Birthing Project USA is the only national African-American maternal and child health program in this country. We are a volunteer effort to encourage better birth outcomes by providing practical support to women during pregnancy and for one year after the birth of their children.
A protein released from the lungs of a developing mouse fetus initiates a cascade of chemical events leading to the mother's initiation of labor, researchers at UT Southwestern Medical Center at Dallas have found.
The research, which has implications for humans, marks the first time a link between a specific fetal lung protein and labor has been identified, said Dr. Carole Mendelson, professor of biochemistry and obstetrics and gynecology and senior author of the study. The paper appears in an upcoming issue of the Proceedings of the National Academy of Sciences and is currently available online.
The initiation of term labor is carefully timed to begin only after the embryo is sufficiently mature to survive outside the womb. Previous studies suggested that the signal for labor in humans may arise from the fetus, but the nature of the signal and actual mechanism was unclear, Dr. Mendelson said.
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In their study, UT Southwestern researchers found evidence that a substance secreted by the lungs of a developing fetus contains the key signal that initiates labor. The substance, called surfactant, is essential for normal breathing outside the womb.
"We found that a protein within lung surfactant serves as a hormone of labor that signals to the mother's uterus when the fetal lungs are sufficiently mature to withstand the critical transition to air breathing," Dr. Mendelson said.
"No one really understands what causes normal or preterm labor. There may be several chemical pathways that lead to labor, but we think that this surfactant protein, which is also produced by the fetal lung in humans, may be the first hormonal signal for labor," said Dr. Mendelson, who is co-director of the North Texas March of Dimes Birth Defects Center at UT Southwestern.
In humans the signaling protein, called surfactant protein A, or SP-A, also helps immune cells, called macrophages, fight off infections in the lungs of children and adults by gobbling up bacteria, viruses and fungi that infiltrate the lung airway.
"Women who go into preterm labor frequently have an infection of the membranes that surround the fetus, and the number of macrophages in the wall of the uterus increases with the initiation of preterm labor. When women go into labor at term, they also have an increase in macrophages in the uterus," Dr. Mendelson said.
This led the researchers to investigate whether there was a connection between what happens during normal labor at term and in infected mothers who go into early labor.
"This also raised the question: If bacterial infection can cause increased macrophage infiltration of the uterus in preterm labor, what is the signal for the enhanced macrophage migration to the uterus at term?" Dr. Mendelson said.
In mice, the developing fetal lung starts producing SP-A at 17 days gestation; full-term delivery occurs at 19 days. The developing human fetus starts producing SP-A in increasing amounts after 30 to 32 weeks of a 40-week normal gestation, at which time the baby's lungs are essentially developed. As the fetus "breathes" amniotic fluid in the womb, the protein is released into the fluid.
"The SP-A protein binds to macrophages in the amniotic fluid, macrophages that come from the fetus itself," said Dr. Jennifer Condon, a postdoctoral researcher in biochemistry and the study's lead author.
The macrophages, "activated" by the protein, make their way through the amniotic fluid to the wall of the uterus. Once embedded there, they produce a chemical that stimulates an inflammatory response in the uterus, ultimately leading to labor.
http://www.utsouthwestern.edu/utsw/cda/dept37389/files/158762.html
BioMed press release.
A newborn baby's weight loss is often used to determine how well a baby is breastfeeding, and concern about a baby which loses too much weight may result in supplementing breastfeeding with formula. However, many women receive IV fluids during labor, and new research published in BMC's open access journal International Breastfeeding Journal shows that some of a newborn's initial weight loss may be due to the infant regulating its hydration and not related to a lack of breast milk.
A group of Canadian researchers looked at relationships among the IV fluids a mother received during labor (or prior to her caesarean section), neonatal output (measured by diaper weight), and newborn weight loss. They found that during the first 24 hours following birth there was a positive association both between the IV fluids given to mothers before birth and neonatal output, and between the neonatal output and newborn weight loss. At 60 hours post birth, the time of the average lowest weight, there was a positive relationship between maternal IV fluids and newborn weight loss.
"Nurses, midwives, lactation consultants, and doctors have long wondered why some babies lose substantially more weight than others even though all babies get small amounts to eat in the beginning," said principal investigator Prof Joy Noel-Weiss from the School of Nursing at the University of Ottawa's Faculty of Health Sciences. "It appears neonates exposed to increased fluids before birth might be born overhydrated, requiring the baby to regulate his or her fluid levels during the first 24 hours after birth."
Prof Noel-Weiss added, "We should reconsider the practice of using birth weight as the baseline when calculating newborn weight loss in the first few days following birth. For mothers and their breastfed babies, accurate assessment of weight loss is important. Although more research is needed, based on our findings, we would recommend using weight measured at 24 hours post birth as a baseline."
Alongside this article, the researchers have provided a standardized method for clinicians to collect and analyze data about newborn weight loss in their own maternity site, in the hope that this protocol will help them to make informed decisions when assessing newborn weight changes.
2. Iatrogenic newborn weight loss: knowledge translation using a study protocol for your maternity setting . Joy Noel-Weiss, A Kirsten Woodend and Dianne L Groll. International Breastfeeding Journal (in press)
Addis Ababa Fistula Hospital is not a mission hospital or affiliated with a particular denomination, but the Hamlins’ faith defines it. The staff begins the day with a prayer meeting, and recordings of Scripture readings and messages are available in at least 25 languages for the women to listen to on headphones as they recover. Many patients have become Christians.
As the second fistula hospital in the world (the first ran in New York from 1855 to 1928 whenVVFs became obsolete in the U.S.), Addis Ababa depends on donations to provide free surgery and care for these women. Organizations give financial support to run the hospital and provide each woman with a new dress, a bus ticket home, and, if they would like one, a Bible. Hamlin Fistula International also raised money to launch five regional hospitals in Ethiopia that serve 3,000 patients a year and hopes to treat 4,000 annually. In order to prevent VVFs, another project involves training midwives to serve in rural areas and supporting them in their work.
Induction with Cytotec should never be attempted anywhere, most especially in out-of-hospital settings. Incredibly, the American College of Obstetricians and Gynecologists (ACOG) recently approved Cytotec induction: 1) in spite of lack of FDA approval; 2) in spite of a letter to doctors earlier this year from Searle (which manufactures Cytotec) imploring doctors not to use it for induction; 3) in spite of lack of approval from the Cochrane Library (the best scientific opinion); and 4) in spite of the fact that it is not approved nor used for induction in any country in Western Europe.
Recent articles in prestigious medical journals such as The Lancet have questioned the validity of standards of practice from professional organizations like ACOG, because their goal of protecting the health of women through using scientific evidence to guide members toward best practices too often conflicts with their other role as a trade union representing the interest of their members. As a result of this "trade union" role, ACOG recommendations are too often compromised by the needs of the obstetricians. A classic example of putting the doctors' needs ahead of the families' needs is the ACOG recommendation not to permit videotaping by families of a hospital birth.
So ACOG quotes studies of Cytotec induction, none of which have a sufficient number of research subjects, and consequently, none of the studies quoted have sufficient statistical power to detect small but potentially important risks such as uterine hyperstimulation and uterine rupture. Furthermore, because published studies of Cytotec induction have such wide methodological variability, meta-analysis is impossible and the published attempts at such meta-analysis are seriously flawed. But Cytotec is a godsend for busy obstetricians, as its use allows them to schedule the woman's labor at a convenient time and speeds up the labor, resulting in a return to "daylight obstetrics"-pharmacological induction of labor has increased from 10 percent to 20 percent in the past decade in the United States. So with their members' needs in mind, ACOG plows ahead, ignoring the best scientific evidence as well as the recommendations of the best scientific bodies, of government agencies not only in the United States but in every country in Western Europe, and of the pharmaceutical company. Instead, ACOG uses weak, inadequate evidence to approve Cytotec induction. Midwives should stay as far away as possible from such vigilante obstetrics-obstetricians taking matters into their own hands while ignoring the recommendations of the real judges.
article from Midwifery Today, Issue 57, Spring 2001, page 44
by Marsden Wagner MD, MSPH
Cover photo of Jessie and Hans © 2000 by Caroline E. Brown, DEd, MS, RNC.
Contradicting the suspicion that breastfeeding moms get less sleep, the results represent "good information to be able to tell women, (that) 'not breastfeeding is not going to help you get better sleep,'" study author Dr. Hawley Montgomery-Downs of West Virginia University told Reuters Health. "And the benefits (of breastfeeding) for both mom and baby are tremendous."
Baby Jamie showed no signs of life when he was delivered along with a twin sister, Emily, at just 27 weeks gestation and weighing 2lb at a hospital in Sydney, Australia.
Doctors said they had lost him and he was given to his mother, Kate, who unwrapped his blankets and placed him on her chest so she and her husband, David, could say their goodbyes.
Following two hours of cuddling and being spoken to by his parents, Jamie began to gasp. Doctors initially claimed it was a "reflex" but the baby began gasping more often and then opened his eyes.
The family have spoken of their experience for the first time since Jamie was born five months ago. They told of the importance of "skin-to-skin" bonding between mother and baby in a technique also known as the "kangaroo touch" in Australia because of the way the animals held their newborns close to the skin in their pouch.
Read the full story by Rebecca Smith on Telegraph.co.uk: Mother's Cuddle Brings Baby Back to Life
"A test leading to an unnecessary major abdominal operation in more than 99.5 percent of cases should be regarded by the medical community as absurd at best," wrote Steven Clark and Gary Hankins in the American Journal of Obstetrics and Gynecology. "Electronic fetal heart rate monitoring has probably done more harm than good."
Why do doctors cling to continuous fetal heart monitoring? An obstetrician will most likely point to the fear of being sued, but the complete answer is more complex. Our medical culture prizes technology and tests, even if they don't work and can cause harm.
"It's our bias that anything that can be quantified is an improvement," said H. Gilbert Welch, a professor at Dartmouth Medical School whose research focuses on harm caused by screening and over-diagnosis.
Thinking of, and clinging to, the “due date” as “the day” makes it difficult for women to trust nature's beautiful plan for the end of pregnancy and the start of labor. What women rarely know, and what people tend to forget, is that some variation exists in how long it takes for an individual baby to mature fully. Acknowledging that babies can safely come 2 weeks before or 2 weeks after the due date does not tell the whole story. Some babies are mature as early as 37 weeks (259 days), and others need 42 completed weeks (294 days) and sometimes a bit more to be fully ready. Size is not an indication of maturity, and the due date is only a guideline.
The period of purple crying is a new way to help parents understand this time in their baby’s life, which is a normal part of every infant’s development. It is confusing and concerning to be told your baby “has colic” because it sounds like it is an illness or a condition that is abnormal. When the baby is given colic medicine it reinforces the idea that there is something wrong with the baby, when in fact the baby is going through a very normal developmental phase.
The period of purple crying begins at about 2 weeks of age and continues until about 3-4 months. There are other common characteristics of this phases, or period, which are better described by the acronym PURPLE. All babies go through this period; some can cry a lot, some far less, but they all go through it.
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