Tuesday, November 29, 2011

Can women deliver safely at home? Results of British study about the place of the birth

British Study: Half Of All Pregnant Women Could Give Birth At Home Safely
AP | Nov 25, 2011 12:09 PM EST

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LONDON -- A new study in England shows little difference in complications among the babies of women with low-risk pregnancies who delivered in hospitals versus those who gave birth with midwives at home or in birthing centers.
Based on the findings, researchers said women with uncomplicated pregnancies in England should be able to choose where they want to give birth – and one expert said about half of all pregnant women here could potentially safely give birth outside a hospital.
But they sounded a note of caution for first-time mothers and their infants, who may face a higher risk if they choose a home birth.
"I would never say women should give birth in a particular place, but hope this gives women more information to make an informed choice," said Dr. Peter Brocklehurst, director of the Institute for Women's Health at University College Hospital in London, one of the paper's lead authors. He conducted the research while at Oxford University.
"Birth isn't an abnormal process, it's a physiological process," he said. "And if your pregnancy and labor is not complicated, then you don't need a high level of specific expertise."
Brocklehurst added that about 50 percent of pregnant women in England – those who are low-risk – should be able to choose where to have their baby.
More than 90 percent of pregnant women in England now give birth in a hospital. Some officials say the new study should prompt women to consider alternatives.
"This is about giving women a choice," said Mary Newburn of NCT, a U.K. charity for parents, one of the study's authors. She said midwife-run birth centers in England have a more homelike environment, with privacy, sofas and birthing pools.
In Britain, midwives deliver more than 60 percent of babies already. Similar care is provided in the Netherlands, where about a quarter of all births happen at home. Elsewhere in Europe, most births are led by doctors, although midwives may also be involved.
In the United States, however, less than one percent of births happen at home. The American College of Obstetricians and Gynecologists does not support planned home births and warns evidence shows they have a higher risk of newborn death compared to planned hospital births. The training of midwives in the U.S. varies by state – and some have no regulations.
Brocklehurst and colleagues collected data for nearly 65,000 mothers and babies between 2008 and 2010 in England. Of those, there were 19,706 births in hospital obstetric wards, 16,840 births at home, 11,282 births in "freestanding" midwifery units – independent clinics where there are no doctors or access to anesthetics – and 16,710 births in "alongside" midwifery units, often housed within hospitals.
All the pregnancies were low-risk, meaning the mothers were healthy and carried their baby to term. Women planning C-sections or expecting twins or multiple births were excluded from the study.
In the U.K.'s hospital obstetric wards, most low-risk women don't see a doctor during labor and are only treated by midwives.
There didn't appear to be a difference for the infants' health based on where the mothers planned to give birth.
But researchers found a higher risk for first-time mothers planning a home birth. Among those women, there were 9.3 adverse events per 1,000 births, including babies with brain damage due to labor problems and stillbirth. That compared to 5.3 adverse events per 1,000 births for those planning a hospital birth.
The study was published Friday in the medical journal, BMJ. It was paid for by Britain's department of health and another government health research body.
Dr. Tony Falconer, president of the Royal College of Obstetricians & Gynaecologists, said his group supports "appropriately selected home birth." He noted the higher risk of problems among first-time mothers choosing a home birth and said that raised questions about where they should deliver.
For Emily Shaw of Oxfordshire, northwest of London, giving birth in a hospital wasn't appealing. She wanted home births for both her sons but because her first baby was induced into labor, she had to deliver him in a hospital in October 2008.
Shaw delivered her second son at home in April. "I felt much more comfortable there," she said. "Instead of getting into a car to go to the hospital, the midwives came to me."
"It was nice to have the home comforts during labor," she added, saying she could eat in her own kitchen and use her own bathroom. "And unlike the hospital, they didn't kick out my partner in the middle of the night."

Monday, November 7, 2011

Effect of stress separation later in life

Postnatal Serotonin Type 2 Receptor Blockade Prevents the Emergence of Anxiety Behavior, Dysregulated Stress-Induced Immediate Early Gene Responses, and Specific Transcriptional Changes that Arise Following Early Life Stress
Madhurima Benekareddy, Krishna C. Vadodaria, Amrita R. Nair, Vidita A. Vaidya
Received 11 February 2011; received in revised form 26 July 2011; accepted 11 August 2011. published online 30 September 2011.

Abstract Full Text PDF Images References Supplemental Materials
Early life adverse experience contributes to an enhanced vulnerability for adult psychopathology. Recent evidence indicates that serotonin type 2 (5-HT2) receptor function, implicated in the pathophysiology of mood and anxiety disorders, is significantly enhanced in the maternal separation model of early life stress. We examined whether postnatal 5-HT2 receptor blockade would prevent the consequences of maternal separation on anxiety behavior and dysregulated gene expression.

Control and maternally separated litters received treatment with the 5-HT2 receptor antagonist, ketanserin, or vehicle during postnatal life and were examined for effects on adult anxiety behavior, adult stress-induced immediate early gene expression responses, and transcriptional changes within the prefrontal cortex during postnatal life and in adulthood.

Treatment with ketanserin during postnatal life blocked the long-lasting effects of maternal separation on anxiety behavior in the open field test and the elevated plus maze. Further, the dysregulated adult stress-induced expression pattern of the immediate early gene, Arc, observed in maternally separated animals was also prevented by postnatal ketanserin treatment. Ketanserin treatment normalized the alterations in the expression of specific genes in the prefrontal cortex of maternally separated animals, including changes in serotonin type 2A receptor messenger RNA expression during postnatal life and in genes associated with G-protein signaling in adulthood.

Postnatal treatment with the 5-HT2 receptor antagonist, ketanserin, blocked specific consequences of maternal separation, including anxiety behavior and dysregulated gene expression in the prefrontal cortex. Our results suggest that enhanced 5-HT2 receptor function may contribute to the emergence of anxiety behavior and perturbed stress responses following early life stress.

Key Words: Activity-regulated cytoskeletal-associated protein (Arc), habituation, immobilization stress, ketanserin, maternal separation, prefrontal cortex