Back when I was trying my damndest to evict little E (can’t believe that was over five months ago!) I decided to dig into the literature on natural induction.
Check out my post over on Medium – https://medium.com/40-weeks/9-ways-to-give-your-overdue-baby-the-boot-supposedly-9119ff1cab96#.4i01pfrdt
Spoiler alert – you may have to get extreme with this one.
What science says about natural induction techniques. Today marks 40 weeks + 5 days pregnant. Not cool, baby, not cool. While I have no trust in due dates, it is still incredibly frustrating to watch yours come and go. Needless to say, natural induction techniques are high on my to-do list these days.
Of all the “no no’s” thrown at your growing pregnant body, the one that I found ridiculously frustrating was the “No sleeping on your back” rule.
Sleep is a precious precious commodity when carting around a huge pregnant belly. Why would you dictate how I sleep with this thing?!
The reasoning for the sleep position policing stems from the idea that back sleeping can choke off your baby’s oxygen supply.
Here is the “logic”:
Your uterus is heavy. So heavy, in fact, that it puts weight on the vena cava, the vein that runs blood back to your heart. A compressed vena cava means decreased blood back to the heart and therefore, decreased blood coming out from the heart. Less oxygenated blood for you, less oxygenated blood for the baby. Not good.
I really wanted to call bullshit on this one during my last pregnancy (yet dutifully buoyed myself on my side with pillows each night). I mean, if oxygenated blood is getting cut off, it would affect how that blood gets to the brain and you would feel dizzy. Right? So, isn’t that a simple test to see if your heavy uterus cuts off your blood supply? Lay down, feel woozy, heavy uterus!
Drs Farine and Seaward at the University of Toronto seem to agree with me.
“Women should be told that a small minority of pregnant women feel faint when lying flat” – Dan Farine, MD, FRCSC, P. Gareth Seaward, MD, FRCSC
Of course, my experimental nature was cut short when a friend sent me this article.
Medical student, Allan Kember is fighting stillbirth with a belt that prevents pregnant moms from sleeping on their backs.
Stillbirth!? Back sleeping!? Holy shit. Maybe this deserves a second look.
I called up Allan.
Allan’s research stemmed from studies like this one and this one. Most inspiring though was a study coming out of Ghana in which the authors showed that a quarter of stillbirths might be prevented by changing mom’s sleep position. Allan wanted to answer the call for a simple, inexpensive solution to solve stillbirth in the developing world. His thought process: encourage expecting moms to not sleep on their back, save a few babies.
Of course, I had to bug him about the whole vena cava scenario. He admitted that this might not be the full picture.
Another culprit? Gestational sleep apnea (sleep disordered breathing).
Here’s the problem though: we really do not understand gestational sleep apnea well enough to point a finger quite yet and we have no idea how sleep apnea might affect a growing baby. Oxygen flow disturbances? Stress responses? Mom snoring too loudly?
Ok, probably not the last one.
At the end of the day, it seems that stillbirth may follow a similar rule as what has recently been shown in SIDS research. It isn’t any one thing that causes it. It’s the perfect storm of complications that can result in stillbirth.
The triple risk:
(1) maternal risk factors, (2) fetal risk factors (low growth rate, placental insufficiency), and (3) a stressor (such as back sleeping).
Don’t tick off all three boxes, you’re in the clear. At risk already? Do whatever you need to do to prevent that third tick and you’re in the clear.
SIDS research has figured out a way to prevent that third tick in as many babies as possible, regardless of preexisting vulnerabilities – the giant, border crossing “Back to Sleep” campaign where parents are reminded to never put a baby to sleep on her tummy. The result? A decrease in SIDS with an increase in flat heads. But flat heads are fine if it means babies keep breathing into adulthood.
Of the 4 possible sleep positions, pregnant women end up on their backs over 25% of the time, with over 80% of women hitting this position some time during the night. It’s normal. It’s common. It’s an epidemic?
Researchers in the UK are now trying to determine if a national campaign, similar to the SIDS “Back to Sleep”, should be launched to tell moms not to sleep on their backs.
This is where I draw the line.
Going to sleep with a homework assignment (“do not sleep on your back!), is enough to keep us pregnant moms up worrying about what all the damage we can do to our unborn child while we toss and turn. One study showed exactly this – asking women to make sure they slept on their left sides results in decreased overall sleep time.
When quality sleep is so freaking important during pregnancy and so freaking difficult to achieve, why mess with it more?
Here’s another gem of a quote from Drs. Farine and Seaward:
“If lying prone had been detrimental to a normal pregnancy, the species would long ago have ceased to exist” – Dan Farine, MD, FRCSC, P. Gareth Seaward, MD, FRCSC
Back to the stillbirth thing. Maybe the first thing to tackle is figuring out how to define which women and babies are at risk and come up with solutions for this small subset. Maybe it’s a CPAP to treat sleep apnea, maybe it’s a belt with balls to encourage side sleeping, maybe it’s a mound of body pillows.
For now, it’s time for me and my big, heavy, vein crushing uterus to hit the hay.
My husband and I had little — meaning no — baby experience before bringing our daughter home. We would jokingly ask questions like “how much do we have to feed this thing?” and then nervously laugh, look at each other with concern, and consult the “owner’s manual” (our affectionate name for the American Academy of Pediatrics tome).
And then, she was born. An insane flurry of eat, poop, soothe, repeat.
After those first few weeks, when the dust settled, I had a profound revelation — I might actually know what I’m doing! Could I now have maternal instincts that were not there before?
By its very definition, “instinct” is a response that is inherent, basic, not requiring thought or careful consideration. Unlearned. Unconscious. Instinct. [Note: maternal instinct makes sense given that we have yet to see a National Geographic film of a baboon parenting class gathering every third Tuesday on the savannah.]
Turns out, there is quite a bit of evidence demonstrating that our brain does, in fact, change when we transition from clueless pregnant woman to caregiver.
As pointed out in a 2012 review in Physiology and Behavior, this transition marks an important point at which our brains have to shift from a world revolving around self-care to one oriented around the care of a tiny helpless being. With a little bit of parenting experience, the mammalian brain shows changes in cognition (e.g. spatial memory, attention), emotional responsiveness (e.g. boldness in new settings, focus), and social awareness (e.g. attention to those helpless little beings). Put a pregnant rat in a cage with pups strewn about, and she doesn’t give a shit. Put a mama rat in a cage with pups strewn about, and she goes right to work, gathering up those babies, protecting and nurturing them.
Now, it probably helps that the mama brain is also altered to respond to baby with a spurt of sweet sweet dopamine right in the reward centers of the brain, similar to a hit of cocaine.
Yup, our babies are addictive.
As demonstrated in a 2005 paper in The Journal of Neuroscience, a mama rat with a suckling rat pup feels the same dopamine reward signal as a virgin rat does when given cocaine. Interestingly, though, in the mama rats, a dose of cocaine does not have this same effect and actually suppresses activity in the reward center. Nature’s way of focusing mom’s attention — You want to get high? Feed your baby.
But wait, a similar high does not require baby at the teat. In a 2008 study in Pediatrics, researchers using human subjects showed moms pictures of their own baby, or someone else’s, along a spectrum from smiley to distressed (see figure on left). Those same dopamine pathways were activated in these human mothers, BUT only when they were shown pictures of their own babies, and only when the babies were smiling.
But, c’mon, did you need a scientist to tell you that your baby’s smiles are like crack?
At the end of the day, though, the joke is on us. Evolution has crafted tiny manipulation machines. All those cute baby features — chubby cheeks, big eyes, tiny noses, large foreheads — drive our most basic urge to cuddle and protect. Our brains instinctively respond to “baby schema,” a term coined by Konrad Lorenz, a Nobel Prize-winning zoologist famous for studying imprinting and having adorable photos of baby geese following him around and preening his beard. Even the guy’s guy can’t ignore a cute baby face. Go watch Three Men and a Baby for the not-so-scientific evidence.
If you do want scientific evidence, a 2009 study in the Proceedings of the National Academy of Sciences documented which areas of the brain are activated when non-mothers were shown pictures of babies with enhanced or downplayed “baby schema”-typical features. Using manipulated pictures of babies either made “cuter” or, well, not so cute, the researchers were able to demonstrate that the cuter the baby, the more activated the area of the brain associated with anticipation of reward. The motivational drive to become caregivers to cute little critters runs deep in our animal instincts.
There you have it, humans. We all have a little bit of mommy brain!
Happy Mother’s Day!
Lambert, K. G. The parental brain: Transformations and adaptations. Physiology and Behavior 107, 792–800 (2012).
Strathearn, L., Li, J., Fonagy, P. & Montague, P. R. What’s in a Smile? Maternal Brain Responses to Infant Facial Cues. PEDIATRICS 122, 40–51 (2008).
Ferris, Craig F., et al. Pup suckling is more rewarding than cocaine: evidence from functional magnetic resonance imaging and three-dimensional computational analysis. The Journal of Neuroscience 25.1, 149-156 (2005).
Glocker, M. L. et al. Baby schema modulates the brain reward system in nulliparous women. Proceedings of the National Academy of Sciences 106, 9115–9119 (2009).
It’s been almost three months from my last post.
Not so coincidentally, the babe (formerly known as “womb baby”) is approaching her three month birthday.
While busy with the madness that is having a new (and very dependent) human in my life, tackling a new post for The Pregnant Scientist has been a bit tricky. Instead, I decided to revisit and summarize seven of my favorite findings during this pregnancy.
I still have a lot of questions to ask and hope to start tackling new posts soon. In the meantime, if you have any ideas/questions for upcoming posts, please leave a comment below!
Recently, one of my mom’s friends had a new grandchild and this friend’s daughter, who works in a neonatal care unit, requested that all family members get a Pertussis vaccine.
My mom wanted to know if this was something she needed to worry about too.
Pertussis is the fancy name for Whooping Cough. And, until a few years ago, I honestly thought that Whooping Cough was a thing of the past. Something that your computer game children caught and died from when electronically traveling on the Oregon Trail.
And then there was an outbreak of the disease in California (and other parts of the country) in 2010. Thousands of children got sick. Ten infants died. Frightening stuff and no longer bound to the confines of a pixelated computer screen.
In the US, Whooping Cough outbreaks are actually more common that I would have thought. And this disease is cyclical: outbreaks tend to occur every 3-4 years. I guess we’re due! Yikes.
So, back to the query from my mother.
Do I (and my family) have to get vaccinated for Whooping Cough/Pertussis?
An info sheet about the Tdap vaccine (Tetanus-Diptheria-Pertussis) that I received from my doctor addresses this question very vaguely. The info sheet only suggests women who “have never had a dose of Tdap” get one. Well, my mom definitely made sure I got all of my shots as a child and I know that I have had a tetanus booster in the last 10 years (I am accident prone… especially around sharp metal objects!) but I cannot tell you the last time I had a booster that covered all three.
Taking a less ambiguous approach, the CDC recommends that ALL pregnant women get a Tdap vaccine during the 3rd trimester. As the CDC notes 30-40% of the cases involving infected infants in the 2010 outbreak could be directly attributed to the mother. 70+% could be attributed to any family member. The “cocooning” strategy that my mom’s friend was subjected to addresses this level of prevention. “Cocooning” is when all persons who may be coming into contact with the pre-vaccine baby (this vaccination series starts at 6-8 weeks of life) also gets vaccinated. Apparently, vaccination as a child is not enough, your immunity to the disease starts to wear thin after about 10 years so you may still catch the disease and unknowingly pass it along to the non-vaccinated baby.
But the cocooning method seems a bit extreme to me. And I feel justified in saying that given that an article in Clinical Infectious Diseases entitled “Infant Pertussis: Is cocooning the answer?” appears to agree. The authors note that cocooning just isn’t practical and a bit too “logistically complicated” to provide the benefits that a simple maternal immunization would allow . So, I think I just might take the “don’t come around if you are sick” and “don’t cough on my baby” approach instead of making everyone around me double check their vaccination history.
You are off the hook, mom.
But what about that maternal immunization/booster?
The recommendation for all pregnant women to get the shot before or immediately after having the baby is a straightforward approach to making sure the mother will not catch and transmit Whooping Cough to the new bundle. Holding off on the vaccine to watch and wait for an outbreak isn’t the most effective strategy – it takes about two weeks for the antibodies to build up to amounts that would effectively fight the illness and limit its spread.
But there is another reason to get the shot during pregnancy. Recent research has suggested that a Tdap vaccination during the third trimester can actually confer some degree of protection to the infant for when it enters this dangerous, disease ridden world. Studies have shown evidence for increased Pertussis antibodies in the cord blood and in the circulation of infants whose mother’s were vaccinated as compared to infants of unvaccinated mothers . Effectively, this allows a brand new baby to have some antibody fighting power against Whooping Cough even before the first vaccine series initiates baby’s self-built antibody stockpile.
Important to note, though, there does appear to be a Goldilocks sweet spot for the timing of getting this shot: post-birth may be too late but before the third trimester may be too early. Getting the vaccine pre-conception or early in the pregnancy does not confer the same placenta-hopping-antibody benefits . That’s right, if you are cooking up your second, third, fourth baby, you will still need to get that arm poked if you want to potentially pass along the benefits of the vaccine.
What about negative side effects? An extensive review of reports sent in to an oversight body, VAERS (Vaccines Adverse Event Reporting System) turned up absolutely nothing of concern for maternal/infant/fetal outcomes post Tdap vaccine ..
So, I’m pretty convinced. I think that passing along a bit of immune system fightin’ power against any potential Whooping Cough outbreaks seems more practical than hanging a sign around the baby’s neck that reads “Please do not cough on my baby”.
But, seriously, please do not cough on my baby.
2. Leuridan E, Hens N, Peeters N, de Witte L, Van der Meeren O, Van Damme P. Effect of a prepregnancy pertussis booster dose on maternal antibody titers in young infants. Pediatr Infect Dis J 2011;30:608-10.
3.Healy CM, Rench MA, Baker CJ. Importance of timing of maternal combined tetanus, diphtheria, and acellular pertussis (Tdap) immunization and protection of young infants. Clin Infect Dis 2013;56:539-44.
4. Zheteyeva YA, Moro PL, Tepper NK, et al. Adverse event reports after tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccines in pregnant women. Am J Obstet Gynecol 2012;207:59, e1–7.
Well, the internet knows I’m pregnant.
Maybe it’s my lazy way of shopping for maternity clothes. Maybe it’s all those searches for silly pregnancy advice. Whatever it is, the internet knows I’m pregnant and now pregnancy related ads follow me everywhere.
The latest – Umbilical Cord Blood Banking.
I didn’t even realize this was an industry!
With tags like “Could One Day Be a Lifeline of Hope for Your Child” and “Saving More Cells-Saving More Hope”, how can one pregnant lady resist?
Yes, promising to save my unborn child from leukemia AND save me $300 if I sign up now is very enticing. Apparently, there are 80+ diseases that I could rescue this baby from by simply bagging up the umbilical cord and paying a company to safeguard until later use. Still not convinced, until I saw a point about it being used as a cure for Type 1 Diabetes. Really? This disease has the best likelihood of actually affecting my family, I paused and thought about it – should I bank my cord blood?
Although perfect in nearly every way, my husband is defective (love you, honey).
If not for the wonders of modern medicine, nature would have killed him off around 14 years of age when Type 1 Diabetes caused him to become completely dependent on insulin injections. Because this disease is genetic, there is a good chance our little bundle will be carrying this defect and either developing Type 1 Diabetes or passing it along.
A brief overview of the disease – Type 1 Diabetes occurs when certain cells in the immune system (white blood cells called T lymphocytes) decide to gang up on little groups of cells in the pancreas called islet β cells. What triggers these T cells, normally defenders of the realm, to turn into maniacal bullies targeting their own kind is still a bit of a mystery But what we do know is that these crazed T cells are very effective in their islet β cells annihilation. Type 1 Diabetes is no longer fatal if treated but it is chronic – all patients have to pick up the slack for their islet cell lacking pancreases and provide their bodies with every drop of insulin their body will need to deal with sugar appropriately throughout the day, every day for the rest of their lives.
Where does umbilical cord blood come in? Well, cord blood is rich with stem cells. And stem cells, especially the unique ones found in cord blood, have yet to be programmed, they don’t have a strict plan for their cellular destiny. This makes them naive enough to be tricked into becoming any number of cell types across the body – perhaps even…. insulin-producing cells! So, could stem cell rich cord blood actually be the answer to treating this baby’s possible Type 1 Diabetes? Could my husband be treated with this magic blood and be cured?
Back to reality – the problem with stem cell therapy for Type 1 Diabetes is that even if you get those islet cells regenerated, the T cell bullies are still hanging around, waiting to beat them down. How could stem cells from cord blood be any different?
This is where I found some really freaking cool science.
As pointed out in a paper in Autoimmunity Reviews by Zhao and Mazzone in 2010, there are three main things that cord blood stem cells will have to accomplish to cure a Type 1 diabetic: 1) bulk up the stock of insulin-producing cells, 2) protect any introduced/re-grown islet β cells and 3) get the patient’s T cells back in line so they won’t attack and destroy. And this research team may have found a way to tackle all of these points using cord blood stem cells using a very unexpected approach.
Zhao’s team followed up this tease of a review with a study published in BMC Medicine in 2012. Rather than trying to introduce or re-grow insulin-producing cells, the team used the cord blood stem cells to educate the bad T lymphocytes.
That’s right! The baby cells are basically sitting this old guys down and saying “Listen up, its time to shape up and stop bullying the islet cells!”
How? Well, this is a bit more complicated that I can even fully wrap my head around, but the gist of it is this: lymphocytes are isolated from the patient’s blood and cycled through a column of petri dishes that are coated with the cord blood stem cells. These stem cells have an added bonus property of sticking really well to the petri dish such that the lymphocytes feeding through the petri dish stacks simply bounce along the top of the stem cells, which are attached tightly to the dish. As they bounce along, the lymphocytes hang out in the presence of the stem cells long enough for the stem cells to bestow their baby wisdom upon them. What is this baby wisdom you may ask? A micro environment created by different secreted molecules and molecules on the surface of the stem cells that alters how the patient’s lymphocytes respond to immune challenge. Let’s just call this the “happy place”.
Once the patient’s lymphocytes visit the “happy place”, they are returned into the patients blood stream. These lymphocytes have been schooled, educated, seen the light and turned away from the dark side.
As tested on a small number of patients (12 receiving treatment, 3 placebo), either showing a degree of islet β cells activity (group A = 6 patients) or absolutely no activity (group B = 6 patients), this Stem Cell Educator therapy was able to return insulin regulation capabilities. Group A patients, who went in with subpar insulin responses, regained normal levels of insulin activity within 4 weeks of treatment. Group B patients, who went in with no insulin activity whatsoever, were already progressing to normal insulin activity within 12 weeks and nearly matching normal levels at the end of the study (40 weeks).
To reiterate: Group B patients went into the clinic with no insulin activity suggesting they had absolutely not a single working insulin-secreting cell in their bodies. After one treatment with the cord blood stem cells educating the patient’s lymphocytes, insulin activity was nearly regained. This suggests that either even these patients have a population of islet β cells struggling to survive or have other unidentified insulin-producing cells waiting in the wings, but the crazy T lymphocytes are constantly playing whack-a-mole to keep the numbers down. Educate the lymphocytes, let these cells bounce back, BAM, Type 1 Diabetes cured? Maybe someday.
To get back to why this relates to me and my pregnancy – I have decided that I am going to try my damndest to donate my cord blood. I am sure this is only one of many amazing scientific pursuits cord blood stem cells are currently being used for and it seems a shame to let those precious precious cells get incinerated in a sad medical waste facility.
I’m still weighing my options, but I did find a helpful list of cord blood banks (public and private).
Maybe those cells will go on to save someone’s life.
Maybe a researcher will use them to cure Type 1 Diabetes.
Maybe this is just my way of making this baby a little scientist in utero.
“What are you up to, baby?”
“You know, just culturing some miracle cells inside the womb”.