Don’t wash the baby!

July 7, 2009

 Vernix, that cheesy, white substance found on newborn humans and immediatley washed off during “baby’s first bath” in the hospital,  has been found to contain AWESOME bactieria fighting properties!! Just read the article to see how you can protect your newborn from hospital-borne infections and disease. Vernix has also been shown to contain GBS-killing antimicrobial components! Think twice about dousing your baby in Johnson’s soap!

Vernix caseosa as a multi-component defence system based on polypeptides, lipids, and their interactions.

Full study found here: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2315785

Vernix caseosais a white cream-like substance that covers the skin of the foetus and the newborn baby. Recently, we discovered antimicrobial peptides/proteins such as LL-37 in vernix, suggesting host defence functions of vernix. In a proteomic approach, we have continued to characterize proteins in vernix and have identified 20 proteins, plus additional variant forms. The novel proteins identified, considered to be involved in host defence, are cystatin A, UGRP-1, and calgranulin A, B and C. These proteins add protective functions to vernix such as antifungal activity, opsonizing capacity, protease inhibition, and parasite inactivation. The composition of the lipids in vernix has also been characterized and among these compounds the free fatty acids were found to exhibit antimicrobial activity. Interestingly, the vernix lipids enhance the antimicrobial activity of LL-37 in vitro, indicating interactions between lipids and antimicrobial peptides in vernix. In conclusion, vernix is a balanced cream of compounds involved in host defence, protecting the foetus and newborn against infection.

Discussion:

In previous studies, we have characterized antimicrobial peptides and polypeptides in vernix [7, 8]. In the present study we demonstrate the presence of many more proteins of immunological importance in vernix. Among the most abundant proteins now characterized are cystatin A, calgranulin A, ubiquitin, and UGRP-1, which are all implicated in innate immunity of humans. Vernix lipids were now also characterized in which antimicrobial activity was detected, in particular for free fatty acids. In addition, our results indicate that lipids may contribute to a favourable microenvironment in vernix by interacting with antimicrobial components such as LL-37. Our characterization of proteins, lipids and their interactions suggest that vernix is a complex innate defence barrier, protecting the foetus and the newborn from infectious microbes, in an apparently crucial manner, since the adaptive immunity of newborns is immature. The antimicrobial property of vernix may also act to facilitate colonization by the normal flora following birth and to block the colonization of unwanted microbes or pathogens. For example psoriasin, which is identified in vernix, directly kills E. coli but not Staphylococcus aureus [33, 34]. The shedding of the vernix in late pregnancy may suggest that the level of protection has to be adjusted to allow proper colonization of the normal flora.
Several proteins now identified are expressed in skin such as cystatin A, profilaggrin, psoriasin and calgranulin C. Due to the close contact of vernix and amniotic fluid, they share some of the same components. This is now shown regarding calgranulin A and B, proteins previously known to be present in amniotic fluid [35]. The origin of UGRP-1 may be the lungs, and a transfer of this protein to vernix may occur via the amniotic fluid. Blood may be another source of the identified proteins in vernix. Using mass fingerprinting, we identified not only α- and β- haemoglobin but also γ-haemoglobin. During the last two trimesters of pregnancy the foetus produces γ-haemoglobin, which is replaced by β-haemoglobin after birth, enabling an efficient transfer of oxygen from the blood of the mother to the foetus. Thus, the γ-haemoglobin detected in vernix originates from the foetus.
Calgranulin A, B, and C, and psoriasin all belong to the S100 family of calcium binding proteins. The S-100 family of proteins has 2 calcium binding motifs of the EF-hand type [36]. These proteins have been shown to exhibit chemotactic properties and may play a role in the pathogenesis of epidermal diseases [36]. Notably, an N-terminal fragment of profilaggrin, with sequence similarity to the two EF-hands [37], was also identified in vernix.
Calprotectin is an antifungal and antibacterial complex consisting of a heterodimer of calgranulin A and calgranulin B [38]. Both subunits were identified, revealing that the active holoprotein is present in vernix. Accordingly, the crude peptide/protein extract of vernix exhibited good antifungal activity. However, after separation of the protein extract by RP-HPLC we could not detect any antifungal activity in the collected fractions (data not shown). Our interpretation of this difference is that the two subunits of calprotectin have been separated upon HPLC, leading to loss of activity. Calprotectin is suggested to kill microbes by chelating zinc, thereby depriving microbes of an essential metal ion [39]. This mode of action has also been described for lactoferrin and psoriasin, the latter being a major E. coli-killing compound in human skin [33].
Calgranulin C was first identified on the surface of onchoceral worms in human subcutaneous nodules [40]. It is proposed to be released by activated neutrophils and thereby attack and kill nematodes [40]. Thus, the presence of calgranulin C in vernix contributes to the protective role of vernix.
Cystatin A is a protease inhibitor that is mainly expressed by epithelial and polymorphonuclear cells [41, 42]. Cystatin A is also a minor cross-linking component of the cornified cell envelope [43] and a part of the mechanical barrier of the skin. Unlike cystatin C, cystatin A has not been shown to possess any direct antimicrobial effect. However, cystatin A has been suggested to be a first line protector against cysteine proteases released from infectious micro-organisms and parasites [44]. Thus, cystatin A could have a dual role in the innate defence of the foetus.
Our results reveal that UGRP-1 (HIN-2/SCGBA2) is one of the major proteins in vernix, whereas UGRP-2 (HIN-1 /SCGBA1) is not as abundant. These proteins are both expressed at high levels in neonatal lungs by different subsets of secretory cells within the surface and glandular epithelia [45]. UGRP-1 has been shown to bind bacteria and to the macrophage scavenger receptor MARCO [46], indicating opsonizing properties. In the lungs of mice the expression of UGRP-1 is upregulated by IL-10 [47], while it is downregulated by IL-5 [48], suggesting that UGRP-1 is a target of anti-inflammatory pathways. In vernix, we have characterised three novel forms of UGRP-1, which are N-terminally differently processed. These forms may have altered binding affinities to bacteria, leading to enhancement of the opsonizing spectra.
Vitamin A has been detected at high levels in vernix [49] and is proposed to serve as a nutritional depot of vitamin A. Vitamin A is secreted from the amniotic epithelium into the amniotic fluid, and is taken up by vernix [49]. Our results show that transthyretin is present in vernix, a protein that binds to the retinol binding protein, which in turn binds vitamin A.
Like lipids previously isolated from human stratum corneum and sebum [50, 51], our results demonstrate inhibitory effects of the free fatty acids in vernix against the Gram-positive bacterium B. megaterium. We also demonstrate that palmitoleic acid (C16:1) and linoleic acid (C18:2), known to exhibit potent antimicrobial activity [14, 52], are a considerable part of the total free fatty acids. The long-chain unsaturated fatty acids found in vernix (C20 to C22 in table 2 ) are also antimicrobial and the activity is enhanced with an increase of the number of double bonds [15]. Like antimicrobial peptides [53], fatty acids and monoacylglycerols disintegrate the lipid envelope of viruses [15] and bacterial plasma membranes [12, 16].
Considering the high lipid content of vernix (10%) [3], it seems possible that lipids influence the function of other components of vernix. It has been demonstrated that other factors such as salts and pH, influence the conformation of the human cathelicidin LL-37 [23]. Therefore we speculate that the lipid fraction of vernix can exhibit similar functions. Under our experimental conditions, lipids isolated from vernix enhanced the antimicrobial potency of LL-37. Thus, LL-37 can be active in a lipid-rich environment.
When studying the antimicrobial activity in peptide/protein extracts of vernix, we found a high antimicrobial activity against bacteria and fungi. The most active antibacterial compound against E. coliand GBS in these samples was isolated and identified as chlorhexidine. Chlorhexidine is a microbicidal substance of vaginal cream used as a lubricant during vaginal examination prior to delivery. For this reason, some of the vernix samples were found to contain chlorhexidine. We noted that the samples with E. coli activity.
In conclusion, we have characterized proteins and lipids that add novel protective functions to vernix, such as antifungal properties, opsonizing features, protease inhibiton, and parasite inactivation. In addition, the antimicrobial action of LL-37 can be potentiated by the lipids in vernix in vitro, stressing the importance of the microenvironment for the function of antimicrobial components.
 
 
Acknowledgements:
This work was supported by grants from The Icelandic Research Fund for Graduate Students, The Swedish Foundation for International Cooperation in Research and Higher Education (STINT), and The Swedish Research Council (no. 11217, 13X-3532). We thank Ella Cederlund, Carina Palmberg, Marie Ståhlberg, Gunvor Alvelius, and Monica Lindh for excellent assistance. We also thank Milan Chromek and Annelie Brauner, for the GBS strain.

LOCAL PREGNANCY FAIR

March 7, 2009

Who wants to meet me? Who needs to interview 6-10 doulas in the same day at the same place?

The perfect place to meet all the local birth professionals in one place! There will be massage therapists, midwives, Child Birth Educators and Doulas and other associated vendors.

Saturday, March 14 11-2pm
Baby Depot at the Citadel Mall.

THIS IS A FREE EVENT

Find a variety of Resources for Expectant Parents! Information on your New baby, pregnancy, Labor, Birth and more!!

Free Resource Guide: Birth and Beyond 2009 Provided by Colorado Springs Birth Newtwork

Enter to Win a prize courtesy of Baby Depot!

I’m giving away an asian style carrier:

xxsling


Homebirth Classes Beginning in the Springs!

January 11, 2009

**HOMEBIRTH SERIES begins Saturdays 1/24/09**

I created this home birth series specifically to meet the needs of home birthing couples.

When planning a home birth, the run-of-the-mill childbirth course won’t cut it!

This series is focused on heath and preventative care, practical, non-medical alternatives to pain relief, practice of relaxation techniques (for labor and life with babies), moving through labor, and presenting information in a non threatening way so you can make your own informed choices for every aspect of pregnancy, labor and caring for your newborn. Classes are taught in small groups of home birthing couples, by a homebirth couple in a relaxed home environment.

We meet SATURDAYS, 7:30pm at my centrally located home.
Series is $150/6 weeks, but you are welcome to pick and choose which classes to attend for a flat $25/per class fee.
see website or call for specific question or to check out my class outline

Carrie Anderson, CCE, LD
Birthing Naturally Childbirth Education
http://www.birthteacher.com
719-634-2928


preventable Cesarean costs in the US and Colorado

November 29, 2008

The Unkindest Cut

     Cesarean is the most common surgery performed on women in the United States.  A cesarean (si-‘zar-E-an) section is major abdominal surgery used for the delivery of an infant through an incision in the mother’s abdomen and uterus. According to the Centers for Disease Control, the cesarean rate in 2007 hit an all time record high of 31.1% of all births.  This is a 50% rise over the past decade, and almost a six-fold increase since 1970, when 5.5% of women gave birth via cesarean section. To combat this alarming trend, professionally trained Doulas should be offered to all laboring women because the support they offer has been shown to significantly reduce the cesarean rate.
     Obstetricians often offer the excuse of defensive medicine for rising U.S. cesarean rate. This means that they are choosing to perform unnecessary surgery in the belief that it will help avoids lawsuits. I think it’s unconscionable to put a woman’s a life, quality of life, relationship with her husband and family, relationship with her child, and future childbearing at risk; not to mention costing the healthcare industry billions each year; simply in the hope of avoiding a lawsuit. Their logic is understandable, but faulty.
According to a study published in the Lancet, “decision to take legal action was determined not only by the original injury, but also by insensitive handling and poor communication after the original incident” (Why do people sue Doctors? Lancet 1994, p343). A doula’s role in a hospital setting is often one of interpreter; being trained both in hospital protocols and communicating with women under the influence of labor hormones and stress, she is in a unique position to prevent misunderstandings which lead to litigation.  We also know that a doula’s support during labor increases a woman’s satisfaction with her experience. In a recent study, of 422 couples who had the support of a doula during their birth, 100% rated their experience with the doula positively (Birth Journal June 2008 pg 2).
    
 The risk to mothers and babies, as well as the financial costs the of all of these unnecessary operations births, has prompted leading medical agencies such as the World Health Organization, the Centers for Disease Control and Prevention, and the National Institutes of Health to call upon the medical community to reduce the cesarean rate to 15% or less. Last year over 4 million babies were born in United States which translates to 1.8 million unnecessary surgeries.   
    A cesarean poses serious risk the mother and her child, and those risks can only be accepted when the reason for the cesarean has higher risks then the operation.  Some of the risks to the mother include infection, blood loss, hemorrhage, hysterectomy, transfusions, bladder and bowel injury, endometriosis of the site of the incision, heart and lung complications, blood clots in the legs, anesthesia complications, and re-hospitalization. Fully one-half of all women who have undergone a cesarean section suffer complications, and the death rate for mothers is two to four times higher then with vaginal birth. Approximately 200 women die yearly in the United States from complications of elective repeat (cesareans, done at women’s request for no medical need) cesarean. Each successive cesarean greatly increases the risk of developing placenta problems in future pregnancies (such as placental previa,  accreta  and abruption).These complications pose life-threatening risks to both mother and baby. Cesareans also increase the odds of secondary infertility, miscarriage and ectopic pregnancy in subsequent pregnancies.
    
A cesarean also poses documented medical risks to the baby’s health as well. These risks include respiratory distress syndrome, iatrogenic prematurity (this is when surgery is performed because of error in determining the due date), persistent pulmonary hypertension (PPH), and surgery-related fetal injuries such as lacerations.
    
Having a trained non-medical support person, or doula, present during labor reduces the need for medical intervention, and raises parents’ satisfaction after childbirth. A tremendous amount of research has been done surrounding the importance and benefit of having a labor doula assist as a part of the birth team. Research shows that having a labor doula “reduces the overall cesarean rate by 50%, the length of labor by25%, Oxytocin use by 40%, pain medication by 30%, the need for forceps by 40%, and requests for epidurals by 60%”.  Mothers who were attended by labor doulas also felt their birth experiences were more positive, their self-image was improved; they felt their babies were healthier, and they felt their relationship with their husband or partner was improved. (Mothering the Mother by Klaus, Kennell, and Klaus ).  Furthermore, in 1999, the Cochrane Library reported on 14 clinical studies involving more than 5000 women. They found that with the continuous presence of a trained support person, the likelihood of episiotomy, cesarean delivery, operative vaginal delivery, medication for pain relief, and a 5-minute apgar score for the baby was reduced.
     Unnecessary cesarean surgery costs the US government billions in health care costs each year.  Last year alone, over four million babies were born; 1.2 million of them by this largely preventable operation.  While vaginal delivery typically requires two days of hospitalization and a one-week recovery, C-section requires four days of hospitalization and a two-week recovery. According to the Agency for Healthcare Research and Quality in Rockville, Md., the average cost of a vaginal delivery is $5,574, while the average cost of C-section is $11,361. If we were able, by the benefit of doulas supporting women in hospitals, to reduce the national rate of cesareans from 31- 15% we could save insurance companies, taxpayers, business owners and private citizens roughly $1,704,150,000 annually. These numbers do not even include the cost of anesthesia, prescription pain relief often used in the days and weeks following a cesarean, prolonged hospital stay or the use of neonatal intensive care for infant.
     The Colorado statewide cesarean rate is below the national average at only 25.9%; however that is still 10% higher then it should be. If we were able to lower just our state of Colorado’s cesarean rate to about 15%, which is what the World Health organization, the Centers for Disease Control and Prevention, and the National Institutes of Health have all called “the highest rate that is acceptable”, the cost savings would have been approximately $5,264,778,905.  In 2007, there were 4,315,000 babies born in Colorado hospitals.  25.9% of those babies were born by cesarean section surgery at a cost to area hospitals of $6,008,639,905.  A hospital based doula program would allow more mothers to have their babies without costly, painful and dangerous risks of a preventable cesarean surgery.

copyright Carrie Anderson 2008, refrences available upon request


Childbirth Refresher Course

November 29, 2008

I’m cutting the price of my Labor Skills Workshop, due to the Holidays (and celebrating my Shingles recovery and ability to work around pregnant woman and infants again)!

One Night Childbirth Refresher $30
7-9pm Sat. December 13th, 2008
634-2928
by Carrie Anderson, CCE, LD

This two hour  fast-paced workshop was created for women and their partners. You will learn the how, what, where, when and why of providing comfort during labor. Get  hands on practice, practical knowledge, reference guide to positions and LOTS of useful BTDT advice. Holiday price includes workbook and refreshments.

www.Birthteacher.com


Pre-Eclampsia Fact vs. fiction

July 15, 2008

I just thought I would post a list of pre-eclampsia myths and challenge you mammas to learn the truth about this deadly disease. Just keep an eye out.

1. Women do not die in childbirth in this day and age.
Every year 585,000 women die in childbirth, most in developing countries. 13% (or 50-70,000) of those deaths are known to be from eclampsia alone. Research shows that more women actually die of preeclampsia than eclampsia. In the USA 18% of pregnancy-related deaths are due to the disease. (Approximately 180 women a year or 3 women a week…) Even women, who do not die experience trauma, lose babies and suffer lifelong disabilities including paralysis, blindness, permanent neurological impairment, hypertension, liver failure, kidney failure, etc…

2. Preeclampsia is rare.
Preeclampsia occurs in 5-10% of all pregnancies. Internationally this accounts for 6-8 million births a year, in the USA—approximately 200-400,000 pregnancies. Preeclampsia is as common in the USA as breast cancer. A woman’s risk of having a baby with Downs Syndrome is 1:250. A woman’s risk of having preeclampsia is 1:20. Preeclampsia is the most dangerous of the leading common complications of pregnancy.

3. Preeclampsia only happens once and only in the first pregnancies.
The leading risk factor for preeclampsia is actually a previous experience with preeclampsia. While rare, preeclampsia can occur in second pregnancies even if it did not happen in the first. It can occur in the first, then skip a pregnancy and reoccur in a third.

4. Only certain kinds of women (heavy, old, young, black, Hispanic, women with twins, etc…) get preeclampsia.
While women with a body mass index (BMI) of 30% or higher, of advanced maternal age (over 35), teenagers, African Americans, Hispanics and those expecting multiples are among those at an increased risk—studies show that these “risk factors” do not predict who will get the disease and to what severity with which it will occur.

5. You can prevent (or you caused) preeclampsia with “x” (diet, exercise, attitude, working/not working outside the home).
Preeclampsia occurs in every country in the world regardless of diet, body size, and lifestyle. No significant study has shown that any of these factors are the cause or the cure for preeclampsia. Women in famine torn Ethiopia experience preeclampsia as often as women in San Francisco.

6. Pregnant women do not need to know about preeclampsia because only 5-10 out of every 100 will get it.
Because we cannot safely predict who will and will not get preeclampsia—and of those women who will and will not lose a baby and/or die, all women, particularly those in their first pregnancy, or with known risk factors, should be warned about the complications and dangers of preeclampsia. Women are taught about Downs Syndrome, breast cancer self-exams, pap smears. Most women would rather know.

7. Once the baby is delivered—the mother is fine.
While it is true that delivery sets in motion the recovery process, most maternal deaths occur in the 24-48 hours after the birth of the baby. Preeclampsia, eclampsia and the complications from it can occur up to six weeks post-partum. Vigilant post-partum care could prevent many of these deaths.

8. Preeclampsia has little to no impact on the baby.
Preeclampsia can cause intrauterine growth restriction and is the #1 reason doctors choose to deliver early. Preeclampsia is the leading known cause of prematurity accounting for 15% of preterm births in the US or approximately 60,000 premature births. It is also a leading cause of neonatal and infant death.


The Hormonal Dance of Laboring

March 2, 2008

What is the role of oxytocin during labor and birth?

Oxytocin is often known as the “hormone of love” because it is involved with lovemaking, fertility, contractions during labor and birth, and the release of milk in breastfeeding. It helps us feel good, and it triggers nurturing feelings and behaviors.

Receptor cells allowing a woman’s body to respond to oxytocin increase gradually in pregnancy, and then sharply in labor. Oxytocin is a potent stimulator of contractions, which help to dilate the cervix, move the baby down and out of her body, give birth to her placenta, and limit bleeding at the site of the placenta. During labor and birth, the pressure of the baby against the cervix and then against tissues in the pelvic floor stimulates oxytocin and contractions. So does a suckling newborn.

Low levels of oxytocin during labor and birth can cause problems by:

  • causing contractions to stop or slow, and lengthening labor
  • resulting in excessive bleeding at the placenta site after birth
  • leading providers to respond to these problems with interventions.

What is the role of endorphins during labor and birth?

Endorphins are calming and pain-relieving hormones that people produce in response to stress and pain. The level of this natural morphine-like substance may rise toward the end of pregnancy, and then rises steadily and steeply during unmedicated labors. (Most studies have found a sharp drop in endorphin levels with use of epidural or opioid pain medication.) High endorphin levels during labor and birth can produce an altered state of consciousness that helps women flow with the process, even when it is long and arduous. Despite the hard work of labor and birth, a woman with high endorphin levels can feel alert, attentive, and even euphoric as she begins to get to know and care for her baby after birth. Endorphins may play a role in strengthening the mother-infant relationship at this time. A drop in endorphin levels in the days after birth may contribute to the “blues” that many women experience at this time.

Low levels of endorphin can cause problems in labor and birth by:

  • causing labor to be excessively painful and to feel intolerable
  • leading providers to respond to this problem with interventions.

What is the role of adrenaline during labor and birth?

Adrenaline is the “fight or flight” hormone that humans produce to help ensure survival. Women who feel threatened during labor (for example by fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labor or stop it altogether. Earlier in human evolution, this disruption helped birthing women move to a place of greater safety.

Too much adrenaline can cause problems in labor and birth by:

  • causing distress to the unborn baby
  • causing contractions to stop, slow, or have an erratic pattern, and lengthening labor
  • creating a sense of panic and increasing pain in the mother
  • leading providers to respond to this problem with cesareans and other interventions.

What steps can women take to help ensure that these hormones work well?

A woman can promote her body’s production of oxytocin during labor and birth by:

  • staying calm, comfortable, and confident
  • avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures
  • staying upright and using gravity to apply her baby against her cervix and then, as the baby is born, against the tissues of her pelvic floor (these stimulate oxytocin)
  • engaging in nipple or clitoral stimulation activities before birth and giving her baby a chance to suckle shortly after birth (these stimulate oxytocin).

A woman can enhance her body’s production of endorphins during labor and birth by:

  • staying calm, comfortable, and confident
  • avoiding disturbances, such as unwelcome people or noise and uncomfortable procedures
  • delaying or avoiding epidural or opioids as a pain relief method.

A woman can keep adrenaline down during labor and birth by staying calm, comfortable, and relaxed. The following can help:

  • being informed and prepared
  • having trust and confidence in her body and her capabilities as a birthing woman
  • having trust and confidence in her caregivers and birth setting
  • being in a calm, peaceful, and private environment and avoiding conflict
  • being with people who help her with comfort measures, good information, positive words, and other support
  • avoiding intrusive, painful, disruptive procedures.