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)

Babies Represent Life Returning to Japan

CNN's Kyung Lah reports on the many signs of people moving forward in Japan's tsunami-devastated areas.

Ob/Gyn Ministers to "Unclean Women" in the Name of Jesus

Dr. Catherine Hamlin, 87, has saved countless Ethiopian women's lives through her work repairing fistulas. Most don't know that she labors out of love for Jesus.

Read the story at: http://blog.christianitytoday.com/women/2011/03/mother_teresa_of_our_age_talks.html

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.

Volunteer Doula Programs Around the Nation

A doula named Miriam has compiled a great list of volunteer doula organizations around the country. The list came to my attention because our local Austin group, Giving Austin Labor Support, was among those listed. Yay, GALS! :) For those of you who are just beginning your doula journey, volunteer organizations like GALS are a great way to gain experience and to support mommas who can't afford to hire a doula and don't need a lot of fancy techniques or philosophy, just a continual presence and a warm touch.

Read the list at RadicalDoula.com:

radicaldoula.com/becoming-a-doula/volunteer-programs/

Visit the GALS website: www.givingaustinlaborsupport.org

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

Debunking Doula Myths

This is a column by Danielle Elwood from Babble, a parenting website. I have included part of it and you can find the rest here: http://blogs.babble.com/being-pregnant/2010/11/18/common-myths-about-doulas/

"The longer I’ve worked in the birth community the more I’ve learned just how many mainstream forums carry horrible inaccuracies about doulas. I wanted to write something to kind of set the record straight and let women, especially pregnant women, or women who will some day plan to have a child of their own what is real, and what is a big ol’ myth."

Myth: A doula shows up only for the birth, and leaves immediately after.
The relationship a doula builds with a mother and her family starts during pregnancy, and expands to labor and postpartum care. When labor begins your doula will accompany you fromstart to finish, and even in the hours after, no matter what setting you have chosen for your birth. After your baby is born you should expect your doula to check in on you a couple times to see how you are adjusting to your new life and roles.

Myth: Doulas are only for crazy hippies.
Contrary to popular belief, all doulas are not going to show up with bongos and magical healing crystals. Most doulas may be into natural healing, or holistic health care, but are not going to be pushy if this is something you do not want to choose for your own birth.

Myth: Doulas take over the role a husband has during labor.
This is probably the most common myth I hear. A doula’s role in labor is to not only be of help tothe mother and her partner, but to work on enhancing the relationship the couple has with the hospital staff. She will advocate for the mother and function as a liason between the couple and hospital staff such as residents and nurses. During labor, mom and dad are often too preoccupied to deal with lots of details– this is one reason a doula comes in handy.
As Penny Simkin says: “While a doula probably knows more than then partner about birth, hospitals and maternity care, the partner knows more about the woman and her personality, likes and dislikes, and needs. Moreover, he or she loves the woman more than anyone else there.”

Myth: Doulas take the place of Midwives or OB/GYNs.
This is another huge myth I constantly hear. Many people mistakenly think that a doula takes the place of a midwife, or medical professional who handles prenatal care and delivery. Or that a doula and midwife are interchangeable. While some doulas may carry other certifications in the medical field they are not midwives or doctors and should not be treated as such. They are there to provide labor support and guidance, not medical care.Myth: Doulas cost too much!
Doulas are not only for the rich, or for those with kick ass health insurance that will cover doula care. Doulas are for all women. In some areas they can range up to about $600 for a birth, but many doulas are willing to work on a sliding scale, or even for free while working on their certification. Many hospitals across the country have programs with doulas on staff that can cost as low as $100 for an entire birth.

Myth: If you have a doula, you cannot have an epidural or pain relief.
While women who make the choice to have a doula do not typically wish to have medical pain relief during labor, doulas are not going to judge your choices for what you want during your birth. They are there to support your labor and birth, not dictate what they think you should be doing. Heck, I had a doula with my second birth and after laboring for nearly a day opted for an epidural for some sleep. There is nothing wrong with it as long as you are educated on your choices.

by Danielle Elwood