger is perceived, keeping one alert and on guard. This shows a basic need for the labouring woman to feel secure. Any situation likely to trigger a release of adrenaline can also be looked at in the framework of factors that tend to stimulate the neocortex.




Stimulation occurs particularly when a woman feels insecure or observed. There is a false belief that a woman is unable to give birth by herself. Rather than protected, she needs to be helped by those standing around her. The epidemic of natural birth videos and groups of people watching the birth counteracts her need to relax. When watched by medical staff or others present in the birthing room, a woman becomes concerned over her bodily functions. This must be a time of cutting herself off from the world, putting aside what she has read or learned, to be on another planet. When a labouring woman is ‘on another planet’, she finds freedom to be impolite, dares to scream, spontaneously takes on bizarre primitive postures such as going onto all fours. This represents the basic need for privacy during childbirth, allowing the activity of the neocortex to be reduced.




Dr. Odent has learnt in the past 50 or more years that the best possible environment for an easy birth is one in which no one is around except an experienced midwife or doula; a motherly figure who can remain silent and keep a low profile. A rediscovery of who the midwife was as a representation of “mother”. Her roles was to help a woman feel secure without feeling observed or judged.




Language, particularly communication with rational language stimulates the neocortex. When women are expected to respond to those around her, answering questions, being told to “breath out” or “push”; this hinders inhibition of the neocortex. Dr. Odent used the analogy of the pre-orgasmic state. The wife asks her husband “what do you want to have for dinner?” Obviously a mood-killer but more importantly the neocortex is activated! Likewise, control over the more primitive brain structures inhibits the birth process. Eliminating the whole neocortex activity leaves no room for voluntary movement and allows women to experience more powerful contractions naturally. Dr. Odent clearly highlighted the basic need of labouring women is to be protected against any sort of neocortex stimulation.




Vasopressin & hydration:


A labouring woman is often told “you must drink or you will get dehydrated!” The main water retention hormones oxytocin and vasopressin are released during the birthing process. When vasopressin (or anti-diuretic hormone) is released, water is released to keep the bladder empty. Maintaining an empty bladder during labour is important. Scientific data shows there is a low risk of dehydration during labour and how there is a risk of water excess (hyperedema) if consuming an abundance of fluids. This example highlights again how beliefs can be dangerous.




Basic needs of a labouring woman...


Oxytocin, the love hormone, is at its highest peak in a woman‘‘s life just after birth. However, a woman must not be cold and must not be distracted. She needs freedom to forget the rest of the world and to discover her baby. This phase of labour is often forgotten, disturbed and made more difficult! In particular this phase of labour between birth of the baby and the delivery of the placenta, is an important moment when a mother is supposed to release a peak of love hormones in a short period of time. This is vital for the safe delivery of the placenta and survival of the mother, to prevent fatal maternal complications such as bleeding.




Dr. Odent emphasised that the point is first to rediscover the basic need of labouring women and the rest will follow! Acquiring more knowledge is a trap that most of us fall into suggests Dr. Odent. Rather there is a need instead to “digest” the concepts that give us a correct understanding of what a labouring women actually needs. It is in understanding modern physiology that we can rediscover the true basic needs of a labouring woman that will cause us to ask the right kind of questions. This paradigm shift involves moving from “helping” a labouring woman to what is truly needed “protection”. We can then begin to digest the concepts that will liberate women to experience a natural and easy birth.




Further Reading:








[1]               Odent, M. (1977). The early expression of the rooting reflex. Proceedings of the 5th International Congress of Psychosomatic Obstetrics & Gynaecology, Rome. London: Academic Press, 1117-1119.

1. 奥当.M (1977),首次提出觅食反射。第五届国际妇产科身心医学大会的议程。伦敦:学术出版社,1117-1119

[2]                Odent, M. (1983). Birth under water. Lancet, 2(8365-66), 1476-7.

2. 奥当.M (1983),《柳叶刀》,水下分娩,2(8365-66), 1476-7

[3]               Wax, J.R., Lucas, F.L., Lamont, M., Pinette, M.G., Cartin, A. & Blackstone, J. (2010) Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis, AJOG, Presented at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago, IL, Feb. 1-6, 2010.

[4]               Evers AC, Brouwers HA, Hukkelhoven CW, Nikkels PG, Boon J, van Egmond-Linden A, Hillegersberg J, Snuif YS, Sterken-Hooisma S, Bruinse HW, Kwee A. (2010) Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. BMJ. 2010 Nov 2;341:c5639. doi: 10.1136/bmj.c5639.

[5]               Li H-T, Ye R, Achenbach T, Ren A, Pei L, Zheng X, Liu J-M. Caesarean delivery on maternal request and childhood psychopathology: a retrospective cohort study in China. BJOG 2011;118:42–48.

[6]    Newton N, Foshee D, Newton M. Parturient mice: Effect of environment on labor. Science 1966; 151: 1560-61

6  牛顿N,福希 D,牛顿 M,《待产的老鼠:环境对于生产的作用》,《科学杂志》 1966151:160-61

[7]    See “Primal Health Research Database”: www.primalhealthresearch.com

7  参见“初级护理研究数据库”:www.primalhealthresearch.com


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