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
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!
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
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
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
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?”
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
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
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
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...
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
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
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
61.
62.
63.
64.
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
Hinweis der Redaktion
I thank you for the invitation to speak at this important conference – I must confess at the outset that I struggled a little when pondering – what new and interesting ideas can I possibly bring to a group of women and their families, and their professional care providers- who are already birthing in the optimal birth environment since the evidence suggests, the place in which you feel most safe and secure is the right location for birth to unfold- and for most of us-that is actually the home in which we live. Or is it? My hope is that you will find what I have chosen to share with you is as intriguing and useful as I have found in considering the birth environment and HOW the choices we make today may be having an impact far beyond what we might imagine.
The focus of my presentation this evening is on how the early stages of life from conception, through pregnancy, and birth and the very early days following birth might influence a child’s subsequent wellbeing ... I want to explore with you some relatively new research so that we can consider what we SHOULD be paying attention to – if anything.Like many of you here I am a parent and grandparent and I have an abiding professional interest as a midwife to try to learn as much as I can about early life experiences so that I understand the choices that I make for myself I MIGHT also BE making for my children and grand children – and to understand better the potential intended or unintended consequences of the options I offer to women as part of my midwifery practice. So we are going to explore how the early stages of life from conception to birth might influence the future child’s wellbeing and to consider whether there is anything we can learn from the available research evidence.
DNA is found in the nucleus of every cell in our body
But I am going to begin this shared conversation between myself, Cathrine and you by presenting a few research examples from perinatal animal research. Three studies in particular I thought might provide an interesting snapshot of what is happening in the field of epigenetics which is particularly pertinent to pregnancy and childbirth.I’m going to examine the experiences of the Agouti mouse, stressed pregnant rats and genetically engineered mice. And then return ultimately to studies in human mothers
In this case its a dietary intervention that can silence the Agouti Gene. IF the Pregnant Agouti mouse is fed a diet rich in soy extract, folate, and B12 she will have babies who still have the agouti gene but are otherwise normal-here is a mother and her normal baby There are several potentially important messages to be gleaned from this study- I hope you are thinking the same thoughts as I did when I first met this mouse- wow diet is potentially very powerful- what you eat can turn on or silence genes – Interestingly all pregnant women are advised to take folate if they are planning pregnancy and to continue taking it throughout pregnancy.By the way We all have an agouti gene – it is what gives fat tissue inside the body its yellow colour.
The next study I discovered concerned pregnant rats who were experimentally stressed- a lot- by moving their nest around and messing it up constantly throughout their pregnancy. When their pups were born, the researchers observed that the new mothers abused and neglected their pups- dragging. Dropping and stepping on them- they didn’t lick and groom them which is very unusual behaviour for mother rats. But what happened to their pups was of great concern. The researchers discovered two things- firstly the pups developed epigenetic modifications to their DNA – the caring, nurturing behaviourie the licking and grooming genes were silenced so that when those pups grew up and became mothers they exhibited the same neglectful behaviour that they experienced at the hands of their own mothers – but wait there’s more –
these same genetic changes and behavioural changes were passed on to the next generation and so on it goes.The message in this study for me was that stress in pregnancy can have quite serious EPIGENETIC effects on the unborn baby that are played out in that baby’s life and then her baby’s life in turn.I wondered if there was some intervention that could stop this intergenerational transfer of DNA mutation
Fortunately I found another study that lifted my mood a little – a fascinating piece of research where mice were genetically engineered to have a memory defect in that they were completely unable to negotiate a simple maze to locate food.step 2 was that these genetically modified mice were then placed in an enriched environment for some time and ultimately their memory improved to the point that they could negotiate the maze – so they overcame their genetic deficit.But step 3 is what was amazing – when these genetically deficient mice had babies- their babies also had the same memory defective gene- but it didn’t affect them at all- they had the same improved memory of their mothers- so the memory defective gene had been silenced.Mm so whats the message here? –the quality of the social environment beyond infancy is capable of shifting patterns of gene expression with consequences for the functioning of the individual– both within and across generationsthe genes can be silenced.The brain is amazingly changeable like plasticine which is what is meant by the plasticity of the brain.I wanted to return to the stressed mother rats and find an intervention that would silence their altered DNA
So what have we encountered so far in relation to animal research?There are similar findings in a range of studies conducted with many other mammalsSo Of what relevance is this to human mothers and their babies?
There are many associations identified between stressful perinatal experiences and later life events- these include life challenges such as diabetes which is increasing dramatically, cardiovascular disease, autism spectrum disorders from mild AHDH to Autism, schizophrenia and psychotic disorders-drug dependency and suicidality
Starts with gaining access to the hospital, place to park car, private, signage, lit