1. Home Birth Aotearoa National
Conference
October 28-30 2011

2. Creating Optimal Birth Space
MARALYN FOUREUR
PROFESSOR OF MIDWIFERY
UNIVERSITY OF TECHNOLOGY SYDNEY

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.  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.  Developing Theory
 Hypothesis generating
 Research stimulus
 Puttingtogether pieces of a puzzle
 (Product warning – all
research has limitations)

6. Relationship + Optimal Birth
based maternity Environment
care
Calm &
Connect
OPTIMISING System
BIRTH
PHYSIOLOGY
Optimal Oxytocin
Lowers BP, Heart
rate, decreases pain
Normal Birth

7. 3 stories
1. Epigenetics
2. Oxytocin
3. Our need to feel safe

8. THE CENTRAL DOGMA OF MOST SCIENTIFIC ACTIVITY
FOR 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. Watson & Crick
1953
DNA Controls All
of life – genes
are subunits of
strands of DNA

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. Genes are being switched on or
silenced by signals from outside
the genes-from the environment
Through a process
called Methylation
or Demethylation ++

12.  Environmental  Can modify genes
influences without changing
including: their basic
blueprint
 Stress = Feeling
unsafe/threatened
 Emotions
 Nutrition
 Toxins

13. 1. The Agouti Mouse
2. Stressed Pregnant Rats
3. Genetically Engineered Mice
 Large population based Studies in Humans

14. Prone to Obesity, Diabetes, Cancer, Early
Death

15. Pregnant Agouti fed a diet rich
in soy extract, folate, B12…
-will have babies who
still have the
agouti gene but are
otherwise normal

16.  Abusedand  Pups developed
neglected their pups epigenetic
modifications to
their DNA
 Pupsgrew up to be
poor mothers

17.  Andpassed on
these changes to
the next generation
of offspring

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.  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.  Environmental  Can modify genes
influences without changing
including: their basic
blueprint
 Stress = Feeling
unsafe/threatened
 Emotions
 Nutrition
 Toxins

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. Therefore we need to
pay attention to the
birth environment…

23. Giving birth
is a feat of
almost
cataclysmic
stress
Mediated by
Endogenous
Oxytocin

24.  Uterine inertia (failure to progress)
 Fetal distress
Why is this so???

25. Feeling
Unsafe
Stress
Catecholamines Catecholamines
Oxytocin Constricts blood vessels
decreases
Uterine blood flow
Placental perfusion
Fetal oxygentation
Uterine contractions
Uterine inertia Fetal Distress

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. Niles
1968
Newton
1968
 Research
conducted on the
mouse!

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. •“...are mammals with more highly
developed nervous systems than the
mouse equally sensitive to perinatal
environmental disturbance?
•...what effect if any do variations
between home and hospital
environments have on the course of
labour and on perinatal mortality?”

30. Studies in primates

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. More recent studies in
pregnant women

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.  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. New scientific discoveries
have now made it possible
to understand more…

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. •Fight OR Flight
•Freeze System
•Calm and Connect

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. 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.  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 the
neuro-endocrine system
 We are just beginning to discover how
important it is and why protecting & promoting
normal birth is essential for our survival

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.  The love hormone
 Much research has confirmed this – starting
with...

43. The Prairie Vole

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.  Oxytocin – secreted during sexual activity
 Female and male orgasm
 Labour
 Birth-fetal ejection reflex
 Placental ejection reflex
 Breastfeeding
 Touch- massage and stroking
 Eating

47. The Ewe and the Lamb….

48.  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

49.  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

50.  Research
with pregnant and lactating
women/babies
 and their midwives
 Karolinska Institute

51.  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

52.  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

53.  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

54.  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

55. 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

56.  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

57.  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

58.  Disturbingnormal neuro-hormonal responses
during labour –disruption to endogenous
oxytocin MAY have epigenetic consequences

59.  Women feel connected to their
careproviders, calm, confident in
themselves, have trust in- and- are trusted
by, their caregivers
 Spaces where women feel SAFE

60.  Prevent disruption
to normal oxytocin
secretion
 Decrease maternal
anxiety
 Increase likelihood
of normal birth
 Increase likelihood
of long term
health of baby

65.  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

66. Relationship + Optimal Birth
based maternity Environment
care
Calm &
Connect
OPTIMISING System
BIRTH
PHYSIOLOGY
Optimal Oxytocin
Lowers BP, Heart
rate, decreases pain
Normal Birth