Volume 8, Issue 19
|Midwifery Today E-News|
“Oxidative Stress and Preeclampsia”
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In This Week’s Issue:
Quote of the Week
"The flowering of midwifery education is in the opening, the grace, the surrender, the beauty and the union with what is great and good, and the strength that comes with this."
— Elizabeth Davis
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The Art of Midwifery
Colic can result from either a rapid ejection reflex or overabundance of foremilk, causing baby to swallow large amounts rapidly, and then getting a lot of air along with it. This can lead to gas, sleepless nights and difficult days that include pain. Try having the mom burp/wind her baby two to three times during a meal, the first time just a few minutes after beginning the breastfeed. The baby can also take little breaks and catch her/his breath. Also have moms try expressing milk before putting the baby to the breast, to decrease pressure and rapid ejection. Have her try it for a few days for every feed and see if it makes a difference. A mom of many who swore all her kids had colic was persuaded to try this technique for the new baby and the colic magically vanished. Eventually the supply will match the demand.
— Maggie Ramsey & Anna
ALL BIRTH PRACTITIONERS: The techniques you've perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to firstname.lastname@example.org.
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Passionate Midwifery Education
My Midwifery Education: My Mentor
I told you in the last installment about receiving "the call" after my first homebirth. In my deep drive toward midwifery I read everything I could get my hands on as I was nursing my baby and caring for my family. I could not get enough. I read OB textbooks and birth books like I was eating chocolate. I loved it. Then I heard Marion was going to teach some classes out near the coast about an hour and a half away. I joined some other aspiring midwives and we drove out to our half-day class telling birth stories and making new friends, midwife friends. (I want to talk more about midwife friends later.) Marion would teach us the basics. She began with the four types of pelvises, then prenatal care, hemorrhage, shoulder dystocia and so on.
As a practicing midwife she always had a fresh supply of amazing birth stories which she would tell in great detail, teaching us the language of birth, both medical and social. I believe the best part of midwifery education is the birth story. It teaches so much. It illustrates what we are doing. It demonstrates the lesson. It extends our experience. When I hear birth stories, especially from a midwife's point of view, I almost feel like I have gone to another birth.
Those of us attending Marion's classes already had our homebirth practices. I was with the birth coop (see first installment of this column). In class, we would bring Marion our cases, both prenatally and after the births. This added such a great dimension to the education, having real-life birth stories for all students to discuss. Marion would give us insights and considerations to check out. It almost felt like she was with us as we met with our mothers. In fact, at every birth I ever attended, whether Marion was there physically or not, I felt I had access to her. She got more than one middle of the night call to help us assess what was going on with a labor.
This is true mentoring. I feel so blessed to have had Marion as a my mentor. I hope each one of you finds a mentor.
— love, Jan
To read all installments of our column on midwifery education, go to our Better Birth and Babies Blog.
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Oxidative Stress and Preeclampsia
An organism uses antioxidant defenses to protect itself from free radicals, molecules that cause harm to living creatures by damaging biologic structures such as DNA, cell membranes and ion transporters. Normally there is a balance between free radicals and the antioxidant defenses an organism uses to cope with them. When the balance tips in favor of the damaging molecules, this is called oxidative stress.
A free radical is a very reactive molecule capable of independent existence for only a short time. Free radicals have one or more unpaired electrons (an electron alone in its orbit). Molecules with all of their electrons paired are more stable. A molecule with an unpaired electron is prone to take one from another molecule.… When it reacts with molecules making up biologic structures (such as cell membranes), it can damage those structures. Free radicals often contain oxygen atoms. In addition to oxygen radicals there are some non-radical oxygen-containing molecules such as hydrogen peroxide that also cause damage to biologic structures; together these are all called "reactive oxygen species" (ROS).
Reactions involving ROS proceed in a chain reaction. If the original radical takes an electron from a stable non-radical molecule, that molecule becomes a radical and will react with another stable molecule, causing damage all along the way. Lipid peroxidation is a chain reaction in which cell membranes are damaged, causing the cells to function poorly or to collapse.
Some ROS are generated by the human body for a purpose. Phagocytes produce superoxide and use it to kill bacteria they engulf. Others are produced as normal metabolites of many biochemical processes, such as aerobic respiration. They also are formed when there is tissue injury or ischemia followed by reperfusion. They can be acquired (toxins or pollutants such as ozone) or generated in response to something occurring in the environment (such as ionizing radiation, including sunlight).
Cells make antioxidants to protect them from oxidative damage by ROS. Uric acid, superoxide dismutase and bilirubin are examples of antioxidants the body makes for itself. Cell membranes incorporate vitamin E and beta-carotene, antioxidants acquired nutritionally. Vitamin E interrupts lipid peroxidation by giving a radical one of its electrons. It then becomes a tocopherol radical, which is much less reactive and therefore safer, effectively putting an end to the chain reaction. It migrates to the membrane surface where vitamin C recycles the tocopherol radical back into vitamin E, and it goes to work again protecting the cell membrane. Different antioxidants work in different places and in different ways to protect against oxidative stress.
Oxidative Stress in Preeclampsia
Compared with healthy pregnant women, preeclamptic women have low levels of several dietary antioxidants in their blood, including vitamin C, vitamin E, lycopene and betacarotene. They also have higher levels of ROS and frequently have increased levels of uric acid, probably resulting from the body's attempt to cope with oxidative stress. The placentas of preeclamptic women also have lower than normal antioxidant levels and higher than normal levels of ROS.
Nutrition and Preeclampsia
Preeclampsia appears to arise after a multistage process. Whether or not dietary factors influence healthy trophoblast migration into the myometrium has not been investigated. Diet does influence blood volume expansion, and this is necessary to optimally perfuse the placenta. Oxidative stress is the likely culprit in the endothelial dysfunction that predates clinically apparent preeclampsia and explains its signs and consequences. A woman's antioxidant status influences her susceptibility to oxidative stress. Many antioxidants are manufactured within the body, but a good intake of dietary antioxidants may help. …Midwives can inform women about sources of dietary antioxidants and recommend several servings per day in as great a variety as possible.
— Jennifer Enoch, excerpted from "Antioxidants and Preeclampsia," Midwifery Today Issue 72
Read the entire article in Midwifery Today Issue 72. Order your copy here.
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Research to Remember
An Eastern Virginia Medical School study of data on more than 5000 two-parent families found that postpartum depression (PPD) in fathers occurs at more than twice the rate of depression in the general adult male population of the United States. The study also found that when both parents have PPD, the babies are less likely to be breastfed and are more likely to be put to sleep with a bottle of formula. While sadness is a marker of PPD in women, men tend to exhibit irritability, aggression and sometimes hostility when depressed. The researchers conjectured that fathers become depressed because they feel burdened or entrapped by the financial responsibility of providing for a child.
— Pediatrics, Aug. 2006, Vol. 118: 659–668
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The scrapbook for Eugene 2005 is online. See Debra Pascali-Bonaro demonstrating techniques with the birth ball.
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I am a new grad nurse and am 13 weeks along in my first pregnancy. I am planning a homebirth with a private midwife and am very confident with my choice. I am looking for advice about how to manage the frustrating comments I'm getting, particularly from coworkers, about my "shocking, dangerous" choice (e.g., "What do you mean you don't want an epidural? Aren't you afraid of the pain?") I try to remember that these comments come from a totally different philosophy from mine, but it's starting to stress me out. Ideas?
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Question of the Week (Repeated)
Q: I have been told that raspberry leaf tea promotes labor. I very much want to have a natural birth, and if this will help me get through it quicker, please could you tell me how do I drink it, how often, etc. I am 35 weeks already, but I am sure it's not too late to start, or maybe it's too early?
— Donna S.
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Think about It
Prenatal diagnosis—the detection of abnormalities of babies still in the womb—is driven by the increasing expertise of medical technology but is clearly sanctioned in many modern societies.… We seem to have decided, collectively as well as individually, that we want to avoid the difficulties of raising children with disabilities and especially, in our society, with intellectual disabilities.…
Prenatal diagnosis can open a veritable Pandora's box for the woman and her family, and it also raises wider, profound, ethical and philosophical questions. For example, how can we call ourselves a tolerant and inclusive society—a society that celebrates difference—when we have an entire industry directed towards eradicating babies who have obvious differences? And our values are portrayed very starkly when we specifically target babies with Down syndrome, a condition that is not usually fatal but is associated with intellectual disability and with characteristic physical features that our society does not recognize as beautiful.
Most women who opt for these tests are unaware that they are entering an emotional minefield, with consequences that may last for years. Many are also unaware that the tests that they are accepting will not detect all, or even most, abnormalities in their unborn babies.
— Sarah J. Buckley, excerpted from "Prenatal Diagnosis—Technological Triumph or Pandora's Box?" Midwifery Today Issue 77
Midwifery Today Issue 77 can be ordered.
Passionate about birth, mothers and babies? Want to be a birth activist? This internship is for you! Work and live with me in gorgeous southwest Colorado for 10 weeks or longer. Suzanne Arms, Suzanne@BirthingTheFuture.com . (970) 884-4090.
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