Understanding perinatal hormonal shifts: What every midwife should know

Dr Ghazala Aziz-Scott, pictured, Clinical Lead Doctor and Specialist in Integrative Women’s Health, Bioidentical Hormone Balancing and Functional Medicine at the Marion Gluck Clinic, discusses perinatal hormonal shifts in women.

The perinatal period is characterised by profound hormonal changes that underpin pregnancy, labour, and the postpartum transition. These shifts are often described as a “hormonal rollercoaster,” but each fluctuation has a clear physiological purpose. For midwives, understanding these changes is essential, not only to support physical health, but also to recognise the emotional and psychological adaptations that occur as a woman transitions into motherhood.

Pregnancy represents one of the most significant physiological transformations in a woman’s life. The body adapts rapidly to support fetal development, with major systemic changes taking place. Blood volume increases substantially, and the immune system adjusts to tolerate the fetus rather than reject it. Alongside these physical changes, there are important psychological, emotional, and behavioural adaptations that help prepare a woman for her new role as a mother.

Hormonal foundations of pregnancy

At the centre of these changes are key reproductive hormones, particularly progesterone and estrogen. During pregnancy, levels of both hormones remain consistently high, largely due to production by the placenta. These hormones work together to support the growth and development of the fetus while maintaining a stable uterine environment.

Progesterone, often referred to as the “progestational hormone,” plays a foundational role in early pregnancy. Its primary function is to prepare the uterus for implantation by thickening the uterine lining, creating a supportive environment for a fertilised embryo. As pregnancy progresses, progesterone also acts to relax the uterine muscles, preventing contractions that could otherwise lead to premature labour. In this way, it helps sustain the pregnancy until the fetus is fully developed.

Estrogen, by contrast, is a proliferative hormone responsible for growth and development. During pregnancy, it supports placental development, increases uterine blood flow, and stimulates breast tissue growth in preparation for breastfeeding. Together, estrogen and progesterone create the optimal conditions for fetal development while also preparing the mother’s body for labour and postpartum recovery.

Hormonal changes during labour

As pregnancy approaches term, the hormonal balance begins to shift. One of the most significant triggers for labour is a sudden drop in progesterone levels. This reduction removes the inhibitory effect on the uterine muscles, allowing contractions to begin. At the same time, levels of oxytocin rise.

Oxytocin, often referred to as the “love hormone,” plays a central role during labour. It stimulates uterine contractions, enabling the progression of childbirth. Beyond its physical effects, oxytocin also has important emotional functions. It helps to reduce fear, pain, and stress, supporting maternal wellbeing during what can be an intense and challenging experience. This dual role, both physiological and emotional, highlights the importance of oxytocin in facilitating a positive labour experience.

Estrogen also contributes to the process of labour by increasing the number of oxytocin receptors in the uterus. This makes the body more responsive to rising oxytocin levels, ensuring that contractions are effective and coordinated. The interplay between estrogen, progesterone, and oxytocin is therefore critical in initiating and sustaining labour.

The postpartum hormonal shift

Following delivery, the hormonal environment shifts dramatically once again. The postpartum period is marked by a rapid decline in both estrogen and progesterone levels. In fact, progesterone levels can fall by approximately 90% within the first few days after the placenta is delivered. This sudden drop has significant physiological and psychological implications.

Progesterone and its metabolites, such as allopregnanolone, interact with GABA receptors in the brain, producing a natural calming effect. When progesterone levels fall sharply, this calming influence is reduced. As a result, many women experience mood disturbances in the early postpartum period. These can range from the relatively common “baby blues” to more severe conditions such as postpartum depression and puerperal psychosis, the latter of which requires urgent psychiatric care.

Estrogen levels also decline rapidly after birth, which can contribute to physical symptoms such as vaginal dryness and reduced libido. These changes are a normal part of postpartum recovery, but they can still have a significant impact on a woman’s wellbeing and quality of life.

Hormones and breastfeeding

While estrogen and progesterone decrease, other hormones increase to support the next phase of motherhood. Prolactin and oxytocin rise in preparation for breastfeeding and bonding. Prolactin is responsible for stimulating the production of breast milk, ensuring that the newborn receives adequate nutrition.

Oxytocin continues to play a vital role in the postpartum period. It supports uterine contractions, helping the uterus return to its pre-pregnancy size and reducing the risk of postpartum haemorrhage. In addition, oxytocin is released during skin-to-skin contact and breastfeeding, promoting the milk let-down reflex and strengthening the emotional bond between mother and baby.

Despite these natural hormonal processes, breastfeeding is not always straightforward. Many women require support, as challenges can arise from issues such as difficulty with latching, tongue tie, exhaustion, anaemia, or birth trauma. In some cases, the involvement of a specialised lactation consultant may be necessary to establish successful feeding.

The role of the midwife

Midwives play a crucial role throughout the entire perinatal journey, from early pregnancy through to the postpartum period. Their responsibilities extend beyond clinical care to include education, emotional support, and coordination with other healthcare professionals such as doctors and health visitors.

One of the key roles of the midwife is to help women understand the hormonal changes they are experiencing. By providing clear, accessible information, midwives can empower women to better manage both the physical and emotional aspects of pregnancy and postpartum recovery. This understanding can also help to normalise common experiences, reducing anxiety and uncertainty.

Supporting women in developing a comprehensive birth plan is another important aspect of midwifery care. A well-considered birth plan allows a woman to reflect on her preferences and expectations for labour and delivery. This process can be empowering, helping to reduce stress and promote a sense of control during childbirth.

Support networks and additional resources

Equally important is encouraging the involvement of partners and family members. A strong support network can make a significant difference to a woman’s experience during the perinatal period, particularly when navigating the emotional challenges associated with hormonal changes.

Midwives should also be aware of external support organisations that can provide additional resources and community support. The National Childbirth Trust offers antenatal classes and peer support networks that extend beyond pregnancy into early parenthood. Similarly, the National Partnership for Women and Families provides educational resources that can help women better understand their health and wellbeing during this time.

Supporting women through hormonal change

Ultimately, the hormonal shifts of the perinatal period are complex but purposeful. Each change plays a role in supporting pregnancy, facilitating labour, and enabling postpartum recovery and bonding. For midwives, a thorough understanding of these processes is essential in providing holistic, informed care.

By combining clinical knowledge with compassionate support, midwives can help women navigate this period with greater confidence, ensuring both mother and baby are supported through every stage of the journey.

About The Marion Gluck Clinic https://www.mariongluckclinic.com/

The Marion Gluck Clinic is the UK’s leading medical clinic that pioneered the use of bioidentical hormones to treat menopause, perimenopause and other hormone related issues. Founded by Dr. Marion Gluck herself, the clinic uses her method of bioidentical hormonal treatment to rebalance hormones to improve wellbeing, quality of life and to slow down ageing.

Staff Writer