immune system

Safe Motherhood

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The chal­lenges to safe moth­er­hood vary depend­ing where in the world you live. In some areas the chal­lenge may be to get ade­quate nutri­tion or clean water; in oth­er areas, it may be to pre­vent infec­tion; and in still oth­er loca­tions it may be try­ing to avoid preg­nan­cy before your body is ready or get­ting access to pre­na­tal care. In the U.S., it may mean avoid­ing being seden­tary and mak­ing poor food choic­es, or hav­ing to deal with the high tech­nol­o­gy envi­ron­ment of med­ical birth that can sab­o­tage the innate phys­i­o­log­i­cal process of labor and birth.

Birth begins the bond­ing or unique love between moth­er and child.

The biol­o­gy of birth is a com­plex series of cause-effect process­es…baby’s brain releas­es chem­i­cal sig­nals to the moth­er and the pla­cen­ta begins to man­i­fest the mater­nal immune system’s rejec­tion of the fetus.

To help the ball get rolling, relax­ation (the trophotrop­ic response) helps pro­mote the release of oxy­tocin. With the help of grav­i­ty, the head press­es on the cervix, ampli­fy­ing the uter­ine con­trac­tions. After an ultra-dis­tance aer­o­bic endurance test, the cervix opens enough to let the baby move into the vagi­na and the mother’s dis­com­fort moves from sharp cramp­ing into the bony struc­ture as she tran­si­tions to the strength test of push­ing. She tran­si­tions. Relax­ation mod­u­lates into an ergotrop­ic — adren­al — response to gath­er her pow­er.

Push­ing is an inter­est­ing term…more mas­cu­line, I think, than the one I pre­fer:  Releas­ing. Releas­ing or let­ting go of the baby. It’s a cathar­sis. In this por­tion of the labor anoth­er set of impor­tant process­es help the baby clear its lungs of amni­ot­ic flu­id, stim­u­late its adren­al sys­tem and chal­lenge its immune sys­tem, as the con­trac­tions dri­ve the baby down­ward. The mother’s deep trans­verse abdom­i­nal mus­cles — if strong enough — squeeze the uterus like a tube of tooth paste, to aid this expul­sion. In the mean­time, the labor is help­ing set up the moth­er to fall in love and pro­duce milk. When the baby emerges and moves onto the mother’s chest, s/he smells and tastes the moth­er, rec­og­niz­ing her mother’s fla­vor and set­ting up the poten­tial for bond­ing.

Any way you slice it, there are two parts to safe moth­er­hood. One is a safe preg­nan­cy…healthy nutri­tion, phys­i­cal fit­ness, safe water, infec­tion pre­ven­tion, sup­port and a safe envi­ron­ment. The oth­er is a safe labor. In a safe labor, there is both an envi­ron­ment that pro­motes the nat­ur­al process of labor and the means nec­es­sary for med­ical assis­tance when need­ed. Women die at an alarm­ing rate from preg­nan­cy or birth-relat­ed prob­lems. Despite some progress made in recent years, women con­tin­ue to die every minute as a result of being preg­nant or giv­ing birth.

What keeps us from hav­ing a bet­ter record on moth­er­hood is often lack of care in the devel­op­ing world and too much inter­ven­tion in the U.S.. They are two sides of a coin. Moth­ers’ expe­ri­ence and health needs are not on equal foot­ing with oth­er cul­tur­al val­ues. In places where basic pre­na­tal care or fam­i­ly plan­ning are low pri­or­i­ties, at-risk women are vul­ner­a­ble to the phys­i­cal stress­es of preg­nan­cy and birth. In the U.S., machine-mea­sured data is para­mount, even if it pro­duces high rates of false pos­i­tives, unnec­es­sary inter­ven­tions or coun­ter­pro­duc­tive pro­ce­dures. We are learn­ing that obe­si­ty and seden­tary lifestyles have detri­men­tal effects, but few­er preg­nant women than their non-preg­nant coun­ter­parts exer­cise.

Despite the mon­ey spent to sup­port the tech­no­log­i­cal mod­el of preg­nan­cy and birth in the U.S., there are parts of the world with low­er rates of mater­nal deaths — espe­cial­ly Scan­di­navia, North­ern Europe and parts of the Mediter­ranean and Mid­dle East (Greece, the Unit­ed Arab Emi­rates, Israel, Italy and Croa­t­ia). In fact, in the U.S., mater­nal deaths are on the rise.

It’s a tricky busi­ness. Clear­ly West­ern med­i­cine has a lot to offer the devel­op­ing world when there are med­ical con­cerns. On the oth­er hand, import­ing the U.S. mod­el could cre­ate more prob­lems than it solves. Instead, the micro-solu­tions now being devel­oped in many loca­tions will be observed and evi­dence col­lect­ed by orga­ni­za­tions such as the White Rib­bon Alliance and UNICEF.

There is an effec­tive inter­na­tion­al mid­wives mod­el adopt­ed by JHPIEGO, the Johns Hop­kins NGO work­ing toward improved birthing out­comes. It assess­es the local pow­er struc­ture, social con­nec­tions, poten­tial for trained birth assis­tants, and loca­tion of avail­able trans­porta­tion to cre­ate a net­work so that locals will know when a labor is in trou­ble and who can get the woman to the near­est hos­pi­tal.

In the U.S., there are in-hos­pi­tal birth cen­ters that allow low-risk moth­ers the oppor­tu­ni­ty to labor and birth in a set­ting designed to encour­age the innate process­es. Women are begin­ning to vote with their feet…staying home for birth. Women are going abroad to give birth. At the same time, women are com­ing to this coun­try to give birth, believ­ing it is safer than where they are. There are sev­er­al ways these scenes could play out.

But, I’ll wager, improv­ing out­comes will involve com­pro­mise:  Watch­ful­ness and sup­port in most births, plus bet­ter ways to assess dan­ger and pro­vide tech­nol­o­gy. No mat­ter where you live in the world, the solu­tion may be essen­tial­ly the same.

Fitness Starts Early!

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Preg­nan­cy fit­ness is not only impor­tant for moms, but for the fetus as well. Evi­dence is clear that aer­o­bic fit­ness improves brain, heart, immune and meta­bol­ic function…at all ages, includ­ing in utero. If con­tin­ued ear­ly in life, healthy phys­i­cal adap­ta­tions that occur in the uterus become rein­forced behav­ior, prepar­ing a good foun­da­tion for a healthy lifestyle. Babies are acute observers of move­ment and activ­i­ty, and learn from each oth­er. A key com­po­nent of a good mom-baby pro­gram is the inter­ac­tion of the babies them­selves. A good teacher will facil­i­tate healthy activ­i­ty among our small­est class mem­bers!

There is grow­ing evi­dence that at all ages, aer­o­bic fit­ness pro­duces the great­est num­ber of ben­e­fits. Recent­ly, researchers deter­mined that aer­o­bic fit­ness in 9 and 10 year olds pro­duced ben­e­fits in the devel­op­ment of two impor­tant brain regions — the basal gan­glia and the hip­pocam­pus — that are sig­nif­i­cant fac­tors in prob­lem-solv­ing intel­li­gence. This is just one of the lat­est reports that tells us the capac­i­ty to absorb and use oxy­gen (which improves with aer­o­bic fit­ness) is a key to health, qual­i­ty and length of life…beginning in the womb!

Pregnancy Pathway — Exercise

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How lucky is this? Just a few days ago, yet anoth­er study was released and has been cir­cu­lat­ing on Med­scape and oth­er med­ical sites that indi­cates exer­cise is ben­e­fi­cial in preg­nan­cy, whether the moth­er is a pre­vi­ous exer­cis­er or not. Just in time for this entry!

Behavior Affects Pregnancy Outcome

Behav­ior Affects Preg­nan­cy Out­come

Phys­i­cal exer­tion (we call it “exer­cise” nowa­days) is a nor­mal state for healthy humans. Only in the last cen­tu­ry has the desire to rest or the need to store extra calo­ries as fat become more pos­si­ble to achieve than our need to move about to sur­vive.

Preg­nan­cy is a state in which both of these fac­tors (rest­ing and stor­ing calo­ries) are enhanced through organ­ic changes in body chem­istry, adap­ta­tions that favor fetal sur­vival. The cur­rent seden­tary lifestyle exag­ger­ates these meta­bol­ic changes and results in syn­dromes that increase the risk for a num­ber of meta­bol­ic, car­dio­vas­cu­lar and immuno­log­i­cal dis­or­ders of preg­nan­cy.

When con­front­ed by the idea that it is coun­ter­in­tu­itive to think exer­cise in preg­nan­cy might be safe (let alone ben­e­fi­cial) I am dumb­found­ed. To me, it is coun­ter­in­tu­itive to think that a seden­tary lifestyle in preg­nan­cy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

Burn­ing Calo­ries in Preg­nan­cy Improves Out­comes!

What is the evi­dence that exer­cise in preg­nan­cy is ben­e­fi­cial? Keep in mind that some stud­ies have been exe­cut­ed more expert­ly than oth­ers. But, what is com­pelling is that numer­ous well-respect­ed researchers have sought to test the hypoth­e­sis that exer­cise is not safe, but come away with results that indi­cate the oppo­site!

Here are some of the major find­ings:

• The pla­cen­ta is larg­er and has more trans­port sur­face in exer­cis­ers than seden­tary women

• The fetus­es of (aer­o­bic) exer­cis­ing moth­ers make ben­e­fi­cial car­dio­vas­cu­lar adap­ta­tions

• Women who do aer­o­bic exer­cise are less like­ly to devel­op severe preeclamp­sia or ges­ta­tion­al dia­betes, and the long term health prob­lems that accom­pa­ny these dis­or­ders

• Women who are aer­o­bi­cal­ly fit recov­er from birth 10 times faster than seden­tary women (as mea­sured by time need­ed to metab­o­lize free rad­i­cals pro­duced in labor)

• Women who exer­cise in preg­nan­cy are more like­ly to be phys­i­cal­ly fit in midlife

• Babies of aer­o­bi­cal­ly fit women are at reduced risk for pre­ma­tu­ri­ty and low birth weight
DTP_mover2
So, we have arrived at the take-home mes­sage: MOVE!! Preg­nan­cy works best when you move and burn calo­ries in a mod­er­ate to vig­or­ous fash­ion. But, alter­nate this activ­i­ty with rest and good nutri­tion, and be sure to stay well hydrat­ed.
If you want more specifics and resources on this top­ic, try these:
“Women and Exer­cise” in Varney’s Mid­wifery.

Pregnancy Pathway, Pregnancy — Maternal Immunological Response

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Today: Mater­nal Immuno­log­i­cal Response…or…the Mother/Fetus Dance!

Maternal Immune Response During Pregnancy

Mater­nal Immune Response Dur­ing Preg­nan­cy

Back to work! Thank you for your fore­bear­ance while we wrote a chap­ter for a nurs­ing text­book!

Dur­ing the course of preg­nan­cy, the mother/fetus dance is ongo­ing. The mater­nal immune sys­tem and the tro­phoblast cells con­tin­ue to influ­ence each oth­er even beyond the implan­ta­tion.

Because the mother’s immune response mod­u­lates near the start of each trimester, the fetus is affect­ed to some degree and mounts a response, as well. For a long time it was thought that mater­nal and fetal DNA mate­r­i­al was not exchanged across the pla­cen­tal mem­brane, how­ev­er recent find­ings indi­cate that there is some exchange of mate­r­i­al. Thus, we all car­ry some por­tion of our mother’s DNA and our moth­er car­ries some of ours.

What is the impact of this chimeric effect? It depends on how well our DNA gets along!

How does this affect the fetus in utero? The fetus may be affect­ed by clot­ting issues. Depend­ing on mater­nal health sta­tus s/he may be sub­ject to a stronger or weak­er immune sys­tem.

How does this affect the moth­er? Women are more like­ly than men to devel­op autoim­mune dis­or­ders (preg­nan­cy play­ing a role here), and those who bear male off­spring are more like­ly than those who only have girls to have these dis­or­ders.

The maternal/fetal dance goes on.…

Be Prepared for Birth!

Be Pre­pared for Birth!

Pregnancy Pathway, Pregnancy

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Time for an entre: Preg­nan­cy!!

Up for dis­cus­sion…

Health Influences in Pregnancy

Health Influ­ences in Preg­nan­cy

Let’s start at the begin­ning…in the first trimester you feel sick and tired, right? Three things:

1) your immune sys­tem is pro-inflam­ma­to­ry (caus­ing nau­sea and fatigue), 2) your body is pro­tect­ing your fetus from some tox­ins (if you eat some­thing not so great for the fetus, you throw up), and 3) you have extreme swings in blood sug­ar lev­els so that after you eat, the lev­el soars and you feel sick.

Num­ber 3 can be fixed with behav­ior, but you may have to wait out 1 & 2. To fix num­ber 3 eat very small meals fre­quent­ly (6 or 8 times a day) and be sure to eat pro­tein, that is, eggs, meat, fish, fowl, cheese, nuts, rice & beans, soy, etc. with each small meal. This sta­bi­lizes blood sug­ar and pre­vents dra­mat­ic ele­va­tions that can cause nau­sea.

In most healthy preg­nan­cies, the immune sys­tem will rebound in the sec­ond trimester so that you feel good; it is pro­tect­ing you again!  But, those wicked tox­ins and infec­tions are still out there in the envi­ron­ment, so the mes­sage is beware bad air (smog, smok­ing, indus­tri­al air pol­lu­tion), high­ly processed foods (lunch­meats, things with names you can’t pro­nounce), any drugs or meds not pre­scribed or okayed by your ob or mid­wife, alco­hol, and dan­ger­ous bac­te­ria, virus­es and oth­er microbes!

Exer­cise wisely…no sky-div­ing or scu­ba div­ing! Eat healthy food and get enough sleep. De-stress through relax­ation and med­i­ta­tive tech­niques. Don’t take risks with your health, but do stay active and start to pre­pare for birth and bring­ing home a baby (or two?).

Third trimester & the immune sys­tem goes on the fritz again — can’t keep this baby in here for­ev­er; must expel! You may feel sick and tired again. BUT, keep your pre­na­tal care appoint­ments, keep mov­ing, get good nutri­tion, rest and stay focused. Before you know it the real work begins, not to men­tion the 18 years of sleep depri­va­tion.

Get­ting from here…

Being Fully Present in Your Pregnancy...

Being Ful­ly Present in Your Preg­nan­cy…

…to here..

Being Fully Present as Mom

Being Ful­ly Present as Mom.

…is a jour­ney like no oth­er. The adap­ta­tions of your body to the demands of preg­nan­cy are amaz­ing. If you pay atten­tion, you will learn more about the mean­ing of exis­tence from this than from any­thing else.

BE HERE NOW!!

Sign up for this Blog (top tool­bar, click blog info and sub­scribe)!! Learn from our more than 30 years of help­ing make healthy moms & healthy babies.

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Pregnancy Pathway…Important Notes from Wonderrobyn

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The fol­low­ing are notes from co-author Robyn Bran­ca­to, CNM (cer­ti­fied nurse mid­wife) who prac­tices in New York City, or, as she is know here: Won­der­robyn! You can read about both authors in the About tab above. Here they are on the beach in San Diego, when they gave a talk at con­fer­ence there a cou­ple years ago. Robyn on the left, Ann on the right.

Robyn and Ann, Pathway authors

Robyn and Ann, Path­way authors

1. Addi­tion to Small Rant: “Resist the temp­ta­tion to watch A Baby Sto­ry on TLC! It does not por­tray birth accu­rate­ly, as they con­dense 15 hours of labor into 30 min­utes and play up the dra­ma so that you will be on the edge of your seat! In the major­i­ty of women, birth is not that dan­ger­ous.”

2. Regard­ing: When does con­cep­tion occur? “This is a real­ly inter­est­ing post… I love the dis­cus­sion about at what point con­cep­tion occurs! Per­son­al­ly, I like the Bib­li­cal notion of quick­en­ing. Even though this varies from woman to woman and can range any­where from 16 to 22 weeks ges­ta­tion, it seems like the most nat­ur­al the­o­ry.”

Dear Read­er:  What do YOU think? Did you read the con­cep­tion post on March 23, ’09?

3. About sperm & preeclamp­sia. “Is the con­nec­tion between bar­ri­er meth­ods and preeclamp­sia actu­al­ly estab­lished? I have read stud­ies stat­ing the con­trary — that bar­ri­er meth­ods have no effect on preeclamp­sia rates.”

HURRAY! THIS REQUIRES FURTHER CONSIDERATION.

More infor­ma­tion: The immune mal­adap­ta­tion the­o­ry sug­gests that tol­er­ance to pater­nal anti­gens, result­ing from pro­longed expo­sure to sperm, pro­tects against the devel­op­ment of preeclamp­sia. Thus, bar­ri­er meth­ods and being young may pre­dis­pose women to this major dis­or­der of preg­nan­cy.

Evi­dence exists on both sides of this the­o­ry. Here are two recent stud­ies (one of each) that read­ers may find help­ful in under­stand­ing this idea. Keep in mind that oth­er fac­tors than just sperm expo­sure may be affect­ing research find­ings. But, it does seem that under some con­di­tions, bar­ri­er meth­ods and amount of expo­sure to sperm can affect the preg­nan­cy itself.

Ness RB,  Markovic N, Harg­er G, Day R. Bar­ri­er meth­ods, length of pre­con­cep­tion inter­course and preeclamp­sia, Jour­nal: Hyper­ten­sion in Preg­nan­cy 23(3):227–235. 2005.  Results did not sup­port the immune mal­adap­tion the­o­ry.

Youse­fi Z, Jafarnezhad F, Nas­rol­lai S, Esmaeeli H. Assess­ment of cor­re­la­tion between unpro­tect­ed coitus and preeclamp­sia, Jour­nal of Research in Med­ical Sci­ences 11(6):370–374. 2006. In a matched con­trols study, women with <4 months cohab­i­ta­tion or who used bar­ri­er meth­ods had high­er risks of devel­op­ing preeclamp­sia than those with >4 months cohab­i­ta­tion. Oral con­tra­cep­tion users had a low­er preeclamp­sia rate than those who used no oral con­tra­cep­tion.

In a com­men­tary arti­cle in OB/GYN News ‚  July 1, 2002, the fol­low­ing note was made by Dr. Jon Einars­son: With insuf­fi­cient expo­sure, preg­nan­cy may induce an immune response and preeclamp­sia in some women with pre­dis­pos­ing fac­tors such as an endothe­li­um that already is sen­si­tive to injury due to age, insulin resis­tance, or pre­ex­ist­ing hyper­ten­sion.

Is there a plain and sim­ple truth about sperm expo­sure and preg­nan­cy risks? Alas, no. But, know your cir­cum­stances. If you are young, pro­tect your­self. Wear a con­dom. When you are ready to be a mom, you will be ready to fig­ure out your risks. So, this, too fol­lows the axiom:

Events in life are rarely plain and nev­er sim­ple.

Pregnancy Pathway, Preconditions — Genetics

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Please refer to Feb­ru­ary 5 entry for com­plete graph­ic. The Pre­con­di­tion we will dis­cuss today is Genet­ics.

bubblus_preconditions_-_genetics

There are genet­ic fac­tors total­ly out­side your con­trol that deter­mine things as sim­ple as your offspring’s hair or eye col­or, how the ear­lobe attach­es to the side of the head and whether or not s/he can roll the tongue. More com­plex things, such as a pre­dis­po­si­tion to types of can­cers, bleed­ing dis­or­ders or var­i­ous oth­er dis­eases, also have a genet­ic basis.

Because the male con­tributes the sex of the off­spring, once con­cep­tion hap­pens, the sex off the fetus is deter­mined — at least genet­i­cal­ly. But, it turns out not every­thing genet­ic is set in stone. In utero, hor­mone expo­sures may affect how male and female char­ac­ter­is­tics devel­op, so that some girls will be very girlie, some will be tomboys, and some may be gay. A sim­i­lar effect will influ­ence how boys devel­op.

Genet­ic, envi­ron­men­tal and behav­ioral pre­con­di­tions can be  inter­twined. Envi­ron­men­tal fac­tors can alter genes, caus­ing them to express pro­teins that would oth­er­wise be dor­mant. Like­wise, our behav­ior affects some of our genes. If we have a fam­i­ly propen­si­ty for heart dis­ease, but we eat a healthy diet, exer­cise and avoid risky behav­iors, we alter the impact of our genet­ic code.

Keep in mind that some things will be com­plete­ly deter­mined by genes. It is not rea­son­able to hope, for exam­ple, that our off­spring will be 6′5″ if both par­ents are short (or vice ver­sa). If the moth­er has “thrifty genes” — that is, genes that make it easy for her to gain weight — she may well do so dur­ing preg­nan­cy, even if she fol­lows a rea­son­ably healthy lifestyle. If the immune sys­tems of both par­ents have some sim­i­lar­i­ties, it may affect the mater­nal immune response to the implant­i­ng tro­phoblast cells, thus affect­ing the pla­cen­ta and, indeed, the entire preg­nan­cy.

So, how do we advise peo­ple who are think­ing of preg­nan­cy to pre­pare them­selves for a healthy preg­nan­cy genet­i­cal­ly? Sure­ly, to deter­mine all the poten­tial genet­ic pos­si­bil­i­ties is not fea­si­ble or afford­able at this point. Maybe in anoth­er cen­tu­ry! But, we can know some fac­tors:  Is there sick­le cell ane­mia in both fam­i­lies? Is there a Mediter­ranean type of sick­le cell dis­or­der? What about clot­ting fac­tors or dif­fer­ences in Rh? What about dis­eases or dis­or­ders that are not com­mon, like ALS? These are things that poten­tial par­ents may want to dis­cuss.

Like so much of life, we can’t know every­thing. There are no guar­an­tees. There is a lot to be learned still about human genes and how they work.

This blog has at its heart the notion that phys­i­cal activ­i­ty has tremen­dous ben­e­fits for moth­er and offspring…and for part­ners, too. How does the genet­ic com­po­nent affect this? First, pre­con­cep­tion fit­ness low­ers some risk fac­tors for moth­ers and babies. Sec­ond, each mother’s genes will make it eas­i­er or more dif­fi­cult for her to enjoy or ben­e­fit from the activ­i­ty of exer­cise. We appre­ci­ate this and encour­age young moms-to-be to find some­thing enjoy­able that you like doing and find peo­ple or sit­u­a­tions that sup­port you in being active now before you become preg­nant.

If you need assis­tance or advice, please go to www.dancingthrupregnancy.com (use the BlogRoll)

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