1.8 “NORMAL” BIRTHS: THE MENTAL STATE OF THE MOTHER-TO-BE


At this point, a digression into the cacophony of obstetric practice is mentioned primarily as a situation inimical to a mother’s sub rosa needs as she faces the immediate future in the delivery room.  It is becoming increasingly apparent that obstetric care in the US is taking into consideration these basic biological needs of the mother and baby.  Quiet rooms within a hospital are provided for natural childbirth with a midwife, where a nurse checks in occasionally and can gain quick access to a doctor in case of the need for intervention.   This is a development made in response to the rather dismal statistics of hospital birth in the recent past.  According to a recent documentary film, “The Business of Being Born”, women in the US are probably the most misinformed about the birth process than anyone in the developed world (Epstein, 2007) .  This ignorance is not only one of the lack of information, but one of misinformation: In the US women fear birthing.   This can be traced back to negative 1920 AMA and insurance propaganda about home births and midwifery depicting midwives as slovenly and unclean street people.  As a result only 8% of American births occur at home with midwives.  Today, over 70% of births in Europe and Japan are managed with midwives.  In the US Caesarean births have increased almost 50% between 1996 and 2002 and today, one out of three or four births are C-section operations.    Women have been taught that their own bodies don’t have the necessary inner knowledge to handle the birth, that it has to be painful and that the doctor knows best how to “do” the delivery.  The outcome is that the US has the second highest infant mortality rate among all the developed countries and is first among seven of these countries in this dismal statistic.  Moreover, 20 to 40 percent of US mothers suffer from postpartum post-traumatic stress disorder, depending on the area of the survey (Czarrnocka & Slade, 2000).   In addidion,  studies have shown that elective caesarian is more dangerous than planned vaginal delivery (Liu et al, 2007; Kitzinger, 2001).

From the ‘20s into the ‘60s a woman’s fear of birth brought on the practice of Twilight Sleep and today it is the rush to scheduled Caesarean section to fit someone’s schedule.   To her, the act of birth is terrifying and, at the same time, trivialized in many hospitals, as if it was an assembly line appendix operation.  Time in the delivery room has to conform to Insurance and Hospital financial mandates requiring that it be as short as possible.    When her contractions begin she is given an epidural injection of an anesthetic, carted into the delivery room, and placed on her back, often with her legs in stirrups.  This position is known to interfere with the abdominal contractions she will use for pushing.   As the anesthetic slows down uterine contraction, the mother may be given a shot of Pitocin, a synthetic analog of her natural contractile agent, oxytocin. The undue pain and the length of Pitosin contractions have been discussed  previously.  Pain, unrelieved by natural opiates, produces a call for another epidural and the prolonged cycle of epidural/Pitosin often leads to a 20 minute Caesarean section to clear the delivery room.

It has been shown that the positive outcome of home/midwife delivery far exceeds that of the hospital and the likelihood of intervention.   This is not to say that the skill and training of the doctor  is not valuable, but this skill is really needed only when intervention is really necessary.  At home, the mother is not a helpless creature obeying every word of the obstetrician.  Now, she is in charge.  The birth belongs to her.  She is in a quiet atmosphere free of the delivery room distractions, as in movies with people coaching her to breathe and push, mostly at the wrong time. Her pushing and breathing are not to be forced, as they obey the natural timing of the birth process.

The question is whether the condition of the mother’s psyche is supported in a manner that correlates  with the profound physiological changes that are occurring as labor proceeds.  Clues can be gleaned from reading comments by midwives and mothers in natural childbirth.  It’s “a rite of passage”, a “transformative” experience, “life-changing”, a “trip to the moon”, “otherworldly”.   However fulfilling, these are not necessarily “pleasant” experiences and there’s often a point called the “wall”, where the mother had to do something she’s convinced is impossible.    “Between a rock and a hard place”, she has to push against pain that she feels is too great just before expulsion of the baby.  When she actually does it she learns on some deep level that she can take on anything.  This realization of empowerment is within a high, altered psychic state that brings on the spiritual nature of the comments.   She’s in love with the baby, owing to the natural oxytocin.  In a sense, she has been born, too, arriving into a different realm of perception about herself.   Then again, there are examples of natural births without any pain at all.

1.8.1 POSTULATE: THE PARTURIENT MOTHER IS UNDER THE INFLUENCE

The model of Figure 9c demands that, during labor, the mother’s (and the baby’s) brainstem reticular nuclei must be activated in order to account for the storage of M’s physical memory.   This could occur by raphe inhibition from EH, e.g., DMT circulating in the placental blood or directly from the fetus (in sheep, it is the fetus that inaugurates labor).  The effect of DMT on the 5-HT2a receptors in the higher cortical regions would coincide with that of the 5-HT1a to elicit the mother’s alert and positive state of anticipation.  This conclusion will be argued from hints derived from frequent observations on the psychic state of the parturient mother during labor, midwife documentation in the context of “natural” childbirth, historical use of birthing hallucinogens and the biology of parturition. Arguments that the fetus is in this LRN activated state will be presented in Part 2.

1.8.2 THE HIDDEN PROCESS

The mother’s putative altered mental state would be a reflection of hallucinogenic 5-HT2a/2c receptors in the thalamic and cerebral regions.   This would be a herald symptom for the parallel physiological (non-hallucinogenic) events mediated by the raphe 5-HT1a receptors.   Introducing the idea of a “birth hallucinogen” active in the mother implies that her perceptive priorities would be removed somewhat from the usual activity in the delivery room.   As with a hallucinogen, she would find herself immersed in a strange new world of alert energy and relatively fearless anticipation.  

The sine-qua-non for obtaining any real psycho-physiological value from taking a hallucinogen is that the imbiber be in a quiet place with attractive, comfortable and safe surroundings, confident that seasoned assistance is nearby.  This was the environment of M’s LSD experiences and, as will be discussed in Part 2, the results at issue were not experienced in more distracting situations.  One reason for this is that the hallucinogen evokes, for lack of a better phrase, one’s subtle and fragile inner domain, something eliciting profound physical awareness, a kind of knowing difficult to express in words.  Speculating on the mother’s mental state, the effect of the hallucinogen at this time would be an unfamiliar but proper sense, as if something “knowing” is taking over the body’s physiology and providing a psychic realm of alert anticipation relatively free of fear.  This inner environment would include the ordinary world within a larger sphere of awareness that shifts our priorities.  On moderate or “museum” doses (Shulgin and Shulgin, 1991), both this new and ordinary worlds are accessible.   If, say, the telephone rings while one is in the altered state, the return to the ordinary domain is effortless and the caller’s convoluted demands are handled easily.  After completing this chore, the subject can return to his or her inner domain.  With somewhat greater doses or higher personal sensitivity, the inebriant is aware, but uninterested in such ordinary trivia and doesn’t even answer the phone.  Something much too profound is happening within.  Nevertheless, cognitive abilities are still present and interruptions will be judged as to their urgency.   

Distractions can militate against accessing and maintaining this fragile state, especially in conventional obstetrics, where preparation and management of the mother’s labor involves the assembly line protocols mentioned above.  While the situation is improving, it is little wonder that doctors, nurses, even midwives and the mothers themselves are generally oblivious to the possibility that a profound holistic change, a transcendent conversion, would now be taking place to give her holy courage and render her anticipation of the contractions as a fulfilling sensual and psychological experience, a condition that evolved over eons to orchestrate parturition and promote survival.  Looking at this in an evolutionary sense, it conforms to the common definition of a miracle, i.e., as a process scarcely believable and directed by a powerful unseen fiat.  The speed and complexity of embryonic development alone is a fabulous process. as it proceeds through biological phyla, our ancient ancestors, a tail, and gills, onto a human with a brain that is forming billions of neurons and synapses with incomprehensible speed.  Ontogeny recapitulates phylogeny; a miracle profound and mysterious recapitulates, a memory from the labyrinths of the ancient, prehistoric past revisits our ancestral lines.    Then, the baby is guided through the birth canal by another fiat that trumps any known choreography in the order and synchronization of the dance.  And all of this takes place without a scintilla of rational thought.  That it is so common, we take it for granted and prefer our miracles to be the tears of blood from a holy statue.   Contemplation of the common miracle of birth is seldom, if ever, part of anyone’s preparation, and expectant mothers are generally afraid of what’s ahead.   But, the evidence exists, though rarely publicized, in regards to the requirements of the mother's inner domain.  Establishing this condition deliberately would require the mother’s freedom from the less important, but noisy hubub during the onset and immersion in the entire birthing process, including late pregnancy.  Today’s expecting mother is no longer in touch with the primordial knowing shared by primate mothers and by humans of the third world without access to a hospital.   The mandate for such conditioning is seldom expressed in books on birthing or midwifery.   A superb exception is the book, “Birthing from Within” (England and Horowitz 1998), which emphasizes that this “knowledge” can be accessed in quiet surroundings and can even emerge in dreams.   The issue of dreams is significant, since REM dreaming and M’s LSD experience may share similarities in terms of raphe activity.  Also, the hypnotic state, another fascinating researh direction for brainstem function, is used in birthing (Mongan 1998) and may involve similar modulations of the raphe nuclei.

1.8.2.1 There are numerous allusions to the altered mental state of the parturient mother by obstetric nurses and doulas (midwives), but they are hard to find in the literature.  The examples mentioned here were obtained from conversations with midwives and obstetric personnel.   Some midwives assess the stage of labor by asking some mundane question, e.g., “Do you want a glass of water?   At one stage, she will hear the question, but find it so “out of context” and trivial to the new influence within that she will not find the answer. This behavior is not a result of perceptual overload or her cognitive preoccupation with overwhelming events.  Rather, there is simply less importance attached to activity in the delivery room.  Her state is well outside anything pertaining immediately to this inner adventure.  Uncharacteristic behavior such as synesthesia and time distortion, are noted occasionally towards the end and after completion of delivery.  One of the symptoms most frequently seen is her loss of habituation, i.e., loss of the normal “tuning out” of common noise.   Now, ringing of a distant telephone and other noises are heard.   Small flying insects, never before noticed, are now seen at long distances, as are new details of her surroundings.  Brain hypoxia, another partner of dehabituation, can be created by hyperventilation at “rest” (as opposed to cardiovascular exercise) and can’t be excluded as a factor.  This could occur as the laboring mother breathes hard naturally, or in response to verbal cues.   However, dehabituation has long been a herald symptom of hallucinogenic inebriation (McGlothin and Arnold, 1971; Szara 1994, Julian 2001).   There are several references to the activation of the locus ceruleus and dopamine sites by hallucinogens that elicit the perception of “newness” and other impressions that would fall under the rubric of dehabituation (Nichols, 2004, p. 147).   It is sometimes seen in spite of the fear and pain levels combined with the bustle of activity in the labor room, but more often in more quiet “natural” situations after the end of labor.   It’s likely that dehabituation corresponds to Phase 3 of the somatic LSD effects presented in Part 2, a phase that would correspond to the time after delivery.

1.8.3 EARLIER HALLUCINOGEN USE IN BIRTHING.

The connection between hallucinogens and birth is not new.  More recent translations of ancient Greek manuscripts, free of the moral strictures of Victorian translators, have inspired commentaries on the presence of hallucinogens in venues such as Greek wine concoctions at private parties, the Kykeon of the Greater Mystery of Eleusis ( Wasson, et al 1998) and the Mystery’s influence on famous Greeks like Euripides and Sophocles.   From 400 to 5000 BC Greek midwives worshipped the Goddess of Birth, who had an interesting choice for a consort: not a man or animal, but a plant (Wasson et al 1986).   This “plant” was probably the fungus Claviceps purpuria, the source of ergot based hallucinogens that infected the rye and barley grown on the Rarian plain about fourteen miles from Athens.   Today this mythologized plain lies under a few feet of water as a wrecking lot for abandoned vehicles.  The present town of Eleusis is an environmentally destroyed port for oil tankers and its ornate Temple of Eleusis, the Telesterion, is a ruin, owing to the vandalism and attempted murder of the Hierophants (Leaders of the Eleusian Mystery) initiated by the Bishop of Milan in ca. 475 AD.   The ancient Greeks and their trading partners, the Egyptians, were well versed in the use of hallucinogenic sources, including the Egyptian red water lily and Grecian mushrooms.

More comfortable evidence for hallucinogenic application for the laboring mother has been found in medieval midwifery in the 16th century, which employed ergot preparations to quicken labor and staunch postpartum hemorrhage.  The crude ergot extract obtained from the fungus that infects rye and barley is a dangerous mixture that caused widespread sufferng at this time.  Purified components, e.g., ergotamine and ergometrine, ergonovine (Ergotrate) and methylergonovine (Methergine), produce uterine contraction, but they can cause gangrene as strong vasoconstrictors and are used mainly in the late stages of labor to control hemhhorage.   In fact, further modification of ergot’s active principle to enhance its “uterotonic” action led to the synthesis of LSD in 1938 and its discovery as the hallucinogen in 1943 by the distinguished Swiss chemist, Dr. Albert Hoffman.   A fascinating history is provided in Dr. Hoffman’s book, “LSD, My Problem Child” ( Hofmann 2005), which identifies Sandoz drugs (Methergide) developed from the ergot indole structure for stopping postpartum hemorrhage and Hydergide, an anti-dementia drug.  Neither of these is used in within the context of enhancing the mother’s mental state and or in quickening desultory progress in labor.  These commercial drugs are'nt notable for their halucinogenic properties.  Could a hallucinogen quicken a mother's labor without imposing the problem of vasoconstriction?

Midwives of today’s Mazatec people, highly skilled in the traditional use of psychoactive plants for millennia, use mushroom psilocybin to enliven the parturient mother’s mentality and restore her desultory contractions to timely effect (Harrison, 2007).    It is curious that the possibility for the existence of a natural endogenous hallucinogen functioning at birth seems to have been missed in view of all these historical and scientific hints. 

1.8.4 THE BIOLOGY OF PARTURITION

Ample evidence exists in the literature to show that there’s no apparent need for an endogenous hallucinogen in the hormonal and enzymatic processes involved in the initiation of human labor (Karim, 1971;  Fuchs et al, 1971).   However, all this work had been done without consideration of a role for hallucinogens.  The only view of the onset of labor is restricted to the roles of oxytocin and prostaglandins that produce uterine contraction.  Prostaglandins are inflammatory factors also involved in cervical ripening and changes in membrane structure in addition to its role in contraction of the myometrium (Gibb W, 1998).    Their concentrations increase abruptly at the onset and duration of labor.

A partial scenario can be gleaned from research on rat parturition. During late pregnancy, the secretion of endogenous opioids suppresses the activity of oxytocin neurons to protect the fetus from premature labor and the secretion of birth glucocorticoids (Russel and Brunton, 2006).    Just before the onset of labor, progesterone concentrations decrease abruptly and it’s enzymatic product, allopregnalone, promotes activation of the GABA(A) system within the supraoptic (vasopressin) nucleus of the hypothalamus and the Para ventricular nuclei (Fenelon and Herbison, 2000).   In addition, allopregnalone removes opioid suppression of oxytocin neurons. The resulting release of oxytocin switches the GABA(A) system off and uterine contraction begins with the additional secretion of inflammatory prostaglandins, now free from GABA(A) inhibition (Leng and Russell, 1999).   

The role of the fetus in the initiation of labor and support of the mother will be discussed (Part 2) In terms of autonomic activation and fetal movements.  An additional clue to fetal engagement is taken from ovine studies showing that initiation of the onset of labor in sheep originates from the fetus.  Results of work in other areas have revealed that prostaglandins are produced in the outer fetal membrane (chorion) and inner membrane (amnion) that surrounds the embryo.  Placental involvement arises from the decidua as well, i.e., the part of the placental lining contributed by the mother (Gibb, 1998). The release of oxytocin promotes the production of prostaglandins in the decidua as labor begins. Also, oxytocin secretion originating in the fetus is increased under conditions of hypoxia.   Other pivotal contributions of the fetus arise from its secretion of serotonin (Eiler & Fecteau,  2000).

Is there a role for EH at this level of parturition?  Normally, the hypothalamus is activated at the onset of labor for the pituitary secretion of oxytocin (uterine contraction), natural opiates (analgesia) and ACTH (cortisol secretion) along with other corticotrophins, e.g., growth hormone and gonadotrophin in timely support of the newborn.  Similar increases in hypothalamus/pituitary secretions follow DMT injection in humans (Strassman and Qualis, 1994).  In Part 2 it will be reported that “fetal” autonomic activation, i.e., spikes in heart rate, blood pressure and oral temperature, all sequalae of hypothalamus activation, are seen in this adult subject with ingestion of LSD.

As to the specific mechanism of EH involvement, reports from studies on rat parturition include involvement of both the inhibitory GABA(A) system and both the dorsal and medial raphe. Their serotonergic axons project into the mmagnocellular area of the hypothalamus, which mediates secretion of the pituitary hormones and vasopressin.  How these systems function isn’t clearly defined, owing to the indirect nature of c-Fos histology, which measures new RNA synthesis (gene opening) for the production of GABA(A) proteins.  Since this implies GABAergic "activation", it's difficult to see how activation of the inhibitory GABA(A) system leads to activation of the hypothalamus to secrete birth hormones.  On the other hand, the hypothalamic nucleus could be analogous to RN in the RaRN model, i.e., dis-inhibition by EH binding to a the 5-HT1a receptor. The dorsal and medial raphe nuclei project to the magnocellular area of the hypothalamus, presumably to inhibit chronically (Cabot et al, 1975). 

Regarding the question of 5-HT receptor identity, once again, the question arises as to how EH and and raphe nuclei interact within the context of GABA(A) involvement.  The dorsal raphe nucleus itself is a complex nucleus consisting of at least five separate systems, including inhibitory (GABA(A) and excitatory neuron systems.   However, only the 5-HT neurons within these nuclei are inhibited by EH/LSD binding and this has been shown to occur directly without intermediate mediation (Aghajanian et al, 1972).  The question remains as to the actual role of the raphe serotonergic neurons.

It has been shown in rat studies that it is the 5-HT2a (not raphe) receptor that mediates the secretion of hypothalamus-pituitary factors, ACTH (cortisol), plasma prolactin and adrenaline (Aulakh et al, 1944).   The possibility that the human 5-HT1a may be involved can only be speculated upon from species variability. As suggested above, with raphe inhibition, human hypothalamic nuclei would now be free to secrete the supportive hormones at the onset of labor in a manner similar to the proposed RaRN model.   EH and LSD, not the inhibitory GABAa system,  would be the factors releasing  hypothalamic corticotrophins for the pituitary secretion of oxytocin, endorphins and ACTH.   However, there is evidence that the dorsal/medial raphe nuclei are involved in combination with the GABAergic system for hypothalamic activity only during parturition, but not before or after (Lin SH, et al., 1995 Lin SH, et al, 1998).  Thus, the initiators of uterine contraction, analgesia, alert strength and paracrine management would emerge in support of the mother in response to both systems.

This involvement of raphe nuclei in promoting hypothalamic, and therefore pituitary, secretion brings up an interesting point related to species differences mentioned previously.  Discriminative cues for 2a in the rat may involve 1a in the primate.  Hypothalamic secretion to produce pituitary hormone release has been seen in the rat in response to the powerful 5HT2a agonist, DOM a phenethylamine hallucinogen (Aulakh, 1994; Nichols, 2004 p 141).  This 2a agonist is blocked in stimulus discrimination in the presence of strong 5HT2a antagonists (Nichols, 2004 p 141, Fiorella et al, 1995).  On the other hand, 2a antagonists do not block LSD stimulus discrimination in the monkey (Nichols, 2004 p141; Nielsen, 1985).  In this more closely related species, it is the 5-HT1a that is involved in antagonist blocking of LSD cue discrimination (Nichols, 2004; Winter et al, 2000).   Is it stretching this species extrapolation too far to suggest that the endogenous hallucinogen 5-HT1a in humans may mediate the same functional venues mediated by the 5-HT2a in the rat?  Might one of these venues be activation of the hypothalamus?   Probably not, since the involvement of raphe nuclei hasn’t been shown in this kind of study.  A trivial pursuit fact might be added: Serotonin re-uptake inhibitors induce birth and spawning in invertebrates (Fong and Warner, 2005; Fong et al, 2008, Cunha & Machado, 2001).

Summarizing, this hypothesis on the role of EH in parturition includes activation of the hypothalamus-pituitary-adrenal-gonadal axis, in addition to those LSD effects related to M’s experience of memory recall, i.e., the opening of memory substrates in the and fetus (and mother) and bolstering the mother’s mental state.  An additional role for EH is further implied from the results of Part 2, in which the use of LSD elicited strong fetal movements in the adult, quite similar to the mother’s abdominal contractions in “pushing”.  While EH is not directly involved in the onset of smooth muscle contraction to start the labor process, it would be involved in the secretion of oxytocin.   In addition, evidence will be presented in Part 2 for the possible role of EH in promoting the contractions of skeletal muscle related to the urge to “push” for the mother and movement for the fetus. 

1.9 WHAT IS THE ENDOGENOUS HALLUCINOGEN?

Referral to the birth agonist as the "endogenous hallucinogen" is somewhat misleading for the main purpose of this dissertation.  This label is made on the the basis that LSD mediates its famous hallucinogenic effects at the cortical 5-HT2a receptors, but the centerpiece of the proposed RaRN model is its non-hallucinogenic effect on the 5-HT1a receptor of the brainstem raphe nuclei.  The most attractive choice for identifying the endogenous agonist would be one having a similar indole structure as LSD and documented to be as potently hallucinogenic and having the same binding properties to these receptors.  Obvously, N,N-dimethyltryptamine and its congeners stand out (below).