Wednesday, January 07, 2015

What Will Be Talked About? : A Road Map for 2015

The New Year is upon us.  While it would be great to gaze into a crystal ball to see what the most researched and talked about birth and breastfeeding topics would be in 2015, one can only speculate.

Based on what was most talked about in 2014, here is my prediction of the top five topics for 2015, in no particular order.

  1. Increase breastfeeding rates by normalizing labor and birth
    Missing often in the conversation is the impact of what is done during labor and birth and
    the influence on the breastfeeding experience.  As author Linda J. Smith so pragmatically 
    presented in her book "Impact of Birthing Practices on Breastfeeding 2nd Ed.", there is mounting evidence that birthing practices/interventions impact the breastfeeding dyad. 

    If we want to promote breastfeeding and raise the numbers as indicated by the Healthy People 2020 initiative AND increase the health of newborns and strengthen the relationship between children and their mothers, we must dynamically address labor/birth practices and how they influence breastfeeding and the postpartum. 
2. Vaginal Birth After Cesarean
In spite of efforts of birth advocates, the cesarean section rate is still alarmingly high.  A "new concept", collaborative care (where obstetricians and midwives work together with a woman for pregnancy care) has produced better outcomes, including lower cesarean rates.

Also many care provides have not heard of or embraced the 2014 ACOG guidelines.  We must continue to bring both of these pieces of information to the forefront of the consumers' focus - in many ways - from articles to Facebook/Twitter posts and also infographics that can be posted in many places including Instagram and Pinterest.
3.  Postpartum support
While many women experience some form of mild mood changes during and after the birth of their baby, it is estimated that 15-20% of women will experience significant depression or anxiety.  Perinatal mood and anxiety disorders (PMAD) is not selective and can affect women from every culture and socio-economic level.  Anyone who works with expectant and new parents need to be very familiar with all aspects of PMAD and the resources in their communities to which referrals can be made.
4.  Epigenetics & the Microbiome
First, what is epigenetics?  Epigenetics is the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself. Epigenetics modifications can be as commonly as the manner by which cells end up as the particular type of cells they become.  In essence, it is the cellular traits inheritable by daughter cells.  Professor Tomas Ekstrom reported in his article ("Cesarean delivery and hematopoietic stem cells epigenetics in the newborn infant: implications for future health?" American Journal of Obstetrics and Gynecology Nov 2014 Volume 211, Issue 5. ) higher rates of methylation of stem cells from 18 babies delivered by cesarean than 25 via vaginal birth.  Methylation of DNA affects whether genes are expressed or not within a cell and is the major path through which environmental factors can alter the expression of genetic traits.

A microbiome is the ecological community of microorganisms that literally share our body space.  In 2007, the National Institutes of Health (NIH) launched the Human Microbiome Project (HMP). Movies such as Microbirth and findings such as those from Gastroenterology & Endoscopy News, show that a baby's first exposure to bacteria varies by the method of delivery and those differences will have health implications in later life. Research is showing that the gut bacteria may be important to the development of a healthy immune system.  Alterations in the gut bacteria early in life tends to increase the occurrence of allergies.  For example, David Brumbaugh, Asst. Professor of Pediatrics at the University of Colorado School of Medicine cited a 2013 article in the American Journal of Obstetrics and Gynecology (Cho, C.E. et al. Cesarean section and development of the immune system in the offspring. American Journal of Obstetrics & Gynecology 2013 Apr; 208 (4): 249-54) where gut bacteria may not get established in early life with babies born by cesarean section.  These babies may be at a higher risk of asthma, Type 1 Diabetes, and possibly celiac disease.  This brings attention to what childbirth educators have said for decades: what we do during the birthing process either positively or negatively affects the baby.
5.  Using Social Media as an Adjunct Education Form
The use of social media is the fastest form of education and outreach for the millennials and younger population. In fact, millennials comprise the largest demographic in the US today. Over 60% find that social media is an important source of news and current affairs. It is the preferred method (over 45%) of communication among millennials in countries such as the US, United Kingdom, China, Brazil, Italy, and Germany.  And the top two apps of the millennials are Facebook and YouTube.  This creates a guide for childbirth educators and other birth professionals to use when educating, or marketing their birth related business.

Where we go and what we do with this information will determine the outcome of our society. It is vital that birth professionals of all ages obtain the most current and evidence-based information for the creation of best practice.

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