Samuel Morse, Blizzard Baby, December 27, 2010

Ah.... One of the great things about home birth -having the midwife come to you in the blizzard instead of  having to trudge out into the blowing snow to go the the hospital. Samuel Morse sure picked a cold and billowy morning to be born. Brrr! But snuggled with mom he is as happy as can be. Welcome!

May all babies be born into loving hands... 

K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com

Nathan Henri, December 23, 2010

Even while waiting on a name, this little guy was as cute as a button. His name was worth waiting for: Nathan Henri. His big brother Levi wasn't sure if the new baby or the blue balloons that came with him were more interesting.

May all babies be born into loving hands...

K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com

Baby Nathaniel Guy, December 22, 2010

Born on December 22, in time to celebrate Christmas in his father's arms, Nathaniel Guy is sturdy, sweet and so alert! Welcome, little one.

May all babies be born into loving hands... 

K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com

Our Christmas baby: Savion Taheim, December 25, 2010

On Christmas Day, Savion Taheim arrived and captured his mother's heart. He is sweet and serene and tenacious. Welcome!

May all babies be born into loving hands...

K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com

MedScape Article: Prenatal Exposure to Acetaminophen Linked to Childhood Wheezing

After so many years of saying that as far as we know acetaminophen is safe to use in pregnancy, now the story has been updated. See below for information that was presented at the World Allergy Organization 2010 Conference. Babies in utero are still of this external world, exposed to our environment, sometimes with long term term consequences. So whats a mother-to-be to do when she has a headache? Drink lots of water, get a neck tub, try and ice pack, judicious use of essential oils, pray, and yes, maybe even some Tylenol. Pain isn't going to be good for babies-to-be either.

May all babies be born into loving hands...

K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com

From Medscape Medical News

Prenatal Exposure to Acetaminophen Linked to Childhood Wheezing

Becky McCall


December 16, 2010 (Dubai, United Arab Emirates) — The exposure of pregnant women to certain environmental factors is associated with wheezing and asthma in their children.

Speaking here at the World Allergy Organization (WAO) 2010 International Scientific Conference, Harold Nelson, MD, professor of medicine at National Jewish Health in Denver, Colorado, discussed the environmental factors that trigger epigenetic changes in the fetus, but which might not manifest until the children are 3 to 5 years of age, or even older.

"The children's genotypes are changed so that if they run into the appropriate environmental factors when they are older, they may be susceptible to wheezing or asthma," he told Medscape Medical News.

Factors that might present a risk to the developing fetus include acetaminophen, maternal vitamin D deficiency, domestic spray chemicals, tobacco smoke, and maternal use of antibiotics.

"How can something that happens in the uterus have an impact on asthma in the child aged 6, 7, or 8? The explanation, if it is causal, is in epigenetic mechanisms," Dr. Nelson explained. "Early environmental exposure in utero plays a key role in activating and altering genes through histone methylation and acetylation of DNA, and alteration of chromatin structure. Once these have occurred in the fetus, they will be replicated throughout the infant's life, and may even be passed to subsequent generations."

Low intake of vitamin D by the mother might be associated with epigenetic changes in the fetus. Dr. Nelson added that low levels of vitamin D are a major problem in people in temperate regions of the globe. "By contrast, the Mediterranean diet, which is rich in oily fish, dairy, and produce, has been reported to be protective against asthma during pregnancy."

"This isn't the severe rickets-causing deficiency, but rather insufficient levels of the vitamin," Dr. Nelson pointed out. He said that insufficient vitamin D is linked to dysfunctional T cell regulation, with a lack of downregulation of Th1 and Th2. Vitamin D also interferes with the toll-like receptor signaling associated with bacterial and viral infections, which predisposes the infant to increased respiratory tract infections."

Domestic spray cleaning products have also been associated with epigenetic changes. Dr. Nelson cited European data from adults supporting an association between maternal use of domestic chemicals during pregnancy and wheezing and impaired lung function in children up to 8.5 years of age.

"They showed that exposure was associated with the early onset of persistent asthma, intermediate onset of persistent asthma, and late onset of wheezing. These were only found in nonatopic children," Dr. Nelson reported.

"There were also detriments in pulmonary function. Risk of wheezing at 8.5 years is linked to exposure to domestic chemicals prenatally. We see no relation with intermittent wheezing, which is more related to viral infections," he added.

An increasing number of longitudinal and observational studies have related exposure to acetaminophen in utero to asthma in later childhood.

In the United States, acetaminophen use by pregnant women has increased substantially since the early 1980s, so that the majority of women in the United States take acetaminophen during pregnancy. "Over a similar time period, 1980 to 1995, asthma prevalence among children in the United States doubled," said Dr. Nelson.

Further evidence of an association between acetaminophen use during pregnancy and wheezing in offspring was drawn from the Nurses' Health Study, an investigation of factors influencing women's health in 48,000 American nurses who were followed prospectively for 6 years. Information was gathered on the use of acetaminophen, and this was related to the development of physician-diagnosed asthma.

"Those who used acetaminophen for over half of the days, compared with those who didn't use it at all, had an increase in asthma of 60%" (odds ratio, 1.62) reported Dr. Nelson.

He referred to a recent study conducted by researchers at Columbia University in New York City, who compared total intake of acetaminophen by women during pregnancy with wheezing in children at age 5. They showed a highly significant dose-response relation for those with no exposure, 1 day of exposure, 2 to 4 days of exposure, and more than 5 days of exposure.

The researchers found that 34% of mothers reported acetaminophen use during pregnancy, and 27% of their children had wheezing at 5 years. On analysis, prenatal acetaminophen exposure predicted current wheeze (multivariate relative risk, 1.71; 95% confidence interval, 1.20 to 2.42; P = .003), and the risk was found to increase with increasing number of days of prenatal acetaminophen exposure (P < .001).

It has been suggested that acetaminophen interferes with the glutathione defense mechanism against oxidative stress in the lungs and with T-regulatory cell development, Dr. Nelson noted.

The researchers looked at the glutathione S-transferase Pi (GSTP) polymorphism in the study children and found that the association between acetaminophen exposure and wheezing was limited to children with a polymorphism in the GSTP gene. "Unaffected children have AA alleles, whereas affected children have at least 1 copy of the GSTP1 minor allele (AG or GG)."

Dr. Nelson particularly welcomed this study because it avoided selection bias. "If there was a bias that caused women with a knowledge of [the association] to avoid acetaminophen, there was still no way they would have known about their genetic make-up. I think this study is really clear of selection bias because it only occurred in the two thirds of the participants with the GSTP polymorphism. The one third that didn't have the polymorphism had no risk."

"This is the strongest argument so far that this is real," concluded Dr. Nelson.

Commenting on the study, Richard Lockey, MD, president of the WAO and director of the Division of Allergy and Immunology at James A. Haley Veterans' Hospital in Tampa, Florida, said that Dr. Nelson addressed a very important aspect of medicine. "Probably the most compelling evidence for such an association is with passive smoking, smoking, and with newer information, particularly acetaminophen."

He added that establishing a causal relation is complicated. "Asthma is so complex that I suspect there are many factors that predispose us to develop this disease — our genes, certain prenatal exposures, diet, exposure to certain kinds of infections, cats, dogs, and dust mite exposure in our environment both before and after we are born, among others."

Finally, Dr. Lockey cautioned that it is too soon to conclude that these findings will alter the prevalence of asthma in the near future. "While some avoidance is possible, much more information is necessary about these associations in particular to determine whether we can change the prevalence of asthma by changing what we do during pregnancy and during childhood."

Dr. Nelson and Dr. Lockey have disclosed no relevant financial relationships.

World Allergy Organization (WAO) 2010 International Scientific Conference. Presented December 7, 2010.

Medscape Medical News © 2010 WebMD, LLC
Send comments and news tips to news@medscape.net.

After Dozens of Deaths, Drop-side Cribs Outlawed

 Even the traditional drop side crib is now outlawed. So many dangers, so many hazards. Oh, what is a parent to do? Just let your baby sleep on his midwife!

May all babies be born into loving hands... 

K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com

After Dozens of Deaths, Drop-side Cribs Outlawed
Associated Press

(Dec. 15, 2010)   It's the end of the traditional crib that has cradled millions of babies for generations. The government outlawed drop-side cribs on Wednesday after the deaths of more than 30 infants and toddlers in the past decade and millions of recalls.

It was a unanimous vote by the Consumer Product Safety Commission to ban the manufacture, sale and resale of the cribs, which have a side rail that moves up and down, allowing parents to more easily lift their child from the crib.

The new standard requiring cribs to have fixed sides would take effect in June. The move by CPSC would also prohibit hotels and childcare centers from using drop-sides, though those facilities would have two years to purchase new cribs. CPSC Chairman Inez Tenenbaum hailed the new standard for cribs as one of the strongest in the world. "I believe these new standards will markedly reduce crib-related hazards and help to ensure that young children sleep more safely in their cribs," Tenenbaum said after the vote.

Around for decades, drop-side cribs have come under scrutiny in recent years because of malfunctioning hardware, sometimes cheaper plastics, or assembly problems that can lead to the drop-side rail partially detaching from the crib. When that happens, it can create a dangerous "V''-like gap between the mattress and side rail where a baby can get caught and suffocate or strangle.

In all, drop-side cribs have been blamed in the deaths of at least 32 infants and toddlers since 2000 and are suspected in another 14 infant fatalities. In the past five years, more than 9 million drop-side cribs have been recalled, including cribs from big-name companies such as Evenflo, Delta Enterprise Corp., and Pottery Barn Kids.....

CPSC video

MedScape Article:Experts Argue about Home Birth Issue

The Wax article, poor as it was, lives on. Here is a recent editorial with some good folks. (Quinn thinks that home birth is just fine and dandy, thank you very much!).

May all babies be born into loving hands... 

K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com

Little Princess Suraya

First December brought Local Care Midwifery a King, and now a princess; Suraya Elizabeth arrived early Friday morning. Just like her name, she is beautiful, calm and adored. Welcome!

May all babies be born into loving hands... 

K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com

Baby Asa

On the morning of December 6, little Asa, named for an ancient king, came into the world. By the time the winter sun was rising in the sky, Asa had met his adoring family and was snuggled in for a nap. Thanks be for the new day and this newborn baby too!

May all babies be born into loving hands... 

 K. Michelle Doyle, CNM, NYS LM
www.localcaremidwifery.com
www.localcaremidwifery.blogspot.com