The Family; From the Uterine Environment to Moment of Birth

Let’s talk about the uterine environment and the moment of birth.

What happens in the uterine environment at birth? Maybe if we had a clear perception of this moment in life we might have a better understanding of our child creation and the enormous responsibility that comes with parenting during conception, fetal growth, and infant health; all of which are essential before a child even begins their first step towards life.

Let’s look at the Latin word ‘infans’. It means ‘not speaking’ and hence the word infancy has come to mean the first year of childhood. Humans are born naked, helpless, and vulnerable. Humans have a long gestation period without obtaining great size or maturity at the time of birth. Another human peculiarity is the size of the brain, which weighs about 350 grams, or .772 pounds, at birth or is 10% of the average total body weight. The fetus adaptation from complete dependence upon the maternal uterine environment and placenta to the extra-uterine environment requires major changes in the infant body organs. Within a minute of the cessation of placental blood supply and the delivery from a watery to a gaseous environment, the infant lungs, heart, skin, and the alimentary, renal, and nervous systems undergo a series of dramatic functional changes.

During pregnancy the fetus depends on the mother for obtaining oxygen and nutrients, and for the excretion of carbon dioxide, heat, and other metabolic waste products through their combined bloodstreams. Upon birth the infant must fend for itself. More blood flow must be directed through the lungs for gas exchange, to the gut for nutrient absorption, to the kidneys for urine formation. But first and foremost, breathing must begin.

Fetal breathing movements are necessary for normal lung development in the womb. The patterns of these movements are related to the ‘sleep’ and ‘awake’ states of the fetus but may also be affected by external factors such as maternal smoking, drinking, drug abuse, and unhealthy diets. Normal vaginally-delivered infants make their first breathing movements within 20 to 30 seconds from the emergence of the nose. Within 90 seconds of complete delivery most infants have started to breathe rhythmically.

The circulation of the blood is drastically re-routed at birth. In the fetus there was relatively little blood flow through the lungs. Oxygenated blood reached the fetus from the placenta in the umbilical vein and joined the blood entering the right side of the heart. Most of this blood bypassed the lungs. After birth, the right ventricle must pump all the blood it receives through the lungs. This change is assisted by the onset of breathing itself. The expansion of the lungs with air reduces the resistance to flow in their blood vessels.

There is a continuum of nutrient supply by the mother from conception until after complete weaning. Even after weaning in most human societies, the mother is primarily responsible for helping the immature offspring to obtain adequate nutrition. The importance of optimal nutrition in human fetal and neonatal life is crucial in early life. Studies strongly indicate an increased incidence of hypertension, strokes, diabetes, and coronary artery disease in later life when the mother neglects her responsibilities for supplying healthy nutrition to her fetus and infant.

The human infant has relatively large stores of lipid, carbohydrate, and important nutrient elements such as iron. After birth, fat and lactose supplied in the mother’s milk are the major sources of energy, whereas before birth glucose supplied by the placenta provided the energy for fetal growth. This abrupt transition in nutrient supply causes major challenges to the digestive, absorptive, and metabolic processes of the infant. Until lactation is established, stores of glycogen in the liver and muscles, and triglyceride fat, help to maintain the infant body temperature, metabolic activity, and tissue growth.

If the infant’s temperature falls, neural thermostats stimulate the sympathetic nervous system to release heat and  fatty acids from brown fat. Brown fat looks brown because its cells are full of mitochondria, which are cellular power-houses for the release of energy from fat; it is located mainly between the shoulder blades in the newborn infant and there is relatively little in later life. Maternal body heat, and covering the head and body of the infant with clothing to reduce heat and fluid loss, greatly reduce the energy and fluid needs of the newborn.

Once the immediate needs for an adequate supply of oxygen have been met the infant normally within minutes begins to seek a supply of water and nutrients at the mother’s breast. During the first few days the mother supplies colostrum, which is specifically designed for her own infant in that it contains antibodies, cells, and other protective substances which will safeguard her infant from virtually all of the infections to which she has been previously exposed.

Over 90% of the fat present in human milk can be digested and absorbed by the infant intestine. Fat digestion is possible because lipases are present in the milk, and are also released from glands in the infant tongue. These enzymes remain active in the environment of the stomach. There are no digestive enzymes for protein in human milk in the infant’s stomach and duodenum. This is significant because there are important proteins in the milk, immunoglobulin and growth factors, which might otherwise be damaged before they can be absorbed from the intestine.

Weaning is the process of expanding the diet to include foods and drinks other than breast milk or infant formula. A Department of Health working group in 1994 recommended that most infants should not be given solid foods before the age of 4 months and that a mixed diet should be offered by the age of 6 months. Cow’s milk is not recommended as a main drink during infancy but during the second year it can make an important contribution to the intakes of several different nutrients and energy.

Factors which influence growth are genetic, nutritional, endocrine, and psychosocial. Malnutrition, specific nutritional deficiencies, and disease can prevent children from achieving their genetic growth potential. They are completely dependent upon their parents for their nutritional needs and brain development through nutrition. At birth much of the underlying brain and neuroendocrine system development is equipped to integrate newborn infant body functions, but it is becoming evident that if there is failure during the first year of life to use and develop good patterns of response to a given stimulus from the environment, then there may be significant impairment in the ability to respond in later life to stresses both physical and emotional.

I propose we begin educating parents and children now, in the family and through courses in our public school system, in an understanding of the fetal uterine environment and the moment of birth. If we could sensitize this generation with an appreciation of the responsibilities they undertake when giving birth, perhaps they will begin to improve the next generation and we could begin to end this cycle of poverty and sloth in our society.

I owe my understanding of this subject to Forrester Cockburn, Emeritus Professor of Child Health at the University of Edinburgh and a Fellow of The Royal Society of Edinburgh.

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