Podcast - Episode 17 - Oxytocin Research
Expert Interview with Kerstin Uvnäs Moberg
This is such a significant episode with Kerstin Uvnäs Moberg who is a huge influence in my work and understanding of oxytocin. I chat with physician, professor of physiology and oxytocin research pioneer Kerstin Uvnäs Moberg. Together we discuss Kerstin's significant discoveries about oxytocin, her experience as a woman in science and the use of synthetic oxytocin. At the core of this conversation is the scientific evidence supporting the idea that how a woman cares for postpartum will have a long-term impact on her health.
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Kerstin Uvnäs Moberg is a specialist in women’s health and female physiology and has worked in these fields for over 30 years. She is a pioneer in research about oxytocin, ”the hormone of love and wellbeing”, and was one of the first researchers to point out the behavioural, psychological and physiological effects of oxytocin during birth, breastfeeding and menopause.
We explore the following questions:
How did you come into your work as a physician and a researcher on the healing aspects of oxytocin?
How did your research on digestion lead to significant discoveries about oxytocin?
How has your work been disruptive as you've discovered things that made you rethink how things work?
What has your experience been as a woman in science? Do you feel that gives you a different perspective and challenges?
How are people being affected by oxytocin as an intervention compared to the oxytocin we generate in our bodies?
What do you notice about the role of synthetic oxytocin in birth?
Is there anything else about oxytocin you would like people to know?
How does your research support the idea that the way a woman is cared for postpartum will have long term impact on her health?
What are the titles of your books?
Additional resources we spoke about:
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Transcript
Julia Jones:
Hello and welcome to Newborn Mothers Podcast. Today we are having a chat with one of the people who has genuinely had one of the biggest influences on my career ever, and this is Kerstin Uvnas Moberg. And Kerstin, let me tell you about how I came across your work. It was after I had been studying postpartum for probably two or three years, I had my own baby. And I found that all the postpartum stuff I was learning about wasn't really answering the questions that I had about my own experience of becoming a mother, which is that it just changed me so much from the inside out. I just felt like a completely different person. And then I was introduced to your work through an amazing pediatrician and lactation consultant called Christina Smillie.
Kerstin Uvnäs Moberg:
I know her. Yes, yes, yes.
Julia Jones:
And she introduced me to this idea of baby brain being a good thing. And that's when I sort of dived down this whole researching a lot of different things, including neuroplasticity, but obviously oxytocin. And that's why I've read all of your books, and I recommend them to all of my students now. So I just can't tell you what a privilege it is to have you on the show. Thank you for being here.
Kerstin Uvnäs Moberg:
It's a pleasure.
How did you come into your work as a physician and a researcher on the healing aspects of oxytocin? (02:00)
Julia Jones:
Oh, hello. Sorry, I lost you for a minute there. I was just going to say you're a physician, but you do a lot of research. So can you tell us a little bit about how you came into what you do?
Kerstin Uvnäs Moberg:
Well, I am as you say, a physician. I didn't know what type of physician to become. So when I had, I think the first baby, I decided that I might go back to the preclinical institutions and make a PhD thesis, because that would help me in the long run with my career. And it would give me completely free hours in a way that you don't get in hospitals. Because at that time, I was married to a surgeon, and with all these on call nights and things, it was just nothing to look forward to.
So I went back and did a thesis on, I would say rather the physiology of the gastrointestinal tract. And I got hooked, because it sort of helped me to be curiosity driven. I loved getting results and then to see how could you explain them, because they never really appear as you expected. There is always something new. But if you keep your line, you will see that you are most often right in your hypothesis if you just keep on going.
And then in connection with having my third and fourth baby, which was 10 years later, I suddenly lost interest in the gastrointestinal tract completely, and changed my focus to oxytocin. Because, I had experience just like you that things happen within you. And when you have four children and you experience, these things, these feelings, these reactions, these changes of your mind come every time. And I would say even more clearly by each child, I understood that must be biology somehow. And then I went into the literature to see if there was anything about changes in women. But everything was called psychology at that time. Psychology explained everything. And to me, that wasn't enough.
So then, I went into oxytocin and saw that there were nerves in the brain. Then I started to do a lot of experiments with oxytocin and could show how this... I would then call it oxytocin system because it's not just the hormones flowing in the circulation…actually can regulate almost all very basic physiological, and also behavioral and mental functions. This was clear in animal experiments that we did. But then of course, how do you transpose that to humans?
And then I was fortunate enough to have a lot of midwives that I could do big studies with at the Department of Women and Health at the Karolinska. And then we started to look for oxytocin levels, and also measure a lot of other parameters, and link them to oxytocin. And then we could confirm that we also have these adaptations in humans.
I mean, not to the degree that you have in animals. Maternal behavior in humans is not like a machinery that moves the animals in a certain direction to do specific things. But there is this turn or change of the mindset to make you more able to do, and more wanting to be caring and take care of the children. So I found that reasonable.
And then I started to write. I haven't stopped yet, because you find new versions, and new expressions of this big adaptation every time you write, because that's when you really see the new things. You sharpen your brain when you write, don't you?
Julia Jones:
Yes, absolutely. I have finished my second book, which you were mentioned a lot in Kerstin, so I'll send you a copy. But I definitely agree. When you start writing, it definitely clarifies your thoughts and it helps you kind of put the pieces of the puzzle together. And one of my favorite analogies of yours is the idea that with research, you know some pieces of the puzzle. And that when you step back and see the bigger picture, you can kind of guess even if the research hasn't been done yet. You can kind of make an educate a guess on, "Well that might explain this as well."
Kerstin Uvnäs Moberg:
Yeah, you can. As you say, you need a few of the pieces of the puzzle of course. And then as in my case, I had a very good training in physiology. So I knew how neurotransmitters work in the brain. I knew how the autonomic sensory nervous system functions. And then I could use other systems like the fight flight system as a model, even if it's doing completely different things. It was obvious that the hypothalamus is a very important system for integrating these types of, I would say, psychophysiological patterns. And so you could actually use knowledge from also other parts of physiology to see what the patterns should be like. And then there is something called intuition too. I agree.
And I would say that intuition is something that you also get more and more of when you have children. It's something that's close to empathy, that's close to trying to understand what people say. So this intuition, it's a broader concept, but I think it's very close to the ability to try to read somebody else's mind.
How did your research on digestion lead to significant discoveries about oxytocin? (08:10)
Julia Jones:
I love it. I also found it interesting. I never knew that you started out studying gastrointestinal stuff. But now, obviously that's linked in with your oxytocin research, because you have discovered a lot of stuff about digestion and oxytocin as well. Can you talk a little bit about that?
Kerstin Uvnäs Moberg:
That was actually how it started. I did experiments with the vagal nerve in particular, so I knew how the brain would control how digestion and metabolism is controlled.
So we did a study at the Karolinska where we could see how the levels of gastrin, and cholecystokinin, and insulin rose every time a mother was eating, as if she's eating in parallel with a baby.
And of course that's very beautiful because that means that when she's breastfeeding, she is also eating, herself, in order to adapt the function of her gastrointestinal tract to the demands of breastfeeding. This is one of those elegant, I would say, parallel systems.
Now then I was at a meeting in California and presented these data. It was at something called The Kroc Foundation, which was a foundation I think created by the person who owned McDonald's. And he had a lot of money, and he had this beautiful farm where he invited researchers who could come there for a few days, with a beautiful surrounding, and a lot of good food and stuff. And then we were giving talks to each other, lot of interaction. And then I presented this data on the GI tract.
And then believe it or not, one guy in the room, he asked me, "Are you sure you're not measuring oxytocin?" And I thought, "He's crazy. Can't he see that it’s insulin or gastrin I'm measuring." And then it just came me like a big insight. "Oh gosh, he's right. He's telling me that these nerves are connecting to the vagal nerve."
So in one way, all these effects act on the level of the vagal nerve. But the vagal nerve in term is regulated by oxytocin, at the same time as it produces milk, and milk ejection, and all these other things. So this was the first connection that I could start to work with. because I could go home then and look for oxytocin and do animal experiments where I gave oxytocin, and could see that you got exactly these effects. But these are the moments when you get insight sometimes. And I would be very happy to remember who that person was, to thank him for that. But I don't remember who he was, so I don't remember the name. Otherwise, I would contact him.
How has your work been disruptive as you've discovered things that made you rethink how things work? (11:32)
Julia Jones:
Yes, and say thank you. So one of my questions for you was going to be, I'm interested to know in some of the things that you've discovered that have been a little bit disruptive, that other people haven't necessarily understood or agreed with straight away. And it sounds like sometimes, that's been the case for you. You've discovered things that have really made you have to rethink how things work. So can you talk a little bit about that?
Kerstin Uvnäs Moberg:
Well, I think by starting to show that oxytocin had all these effects outside the box of being a hormone for milk ejection and birth was upsetting by itself. Because it seems as if people started to work with oxytocin 1910 something, and then they started to use it clinically in 1960/70.
And I think that then because of these effects, oxytocin was put in a box called female hormone something, and lost significant value. Because vasopressin, a very much related hormone and very similar, was studied to a much bigger extent at that time. And it's interesting. So there is something with how you value different types of findings.
Now then, I could show that you had all these parallel effects during lactation, breastfeeding, whatever. But then, what we also found of course, was that basically, we could induce the same effects, the physiological effects on stress levels, or in males also, in females and males. And then that was surprising. People couldn't understand how oxytocin could reduce anxiety, and stress levels, and stimulate digestion in males. But this is the case.
So then it was obvious that oxytocin isn't basically a female hormone. It's everybody's hormone or signaling substance. It's just that during breastfeeding and labor, you need more of it, because this is the period when you really need to maximize your ability to communicate with babies, in this non-verbal way. And this is the time you need to lower stress levels and to have a perfect, I would say digestion and metabolism. But it's the tip of the iceberg because you always have it. The fetus has its own oxytocin. It has a lot of oxytocin when it's born. So there are many, many situations where you have oxytocin. That was questioned.
Now, the more interesting thing was that we could also show that if you really give oxytocin repeatedly, you get into something even more I would say surprising. And that is that the effects become long-lasting.
So if you give oxytocin say five times, then not one, you have the effect of each individual oxytocin administration. But you also get a sustained increase, which last for weeks or even months after the last injection.
And then this is the real, I would say, very important thing. Because this means that you get long-term, you can actually interpret it as health consequences of oxytocin, because you will lower your stress levels. You will have less inflammation actually, and you will have more activity in systems of the body, which are related to not only digestion, but also to healing, and restoration, and growth, actually. And that was very difficult. And I think the first paper on blood pressure we sent in to show that five injections of oxytocin would cause effects for three weeks. Males and females. We got the paper back several times and said, "This is not right." And we sent it back and said, "It is right." They said it should be immediate. "Why do you look at three weeks?"
And in the end, we could convince them that this just shows you how, I would say, the scientific system is in a way so conservative, that it's difficult to come in with results that change the basis or the fundamentals. Especially when you discuss female hormones and things, you get closer to the bone somehow. It's more even more difficult.
But that I've learned, that you don't need to bother, because it's not against you. It's somehow some scientific barriers that you just have to forget, and go on. And sooner or later it gets in, and then you will have a lot of other people confirming it. But that's interesting. But that's typical of, I would say, new ideas or ideas that are not in line with the current concepts.
What has your experience been as a woman in science? Do you feel that gives you a different perspective and challenges? (16:51)
Julia Jones:
Yes, absolutely. And I think women often find these patterns or see things from a different perspective. One of my other favorite woman scientists is Marion Diamond who did a lot of pioneering research into neuroplasticity, and was same as you, completely ignored for quite a long time. And eventually, obviously people come around and go, "Oh yeah, actually there's a lot of evidence for that. We can prove that time and time again." But how is it for you as a woman, do you feel that gives you a different perspective? But do you also think that makes it a little bit harder perhaps to get funding or recognition or anything like that?
Kerstin Uvnäs Moberg:
Oh, yes. Because when you apply for positions, the results you have are not considered important. And at least it was. I mean today, it is a little bit different because these issues about women in science have been raised. And people have actually shown these in a scientific way. But still, I remember the first time I applied for a professorship. That's a long time ago now. Then my research proposal was based on the role of oxytocin in social interaction, and also these anti-stress effects.
But nobody found that interesting, because the normal subjects in physiology was more like physical exercise, pain research, fertility for men. So they had big number of topics that they considered real physiology. These are the things, there wasn't anything. And then there was no value to it.
And maybe I also think basically that as you say, there are some differences in the way women and male see things, which are based on these hormonal effects or something. That women somehow more easily see these things on interaction, social interaction, and rest, and relaxation. Whereas men are a little bit more in tune with the fight flight. And therefore they go for these questions, and women ask other questions.
So I think somewhere you express your personality, which is not just your personality, it's part of the female community personality when you do studies. And at my time then, there were no other females. There weren't any women in physiology who could do anything, because it takes that you have some money and you have some people working with you to be able to do something. And most women fell off at that time. Either they stopped because they didn't want to invest that much energy and time.
The other thing is that they also maybe I think tried to adapt to the system. They did what was supposed to be done. And as soon as you do that, you lose contact with your inner research self, and maybe you don't do as interesting things.
I mean, we know there are a lot of women who have been fantastic in doing that. But for many women, and especially those who need to be in contact with that creative, intuitive part of your mind, need to be follow your own wishes to a certain extent, to enjoy it. And that's the way how to continue. You have to give fuel to your curiosity by the right type of fuel, I think.
Julia Jones:
Yes, yes. That makes a lot of sense. And I can relate that to a lot of women's scientists. But another really famous one is Marie Curie, who was able to continue her work because of her husband. I think a lot of the funding and research that they did was under her husband's name, just because at the time, women weren't supposed to be doing that sort of thing.
Kerstin Uvnäs Moberg:
So that was a way, at that time, of being successful. If a very, very talented woman was lucky enough to have a father or be married to somebody who were accepted, of course in the system, they could get under that umbrella. That doesn't mean that they were not fantastic. It's just that they needed that to be able to be seen.
But not all women have had that. And therefore, I think so many women have dropped out, because you need somebody who supports you to survive. I think financially, but also mentally in a way. Because it's very hard. It takes an enormous mental strength to sort of act against, "I don't think that's something or perhaps. That's absolutely nonsense. This is not right." I mean, you have to almost be an idiot to continue.
Julia Jones:
Yes, absolutely. But just before we hit record, you were talking about this as though it's a calling for you. And I think a lot of women, you need the opportunity, but you need to have that drive. And you obviously do have that drive.
Kerstin Uvnäs Moberg:
It is true. There is some kind of inner motor or whatever, call it. Vision, or mission, or something that can't be stopped. And therefore, you continue whatever they say, or maybe you have to stay for a while and take another door out of the room.
So it's also a model of flexibility, because it's not always necessary to work with exactly your own, I would say, defined research project. Because you can also collaborate, and you will always find bridges between others' work and your own, that you can add to your own building of ideas. So luckily, it's flexible to do that, these two. Because with these kinds of ideas, you would never get into the real big funds because they are reserved for diabetes, cardiovascular disease, cancer, all these things. And the mother infant questions, the breastfeeding questions. These things still don't have the same priority. Even if they say so, they haven't.
Julia Jones:
Yes. And even if they're known to contribute later in life to those other big issues, like World Health Organization keeps saying that we've got to focus on newborn health and mother's health. And we are going somewhere with newborn health, but mother's health around the world is still not a priority at all, even though we can see those long-term benefits.
Kerstin Uvnäs Moberg:
That's a very important question. Because it's also as if when you look at mother's health, it becomes an issue of having two meetings. The mothers will come for control before she gives birth two times or three times, and then it's the baby that you take care of after birth.
It's something in the real understanding of the process that's completely out of the system. And I think it takes women who have these insights to create a new system to make it the way the woman would like it.
But we are not there. I've been working a little bit with birth, together with a European Union research group. I would say it's been a group where we have been meeting for four years, and discussed things. The subject has been, what are the bad consequences of medical interventions during birth?
And it's been an eye-opener to see that there might be bad consequences of these interventions. But the growing insight is, why the hell are they there? I mean, of course it's good to have a cesarean section if there is a very life-threatening situation. But why go on to do it on everybody? What are these strange thoughts behind that? There is no reason for it. And then you really get to think, what is it that makes these crazy new medical interventions become the norm?
How are people being affected by oxytocin as an intervention compared to the oxytocin we generate in our bodies? (26:00)
Julia Jones:
It's crazy. But it does strike me as something you said earlier that it's probably because of a result of a lot of men perhaps working from a fight or flight perspective. And that has really influenced our perspective on birth and making these decisions. But something I think my listeners will be all thinking about at home is can you talk a little bit of about oxytocin as an intervention? How is it different in your studies of animals, and of people? The oxytocin that we generate in our own body compared to oxytocin injections or nasal sprays, how is that affecting people that that's now such a common thing?
Kerstin Uvnäs Moberg:
Now, it is a very, very important question, because this is something I have seen recently that the internet isn't always the perfect site to discuss the role of oxytocin. Because there are many false ideas and rumors running around. I think the frightening aspect of things becomes very much stronger, I would say, on the internet sometimes.
But basically, if you look at the molecule, oxytocin, the chemical entity, it's the same whether it's produced in yourself, or if you give it as an infusion, or use it as a nasal spray. The same chemical molecule.
There are many people who still think that synthetic oxytocin is different from endogenous oxytocin. There's no difference. There's absolutely no difference in the structure of the molecule.
Now the difference is of course, that if you have your own release of oxytocin, we know that it occurs in small peaks. At least during breastfeeding and birth. You have short lasting high peaks of oxytocin, and then there is less in between. And then you have a new peak. And that allows during birth, for example, the muscles in the uterus to rest a while. Whereas if you give an infusion, you will have a high level all the time. And that's very confusing to the uterine muscles, because they start to contract in an unphysiological way. And that in turn informs the brain of something very, very strange.
Because there is also this, which I think is what you are saying about. When people work with a control of the uterine functions, they still seem to almost look at the uterus as a so so-called denervated preparation. I mean, you have the baby there, and you have the uterus working. You have a lot of mechanism in the uterine wall.
But they forget that the uterus is also innovated by the autonomic nervous system. They forget that there are a lot of nerves from the uterus going up, telling the brain that, "Now this has happened, now that has happened. Oh, now that is too much." And then there will be information to the brain about pain and enormous increase in stress levels. And you have also the other information becomes, which is oxytocin being sent to the brain to help the mothers adapt.
As you say, they have taken some details and looked at it very much, but forgotten... Basically, I know that from the studies of the gastrointestinal tract that the stomach and the intestines, they are regulated by hormones, yes. But also by the autonomic nervous system. And without the combination of the two, the system gets very clumsy.
So this is what's happening here. It's not the physiological model to infuse oxytocin. What you would need is a system where you had pulses of oxytocin being infused, and perhaps also somehow increasing the parasympathetic nervous activity. Which a doula makes, by the way.
So there are many, many interesting things that come out of this. And basically, I see that some of the aspects of the physiology of birth have been left out. And this may be the view you get when you have the fight flight view where you see details and pieces rather than the whole picture. So I think there are many things to correct here.
Now if you then give oxytocin... The problem with oxytocin is you can't eat it, because it'll immediately be a little bit broken down in the intestines. But basically, it's very difficult for oxytocin to be absorbed, because oxytocin is a polypeptide. So it's a protein. And proteins don't pass membranes, so it doesn't pass the barriers in the intestine unless in very, very small amounts.
It doesn't pass into the baby from the mothers during birth, because of the placental barrier. It doesn't pass into the brain of either babies or mothers, because of the blood brain barrier. Unless you give enormous amounts, of course.
So how do you then give oxytocin? Well, we had one example. And that is during birth, when you give it as an injection or an infusion. Then you can get directly into the bloodstream. But that oxytocin will not then influence the brain in the same way as the real, endogenous oxytocin does during birth.
Because then oxytocin is released in the brain to stimulate decreased pain and to make the mothers feel better than they should without. But if you give an infusion of oxytocin, you won't get this effect, because there is the blood-brain barrier. So that's another difference between when you give oxytocin as a drip or the normal oxytocin.
Now then, people have tried to come around all these problems with absorption by giving oxytocin as a nasal spray. And at least in Sweden, you used to have oxytocin as a spray at the maternity wards to help the mothers with milk ejection. I don't think it's so regular now. But when I had my first children, it was always there to get it anytime you want it.
And then you give it into the nose. And there is some areas which are little less, I mean the blood brain barrier, so to say, is a little bit weaker in there. And therefore, you can get some oxytocin into the system and into the blood vessels. And then the oxytocin will go into the blood, and then it'll help with where your milk ejection. And I've seen these absorption curves, and it looks pretty convincing. Then people have expanded the research on oxytocin spray, and started to look, if you also can get some of these other effects. I mean, on social interaction. On the stress levels.
Lots of studies have been performed. And at least in some of them, you can see that to a certain extent you can increase the interest in social interaction and the skills of social interaction. By understanding, interpreting the mood of the one you are interacting with. And you increase these capacities. And I think very early, it was shown that it was better in autistic children than in adults. Or other, I would say those who have a bad capacity sometimes, you could influence to higher degree than those who are already in the top. Now, they also had some effects on trust and stress levels. But not the full spectrum I would say. You don't really see the really strong anti-stress effects of oxytocin, like lowering of blood pressure and things. And that was my problem with that.
And then there has been some studies saying that, "This can't be true because there is no way oxytocin could really pass into the brain structure if you give it through the nose." And so there is a big controversy now, whether there are any effects of oxytocin spray or not.
I still think there are, but I don't think you have the full pattern of oxytocin effects. And I think it may be that some of the effects are indirect, and actually are caused by oxytocin being taken up into the circulation. And then when you have it in the blood, you might activate reflexes or something. So I think there is something. But it seems that in some experiments, you can't see all these effects.
But if that depends on how you administer it, maybe something that people very often forget. And that is that oxytocin, the effect spectrum of oxytocin that you induce is very, very much depending on the environment.
Now, if you go back to the very, very I would say principle effect that is maternal behavior. We know that all these animals, even humans that get oxytocin. They would be more interactive with their offspring. They would take better care of them. They would try perhaps to build a nest or give them milk, whatever.
But in case there is something dangerous happening, an intruder coming, or there is something that frightens the mothers in the surrounding. They will immediately become super aggressive. So there is an oxytocin, the ability to be nice, to be pleasant, to care for, and all this. But, under one condition, that is that the environment is unconsciously regarded as safe. Because otherwise, you should take the baby and run away and make it safe, or you should fight the one coming in or something.
And I think this is a general thing, that oxytocin has these two potentials. And I'm not sure that people who have actually made all these experiments have created a safe, and pleasant, and warm environment for the experimental persons. Not so fun to come to a lab, and then you receive the oxytocin spray.
So maybe sometimes, the positive effects have been blocked out. When you read the papers, I don't see any mentioning of this aspect. Oxytocin, I think it's Michel Odent who gave it the name the shy hormone. That actually, you should not breastfeed, you shouldn't give birth, you should not do anything too sensitive when you don't feel safe. And normally, oxytocin is actually released within a known family setting. It's not really released so much in response to strangers unless you get to know them.
So I think there might be something that will come out, that the environmental setting is going to show that it's important to think of in these experiments. Because I think there is something. There are too many experiments that show effects that are the expected ones, but there is really a tough debate now. And some people say that that oxytocin spray is just a fake. It's just a scientific mistake. But I don't think. I think there is something, but I think there may be a problem with how the experiments have been performed. And you shouldn't expect a hormone or a substance to cause these fantastic effects in any environment. That would be stupid, don't you think?
What do you notice about the role of synthetic oxytocin in birth? (39:43)
Julia Jones:
Yes, that makes so much sense. And I think it's very reassuring for people who are listening at home. I know a lot of women feel like if they did have... And most women do now have synthetic oxytocin during labor at some point or afterwards. And then they feel somehow like maybe that's inhibited my ability to bond with my baby, or maybe that's impacted my body's ability to produce its own oxytocin.
But I think what you were saying, it's actually so much more complicated than that. And if they're in the right environment that feels safe, and they've got all the environmental cues that also increase oxytocin naturally, it's not as simple as saying this and then that. It's very complicated, and everyone can experience oxytocin in their lives through very simple things.
Kerstin Uvnäs Moberg:
Yeah. And actually I think that the infusions... I think the big problem is that if you give too much... The first doses of oxytocin that you received during labor, they're not particularly high if you compare with the normal levels. So the difference is that they are flat, not pulsatised.
Now if you give very, very high levels, you get also too high levels. But I think the basic problem is that the uterus responds differently, and then the information to the brain is chaotic, and you have problems.
Because what we have seen is that if you give infusions after birth, just after a cesarean section, an elective cesarean section. It seems that if a mother has had an elective cesarean section, she does not have all these adaptations that normal mothers had in her psychology, and the stress levels, and all that. But if they receive this infusion of oxytocin afterwards, it seems that it comes back. So I think the real bad consequences of oxytocin if there are any, are restricted to labor. And that's because it upsets labor.
Julia Jones:
Interesting.
Kerstin Uvnäs Moberg:
So I think then more studies have to be done, but it's not so easy. We have just summarized a lot of studies where we looked at the levels of oxytocin, I mean the endogenous levels of oxytocin during birth. And there are about 20 studies, and they're all different. Because if you study oxytocin during labor, when do you study? Well, some people have started studied the beginning. Some people have studied the difference between the first and second states. Some people have taken very close samples just around birth. They give different pieces of the puzzle.
But then some people say, "These studies are bad. They don't cover everything." Now, how could they? Can you imagine a situation where a mother would be blood sample for 12 hours?
Julia Jones:
Whilst she's in labor, yeah.
Kerstin Uvnäs Moberg:
To get the peaks of oxytocin that occurs with the perhaps 90-second intervals. So I think you should be very grateful to these studies and make the best of them, because there won't be any new studies, because I think the ethics committees will be even more restricted today than they were.
So I think we have to live with that information. It's very important. And if you read these old studies, they are in fact some of them very, very good. And these should be known, I think, to the new generation of people, because that's where you see the differences between the endogenous and the exogenous oxytocin. The levels and things.
So you can understand that there is no way that oxytocin could pass from the mother's circulation to the baby, because it just isn't enough. And the baby, by the way, has higher levels of oxytocin than the mother. So the baby produces its own oxytocin, which will help the baby with pain and other things during birth. So there are some misunderstandings, I think circulating on the internet. So it's important to correct that, because otherwise you won't be able to solve the problem. I mean, to get the right solutions for this.
Julia Jones:
Yeah. Yeah, that's fascinating. And I think the fact that babies produce their oxytocin, it just shows that this system, it's designed with intention to make us happy and fall in love. So we probably overestimate the impact of synthetic interventions, negative and positive. But perhaps if we just let nature run its course, it would all be fine.
Kerstin Uvnäs Moberg:
Yeah. And I think that there could be problems if you give too much oxytocin. Because with too much contractions, you will have less blood flow to the baby. And less blood flow will always be linked to a risk of hypoxia and all these things.
Julia Jones:
Yes, and I think it increases the risk of hemorrhage as well.
Kerstin Uvnäs Moberg:
Sure. I think if you need it at all, that's the big question of course. If you need it, you should minimize the doses. And maybe you should pulsatise administration schedule, because that would really minimize... You can take away, I think half of the amount or even more by giving it in a pulsatise way, and it takes the same time and then.
Julia Jones:
It's so simple.
Kerstin Uvnäs Moberg:
So if there are side effects, I mean we know one thing. And side effects are always dose dependent and concentration dependent. So the less you get, that's better.
Is there anything else about oxytocin you would like people to know? (45:50)
Julia Jones:
Yeah. My next question and my last question you may have just answered, because I think that's really fascinating. If we could just make that one simple change in hospital policies around the world to give synthetic oxytocin in pulses, you'd reduce the dose drastically, you'd much more closely mimic the human body. But also only give it when it's genuinely needed and not routinely. I think that's a huge insight.
But what I was going to ask you is, is there anything that you know about oxytocin that we haven't already covered today, that you wish everyone knew about? Because it's such a fad thing at the moment. It's such a popular thing that I think there's so much misunderstanding and hype around oxytocin. So is there anything you would like people to know?
Kerstin Uvnäs Moberg:
Well, I think still, looking at it all together. It is a fabulous system of life, I would say, because it has all these protective effects. And there is also, I think there's a tendency that the effects on social interaction have been, in comparison with the other effects of oxytocin overstudied. Perhaps because psychologists and sociologists understood when they started to learn about oxytocin, "Okay, we have something here that we could sort of link to our knowledge." And then they start to measure oxytocin levels in different situations.
The problem is that some of the methods by which you measure oxytocin are not so good as the others. Some of the techniques measured give too high levels, and they are not moving as they should in certain situations. So you have to have a very, very expert knowledge of the techniques for measuring oxytocin when you interpret these data. Because if you use the so-called radioimmunoassay, you get much lower values and very distinct pulses during breastfeeding and breast, and labor and things like that. Whereas if you use ELISA, which is a other type of technique, you don't get the same effects, and you get too high effects. And there is a lot of unspecific things in that one.
So a lot of the results have been made based on a technique. It doesn't at least measure the same things as the RIA. And I think that has to be clarified, because it's studying two different things.
The second thing here is that the oxytocin has so many other effects that people haven't really understood. And it has extremely powerful anti-inflammatory effects. So it cleans your blood vessels of inflammations. It reduces inflammation everywhere. And it has these anti-stress effects that lowers your blood pressure, and keeps the heart working at a more modest level. It has growth promoting and healing properties.
I think this whole battery of oxytocin effects is going to become the real key of the future research of oxytocin, because this is the core of the health effects. Because if you live in a relationship or if you have been breastfeeding, you know that you get positive health effects.
For example, women who have been breastfeeding children, the more, the better. They will after 10 to 20 years, have a reduced risk of developing cardiovascular disease, including stroke, heart infarction, high blood pressure, and also diabetes type 2. They have a reduced risk of developing rheumatoid arthritis, and probably breast cancer. So there are so many things that oxytocin does that help us with against a lot of problematic outcomes in disease.
And that's also why I think we need to keep the oxytocin levels up. But that's not been studied as much as the love aspect, which is perhaps more initially intriguing. But I think that this other pattern, the other part of the oxytocin will be in more studies now in the future. And that's where you have the positive long-term effects of any kind of positive social relationship, be it a dog, or a couple, or being in a choir, or all these different ways by which you can feel that you are in a group that you belong to and are bonded to.
Julia Jones:
And then that has sustained health effects.
Kerstin Uvnäs Moberg:
The sustained effects.
How does your research support the idea that the way a woman has cared for postpartum will have a long-term impact on her health? (51:06)
Julia Jones:
Sorry, I'm just going to interrupt you because I love that so much. Because something that I've studied a lot in my postpartum work is also traditional cultural care. And so many cultures have this belief that the way that a woman's cared for in the first weeks or months after her baby's born and her health and wellbeing during that time will have long-term impact on her health for 20, 30, 40 years to come. And that's basically what they're saying, isn't it?
Kerstin Uvnäs Moberg:
Yeah, well that's right. It's right. Now we can show it. I mean, the breastfeeding model is one, because then you can actually link it to how much the women have breastfed.
Now, you can also look for long-term effects of positive human relationships. Good marriages. I'm not saying it's not a relationship, it's good relationship. Better cardiovascular outcome, less infections and all that stuff. The same if you have a dog that you like a lot.
I mean, if you have somebody that you like, you're going to touch that one very much. And you will get not only into these feeling of happiness, but you will actually get into these very basic, very autonomic nervous system related and hormone related health promoting effects. And that's going to be the big story.
Julia Jones:
Yeah, I love it. So even though this is already a miracle hormone of the moment, but the best is yet to come.
Kerstin Uvnäs Moberg:
Yeah. And also as you said. The thing is that we also have seen of course, that if you induce oxytocin release around birth... We know the postpartum period, as you have mentioned several times. I think also, which Marshall Klaus would call the early sensitive period. I would include probably birth in that one.
We know that very short exposures with skin-to-skin, which is one of these enormous oxytocin releasing situations, will have consequences for a very long time. And I just saw some paper from, I think by Ann Bigelow where she is shown that if you have skin-to-skin contact between mother and baby, full term babies, not directly after birth, but for a while during the first month, every day a little bit. You can see positive effects after nine years. So that means that there are probably lifelong effects as there is in animals, but it's more difficult, of course, to study humans. And there are so many. In fact, I think it's fantastic that you can see.
Julia Jones:
It's also very inspiring, I think for women who maybe have experienced that. Because a lot of emphasis is on that first few hours after birth. But it also gets missed a lot when women have traumatic births. But knowing that they can still just cuddle for the next months afterwards, and that still has a huge impact.
Kerstin Uvnäs Moberg:
Yes. It's just that you have to do it a little bit more. I mean, the only difference is that the period right after birth is extremely time efficient. So one hour there will probably correspond to one hour a day perhaps, or half an hour a day.
But that doesn't matter really. Because basically, it's the same type of effects. And if you can't have it immediately after birth, why don't take it later on? And I think of course, that if you breastfeed, you will have all these effects naturally. If you very exclusively breastfeeding, you get this positive effect. But not so many people breastfeed for very long anymore.
Julia Jones:
So then cuddling is also an option.
Kerstin Uvnäs Moberg:
Yes, I think it is. We know that there is this place on the chest, which is I think the most sensitive to induce the actions of skin-to-skin on these basic physiological effects.
But basically, I think co-sleeping is the same, really. I think there are many ways of getting these effects. But most of them, we don't get today. That is the problem. And also I think the risk is if you're not aware of these things, that if you've had a birth with a lot of interventions, you may not by yourself so easily choose these things because you're a little bit outside the system. And then of course you need help and information that if you do this now, maybe you can get on the track again. I think so.
Julia Jones:
Yes, I think. And that's really the role of doulas, isn't it? Because there's so much in our society now that does push you off that track. But if you can have a doula just saying, "Let's just tune into how you're feeling, tune into your baby, spend some time together." Yeah. And just caring for the mother. Because then when you care for the mother, then her oxytocin increases and then she's more likely to want to care for the baby in that way anyway.
Kerstin Uvnäs Moberg:
Exactly. So I think it's a basic archetypal situation, which can be induced in different ways. It takes support and some intuitive and nice friendly people, takes surrounding, which is relatively calm. I think that one reason why women have problems giving birth today is that they don't really consider the hospitals as being safe.
Julia Jones:
Yes.
Kerstin Uvnäs Moberg:
On this very old-fashioned type of thinking, the amygdala will not recognize the hospitals as the normal place. And then you will have this risk of stopping oxytocin release. From a basic point of view, this is not where you should give birth, because you should give birth where it's safe and where you feel at home. And unless you are at home, at least when these systems were created, you went home, and then you had your birth.
So the problem is now that these effects could be very subtle, that it looks different and strange people, they may be friendly and they mean well in a sense. But the oxytocin system may stop working, at least for a while. And that's when people start to give oxytocin drips, because they think mothers can't give birth. I think it's just that it's delayed. Because after a while, they will consider the environment more normal, and then it'll come.
Julia Jones:
Yes, that's right. If you can build up that trust and make them feel safe, then it would naturally start again. And the same could be said for postpartum as well. You were saying that women have a couple of visits for the baby to get checked. But often, those visits are very stressful for mothers. They often feel judged and they have to get dressed when they're not ready to leave the house, and drive around, and they're still sore and tired. So the postpartum care we have, the whole system we have is really not supporting these natural cycles.
Kerstin Uvnäs Moberg:
No, I think you have to interpret these things from the perspective of mothers who lived when these systems were developed, and they lived very differently. And so we have to protect ourselves from different things. But still, we have these old reaction patterns. The limbic systems haven't changed very much over the years. So we could get, not frightened. But just getting the feeling that I don't feel safe here because I don't recognize these things. And then oxytocin is stopped.
So I think that's very, very important. That will be interpreted as an inability, which it isn't. It is just a system of cautious that really will give mother the time to find a safe place. So the more the hospitals will have nice people around, and maybe they have met the people around before, visited a place, I'm sure it's going to be better. I don't think the system of oxytocin is gone or anything. I just think you need the right primers to make it work.
Julia Jones:
Yeah, I love that. Thank you so much. I think I'm going to wrap it up there, unless you have anything else to add.
Kerstin Uvnäs Moberg:
I think this was a nice talk. And I think I have talked perhaps too much.
Julia Jones:
No. It's definitely longer than our usual podcast, but I couldn't cut you off anywhere. I've got 1,000 more questions for you. Maybe we'll need to have you back on the podcast again. But really, it's been so, so interesting to learn from you.
Kerstin Uvnäs Moberg:
Okay, thank you, Julia.
What are the titles of your books? (01:00:00)
Julia Jones:
Thank you so much. And maybe just before we wrap up, you have two books, is that right?
Kerstin Uvnäs Moberg:
No, I have three books. There are three. There is two that originally came from Sweden. ‘The Oxytocin Factor’ and ‘Oxytocin and Closeness’. And then there is this one from America, which is called Oxytocin: The Biological Guide of Motherhood.
Julia Jones:
Yes. So I haven't read that middle one. Oxytocin and Closeness, did you say?
Kerstin Uvnäs Moberg:
Yeah. Actually, I think it is Martin and Pinter in England.
Julia Jones:
Yes.
Kerstin Uvnäs Moberg:
I can send that out. Yeah.
Julia Jones:
Excellent. So everyone listening, if you are interested, they are very detailed and thorough books on Kerstin's work on oxytocin. And really, you are one of the leading researchers in this subject in the world ever. So if anyone's interested in this topic at all, definitely don't get your information off the internet. Go and find these books, and someone who really knows what they're talking about. So it really has been an honor to have you on the show. Kerstin, thank you very much for your time.
Kerstin Uvnäs Moberg:
Thank you, Julia. It was a pleasure.
Julia Jones:
Thank you. We'll pop some links to your books and your website under the podcast in the show notes too. So if anyone does want to find you, they know where to look.
