Fascinating. Also I love how she translated her mechanical engineering into applications for the human body- so cool.
I had one emergency cerclage and one preventative cerclage done by one of the top perinatalogists in the country and let me tell you, the article is spot on talking about all the stuff we don't know. I had zero preterm labor, just a shitty cervix that didn't want to hold and the best anyone could do was guess as to why.
I was very very lucky to have 2 full term healthy babies. I'd love to see this progress our knowledge about the how and why of everything labor /cervix related.
Post by georgeglass on Feb 18, 2019 11:45:03 GMT -5
I'm glad to see more research here. I went into labor at 25 weeks - had mag and was lucky enough to get stabilized. I stayed in the hospital for 6 weeks before they let me go home for modified bedrest. I very rarely let my brain go back to that dark place, so clearly I still haven't processed it all.
Post by formerlyak on Feb 18, 2019 11:49:35 GMT -5
While I think it’s great that this research is happening, it seems to leave out some things that are known and can be monitored in pregnancies where there is known risk of preterm labor, as there was with the woman in the story. Her first baby came early, which was my case as well. When I got pregnant with my second, I had to have additional monitoring starting at week 25 to see if there were any hints of early labor. I had my cervix measured weekly because doctors know that the cervix shortens when labor is near. I was hooked up to a monitor every week to see if there were any contractions I may not be feeling. I was put on bedrest at 34 weeks because I was showing signs of labor being near and they wanted to ensure stress didn’t aggravate it. The day my water broke, I happened to be in the doctor’s office for my twice weekly monitoring when the monitor picked up contractions. With rest, they stopped, so I was told to go home and come back the following day for another round. My water broke a few hours later. I was happy to have made it to 36 weeks before real labor started, since I went into labor at 32 weeks with my older son.
So while I’m glad they are doing this research, I don’t like that the article reads as “we know nothing” instead of “we have very limited knowledge and try x, y, and z in these high risk situations, but it’s clearly not enough and we want to do more.”
I distinctly remember after BB was born, that when every single OB/GYN that came to talk to me I would ask them why. Why did this happen? Why was my baby born 9 weeks early without any sign or indication that I was at risk for preterm labor. None of them knew. "This just happens" was the answer I got the most, followed by next time they can do things differently.
They did tests, there were no infections, my placenta was found to be normal. I was like the woman in the article, blown away by the fact that no one had any answers and just shrugged their shoulders.
How on earth is pregnancy and childbirth this unknown frontier?
Post by debatethis on Feb 18, 2019 11:53:02 GMT -5
First kid - Preterm labor at 35 weeks and I stayed dilated to 7 cm (yes really) for three weeks, on bedrest at home. Second kid - shortened cervix at 20 weeks, pessary placed (and failed), preterm labor and a hospital stay at 31 weeks, delivered at 36 weeks.
I have other health concerns, too, but the fact that my pregnancies keep getting shorter and docs really don't have any idea what can be done to prevent it has basically made the decision for me that we are done. We got really, really lucky to have two healthy kids with no NICU time, I'm not taking that risk again.
They’re doing great work. When I had my loss one of the things that I struggled with the most was that no one could tell me why it happened. Just that it sometimes happens and as of right now it’s still a mystery as to why. They’re working on answering the same exact questions I had.
Post by downtoearth on Feb 18, 2019 12:00:17 GMT -5
I almost posted this today when I read it on NPR. I also read an article last month that discusses how the release of oxytocin and prostaglandin (the hormones that increase right before labor and are responsible) was thought to come from the mother's pituitary, but now they think it's not triggered by the mom, but by something the baby might do. So crazy that the baby basically decides to be born?! What gland in them matures enough to give off some hormone to trigger the mom's hormones? So strange that we don't know when we know gestation so well. ETA - And those complex hormone exchanges don't even take into account the mechanics of the uterus or cervix or the connection with the amniotic sac and placenta. It's very fascinating that we can know so much and not a simple answer to why labor starts or stalls.
I distinctly remember after BB was born, that when every single OB/GYN that came to talk to me I would ask them why. Why did this happen? Why was my baby born 9 weeks early without any sign or indication that I was at risk for preterm labor. None of them knew. "This just happens" was the answer I got the most, followed by next time they can do things differently.
They did tests, there were no infections, my placenta was found to be normal. I was like the woman in the article, blown away by the fact that no one had any answers and just shrugged their shoulders.
How on earth is pregnancy and childbirth this unknown frontier?
I'm going to just make a guess and say because it's a "woman" problem? I'm not even being sarcastic or snide with that- I legitimately wonder if that plays a role and if we would know much more if it were men giving birth.
I distinctly remember after BB was born, that when every single OB/GYN that came to talk to me I would ask them why. Why did this happen? Why was my baby born 9 weeks early without any sign or indication that I was at risk for preterm labor. None of them knew. "This just happens" was the answer I got the most, followed by next time they can do things differently.
They did tests, there were no infections, my placenta was found to be normal. I was like the woman in the article, blown away by the fact that no one had any answers and just shrugged their shoulders.
How on earth is pregnancy and childbirth this unknown frontier?
I'm going to just make a guess and say because it's a "woman" problem? I'm not even being sarcastic or snide with that- I legitimately wonder if that plays a role and if we would know much more if it were men giving birth.
It's certainly possible. My other thought is that it's difficult to get "healthy" subjects to agree to additional testing and monitoring for the sake of research with the potential risks it could carry. I can understand that as a woman, a first time mom at that, I don't know if I would have agreed to such a thing.
DS1 was born at 37+6, so not exactly early but he clearly was not ready to be born as he couldn't breathe on his own. I also developed severe postpartum pre-eclampsia.
I've obviously been focused on avoiding pre-e again, and there's been a lot of (not so mainstream) research that diet and nutrition plays a huge component. It's kind of exhausting to follow the recommendations (basically plenty of protein and calories). I'm pretty sure I've read the same nutritional theory applies to early labor, though there is still an "other reasons" percentage.
I'm really anxious to see how this pregnancy compares. I've read a lot of success stories though.
While I think it’s great that this research is happening, it seems to leave out some things that are known and can be monitored in pregnancies where there is known risk of preterm labor, as there was with the woman in the story. Her first baby came early, which was my case as well. When I got pregnant with my second, I had to have additional monitoring starting at week 25 to see if there were any hints of early labor. I had my cervix measured weekly because doctors know that the cervix shortens when labor is near. I was hooked up to a monitor every week to see if there were any contractions I may not be feeling. I was put on bedrest at 34 weeks because I was showing signs of labor being near and they wanted to ensure stress didn’t aggravate it. The day my water broke, I happened to be in the doctor’s office for my twice weekly monitoring when the monitor picked up contractions. With rest, they stopped, so I was told to go home and come back the following day for another round. My water broke a few hours later. I was happy to have made it to 36 weeks before real labor started, since I went into labor at 32 weeks with my older son.
So while I’m glad they are doing this research, I don’t like that the article reads as “we know nothing” instead of “we have very limited knowledge and try x, y, and z in these high risk situations, but it’s clearly not enough and we want to do more.”
But the stuff you're talking about is mitigation, not prevention. Bedrest doesn't prevent PTL and carries a whole bunch of its own risks. Weekly monitoring and cervical length checks are really about all that can be done (with the exception of cerclage or pessary placement) but it's not preventative. It's essentially a wing and a prayer that they manage to catch the cervical shortening in time to give mag and steroids or get you to a hospital with a better NICU for a better outcome. They know that some pregnancies will respond to magnesium, and some will go to term with cerclage, but what they're investigating is why those things happen in the first place to be more proactive instead of only having reactionary measures in their bag of tricks.
DS1 was born at 37+6, so not exactly early but he clearly was not ready to be born as he couldn't breathe on his own. I also developed severe postpartum pre-eclampsia.
I've obviously been focused on avoiding pre-e again, and there's been a lot of (not so mainstream) research that diet and nutrition plays a huge component. It's kind of exhausting to follow the recommendations (basically plenty of protein and calories). I'm pretty sure I've read the same nutritional theory applies to early labor, though there is still an "other reasons" percentage.
I'm really anxious to see how this pregnancy compares. I've read a lot of success stories though.
So avoiding pre-e can be somewhat (loosely) tied to diet? I know when we took Bradley classes that they had a high protein diet that we had to track, but I can't remember why Dr. Bradley picked a high protein diet now - was it from anecdotally seeing less complicated births if diet was high in protein? That is interesting.
DS1 was born at 37+6, so not exactly early but he clearly was not ready to be born as he couldn't breathe on his own. I also developed severe postpartum pre-eclampsia.
I've obviously been focused on avoiding pre-e again, and there's been a lot of (not so mainstream) research that diet and nutrition plays a huge component. It's kind of exhausting to follow the recommendations (basically plenty of protein and calories). I'm pretty sure I've read the same nutritional theory applies to early labor, though there is still an "other reasons" percentage.
I'm really anxious to see how this pregnancy compares. I've read a lot of success stories though.
So avoiding pre-e can be somewhat (loosely) tied to diet? I know when we took Bradley classes that they had a high protein diet that we had to track, but I can't remember why Dr. Bradley picked a high protein diet now - was it from anecdotally seeing less complicated births if diet was high in protein? That is interesting.
It's called the Brewer Diet. Basically the theory is pre-e is caused by lack of placental blood flow. By eating a high protein, high calorie diet you encourage blood volume expansion which will then go to your placenta.
Each day you have to eat: 8 servings protein 2 eggs 4 dairy 5 starch (grain, starchy veggies) 2 vitamin c 1 vitamin a 2 dark greens
It's...a lot. But I figure even if it doesn't help, all I've done is gain a few extra pounds. It should all work out to around 2500 calories.
DS1 was born at 37+6, so not exactly early but he clearly was not ready to be born as he couldn't breathe on his own. I also developed severe postpartum pre-eclampsia.
I've obviously been focused on avoiding pre-e again, and there's been a lot of (not so mainstream) research that diet and nutrition plays a huge component. It's kind of exhausting to follow the recommendations (basically plenty of protein and calories). I'm pretty sure I've read the same nutritional theory applies to early labor, though there is still an "other reasons" percentage.
I'm really anxious to see how this pregnancy compares. I've read a lot of success stories though.
So avoiding pre-e can be somewhat (loosely) tied to diet? I know when we took Bradley classes that they had a high protein diet that we had to track, but I can't remember why Dr. Bradley picked a high protein diet now - was it from anecdotally seeing less complicated births if diet was high in protein? That is interesting.
My OB/MFM/midwives told me the same thing. There's not a ton of research around it but anecdotally it seems to correlate. And they ordered a high-protein/high-calorie diet for me when I went into labor at 31 weeks because they wanted the baby to get as many extra calories as possible - they said babies w/moms who've been eating high cal/high protein in their pregnancies tend to fare better in the NICU too.
It is amazing to me how little research has been done on this. For all our talk about caring about babies in this country, we don't do a lot to show it.
The story was fascinating to listen to. I was also very impressed with the woman who transferred her skills as a mechanic to human biology.
DS1 was born at 37+6, so not exactly early but he clearly was not ready to be born as he couldn't breathe on his own. I also developed severe postpartum pre-eclampsia.
I've obviously been focused on avoiding pre-e again, and there's been a lot of (not so mainstream) research that diet and nutrition plays a huge component. It's kind of exhausting to follow the recommendations (basically plenty of protein and calories). I'm pretty sure I've read the same nutritional theory applies to early labor, though there is still an "other reasons" percentage.
I'm really anxious to see how this pregnancy compares. I've read a lot of success stories though.
While this may be true for some (anecdote!), I was on a high-calorie, high-protein diet when I went into early labor. Sometimes, I pretend I still am - at least the high calorie part.
DS1 was born at 37+6, so not exactly early but he clearly was not ready to be born as he couldn't breathe on his own. I also developed severe postpartum pre-eclampsia.
I've obviously been focused on avoiding pre-e again, and there's been a lot of (not so mainstream) research that diet and nutrition plays a huge component. It's kind of exhausting to follow the recommendations (basically plenty of protein and calories). I'm pretty sure I've read the same nutritional theory applies to early labor, though there is still an "other reasons" percentage.
I'm really anxious to see how this pregnancy compares. I've read a lot of success stories though.
While this may be true for some (anecdote!), I was on a high-calorie, high-protein diet when I went into early labor. Sometimes, I pretend I still am - at least the high calorie part.
I'm certainly not meaning to diminish the other factors. I apologize if it came across that way.
It is amazing to me how little research has been done on this. For all our talk about caring about babies in this country, we don't do a lot to show it. .
Daughter and sister of research ethicists here — the ethics of researching children, babies, and pregnant women make it really challenging to perform actual controlled studies. If you think about it, having a control group means you could actually be withholding lifesaving treatment from a fetus, baby, child, pregnant woman, etc. The ethics of that are different from doing similar research on consenting non-pregnant adult subjects. Sometimes the best they can do is try to collect data after-the-fact, but it’s not as controlled and won’t be as accurate.
While this may be true for some (anecdote!), I was on a high-calorie, high-protein diet when I went into early labor. Sometimes, I pretend I still am - at least the high calorie part.
I'm certainly not meaning to diminish the other factors. I apologize if it came across that way.
No worries - I think that's one of the many problems with not having a real understanding of what causes any of this. There is so much guilt/anxiety about what causes everything, and it's so easy to obsess about what I/we might have done/should have done differently.
I went into labor just before 24 weeks, and we still don't know what caused it. I didn't even know I was having contractions until I was too far gone to stop it. I'll never forget being in the hospital room and them telling me, "the head is down, you're 7cm dilated and she's going to be born in the next 24 hours." She was born 8 hours later. I hadn't even read anything about labor, so in the delivery room, I initially didn't know why they were counting during contractions.
Fortunately, she's healthy, but there is no explanation for why my body started the labor process.
It is amazing to me how little research has been done on this. For all our talk about caring about babies in this country, we don't do a lot to show it. .
Daughter and sister of research ethicists here — the ethics of researching children, babies, and pregnant women make it really challenging to perform actual controlled studies. If you think about it, having a control group means you could actually be withholding lifesaving treatment from a fetus, baby, child, pregnant woman, etc. The ethics of that are different from doing similar research on consenting non-pregnant adult subjects. Sometimes the best they can do is try to collect data after-the-fact, but it’s not as controlled and won’t be as accurate.
I definitely understand that, but it seems that there has been minimal effort to do research, never mind the challenges.
This article is really interesting. Just sent it to a friend of mine whose first baby was born at 34 weeks. He's fine and healthy, but she understandably carries trauma from his sudden appearance. She had to be induced with her second at 40 weeks, and no one could tell her why she went full term with him and not his brother.
I remember when they discovered my cervix was only 1cm at 29 weeks. I was sent home on bed rest, but the doctors couldn't tell me why my cervix was so short or guess when I might go into labour. One doctor even said "well, we don't measure cervixes after 20 weeks in normal pregnancies. We only caught yours because we checked on your placenta previa. There could be tons of women with normal pregnancies walking around with shortened cervixes for weeks, going to full term and we'd never know." My DD was ultimately born at 37 weeks because she was IUGR and I had a c-section, so we'll never know exactly how my cervix would have behaved in labour, but the doctors were all amazed it held out for another 8 weeks.
I think that the article is not considering what is happening in the whole body, just the reproductive tract. For instance, oral health has been associated with a lot of systemic health conditions, including preterm birth. This data has been out since the late 1990s,
I am curious as to whether OBs consider what is happening in their patient’s mouths during pregnancy. I have never been pregnant, so have no personal experience here, but my sister has and her oral health wasn’t even discussed in any of her 4 pregnancies. Her kids were born 1994-2004, so about 8 years after the first report of this in 1996.
Post by crystald528 on Feb 18, 2019 15:36:03 GMT -5
I am so glad that they are researching this. I am sure it has not been researched since it is a woman's issue and we are treated as only the vessel when pregnant. I read about all of the awful things that can happen when new mom's symptoms are ignored and feel lucky to be healthy on the other side of 3 pregnancies.
My water broke at 34 weeks with my 1st. When the doctor couldn't explain it, my husband asked me if we shouldn't have more kids. He was so freaked out that they didn't know why it happened or how to prevent it when everything else about the pregnancy was textbook. We went on to have 2 more without any issues, thank goodness.
So avoiding pre-e can be somewhat (loosely) tied to diet? I know when we took Bradley classes that they had a high protein diet that we had to track, but I can't remember why Dr. Bradley picked a high protein diet now - was it from anecdotally seeing less complicated births if diet was high in protein? That is interesting.
It's called the Brewer Diet. Basically the theory is pre-e is caused by lack of placental blood flow. By eating a high protein, high calorie diet you encourage blood volume expansion which will then go to your placenta.
Each day you have to eat: 8 servings protein 2 eggs 4 dairy 5 starch (grain, starchy veggies) 2 vitamin c 1 vitamin a 2 dark greens
It's...a lot. But I figure even if it doesn't help, all I've done is gain a few extra pounds. It should all work out to around 2500 calories.
Discuss the aspirin protocol with your doctor it’s has a good bit of success.
Pre-E is placenta related so in your case I wouldn’t be surprised if placenta was crapping out which led to pre-term delivery and your PP Pre-E
I was born at 28 weeks in the late 70's, my brother at 30 weeks in the early 80's. My mom and dad lost 3 other babies. I can't believe that the research hasn't discovered anything new in all those years! Glad these women are working on this - no one should have to go through the trauma my parents did.
I went into labor with DD1 at 34w, 6d. Up until then, there were no indications that I'd deliver early and even after the fact the was no real reason as to why it happened. So during my 2nd pregnancy, my OB took extra precautions: frequent cervical length checks, rest orders, weekly progesterone shots, etc. Despite all that, and again no indications of any particular problem, I went into labor with DD2 at 35w, 1d.
Although DD1 did spend a week in NICU, we were fortunate in that both girls were healthy overall. But the 2nd pregnancy and ita outcome confirmed that we didn't want any more kids. My body just doesn't seem to want to stay pregnant past 35 weeks and no one knows why, and we didn't want to push our luck.
I went into labor with DD1 at 34w, 6d. Up until then, there were no indications that I'd deliver early and even after the fact the was no real reason as to why it happened. So during my 2nd pregnancy, my OB took extra precautions: frequent cervical length checks, rest orders, weekly progesterone shots, etc. Despite all that, and again no indications of any particular problem, I went into labor with DD2 at 35w, 1d.
Although DD1 did spend a week in NICU, we were fortunate in that both girls were healthy overall. But the 2nd pregnancy and ita outcome confirmed that we didn't want any more kids. My body just doesn't seem to want to stay pregnant past 35 weeks and no one knows why, and we didn't want to push our luck.
My friend had this happen as well. 1st kid 32 weeks, second 34, and third had to be induced at 42 weeks - so bizarre!