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The Report, Part 2

May 2016

"The outcomes of maternity care and maternity care interventions have traditionally focused on important short-term outcomes such as perinatal mortality, newborn morbidity (e.g., measured by Apgar score, cord blood analysis, and/or admission to advanced care), and certain maternal outcomes. There is increasing recognition, including from other frameworks, that exposures during the highly sensitive perinatal period may have implications for longer-term health and well-being" (Buckley, 2015).

Let's take a look at the a few of the other frameworks mentioned in the report by Buckley, and why they should be taken into consideration when looking at the hormonal physiology of labor and delivery.

Belly Scan  

One framework, entitled Fetal Origins of Adult Disease (FOAD), has now branched out into the peri- and post-natal periods, looking at the developmental origins of health and disease (DOHaD). It recognizes that "a stimulus or insult at a critical period of development has lasting or lifelong effects" and now considers the newborn to be equally vulnerable. Research shows fetal programming is a mechanism to optimally adapt the infant for future environments and effects. Studies in the biochemical process of epigentics, which turn genes on and off, have found "increased DNA methylation, a marker of epigenetic changes, in human newborn tissues following cesarean compared with vaginal births" (Buckley, 2015), as well as adult animal behavior and brain function when comparing vaginal and surgical births, and increased stress responses and increased risks of certain adult diseases in infants born surgically (asthma, allergies, Type 1 diabetes, overweight and obesity, and celiac disease).

Out of the multitude of epigenetic programming research has risen the EPIIC hypothesis: epigenetic impact of childbirth, which suggests that "physiological labor and birth have evolved to exert eustress (a healthy positive form of stress) on the fetus, and that this process has an epigenomic effect on particular genes...Reduced or elevated levels of cortisol, adrenalin, and oxytocin produced during labor may lead to fetal epigenomic remodeling anomalies which exert influence on abnormal gene expression. This reprogramming could manifest in a range of non-cummunicative diseases and biobehavioural problems in the neonate and into adulthood" (Buckley, 2015).

The microbiome is an area of intense study and research at this time. In fact, there are hospitals and birthing centers around the world that are using vaginal secretions at birth to "seed" the neonate born surgically, who has had no direct contact with the birth canal. This assists with the appropriate microbes introduced to the infant for establishing appropriate microbiomes throughout their internal and external systems.

Few medium- and long-term studies have been done on the impacts over time of the maternity care provided during the birth process. Buckley notes, "Markedly missing from current research are high-quality studies of the impact of perinatal interventions on medium-term outcomes such as breastfeeding success and duration, maternal-infant attachment, maternal emotional well-being, and other hormonally-mediated salutogenic outcomes" (2015).

Lastly, Buckley makes an excellent case for questioning total reliance on evidence-based health care, in that there is:

  • lack of a physiologic childbearing comparison group experiencing minimal or no interventions in most studies, so that differences may be underestimated.
  • difficulty of measuring effects of interventions due to the common involvement of co-interventions
  • frequent lack of data on critical hormonally-mediated outcomes such as breastfeeding and attachment, which are plausibly impacted by preceding maternity care interventions
  • minimal follow-up beyond hospital discharge in most studies, including most randomized controlled trials, the preferred study design of evidence-based medicine
  • to date, no consideration of possible epigentic programming effects

"Because of these limitations, the use of evidence-based health care may be an insufficient safeguard for maximizing benefits and minimizing harms in the mothers and babies in relation to maternity care" (Buckley, 2015).
Very stimulating and though-provoking information is provided in the extensive and well-researched Buckley report. It causes me to wonder what we have done in years past, and what we currently do for childbirth....what will be the outcomes in decades and centuries to come? Hmmm.

 

Kathy Parkes, MSN-Ed, BSPsy, RN, IBCLC, RLC, FILCA
Professional Development Educator, Step2Education International

 

References:

Buckley, S. J.  (2015).  Hormonal physiology of childbearing: Evidence and implications for women, babies, and maternity care.  Downloaded from http://childbirthconnection.org/pdfs/CC.NPWF.HPoC.Report.2015.pdf

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