Maralyn Foureur 2011 Home Birth Conference


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  • I thank you for the invitation to speak at this important conference – I must confess at the outset that I struggled a little when pondering – what new and interesting ideas can I possibly bring to a group of women and their families, and their professional care providers- who are already birthing in the optimal birth environment since the evidence suggests, the place in which you feel most safe and secure is the right location for birth to unfold- and for most of us-that is actually the home in which we live. Or is it? My hope is that you will find what I have chosen to share with you is as intriguing and useful as I have found in considering the birth environment and HOW the choices we make today may be having an impact far beyond what we might imagine.
  • The focus of my presentation this evening is on how the early stages of life from conception, through pregnancy, and birth and the very early days following birth might influence a child’s subsequent wellbeing ... I want to explore with you some relatively new research so that we can consider what we SHOULD be paying attention to – if anything.Like many of you here I am a parent and grandparent and I have an abiding professional interest as a midwife to try to learn as much as I can about early life experiences so that I understand the choices that I make for myself I MIGHT also BE making for my children and grand children – and to understand better the potential intended or unintended consequences of the options I offer to women as part of my midwifery practice. So we are going to explore how the early stages of life from conception to birth might influence the future child’s wellbeing and to consider whether there is anything we can learn from the available research evidence.
  • DNA is found in the nucleus of every cell in our body
  • But I am going to begin this shared conversation between myself, Cathrine and you by presenting a few research examples from perinatal animal research. Three studies in particular I thought might provide an interesting snapshot of what is happening in the field of epigenetics which is particularly pertinent to pregnancy and childbirth.I’m going to examine the experiences of the Agouti mouse, stressed pregnant rats and genetically engineered mice. And then return ultimately to studies in human mothers
  • In this case its a dietary intervention that can silence the Agouti Gene. IF the Pregnant Agouti mouse is fed a diet rich in soy extract, folate, and B12 she will have babies who still have the agouti gene but are otherwise normal-here is a mother and her normal baby There are several potentially important messages to be gleaned from this study- I hope you are thinking the same thoughts as I did when I first met this mouse- wow diet is potentially very powerful- what you eat can turn on or silence genes – Interestingly all pregnant women are advised to take folate if they are planning pregnancy and to continue taking it throughout pregnancy.By the way We all have an agouti gene – it is what gives fat tissue inside the body its yellow colour.
  • The next study I discovered concerned pregnant rats who were experimentally stressed- a lot- by moving their nest around and messing it up constantly throughout their pregnancy. When their pups were born, the researchers observed that the new mothers abused and neglected their pups- dragging. Dropping and stepping on them- they didn’t lick and groom them which is very unusual behaviour for mother rats. But what happened to their pups was of great concern. The researchers discovered two things- firstly the pups developed epigenetic modifications to their DNA – the caring, nurturing behaviourie the licking and grooming genes were silenced so that when those pups grew up and became mothers they exhibited the same neglectful behaviour that they experienced at the hands of their own mothers – but wait there’s more –
  • these same genetic changes and behavioural changes were passed on to the next generation and so on it goes.The message in this study for me was that stress in pregnancy can have quite serious EPIGENETIC effects on the unborn baby that are played out in that baby’s life and then her baby’s life in turn.I wondered if there was some intervention that could stop this intergenerational transfer of DNA mutation
  • Fortunately I found another study that lifted my mood a little – a fascinating piece of research where mice were genetically engineered to have a memory defect in that they were completely unable to negotiate a simple maze to locate food.step 2 was that these genetically modified mice were then placed in an enriched environment for some time and ultimately their memory improved to the point that they could negotiate the maze – so they overcame their genetic deficit.But step 3 is what was amazing – when these genetically deficient mice had babies- their babies also had the same memory defective gene- but it didn’t affect them at all- they had the same improved memory of their mothers- so the memory defective gene had been silenced.Mm so whats the message here? –the quality of the social environment beyond infancy is capable of shifting patterns of gene expression with consequences for the functioning of the individual– both within and across generationsthe genes can be silenced.The brain is amazingly changeable like plasticine which is what is meant by the plasticity of the brain.I wanted to return to the stressed mother rats and find an intervention that would silence their altered DNA
  • So what have we encountered so far in relation to animal research?There are similar findings in a range of studies conducted with many other mammalsSo Of what relevance is this to human mothers and their babies?
  • There are many associations identified between stressful perinatal experiences and later life events- these include life challenges such as diabetes which is increasing dramatically, cardiovascular disease, autism spectrum disorders from mild AHDH to Autism, schizophrenia and psychotic disorders-drug dependency and suicidality
  • Starts with gaining access to the hospital, place to park car, private, signage, lit
  • Lighting and privacy and thermal environment
  • Maralyn Foureur 2011 Home Birth Conference

    1. 1. Home Birth Aotearoa National Conference October 28-30 2011
    3. 3. AIM: EPIGENETICS, OVERWEIGHT AND OBESITY To explore how the birth environment influences childbirth, parenting and our future health Maralyn Foureur Professor of Midwifery University of Technology Sydney
    4. 4.  Research evidence from cross disciplinary scientific traditions (behavioural & biological sciences) Research conducted across species  Rodents – mice, prairie voles, rats  Sheep  Primates  Humans Using a range of research methods Aided by new tools such as fMRI, PET scans & the New Science of Epigenetics
    5. 5.  Developing Theory Hypothesis generating Research stimulus Puttingtogether pieces of a puzzle (Product warning – allresearch has limitations)
    6. 6. Relationship + Optimal Birth based maternity Environment care Calm & ConnectOPTIMISING SystemBIRTHPHYSIOLOGY Optimal Oxytocin Lowers BP, Heart rate, decreases pain Normal Birth
    7. 7. 3 stories1. Epigenetics2. Oxytocin3. Our need to feel safe
    8. 8. THE CENTRAL DOGMA OF MOST SCIENTIFIC ACTIVITYFOR THE LAST 150 YEARS HAS BEEN CHALLENGED… Darwin’s Theory of Evolution … we inherit all of our characteristics from our parents… Is NOT entirely right!
    9. 9. Watson & Crick1953DNA Controls Allof life – genesare subunits ofstrands of DNA
    10. 10.  Human Genome  But found human Project genome only Looked for 120,000 consists of 30,000 genes to account for genes all the complexity &  About the same as a diversity of life fruit fly  Forced to conclude that genes do NOT control life- so what does????
    11. 11. Genes are being switched on or silenced by signals from outside the genes-from the environmentThrough a processcalled Methylationor Demethylation ++
    12. 12.  Environmental  Can modify genes influences without changing including: their basic blueprint Stress = Feeling unsafe/threatened Emotions Nutrition Toxins
    13. 13. 1. The Agouti Mouse2. Stressed Pregnant Rats3. Genetically Engineered Mice Large population based Studies in Humans
    14. 14. Prone to Obesity, Diabetes, Cancer, EarlyDeath
    15. 15. Pregnant Agouti fed a diet richin soy extract, folate, B12…-will have babies who still have the agouti gene but are otherwise normal
    16. 16.  Abusedand  Pups developed neglected their pups epigenetic modifications to their DNA  Pupsgrew up to be poor mothers
    17. 17.  Andpassed on these changes to the next generation of offspring
    18. 18. 1. Mice genetically 3. Offspring of those engineered to mice - who had have a memory the same memory defect defective gene -2. Placed in an also had an enriched improved memory environment Memory improved
    19. 19.  Gene mutation can  The changes to the cause obesity, gene expression diabetes and cancer result in behavioural Changes to diet can changes in the silence the gene offspring mutation from being  Changes to the gene expressed expression can Maternal Stress continue to occur during pregnancy across generations can alter the  An enriched structure of the DNA environment can (gene expression) in overcome changes the unborn offspring in the genes
    20. 20.  Environmental  Can modify genes influences without changing including: their basic blueprint Stress = Feeling unsafe/threatened Emotions Nutrition Toxins
    21. 21.  Identified in  Obesity population based  Diabetes studies with humans  Cardio vascular naturally occurring disease experiments  Autism spectrum disorders  Schizophrenia  Psychotic disorders  Drug Dependency  Suicidality
    22. 22. Therefore we need topay attention to thebirth environment…
    23. 23. Giving birthis a feat ofalmostcataclysmicstressMediated byEndogenousOxytocin
    24. 24.  Uterine inertia (failure to progress) Fetal distressWhy is this so???
    25. 25. FeelingUnsafeStress Catecholamines Catecholamines Oxytocin Constricts blood vessels decreases Uterine blood flow Placental perfusion Fetal oxygentation Uterine contractions Uterine inertia Fetal Distress
    26. 26.  Sosa, Klaus and Kennel 1986 Social Security Hospital-Guatemala Continuous presence of supportive companion = shorter labour & less intervention ? Oxytocin secretion not disrupted by fear induced adrenaline
    27. 27. Niles1968Newton1968  Research conducted on the mouse!
    28. 28.  Created hostile birth environment Significantly fewer mice give birth in hostile environments Disturbed mice have longer labours Delivery initially slows - then becomes precipitous to empty the birth canal Pups of continuously disturbed mice more likely to be found dead-suggests fetal damage occurred in utero
    29. 29. •“...are mammals with more highly developed nervous systems than the mouse equally sensitive to perinatal environmental disturbance?•...what effect if any do variationsbetween home and hospitalenvironments have on the course oflabour and on perinatal mortality?”
    30. 30. Studies in primates
    31. 31.  Injectedadrenaline directly through the mother’s abdomen into the fetus - had no effect other than increased heart rate However when injected into the mother - Induced fetal asphyxia and acidosis Postulatedthis was due to vasoconstrictor effect of adrenaline leading to impaired uterine blood flow
    32. 32. More recent studies inpregnant women
    33. 33.  Anxiety is associated with increases in uterine artery resistance index Blood flow to baby is reduced May effect fetal development May initiate premature birth Associated with baby who is small for gestational age Possibly alters neuro anatomy & impacts later behaviour
    34. 34.  Providing women with continuous labour support so that fear does not take hold… Providing women with fear reducing birth environments that… Preventdisruption to oxytocin secretion = normal labour will happen
    35. 35. New scientific discoverieshave now made it possible to understand more…
    36. 36.  Most research conducted with male subjects Studies with females yields inconsistent data ? Cyclical variation in neuro-endocrine response the only reason. Studies of oxytocin reveal another explanation
    37. 37. •Fight OR Flight•Freeze System•Calm and Connect
    38. 38.  Fight, flight  Calm &Connect Increased heart rate  Lowered heart rate Elevated BP  Lowered BP  Increased Increased blood to muscles circulation to skin Extra fuel from (rosy cheeks) release of glucose  More effective from liver digestion, nutritional uptake Higher level of and storage stress hormones  Lower levels of stress hormones
    39. 39. Taylor,Klein et al,2000 Not predominantly - fight or flight or freeze More likely to be the oxytocin mediated - calm and connection/tend and befriend response (a desire to affiliate with others -more adaptive)
    40. 40.  Isthe key to the calm and connect system Involved in much more than contractions of the uterus and in breastfeeding Oxytocin is the major orchestrator of theneuro-endocrine system We are just beginning to discover how important it is and why protecting & promoting normal birth is essential for our survival
    41. 41.  Is a neuro-hormone Secreted by the BRAIN as well as in different sites in the body Influences BEHAVIOUR generally - as well as having localised impact on different body systems
    42. 42.  The love hormone Much research has confirmed this – starting with...
    43. 43. The Prairie Vole
    44. 44.  Need to access oxytocin in the brain Can be blocked by antagonists injected into the prairie vole brain Stops taking care of its pups – stops breastfeeding- rejects its mate Remove the antagonists – starts nesting again
    45. 45.  Oxytocin – secreted during sexual activity Female and male orgasm Labour Birth-fetal ejection reflex Placental ejection reflex Breastfeeding Touch- massage and stroking Eating
    46. 46. The Ewe and the Lamb….
    47. 47.  Sheep bond like glue within one hour of birth if separated at this time – will not ever bond Introduce oxytocin directly into the brain – the ewe will bond instantly with any lamb it is shown- or use vaginal stretching –’dildo’ – stimulates oxytocin release = bonding! Epiduralised ewe will not bond with lamb
    48. 48.  Suckling releases oxytocin in the lamb’s brain and cholecystokinin in the lamb’s gut Block either oxytocin or cholecystokinin and you interfere with the lamb’s ability to bond to its mother
    49. 49.  Research with pregnant and lactating women/babies  and their midwives Karolinska Institute
    50. 50.  Breastfeeding women more social and less anxious than non breastfeeding Personality changes persist up to 6 months after birth Onset is more rapid in multiparous Higher the level of oxytocin the more calm and social the mother BP lowered short/long term depends on length of time spent breastfeeding
    51. 51.  Enhances nutrient absorption Reduces stress-anxiolytic Increases pain threshold Conserves energy –Induces sleep Reduces blood pressure and heart rate – short and long term Balances body temperature Enhances social memory Improves learning ability Facilitates affiliative behaviour – love and altruism - attachment
    52. 52.  In social situations by tone of voice By a pleasant approach/ authentic smiles with crinkled skin around the eyes Caring/Comfort Touch, hugging, cuddling, grooming By having a meal with friends-around a table By Imagining pleasant things By viewing nature and scenes/objects of beauty Involves every sense modality, smell, taste, sight, hearing, feeling, dreaming
    53. 53.  Mothers secrete oxytocin when they stroke their babies Rhythmically – 40 beats per minute Animals lick at the rate of 40 bpm Warm pulsing water has the same effect Underlying physiology of kangaroo care Skin to skin contact increases rate of growth of neonate Oral simulation-internal touch (non nutritive sucking) – activates oxytocin - calming
    54. 54. Epidural – mother less  Animal studies calm & less close to baby at least one day have found after birth Large amount oxytocin artificial oxytocin to induce labour alters neuro- stimulates vasopressin has anti-diuretic effect anatomy and = fluid retention subsequent risk of pph increases behaviour breastfeeding impaired In the long term suppresses endogenous oxytocin
    55. 55.  Women with high anxiety levels Have low oxytocin levels Children with recurrent abdominal pain have extremely low oxytocin levels Recurrent abdominal pain is a classic symptom of anxiety in children
    56. 56.  Genetic blueprint is plastic Environmental variations switch on and/or off parts of the genome resulting in a variety of outcomes Oxytocin, endogenous opioid mechanisms & estrogen are not the only neuro-hormones that play a role in behaviour – future research will reveal more
    57. 57.  Disturbingnormal neuro-hormonal responses during labour –disruption to endogenous oxytocin MAY have epigenetic consequences
    58. 58.  Women feel connected to their careproviders, calm, confident in themselves, have trust in- and- are trusted by, their caregivers Spaces where women feel SAFE
    59. 59.  Prevent disruption to normal oxytocin secretion Decrease maternal anxiety Increase likelihood of normal birth Increase likelihood of long term health of baby
    60. 60.  Attention paid to every aspect of the environment and how it impacts the emotional mindbody through our senses Smell Touch (feeling and moving) Hearing Seeing Tasting Dreaming
    61. 61. Relationship + Optimal Birth based maternity Environment care Calm & ConnectOPTIMISING SystemBIRTHPHYSIOLOGY Optimal Oxytocin Lowers BP, Heart rate, decreases pain Normal Birth