The perinatal application of oxytocin and its potential influence on the human psyche
Christof Plothe, D.O., BSc., (OST), H.O.N.S., M.R.O., DPO, HP
Bleichstrasse 21, 55232 Alzey, Germany
E-mail: c.plothe at ostmed dot net
One of the human body's own naturally occurring hormones, oxytocin is released in the posterior pituitary gland and controls a number of important bodily functions. Since the 90's, the psychoactive components of the hormone have become the subject of scientific study and subsequently became meaningful during diagnosis and subsequent therapy in the fields of Psychiatry and Psychology. The new awareness and research regarding the psychoactive character of the hormone is particularly of concern in view of the fact that since the 1960's, oxytocin has also been used medically, primarily by Gynaecologists, to induce labour.
The conclusions reached in the article emerged after over a decade of work with new-born babies. The theory resulting from this work postulates that the use of oxytocin during and before birth can have consequences for the psyche of the child, both during the critical span of months immediately after birth and even beyond that for the remainder of childhood and even on into adulthood. Its use before birth should therefore be carefully considered. Currently in the USA almost 80% of all births take place under conditions of an oxytocin-induced labour. Due to this widespread use, the broad application of oxytocin medically to a huge portion of the American population could even be seen as a matter of social importance. Over the course of many years, the author has set up treatment for a large number of affected children and adults, and therefore describes in detail various treatment options.
2) The Chemistry of oxytocin
Oxytocin was discovered by Sir Henry Dale in 1906. He found that extracts of the posterior pituitary gland could produce a stimulating effect on the uterus. A few years later the new substance, now called "Pituitrinâ€ was administered to women to prevent a postpartum haemorrhage (Mitchell BF, 2001). The nonapeptide oxytocin was isolated and synthesised for the first time by the US Chemist Vincent du Vigneaud (Du Vigneaud V, 1953). It was the first ever neuropeptide to be decoded and artificially reproduced. In 1955, he received the Nobel Prize for his research. Already by 1960, oxytocin was widely available on the pharmaceutical market, as it became widely known that the hormone could trigger contractions of the uterus. Likewise, it was also known that it encouraged lactation. Its name is translated directly from the Greek language and literally means "fast birth" (Dale H, 1906). In 1984, its genetic sequence was decoded (Ivell R, Richter D, 1984).
It was found to be formed in the paraventricular and supraoptic nucleus of the hypothalamus, concentrated in formation around the magnocellular neurons (Brownstein M J, 1980; Buijs R M, 1985). The neurones modulate hormone production and are capable of immediately starting/stopping production based upon continually monitoring its presence and concentration in the plasma (Leng G, 1999).
The hormone's influence is not only limited to its general role as a physiological regulator (posterior pituitary secretion) coming from within the bloodstream. It is also created at connections within the anterior pituitary gland, where the hormone controls general endocrine function within the body. A very important study of the regulating functions of the hormone was in regard to its influence on the production of Prolactin and ATCH (Samson WK, 1995). In the artificial production of oxytocin (synthesis) several forms may be produced, differing from one another based upon the extra amino acids attached to one end. These "prohormones" are collectively known as oxytocin-X hormones, and have been found to occur naturally in the peripheral circulation of women.
Oxytocin-X may occupy the usual receptor position of normal oxytocin on the neuron, effectively blocking the effect of the normal hormone (Mitchell BF, 2001). This "immature" form of oxytocin, oxytocin-X, is also detectable in the blood of newborns at levels higher than that of normal oxytocin itself. Oxytocin-X levels have been found to be higher in the newborn's umbilical vein than in its umbilical artery, and the ratio (oxytocin-X to mature oxytocin) increases even more after the onset of labour. This suggests that, unlike oxytocin which is produced by the fetus, oxytocin-X may be produced in the mother's uterus during labour and may be involved in regulating the processes of labour (Mueller-Heubach E, 1995).
After birth, newborns produce increasing amounts of mature oxytocin. In a detailed study of oxytocin concentrations in laboratory rats, the same fetal rats producing virtually no mature oxytocin at term had increased the proportion produced postnatal to one of over 50% mature oxytocin within seven days (Mueller-Heubach E, 1995). Higher ratios of oxytocin-X versus oxytocin have also been found to occur in cases involving autism. Multiple studies point to a short half-life for oxytocin in the bloodstream, making its direct effects transient. Oxytocin's half-life has been variously estimated as three and a half minutes (Fuchs AR , 1984), 10 to 12 minutes (Arias F, 2000) and 15 minutes (Gonser M, 1995).
Based upon analysis and scientific study, it is generally accepted that all vertebrates possess some form of oxytocin (and vasopressin) equivalent. The broad presence of the hormone in so many vertebrate species implies that oxytocin is around 500 million years old (Acher R. 1995). Studies have found that particular stimulating activities such as sucking, sexuality (Anderson H M, 1994; Arigolas A, 1992; Arletti R, 1985), birth (Alexandrowa M., 1980) and different types of positive and negative stress cause oxytocin to be released into the circulatory system by the posterior pituitary gland. Its secretion was also found to be dependent on the presence of other hormones, such as those of the thyroid (Adan RA, 1992).
From within the bloodstream the hormone is put to use within the central nervous system, where rows of oxytocinergic neurons use it in many different physical regions across the nervous system as a whole (Barberis C, 1996; Elands J, 1988). Since it is well documented that high oxytocin concentrations may be found in important parts of the autonomous and limbic system, its assumed use there is as a neurotransmitter and neuromodulater, with greater effects beyond that influencing the entire CNS (Loup F, 1989; Sawchenko PE, 1985).
Interesting also is the finding that oxytocin bonds exist in the spinal cords of both newborn and adult rats between C8 and L2 (Horseman MK, 1994). However, it is also known that oxytocin can be formed in peripheral structures (uterus, placenta, amnion, corpus luteum and also the heart). It even appears to play a large role in the area of masculine sexuality. Through animal testing, oxytocin was found to be present in the testicles, the epididymis and the prostate gland. It seems to have a function during the process of ejaculation, which in some mammals, changes the contractility in the tubuli seminiferi (island TR, Young L, 1997). oxytocin injections were found to cause erections in animals (Melis MR, 1986).
Among its CNS collection points, the hormone was found concentrated in the cerebral spinal fluid (Amico YES, 1983). In this regard, oxytocin was also found to modulate our experience of pain (Arletti R, Benelli A, 1993). Memory and mood are also influenced through the release of this hormone (Arletti R, Benelli A, Poggioli R, 1995), as is the modulation of the autonomous nervous system (Armour YES, 1990). Oxytocin has also been found to play an important role in digestion and nutrient absorption. Its release activates the vagal nerve, which in turn increases the activity of hormones in the gut. The resulting increased levels of these hormones (such as cholecystokinin and gastrin) leads to growth of the gastrointestinal tract, leading to a larger surface area for more efficient nutrient absorption (Uvnas-Moberg K, 1989; Uvnas-Moberg K, 2003).
A further study found that oxytocin-triggered processes also promote anabolic metabolism, that is, the metabolic processes which prioritize growth over "catabolic' break-down. An example process documented in this paper shows how oxytocin release leads to insulin elevation (Uvnas-Moberg K, 1989; Uvnas-Moberg K, 2003) which in turn promotes the cellular uptake of glucose and other nutrients. All of these effects are obviously beneficial in optimizing the nutritional state of pregnant and breastfeeding females.
At a biochemical level, the receptor used by oxytocin is tied to the phospholipase C enzyme. Its genetic sequence was decoded in 1992 (Kimura T et al., 1992). For the hormone to bond, magnesium (Pliska V, 1991) and cholesterol (Gimpl G, 2000) are necessary. Its activation is dependent (Coirini H, 1991; Dawood MY, 1986) on steroid hormones. In one documented case bonding involved for example oestrogens (Caldwell JD, Walker, 1994). In all of these studies, both a modulation of the oxytocin receptors and also the oxytocin itself could be verified. In light of the view that the oxytonergic system is very old (see above) and also that it exercises a central function in the reproduction, investigations of its potential interaction with sexual steroids may play a huge role in the research of reproduction control (Ivell R, and Walther N, 1999) (the author believes that this theory also applies to human interaction with other similar oestrogen-bearing substances found in some plastics, for example, within our environment.) Oxytocin receptors are found in both the brain and the periphery (Adan RA; Van Leeuwen, 1995). Interestingly enough, they are also found in the heart. It is modulated through the oxytocin and the receptors formed here (Jankowski M, 1998). Both the hormone and its receptors were analyzed and found present in the central vascular system of a laboratory rat (Jankowski M, Wang D, 2000). Even on osteoblasts, functional receptors for oxytocin were found (Copland YES, 1999). With increasing age, we seem to lose the possibilities of bonding oxytocin to its receptors (Arsenijevic Y, 1995).
3) Perinatal function of oxytocin
At the beginning of the 90's, Benedetto (Benedetto MT, 1990) observed changes taking place within the oxytocin receptors inside fetal membranes during births occurring under the influence of oxytocin. They showed that in the beginning stages of birth and throughout the later advancing stages there was a significant rise in the number of receptors present. This seems to point towards a critical role for oxytocin at the onset of labour. Chibbar et al. (Chibbar R, 1993) also proved the importance of the hormone. They found large quantities of altered oxytocin in amnion, chorion and decidua before the birth. The significant role which oxytocin plays in controlling the birthing process was also shown by Fuchs et al. (Fuchs AR, 1982). The hormone was found to display even paracrine characteristics at a cellular level during its control of the birth process flow and development (Mitchell BF, 1998). In fact, it has been shown that throughout the long journey from the sexual stimulation to the role of being a parent starting with birth, oxytocin plays a continuous leading role in process control (Insel TR, Young L, and Wang Z, 1997). For example, injected oxytocin hormone into a sheep's ventricle will immediately lead to "motherly" behaviour being observed towards little lambs (Kendrick KM, Keverne EB, 1987).
In lactating cows, increased oxytocin levels were proven to be necessary for milk production (Bruckmaier RM, 1994). The human physiological reaction was also similarly analyzed during lactation and subsequently documented during nursing (McNeilly ACE, 1983). Similarly, during the hour or so after birth when bleeding is most likely, oxytocin levels were found to be elevated in healthy mothers who gave birth vaginally and made continuous skin to skin contact with their babies (Nissen E, 1995). Kennell and McGrath noted, "before the availability of medications such as pitocin, the newborn's touch was probably crucial for the survival of mothers by raising oxytocin levels to cause strong, repeated uterine contractions, which prevented a fatal hemorrhage." (Kennell JH, 2001). A second earlier study on a related topic also proved the significance of good bonding between mother and child, especially directly after birth (Kendrick KM, 2000).
The significance of low levels of postnatal stress in infants for developing skills in dealing with stress later in life was investigated by Henry et al. (Henry JP, 1998). Their results showed the critical importance of gonad steroids and oxytocin for humans in order to connect to each other. If it comes to a stressful loss of control, the catecholamines and the "fight and flight" mechanism come to dominate the control of our behavioural strategy. Several studies on the impact of epidurals (which reduce the maternal oxytocin peak at birth) correlate this intervention with deficits in maternal-infant attachment in both humans (Murray AD 1981; Sepkoski CM, 1992) and sheep (Krehbiel D, 1987). In sheep, the notable deficit in maternal-infant attachment was corrected using oxytocin injected directly into the brain (Levy F, 1992).
Similarly, externally induced barriers to the early childhood bonding process can have long term anti-social/-bonding impact and can lead to disturbances at a biochemical level in the processes within the right hemisphere of the brain. The resulting behavioural pattern caused by this "malfunction" is driven by a permanent perceived need for self-preservation. An example manifestation of this sort of behaviour may be found in the definition of a typical Type A personality (the term originated in the field of cardiology).
Michel Odent, a gynaecologist and important advocate of natural birthing summed up both the meaning and significance of oxytocin with the phrase: [oxytocin represents for us the] "roots of the love". This is also the title of his latest book. In 2007 in Israel, Dr. Ruth Feldman proved that oxytocin takes over the main role in guiding the emergence of behavioural and mental representations, which are typical for human bonding. The levels of oxytocin present in the systems of studied individuals after birth were able to be ascertained with a high degree of accuracy based upon observed behaviours such as eye contact, vocalisation, positive visual cues, caring physical contact, directed activities towards bonding and associated thought processes, and finally simply by maintaining continuous visual contact between the mother and the studied children (Feldman R, 2007). Also, in tests using newborn voles, the effect of (non-naturally occurring) applied oxytocin was found to provide further insights into the postnatal bonding behaviour of treated animals. Significant correlation in the level of applied oxytocin to the rate at which the treated vole subjects would show motherly behaviour in later life (towards the next generation) was found (Bales K, 2007). The higher the original dose of oxytocin, the higher the likelihood was that females, as fully grown animals, would care for vole cubs, even if they were not of the same family. In 2005, doctor Alison Wismer Fries (Wismer Fries A, 2005) examined the impact of early childhood experience and its relationship to later social behaviour in which she took two groups of children and examined oxytocin- and vasopressin-levels present in the urine of each group. Group one consisted of children who had, since their birth, been brought up by their biological parents and group two of children that had grown up in orphanages in Romania and Russia. It appeared that as a result of being in contact with their biological mothers, the measured level of oxytocin present in the urine of the children in group one increased. In the orphans, this level stayed constant. This finding could provide the neuroendocrinal basis for the noted phenomenon in some adopted children, especially those with personal experiences deprived of close social contact, of difficulties establishing safe, stable, and close relationships even if they live in loving families. In Germany, oxytocin is currently administered during or before birth for four primary reasons: to induce labour, to augment labour during birth (which also seems to have a supportive and positive effect on the psyche of a treated person), treatment after a performance of a caesarean section, and to accelerate placenta relief. The application is usually intravenous, but a spray is also available and currently used in many cases. All dosage types potentially have an influence on mother and child, whereby the last two mentioned seem to only influence the nursing of a baby.
4) Psychoactive components of oxytocin
While the physiological effects of oxytocin were well documented by the end of the 1960s, the hormone's effect on our nervous system was not a serious subject for researchers until well in to the 90s. Findings since that time suggest that oxytocin plays a key role in the stress response of the human body. It was discovered that under stress, more RNA from oxytocin, and also an increase in production of magnocellular neurons of the nucleus paraventriculus (not the N. supraopticus) was present (Jezova D, 1995). Because oxytocin is released during both positive and negative life events, one important question is if oxytocin is also capable of causing different reactions within the body's nervous system (Carter, C S, 1998). One measurable positive effect is the hormone's impact on memory (Boccia MM, 1998). A pain modulating effect could also be proven (Boccia MM, 1998). A positive effect on the cognitive abilities of the nervous system was also investigated (Bruins J, 1992). It also has an anxiolytic effect on mammals. In this study, anxiety-related behaviour evidenced under manually induced stress was actually less present in lab animals after the administration of oxytocin (McCarthy MM, 1997). Oxytocin also seems to modify many forms of generally addictive behavior (Sarnyai Z, 1994). This was proved specifically in cases involving opiate and cocaine abuse (Kovacs GL, 1998). In certain cases of extremely compulsive behavior (obsessive-compulsive disorder), a potential basis was found to be a dysfunction in the balance of oxytocin levels (Leckman JF, 1994).
Blocking oxytocin intake by the receptors has a subsequent noticeable impact on the sexual behavior of the individual involved (Caldwell JD, 1994). Oxytocin levels are measurably elevated during sexual activity (Carmichael M S, 1987). For many authors, it seems to play a central role in human sexuality in general (Murphy MR, 1987). Further, the motives and subsequent behaviour of being faithful to a single partner seem to be dependent on oxytocin. In this study, Carter (Carter CS, 1995) was able to prove that voles with a higher number of active oxytocin receptors (and thus more oxytocin reception in general) tended to be faithful to a single partner over their entire lives. Cho also conducted tests on this same subject animal while researching the differences in performance of different types of oxytocin receptors. Tom Insel (Insel TR, 1995) injected voles with oxytocin, and was thereby able to increase their faithfulness. The opposite effect was observed when the voles' oxytocin receptors were blocked; in this case, there was no sign of bonding with the partner at all.
This social effect was put to commercial use in America in 2006, when a nasal spray was put on the market containing oxytocin. "Liquid Trust' (or Instant Trust, Instant Openness, etc.) as it is known, promises higher success rates in seduction after its use. One important insight also arose parallel to the discovery and commercial introduction of the spray, researchers also reached the contrary conclusion (i.e. that one can prevent a personal bond to a sexual partner through blocking the oxytocin receptors). Through this, sexual contact with a potential partner could result without the "troublesome" emotional tie (Tierney J, 2009).
This central hormone can do even more than influence sexual behaviour, however. In the 90's, British researcher Richard Windle showed that after the admission of the hormone, stress and anxiety were diminished in rats (Windle R, 1997). Baumgartner and Heinrichs (Baumgartner T, Heinrichs M, 2008) were also able to prove this in humans, when they were able to assess a significant rise in confidence after the application of oxytocin. The experiments showed that after the oxytocin application, the inclination of the test subject to take social risks, increased. Based on findings in neurochemical research, higher oxytocin levels in humans seem to engender positive psychic states similar to those described as love, confidence and peacefulness by test subjects. Experiments, like those conducted by Michael Kosfeld of the University of Zurich, support this theory. Kosfeld let test subjects conduct an investor game winning real money, whereby one part of the group received a dosage of oxytocin nasal spray, thereby increasing the overall level in their bodies. Observations of player behaviour led to the unmistakable conclusion that the "oxytocin-boosted" players showed more trust in their fellow players. Kosfeld and Heinrichs (Kosfeld M; Heinrichs M, 2005) were later able to show that oxytocin also reduces anxiety and has a stress reducing effect, which evokes social support. Within mammals, the hormone is generally responsible for the control of social behaviour, motherly care (Fahrbach SE, 1985) and the ability to bond.
All of these effects should also be transferable on humans. Insel and Winslow et al. (Insel TR, Winslow JT, 1998) created a neuroendocrinological model for couples to bond based on the availability of oxytocin receptors. The higher the quantity, the more likely it is that one will bond to his or her partner. In a further study, they created a neuroendocrinological model for monogamy (Insel TR, Winslow JT, Wang ZX, Young L, 1998).
Walter (Walter H, 2003) postulated that the release of oxytocin would not only be beneficial for the mother when nursing, but would also release feelings of happiness. This is said to be elementary for the bond between the mother and her child. The importance of this phase of bonding, directly after the birth, for our behaviour in later life was shown in studies by Bowlby (Bowlby J, 2005). He identified four different types of bonding behaviour, from firm to unstable, dependent on the early experiences the baby had after the birth. The team of Beate Ditzen investigated the influence of oxytocin, by requesting spouses to start a discussion on a subject about which they frequently argue. The results of the study suggest that the neuropeptide has a calming and deescalating effect. The significant calming effect was once again tested and proven in 1998. In this study the findings suggest that the mediation of positive interpersonal action and emotion is significantly enhanced through elevated oxytocin levels. Not only somatic sensory attraction, such as impressions induced during and before nursing, but also simple physical contact and warmth can lead to a release of the hormone. The consequences of such a release are that even as the body's own opiates are being formed, the production of cortisol decreases, insulin increases, blood pressure sinks etc. Because the hormone seems to be so beneficial in engendering positive states of mind, its supporting use has also been emphasized recently in the areas of hypnosis and meditation. Testing in these areas led to the development of a model explaining its use in so-called alternative healing methods (Uvnas MK, 1998). An equally crucial skill for social communication, facial recognition, also seems to be strongly influenced by oxytocin (Domes G, 2007).
5) Insights within Psychiatry and Neurology
Initially, in order to be able to determine the psychoactive impact of oxytocin, researchers began by searching for the relevance of the hormone in its known pathologically variant forms. Here it was found, for example, that there are changed values of the hormone in people suffering from schizophrenia (Beckmann H, 1985). Equally, changes in the concentration of oxytocin were examined in people suffering from eating disorders (bulimia, anorexia) (Chibbar R. 1993; Demitrack M A 1990). In cases of individuals suffering from obsessive-compulsive disorders, one researcher also found significant variations (Den Boer J A, 1992). Through the application of oxytocin in the bulbus olfactorius of rats, one researcher was able to cause antisocial variations in their social behaviour (Dluzen D E, 1998).
The presence or lack of the hormone and an attendant effect on memory was also discovered (Engelmann M, 1996; Fehm W G, 1984). One significant finding involves senile dementia, which was found to result after a significant reduction in oxytocin production in the nuclei of the hypothalamus (Fliers E, 1985). On the other hand, increased concentrations (33%) of oxytocin are found in patients with Alzheimer's in the area of their Hippocampus, which is where our short-term memory is situated (Mazurek M F, 1987). In fact, in cases involving multiple neurodegenerative illnesses, a parallel reduction in the body's ability to metabolize oxytocin has been noted (Freund-Mercier M J, 1989). Specifically, connections between a reduced metabolism of oxytocin and autism have been noted (Insel T R, O'Brien D J, 1999). On the treatment side, initial successful trials in the clinical application of oxytocin as a means to improve identification of emotional content in autistic and Asperger patients, were documented in 2003 (Hollander E, 2003). Generally many of the behaviour patterns attributable to active oxytocin processing are impaired in autistic individuals, including social recognition and social bonding.
These observations have lead researchers to look at oxytocin malfunction as a possible causative factor and also to test oxytocin in the therapeutic treatment of autism. At the basis of this assumption-, researchers have categorically found deficits in the oxytocin processing systems of autistic individuals.
One study found lower blood oxytocin levels in pre-pubertal autistic children (Modahl C, 1998) and another study found a lower ratio of oxytocin in relation to its immature forms (oxytocin-x) in autistic children, reflecting a possible deficiency in the pathway conversion process mentioned earlier of oxytocin-x to oxytocin. In these children, oxytocin-x was not increasingly replaced with mature oxytocin with age, as in normal children (Green L, 2001). Other research suggests a bigger role for the related hormone AVP in bringing about the behavioural changes associated with autism. In animal research, the social/developmental functions of AVP in the male were noted to be similar and in some areas overlap the functions of oxytocin in the female. However AVP is associated with arousal, activity and aggression, as opposed to the soothing, pro-social effects of oxytocin. Exaggerated AVP activity that is not balanced by oxytocin's "calm and connection" effects might explain some features of autism, as well as its increased prevalence among males, whose oxytocin system is less active (Carter CS, 2007). The researchers go on to suggest that alternations in this system (AVP/oxytocin levels) may be due to developmental or epigenetic factors, possibly including prenatal stress; exposure to excessive or deficient levels of hormones such as estrogens, androgens, AVP and oxytocin in the perinatal period; and factors such as illness, inflammation and early social experiences (Carter CS, 2007).
In a double-blind study, Hollander and colleagues found that an intravenous infusion of oxytocin at 2- to 3-week intervals significantly reduced repetitive behaviours in adults with autism and Asperger's syndrome as compared to those receiving a placebo (Hollander E, 2003). In another study, oxytocin was also found to facilitate social information processing in autistic individuals (Hollander E, 2006), and this was consistent with yet another similar finding in normal adults (Domes G, 2006). The origins of the abnormalities in the oxytocin/AVP systems that are described in all of these papers remain unknown. Some researchers hypothesize that interference in the perinatal period, especially through the ubiquitous administration of exogenous oxytocin (pitocin) to women in labour and birth, may be involved (Wahl RU 2004). It deserves mentioning here that autism is also linked to high mercury levels in the body. Studies have shown that it can interfere with oxytocin production in the posterior pituitary gland (Kistner A, 1995; Mass C, 1996). If one of the theses suggested in this paper, namely the possible reduced function of oxytocin receptors after the perinatal application of oxytocin should prove to be correct, what would this cause in a child that has already a reduced production of oxytocin (through the mother) in the first place? Could this combination be another explanation in the aetiology for autism? Through its key role in controlling human behaviour, oxytocin is seen as a basis for many neuropsychiatric illnesses (McCarthy M M, and Altemus D M, 1997).
6) Possible physiological alterations due to perinatal application of oxytocin
In 1997, it was shown that when the uterus is treated with oxytocin, the oxytocin receptors there react in a diminished fashion, leading to an overall depressed oxytocin-based system regulation and also a desensitisation of the tissue (Phaneuf S, 1997). As a possible mechanism for the variation in the uterine cells of the myometrium, transcriptional suppression and destabilisation of the mRNA (through RNA bonding proteins) were the postulated causes.
A recent 2009 study in Sweden of 630 women supports the theory of oxytocin as anaesthetic with questionable physiological benefit. The study found that while the use of oxytocin during the early stages of birth shortened the duration of pain (even in births involving reduced cervical dilation) there was no significant parallel decline in the rate of c-section or instrumental births (Brown A, 2009). Also, the administration of oxytocin during birth was found to lead to an increase of oxidative stress. The testers in controlled group involved in testing of a contraction-promoting medication containing oxytocin, showed significantly low levels of glutathione compared to the other group of testers (Schneid-Kofman N, 2009). Based on studies involving mice with deficient oxytocin levels, findings show that even though reduced sexuality and problems related to contractional dysfunction during birthing eventually disappear over time under normal conditions, there were noticeably significant problems with nursing and social deficits within the oxytocin-treated mice later in life (Takayanagi Y, 2009). In addition, a significant increase in the level of aggression in the offspring-mice of oxytocin-treated mother animals was found, when these subjects later matured into adulthood (regardless of gender). Using rats, it was proven that the admission of oxytocin after birth resulted in the heart of the animal containing a widely variant number of receptors (Pournajafi Nazarloo H, 2007).
While this article seeks to emphasize the psychiatric and psychological aspects of oxytocin treatment, a significant contribution in the form of a thesis, written by a doctor from Uppsala, Sweden, deserves special recognition. The doctorand in this case evaluated data from 28,486 births during a ten year period. The goal was to examine use and abuse of oxytocin admission. Uterine hyperactivity, as it occurred in births involving the proactive administration of oxytocin, was found to have a high correlation with metabolic acidosis within the umbilical cord. 75% of the noted uterine hyperactivity was actually attributed to the oxytocin. The conclusion of the study notes that a minimum of 40–50% of metabolic acidosis, which by the way entails health risks for the child, could have been prevented through proper use of oxytocin and early recognition of foetal stress (Johnson M, 2009).
I am very grateful to Dr. Sarah Buckley, who in the course of presenting her research to me on the subject of oxytocin also introduced me to the concept of "hormonal imprinting," a theory introduced by Prof. Csaba. He states that perinatally, the first encounter between the maturing receptor and its target hormone results in hormonal imprinting, which adjusts the binding capacity of the receptor for life. In the presence of an excess of the target hormone or foreign molecules that can be bound by the receptor, faulty imprinting can potentially carry life-long consequences (Csaba GB, 2004).
Could this also be true for oxytocin? If so, what would be the consequences of an artificial perinatal application of an important physiological hormone called oxytocin for our lives? Winstone (Winstone C, 2008) in her thesis looked at children at the age of three after an oxytocin induced labour. She concluded that the polyvagal theory can serve to provide an understanding of such factors, interpreted as (a) assertiveness (exemplifying social engagement) and (b) a need to control the environment (exemplifying sympathetic nervous system activation) that may be seen as statistically relevant. The evaluative data for these criteria was arrived at through questioning the children's parents. Both factors appeared to portray improperly regulated internal responses in the affected children to outside-in influences. The study's findings appear to her to also support the concept of hormonal imprinting by Csaba, in that pitocin use at birth seems to result in enduring faulty oxytocin systems in mother, infant, or both, apparently affecting internal regulation and mother-child social attunement.
In the studies mentioned thus far, much has been quoted from the present state of the oxytocin research. The main focus has been on the psychic component of the hormone. The goal has not been to discuss the indication criteria or if its use during birth is sensible, for this decision lies in the hands of a gynaecologist. Nevertheless, a sizeable medical and social benefit may be realized when psychological insights are used to improve the precision and understanding of obstetrical treatment options and effects.
The factors which trigger labour pain are as yet not exactly clarified. Instead we do know that through a complex interaction of estrogens, gestagens, adrenalin, prostaglandins, CRH, oxytocinase and the sensitisation of the uterus; -that all these changes lead to a release of oxytocin. At the same time, based on Dr. Tagayanakis' research we know that rats do not need oxytocin for birth. Its complete absence however probably led to social deficits in the concerned rats. If this theory also applies to human beings, perhaps a greater degree of sensitivity than is commonly practiced today is needed by doctors when dealing with this subject. Many years ago, Michel Odent proposed that the initial promotion of labour pains use mother-centered individual measures before resorting to a more direct intervention in the birth, through the administration of syntocinon (synthetic oxytocin). His approach emphasized the importance of peace and quiet for a woman during labour and birth. It also stressed the activation of the parasympathetic nervous system to be important for avoiding stress during birth. In order for the birthing mother to be free to experience greater activity in the more mature and stable areas of the brain, he recommends a minimization of auditory, visual and olfactory sensations in order to retain a relatively low level of activity if the neocortex.
Equally, sociocultural factors in the immediate environment such as the availability of constant care and the continual presence of a caretaker were evaluated as very helpful in withstanding the stress of labour pains. Similarly, access to a focal person of trust and confidence (midwife, Doula) throughout the entire birth has been proven to be just as beneficial. These same environmental factors also apply to the subsequent establishment of positive communication during birth between mother and child. One method for measuring and reproducing these factors effectively is described in the so-called "Bindungsanalyse" (analysis of the mother-child birthing environment) developed by Hidas and Raffai (Hidas G, 2006), a procedure which is actually followed during the pregnancy. Other beneficial factors are warmth (warm baths), movement and changing position, maintaining a healthy supply of fluids (including electrolyte glucose), mamillary stimulation (leads to a release of oxytocin), massages, breathing exercises and later in birth the opening of the amniotic sack. All of these factors boost the value of a midwife during birth, as they belong to the traditional methods used by midwife practitioners. These potential benefits of these "traditional' methods deserve to be researched more closely, especially when the potential consequences of administering oxytocin during birth are considered.
In endocrinology, the principle of down-regulation dictates that after an increased concentration/level of a cellular component has been attained, it drops off significantly and (at least in the cases of hormones) desensitization and hormonal deregulation follow. To the best of my knowledge, a significant investigation of down-regulation has yet to be undertaken regarding oxytocin levels in a human mother and child.
Pournajafi Nazarloo et al. were able to prove this for the oxytocin receptors in the heart of a rat. Why shouldn't the same mechanism also be active in the human organism? Could a prenatal application of oxytocin not also lead to a variation in the amount of receptors? What would be the effect of a strong oxytocin release without having the corresponding or appropriate number of receptors in the mother and the child? Can effective bonding take place under such conditions? Often, after the use of oxytocin, many treated mothers in my practice reported they failed to sense an immediate closeness towards their newborn child after birth. Such an experience leaves traces of doubt and nervousness towards the concerned child in the mind of the mother. Mothers also reported experiencing differences in the quality of the bonding after birth, -differences which were noted based on comparisons of oxytocin-assisted childbirths to ones taking place without the use of oxytocin. Midwives also reported significantly higher rates of postnatal depression after an oxytocin-assisted delivery.
From the perspective of the newborn, babies also more often seem to have problems making close contact with their mothers after an oxytocin-assisted delivery, -which can lead to problems during nursing. Disproportionately, such babies coming in to my practice displayed behavioural signs of trauma. They were more likely to display the moro reflex and this over a longer period of time, and they were often very easily startled. Such infants are often known as "screaming childrenâ€, and may only be calmed when on someone's arm. Usually, an infantile colic is diagnosed in such cases and a therapy is then arranged to address this "disorder'. Affected infants also tended to show a change in skin complexion, and to sweat. They were usually restless and only able to focus after a while. They were sometimes hypotonic or hypertonic and often had problems controlling head movements.
Even if these criteria are not seen as oxytocin-specific, but rather as general criteria for a traumatised baby, I first became aware of a correlation with the use of a labour promoter, because these same children were also the children who were not able to be comforted immediately after birth, even by their own mothers. While in cases of non-assisted births (even those completed only after many days of labour-related strain), once the newborns had overcome the stressful experience of birth, these children were subsequently able to be calmed through bodily contact. Could the missing of oxytocin at the bonding sites be a possible mechanism for the persistent restlessness of these children?
Further, what is the true impact of a forced increase in the level of the human hormone, which is the one primarily responsible for regulating our behaviours regarding confidence, bonding, and love (within the organism), at exactly that moment in time where we experience maximum stress (i.e. during birth)? Could not mixed or ambivalent feelings towards these subjects and traits result and continue to follow us on for the rest of our lives? Or, in other words, instead of being able to recover from the strain of the birth, in the arms of the mother or father, the (elevated) oxytocin itself could already be connected with a lot of stress but also with positive connotations.
This, in itself, is a confusing situation for a new-born baby and it is fraught with many consequences, especially when the individual is faced with burdens and relationships later in life. Dr. Wismer Fries reported on how such positive oxytocin-regulated behaviours seemed to be lacking in adopted and neglected children, ones who also experienced a significantly dysfunctional environment during the important phase after birth. Dr. Feldman proves to the prominent role oxytocin has in bonding. The meaning behind these findings (taken together) is also supported by the current research done by Henry and Bowlby. Through his studies, Dr. Takayanagi showed that signs of aggression in later life were a reaction to a lack of oxytocin. What other possible areas exist as an explanation for an interruption in the oxytocin balance?
One certainty is that in many cases the initial imbalance occurs prenatally through the administration of oxytocin during birth. In adolescent oxytocin imbalanced children, I identified an increased amount of unspecified feelings (inexplicable feelings of joy or sadness) as being a key symptom. Often, insecurity seemed prevalent in such children. Disruptions in completing school work and often relational problems with siblings or parents arose. When part of a group, such children stated they often felt left out, or they expressed a desire or need to dominate. These are all symptoms that improved or even disappeared altogether through the administration of potentized oxytocin (C30}, so we were able to directly attribute the symptoms in such cases to a hormonal imbalance. In adults, such symptoms and their associated problems expanded. The ability of affected adults to start relationships was difficult, and they seemed to exhibit a significant ambivalence towards positive events ("Yes this sunset is beautiful, but…..").
We know about the relevance of the oxytocin hormone within social communication, its relevance for developing an ability to have confidence in another individual and in one's own self, and its almost instinctual impact on our behaviour when we come into contact with a baby. We are aware of its relevance within sexuality, flirting, and for the masculine erection and the human perception of desire. We are also aware of its prominent role in diagnosed neuropsychiatric problems such as schizophrenia, Morbus Alzheimer, autism, eating disorders, obsessive-compulsive disorder etc. Also, the psycho-physiological control the hormone has, for example on the heart is of great importance. All in all, when it comes to the subject of dealing with children, juvenile and adult aggression, problems with bonding, social phobias, etc. we are, at present, faced with large variety of highly complex subjects. Would it be possible that some of these factors are at least in part explicable based on environmental factors existent at the time of our own birth? Further, what if the proactive administration of oxytocin is found to be partly responsible? I would like to, at this point, make a plea for more research on this subject, so that more studies and an interdisciplinary exchange are undertaken for the future of our children.
8) Therapeutical suggestions after a known application of oxytocin
The most important therapy after the application of oxytocin during birth is simply physical (body) contact with the parents. Both the olfactory system and the somatic sensory communication are very important methods for gathering information in a newborn baby. The next pillar of therapy is in the practice of Osteopathy, where practical solutions for problems associated with somatic and psychic components disrupted during birth are implemented. Damasio (Damasio A R, 2000) wrote about the somatic portion of human memory. One somatic correction might be, for example, to transfer cranial bones, joints, body fascia and organs back to their optimal condition (in order to be able to release the unpleasant memories in the organism at the birth) as an effective part of an osteopathic therapy program.
An intravenous application of oxytocin via drip, while stimulating the labour, can actually cause a woman to lose control of the birth process. As a result, newborn children may experience extreme pressure on their skulls during birth, more so, for example, than in an unassisted birth. The osteopathic perspective sees the forced birthing process as detrimental to proper CNS' development. The subsequent treatment of a baby's potential shock experience from birth, and the resolution of cranial blockades usually lead to serious differences in the psyche, neurological and motoric development in children. In cases involving new-born babies after oxytocin was administered, it is recommended that therapeutic regimens, such as baby-massages (eg. Butterfly-Massage by Reich), therapies from Emerson, Terry, Harms, Castillano and later on also the "clinging-on" therapy by Prekop etc., are followed. An effective method of treatment is the isopathic potentisation of oxytocin on a potent of C 30, which after birth, is given as 3 Globuli per day for at least 4 weeks. Here, even in adults, dramatic differences appear after an oxytocin-assisted birth. During therapy and as a support to patients, there are chat rooms, where one can exchange experiences and reactions after taking Globulin. A homeopathic treatment, thorough a competent therapist is also recommended. Presently in the practice, we are analysing the bond between mother and child under the simultaneous administration to both parties of isopathic oxytocin (D6).
9) Summary and Perspective
The professionally recognized effects of oxytocin were limited for years to its medical applications, i.e. the contraction of the uterus and in stimulating lactation. Within only a few years of its discovery, it was already being used on a worldwide basis during and before birth to induce labour pains and assist in placenta relief. Yet its effects on psyche, sexuality, the human ability to bond etc. did not become publicly known until the nineties.
The postulated consequences of a possible down-regulation by oxytocin within a treated person were later proven through studies for animals. Also, our observations showed that for new-born babies, growing children and adults alike, the subject of oxytocin history had great social significance and impact within their lives. One other aspect of the research tells us is that it is not the distributed quantity oxytocin, but rather the amount and ability of the hormonal receptors to receive it which result in the hormone unfolding to any degree of success. Lack of confidence in one's self and others, aggression and the inability to bond whether socially, or in interpersonal relationships, are critically important subjects in the modern age. It is hoped that through this article a more selective and thoughtful use of the medical community's current primary labour promotion agent, as well as a debate on the subject within the concerned occupational groups (gynaecologists, midwives, and researchers) are initiated. A serious study on the potential long-term psychological effects of oxytocin, after half a century of its widespread use, is long overdue and hopefully may at least in part be initiated by the concerns brought forth in this article. In addition I would also be very gratified if concerned parents, children and other adults, recognising their own personal story or situation in any of the above mentioned behavioural patterns (and problems), are now able to select a suitable therapy as a result of the suggestions presented.
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