Fetal Lungs Provide a Signal Initiating Labor

This isn't new information (the press release below was published in 2004), but it seems to be relatively unheard of among mothers and childbirth educators. It has significant implications and should greatly influence families' decisions about inducing labor or electing to deliver a baby via cesarean section. If the mother has not gone into labor, the baby most likely has not given the signal that he's ready!

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.

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

Canadian Research Suggests Maternal IV Fluids Linked to Newborns' Weight Loss

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.

1. An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss. Joy Noel-Weiss, A Kirsten Woodend, Wendy E. Peterson, William Gibb and Dianne L Groll. International Breastfeeding Journal (in press)

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)

Cytotec Is Dangerous, No Matter What Your Doctor Told You...

There has been renewed conversation about Cytotec in my local doula community recently because a doula was concerned that this was what a doctor had prescribed for her client. A few doulas commented that their clients had experienced medically-induced labor with Cytotec and had good outcomes. But we must remember that a few happy endings are not evidence that the practice is safe.



This article by Marsden Wagner in a 2001 issue of Midwifery Today covers the major points...

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.

http://www.midwiferytoday.com/articles/midwivescytotec.asp

Study Shows Pregnant Mother's Diet Impacts Infant's Sense of Smell

PRESS RELEASE

A major new study shows that a pregnant mother's diet not only sensitizes the baby to those smells and flavors, but physically changes the brain, directly impacting what the infant eats and drinks in the future.

"This highlights the importance of eating a healthy diet and refraining from drinking alcohol during pregnancy and nursing," said Josephine Todrank, PhD, who conducted the two-year study while a visiting scientist at the University of Colorado School of Medicine. "If the mother drinks alcohol, her child may be more attracted to alcohol because the developing baby "expects" that whatever comes from the mother must be safe. If she eats healthy food, the child will prefer healthy food."

Researchers studying mice found that the pups' sense of smell is changed by what their mothers eat, teaching them to like the flavors in her diet. At the same time, they found significant changes in the structure of the brain's olfactory glomeruli, which processes smells, because odors in the amniotic fluid affect how this system develops.

"This is the first study to address the changes in the brain that occur upon steady exposure to flavors in utero and early in postnatal life when the newborn is receiving milk from the mother," said Diego Restrepo, PhD, co-director of the Center for NeuroScience at the University of Colorado School of Medicine and sponsor of the study. "During these periods the pup is exposed to flavors found in the food the mom is eating."

The research, he said, could have important public health implications.

"Many diseases plaguing society involve excess consumption or avoidance of certain kinds of foods," said Restrepo, a professor of cell and developmental biology. "Understanding the factors that determine choice and ingestion, particularly the early factors, is important in designing strategies to enhance the health of the infant, child, and adult."

In her study, Josephine Todrank fed one group of pregnant and nursing mice a bland diet and another a flavored diet. At weaning age, the pups from mothers on the flavored diet had significantly larger glomeruli than those on the bland diet. They also preferred the same flavor their mother ate, while the other pups had no preference.

"Exposure to odor or flavor in the womb elicits the preference but also shapes the brain development," said Todrank, whose work was funded by a grant from the National Institutes of Health and was published December 1, 2010 in the Proceedings of the Royal Society B, a major biological research journal.

"From the fetus' point of view, whatever is in the womb is considered "good." If your mother ate it and survived to give birth to you then it was probably safe," she said. "This is a good strategy for a mouse that is foraging for food. It treats those same foods as safe."

Due to the similarities in mammalian development, she said, there is no reason to think that experiments would produce different results in humans.

"What an expectant mother chooses to eat and drink has long-term effects – for better or worse – on her child's sensory anatomy as well his or her odor memory and food preferences in the future," Todrank said. "It is not yet clear how long these changes and preferences last, but we are currently investigating that question."

ob/gyn: "Fetal heart monitoring is an appallingly poor test."

This story in The Philadelphia Inquirer asks a good question...

Why do we use fetal heart monitors when they do not lead to improved outcomes?

"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.

Alex Friedman is a fellow in maternal-fetal medicine at the Hospital of the University of Pennsylvania.

Read the full story by Dr. Friedman in The Philadelphia Inquirer: http://www.philly.com:80/inquirer/magazine/20100426_Test_leads_to_needless_C-sections.html

Images from FetalMonitorStrips.com

Breastfeeding Cuts Fever Risk After Vaccines

A new study shows that infants who are exclusively breastfed are less likely to run fevers after their routine immunizations than infants who are partially breastfed or only receive formula.

"Babies want to nurse more frequently, and because they are nursing more frequently, they are getting more food [than formula-fed infants], so whatever need they have to repair their body and bring down the fever is being met," said Barbara Holmes, a lactation specialist at New York University Langone Medical Center in New York City.

Read more:

Study Shows Breastfed Babies Less Likely to Have Fevers After Vaccinations, by Denise Mann

Don't Short-Change Your Baby By Inducing Labor

I read this column on MSNBC today, about why women should not choose to induce labor in their final weeks of pregnancy. The author refers to a recent study that details the complications that come with late preterm births, including respiratory distress and difficulty sucking and swallowing.

I agree with the column, but I would add that the dangers of induction do not end at 40 weeks or the "due date" your doctor wrote in your medical file. Just because some babies are born around 40 weeks does not mean every baby is ready to be born at 40 weeks. Why induce at 40 weeks if you would not induce at 38?

Here are some good comments from Judith A. Lothian in the Journal of Perinatal Education:

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.

She notes that "Waiting for labor to start spontaneously is almost always the best way to know that the baby is ready to be born and that a woman's body is ready for labor." Read her article for more details about the risks of induction: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595289/

Tactile and Emotional Support During Labor

This month's issue of the Charis Childbirth newsletter included great introductory information about the role of birth doulas. I've included an excerpt below, but there's more info at this link:

http://www.charischildbirth.org/newsletter/0510/page4.htm

A doula is a layperson, most often a woman, who understands the biological and medical processes involved in labor and obstetrics, and who usually has assisted in at least five or six deliveries under the supervision of another doula. Her training also provides her with knowledge of obstetrical interventions, so that she can explain them to the woman and her partner in the event they are needed.

Doulas typically function as a part of the "birthing team," serving as an adjunct to the midwife or the hospital obstetrical staff. Physicians and labor and delivery nurses may appreciate the doula's sustained attention to the mother, especially in hospitals where demands on the staff interfere with exclusive contact with the mother. The doula also serves a critical role in supporting and educating the woman's partner, enabling him or her to be as involved and as effective as possible in supporting the mother.

In the United States, most doulas work as independent providers hired by the expectant woman. (In fact, many hold full-time jobs outside the realm of health care.) Increasingly, managed care organizations are offering doula support as part of regular obstetrical care. In some European institutions, doula support is offered as a standard of care by midwives or nursing students. In many cultures, of course, the practice of a knowledgeable woman helping a mother in labor is not labeled anything as official as "doula" support; it is simply an ingrained, centuries-old custom.

Overall, the defining characteristic of doula-type care is continuous, uninterrupted, emotional and physical support of the woman for the duration of the labor and childbirth.

Vaginal Birth Now Recommended for Babies in Breech Positions

This is year-old news, but I just found it today. It surprised me that this wasn't bigger news when the study was released... The Society of Obstetricians and Gynecologists of Canada has announced that c-sections are no longer recommended for breech babies!

An article at the Globe and Mail states that Canadian medical schools will now start training doctors to deliver breech babies, so that they can conform to the current guidelines:

Since 2000, C-sections have been the preferred method of delivery in breech births. Studies suggested that breached births were associated with an increased rate of complication when performed vaginally.

As a result, many medical schools have stopped training their physicians in breech vaginal delivery.

The problem now, according to Dr. Lalonde, is that there is a serious shortage of doctors to teach and perform these deliveries.

With the release of the new guidelines, the SOGC will launch a nationwide training program to ensure that doctors will be adequately prepared to offer vaginal breech births .

The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

The article also references an organization called the Coalition for Breech Birth. Their stated purpose is to educate women about breech birth and to inform them that they have the option to choose to birth a breech baby vaginally, c-section is not the only option. “Educating women is our primary goal because it takes more than just a guideline change,” the coalition co-founder says.

Read more here: http://www.theglobeandmail.com/life/health/c-section-not-best-option-for-breech-birth/article1186104/

If you're interested in seeing images of other breech positions that babies may take, check out this page: www.health-res.com/pictures-of-breech-presentation/

The Myth of a Vaginal Exam

I found this article interesting, especially in light of my most recent post about all the alternative ways of assessing a mother's progress in labor. Apparently, cervical checks are not merely one of many comparable ways to check progress; they are actually inaccurate and unhelpful ways to attempt to check progress. These checks may give doctors and mothers a false idea of how soon labor may or may not begin and also introduce risks that are often not considered.

The Myth of a Vaginal Exam, by Robin Elise Weiss, on About.com

Vaginal exams can measure certain things: dilation, ripeness, effacement, station, position of the baby, and position of the cervix.

What this equation leaves to be desired is something that is not always tangible. Many people try to use the information that is gathered from a vaginal exam to predict things like when labor will begin or if the baby will fit through the pelvis. A vaginal exam simply cannot measure these things.

pregnancy.about.com/cs/interventions/a/vaginalexam.htm

Natural News: Birth Drugs Impair Breastfeeding

www.naturalnews.com/028010_birth_drugs_brstfeeding.html

"A lot of women are not given enough information about the medications that might be given to them during childbirth, and women at low risk of bleeding may not need to take these drugs," said Rosemary Dodds of the National (British) Childbirth Trust. "It is important that women understand the risks and can give their informed consent before they go into labor."

The researchers suggested that the anti-bleeding drugs could interfere with milk production, thus making breastfeeding more difficult and causing new mothers to give up in frustration.

The study also found that high doses of painkillers known as epidurals also reduce a woman's chance of breastfeeding. Prior studies have also found this connection.

Read the full press release at naturalnews.com.

Newborn Babies Cry in Their Native Tongue

Here's an excerpt from an interesting news story about still another way babies are influenced by their mothers while in the womb...

http://www.msnbc.msn.com/id/33656622/ns/health-kids_and_parenting/

"Prenatal exposure to language was known to influence newborns. For instance, past research showed they preferred their mother's voice over those of others.

Still, researchers thought infants did not imitate sounds until much later on. Although three-month-old babies can match vowel sounds that adults make, this skill depends on vocal control just not physically possible much earlier.

However, when scientists recorded and analyzed the cries of 60 healthy newborns when they were three to five days old — 30 born into French-speaking families, 30 into German-speaking ones — their analysis revealed clear differences in the melodies of their cries based on their native tongue."

Current Issue: H1N1 Vaccine

Here is some good commentary from Midwifery Today:

www.midwiferytoday.com/articles/preg_H1N1fluvirus.asp

"Historically, alternative preventative treatment has been utilized successfully in times of epidemic flu outbreak. Although there is an option to vaccinate oneself with this new H1N1 vaccine, I would argue that the current global situation warrants a more serious search for safe, non-invasive alternatives. The inherent risks of vaccinations can serve as a reminder for midwives to return to the basics, creating and maintaining a healthy immune system."

Author Jeramie Peacock describes some of the problematic ingredients in the H1N1 vaccine, as well as alternative approaches being taken in France and India.

Homebirth in the media

This TODAY Show report - portraying homebirth as a particularly risky option - is taking a lot of flack: http://today.msnbc.msn.com/id/26184891/vp/32795933#32795933

It doesn't address the sad reality that sometimes babies die, even in births at the hospital. There is no way to completely prevent infant mortality, but homebirths do result in fewer infant deaths than hospital births. Like the video points out, that is in part because homebirths are low-risk births. But all the more reason to choose homebirth if your pregnancy isn't high risk!

Here are two stories about homebirth on USA Today. These provide the positive coverage to balance out the negative stuff from the aforementioned video!

Study Shows Home Birth with Midwife as Safe as Hospital Birth
by Amanda Gardner
http://www.usatoday.com/news/health/2009-09-03-midwife-home-birth_N.htm?obref=obinsite

Home Births Get a Bump, Over Obstetricians' Objections
by Rita Rubin
http://www.usatoday.com/news/health/2009-09-13-home-births_n.htm

Reducing Infant Mortality

The folks at www.ReducingInfantMortality.com are raising money to fund this film about the state of childbirth in America. Watch the commercial and feel free to donate money towards the cause on their website.

"Listen to obstetricians, doulas, neonatologists, midwives, psychologists, pediatricians, and other physicians explain how our health care system is failing babies and mothers and what we can do about it."

http://www.youtube.com/watch?v=eFaryTo0w4U

http://www.reducinginfantmortality.com/

Laboring Without the Labor Bed: It's a Good Thing

This press release from the University of Toronto details a pilot study that removed the standard hospital bed as a focal point of labor. In the redesigned "ambient" room, instead of the typical hospital room, women didn't spend as much time in the bed. And the result was that they labored better and had a better perception of their labor experience.

Here's the story:

A University of Toronto pilot study that re-conceptualized the hospital labour room by removing the standard, clinical bed and adding relaxation-promoting equipment had a 28 per cent drop in infusions of artificial oxytocin, a powerful drug used to advance slow labours. The study, called PLACE (Pregnant and Labouring in an Ambient Clinical Environment) was published in the current edition of the journal Birth.

In addition, more than 65 percent of the labouring women in the ambient room, compared to 13 per cent in the standard labour room, reported they spent less than half their hospital labour in the standard labour bed.

Led by Dr. Ellen Hodnett, Bloomberg Faculty of Nursing professor and Heather M. Reisman Chair in Perinatal Nursing Research at the University of Toronto, PLACE included 62 women at two Toronto teaching hospitals.

Hodnett devised a set of simple, but radical modifications to the standard hospital labour room, with the intention of surrounding the women and their caregivers with specific types of auditory, visual and tactile stimuli.

"The removal of the standard hospital bed sent a message that this was not the only place a woman could labour," says Hodnett. A portable, double-sized mattress with several large, comfortable cushions was set up in the corner of the ambient room. Fluorescent lighting was dimmed, and DVDs of ocean beaches, waterfalls and other soothing vistas were projected onto a wall. A wide variety of music was also made available.

"The intent was to allow the women the ability to move about freely during their labour, to permit close contact with their support people, and to promote feelings of calm and confidence," says Hodnett.

Reaction to the ambient room was overwhelmingly positive, as respondents were pleased to have options for mobility and for helping to cope with their labour. They also indicated they received greater one-on-one attention and support from their nurses.

"This study raises questions about the assumptions underlying the design of the typical hospital labour room," says Hodnett. "The birth environment seems to affect the behaviour of everyone in it – the laboring women as well as those who provide care for her.
Hodnett hopes to further this study with a larger, randomized controlled trial.

View Dr. Hodnett's study here: http://www3.interscience.wiley.com/cgi-bin/fulltext/122413904/HTMLSTART

Read Dr. Hodnett's bio here: http://bloomberg.nursing.utoronto.ca/staff/Faculty_Bios/Ellen_Hodnett.htm

"We Can Be Much Kinder" video

:: more info about babies' circulation ::

In this video, doctors, midwives, and nurses discuss cord clamping/cutting over images of homebirth, with delayed cord cutting, and hospital birth, with immediate cord clamping.

http://www.metacafe.com/watch/2870183/we_can_be_much_kinder_birth_matters_video_contest/