Dr. Decipher: Mild Birth Problems and Their Implications Later

By Dr. John Janousek, M.D. Monday, January 23, 2012

While giving birth, did you or anyone in your family have an urgent C section? During labor, a belt around the waist records maternal uterine contractions and fetal heart rate. These are shown continuously as two lines on a monitor.

The normal fetal heart rate is 120-160. Drops during labor are called decelerations or "decels." Early decels are usually caused by compression of the baby's head and are not considered to be serious, but variable and late decelerations may indicate fetal hypoxemia (low oxygen), usually from umbilical cord compression. Too many of these is an indication for immediate delivery - usually by surgery.

I recently read a psychiatric autopsy of a young adult who committed suicide. The psychiatrist cited fetal hypoxia during labor and a low apgar at birth as contributing to the later development of poor non-verbal functioning and psychiatric problems, including bipolar illness and depression. This child was not premature or put in an ICU, and the parents said that they had been told only that the baby had mild hypoxia at birth.

It has been shown that severe hypoxia in the womb or at birth is associated with mental retardation, epilepsy, schizophrenia, autism, and cerebral palsy but is there evidence that a less serious deprivation of oxygen can cause less severe illness?

A study by Drs. Hoplins-Golightly, Raz, and Sander published in 2003 found that babies with mild to moderate birth hypoxia had a greater incidence of later cognitive and language abnormalities. It seems plausible that this could be extrapolated to psychiatric development also.

Some of the treatments for hypoxia include the use of supplemental oxygen, medications, and birth by caesarian section. Of course, there are dangers to surgery  such as maternal infections, bleeding, and anesthesia.

A more recent study by researchers at The Scripps Institute showed that in-utero fetal brain damage from hypoxia is linked to the action of a molecule known as LPA (lysophosphatidic acid). Perhaps in the future if LPA is definitively shown to be an intermediary in the pathway of brain damage a medication could be biologically engineered to block its action. This could be administered to mothers in labor.

Anyway, it looks like birth is a more important time for future mental health of a child than has been appreciated in the past.

Studies are difficult because it means following children for many years after birth, but we have barely scratched the surface of knowledge about this topic. It is an interesting concept that mild birth problems may cause subtle brain damage. If so, then much more attention should be paid to fetal monitoring and the prevention of even mild hypoxia during the birth process.