2014 Speakers & Topics

Men are in the midst of cultural change of redefining fatherhood. What hasn’t changed yet is the cultural assumptions of perinatal professionals towards men’s involvement in pregnancy and childbirth. Taking a biopsychosocial approach to understanding male behavior and needs during labor, Dr. Gilliland utilizes gender theory, studies of men's experiences of pregnancy and birth, and her own original research to increase the effectiveness of perinatal professionals. Participants can expect to comprehend male behavior more deeply by confronting their cultural assumptions, and bringing together their own experience with new knowledge.

Doula support practices of mothers during labor and birth are complex processes that involve attachment behaviors, therapeutic strategies, and communication skills. Similar to the infant relying on a primary caregiver as an attachment figure, the mother relies on the doula as a secure base during labor. In both situations the doula and caregiver are available for assistance; can accurately perceive her emotional needs; effectively represent her interests; are strong and capable physically and emotionally; and have resources that the mother or infant does not possess. Additionally, the rhythm and ritual of labor support set the stage for attunement between doula and mother, similar to the attunement process between mother and infant outlined by Daniel Stern. This research is significant since it provides a strong theoretical basis why doulas are effective; namely that they provide a focus for attachment behavior and provide a secure base for the laboring mother. The doula as a secure base theory also offers a well developed explanation why nurses have been shown to be less effective than doulas in obtaining the same outcomes. Except in unusual situations, nurses and fathers are unable to fulfill many of these attachment functions for mothers. With further development, this may become the fundamental theory of doula support.

Breeders, veterinarians, zoo curators, and field researchers with an interest in mammalian infant survival don’t focus on lactation. They focus on birth. If a birth is unimpeded, postbirth feeding almost always ensues; if there are too many birth interventions, non-human mammal mothers may reject the baby, and there is no feeding. Interventions can include a change of location during labor, an unfamiliar setting, a laborless birth, removal of normal birth smells, stress, and more. In other mammals, a good birth isn’t a bonus, it’s a basic. This talk ranges from infant survival strategies to the importance of maternal cleaning of her newborn, to the biology behind a mother drowning her toddlers in order to keep a boyfriend. The solemn and strong message: "It's the birth, silly!"

Pregnancy and birth are physiological events embedded in a social and cultural setting and therefore a good example of the application of a medical or social model.

On the one hand, the average woman in childbirth is not ill because pregnancy is not an illness. On the other hand, pregnant women are deemed to need a lot of health care throughout pregnancy and childbirth. Those who support the idea of a medical model often claim that: ‘Birth is only safe in retrospect’. Whilst those more in line with the social model would make the counterclaim that “every pregnancy is normal unless there are indications that something is wrong” or “childbirth is in principle a normal physiological event”.

The importance of understanding which model someone is adhering helps us to understand where they are coming from, what their likely view of the problem and hence to likely solutions are.

In this talk we will explore research that examines normal infant sleep development and consider the factors that affect infant sleep such as what babies are fed, where they sleep, and how we interact with them. We will compare human babies with those of other mammals and think about the ways in which biology leads to different caregiving needs and styles.
Using the research we have conducted at Durham Parent-Infant Sleep Lab, and that of other infant sleep researchers, we will consider what we know about parental attitudes and practices regarding night-time infant care, and practical issues such as parental tiredness, bedsharing, and sleep safety.

By keeping continuous track of the fetal heart rate during labor, cardiotocography (CTG), also known as electronic fetal monitoring, was supposed to prevent brain injury due to inadequate oxygenation and reduce emergent deliveries for suspected distress. This presentation will lay out the evidence documenting its failure to deliver on either count along with the reasons why its use persists despite this. In addition it will recommend evidence-based and “good practice” strategies during labor for minimizing the likelihood of nonreassuring fetal heart rate as well as optimal fetal monitoring practices for low- and at-risk women.

The idea of glucose as the sole metabolic fuel for the neonatal brain is still over-emphasised, in spite of long standing animal and human research that shows the relevance of other metabolic fuels such as lactate and ketones. Furthermore, innovative approaches to treating hypoglycaemia with buccal glucose have shown promise in well conducted randomised trials. In view of the wide availability of simultaneous near-patient blood glucose and lactate analysis, it is now possible to move away from simplistic assessments of blood glucose alone in day to day clinical management. However the clinical assessment of neurological status remains central to the evaluation of babies who are at increased risk of fuel deficiency, and ultimately determines which babies should be subjected to any measurements.

There is increasing evidence that the cultural context of infant care is influential in both creating and mitigating risks relating to sudden unexpected death in infancy; furthermore it is known that some ethnic minority communities in England show far lower risks for SUDI than the background population. Recent ethnographic work in multicultural communities in the north of England has demonstrated that attitudes and practices among the south asian immigrant community diverge from the stereotypical beliefs of the (mainly white british) primary care health professionals. 'Health' messages designed around the culture and behaviour of the white british community have no resonance with the experiences and expertise of the south asian community, and have the paradoxical potential to increase the risk to ethnic minority infants if it were not for the fact that they are largely disregarded by the minority community.

The exciting field of epigenetics contributes much to our understanding of the impact of intrauterine life on the child’s and adult’s physical and mental health, as well as the personality, stature and physical appearance. This presentation will give examples of historical events and discoveries that have led to today’s understanding that DNA – the genetic blueprint -- is only part of the equation that determines one’s life course. Epigenetics is the study of factors that foster or inhibit the expression of genes as dictated by DNA. Factors that interfere with optimal gene expression include maternal exposure to environmental toxins, violence or war, poor nutrition, emotional distress, racism, poverty and disease. The effects on the fetus can last a lifetime. The session ends with practical suggestions for institutions, individual birth workers and families to improve the maternal- fetal environment.

Engorgement and edema in breast tissue can lead to breastfeeding challenges which may contribute to early weaning. This first part of this presentation looks at a pilot research study which explores the relationship between intravenous (IV) fluids given to mothers during the peripartum period and postpartum breast or nipple swelling in the first ten days postpartum. Women who received IV fluids during labour had higher levels of edema postpartum and rated their breasts as firmer as and more tender than women who did not receive IV fluids. The second half of the presentation will look at differentiating between engorgement and edema, and ways to treat both of these conditions.

Program experience suggests that growth charts may not be as useful for screening at-risk infants as they are for education and motivation. When mothers are concerned about their baby’s current weight, growth charts can be used to enhance the investigation into her concerns. The visual trajectory of the curve of the baby’s growth can be used to expand the conversation from “how is your baby feeding now” to “how did your baby’s feeding patterns change from this point of the curve to this point of the curve.” This enriches the context from which to delve into the underlying factors that drive the dynamics of growth and determine if any of those factors need to be modified. It can also deflect the tendency to “judge” babies based on how they compare against other babies. Case studies of how the visual display of curves might influence focus will be presented.