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Maralyn Foureur 2011 Home Birth Conference

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Maralyn Foureur 2011 Home Birth Conference

  1. 1. Home Birth Aotearoa National Conference October 28-30 2011
  2. 2. Creating Optimal Birth Space MARALYN FOUREUR PROFESSOR OF MIDWIFERYUNIVERSITY OF TECHNOLOGY SYDNEY
  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

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