Doula Program Supports Latina Mothers The word "doula" is a Greek term traditionally used to describe a "mother's helper." Today, it refers to a woman specially trained to assist other women during labor and delivery. This kind of support is commonplace in cultures throughout the world, and studies have shown that when a mother-to-be has the support of a doula, her labor is often shorter and easier, with fewer complications.
Last summer, the Beth Israel Deaconess Department of Obstetrics and Gynecology instituted a Doula Program for Latina Women, providing expectant mothers with culturally competent care and emotional support during labor and delivery. This is the only program of its kind within the Harvard Medical School hospital system.
"The presence of a trained doula enhances communication and creates a more friendly, less isolated birth experience," explains obstetrician Adrienne Lara, M.D., medical director of the program. "For many of our Latina patients, this can be particularly important."
Doulas do not replace fathers, family members or medical staff in the delivery room. They do serve as non-medical labor coaches/interpreters, providing women with back rubs, helping them change positions, and offering words of encouragement to both mothers and fathers. In addition, says Lara, the doulas participating in the Beth Israel Deaconess program provide Spanish interpretation services, and often help facilitate communication between the patient and the caregiver.
The program is currently staffed by eight women who received doula training from Lara and, as part of their training, identified common life experiences connected to their Latina heritage. "The doula's role [in our program] goes far beyond providing interpreter services," explains Lara. "Understanding culture-specific experiences and beliefs is something that can't be taught."
The Role of Thrombospondin-1 as an Angiogenesis Inhibitor
New findings from Beth Israel Deaconess Medical Center are providing another important clue to the puzzle of angiogenesis, the process by which blood vessels grow and multiply, enabling tumors to thrive. These findings, which help explain the role of the naturally occurring protein thrombospondin-1 (TSP-1), could lay the groundwork for future cancer therapies. "The history of cancer research has traditionally focused on the genetics of cancer cells," explains Jack Lawler, Ph.D., of the Division of Cancer Biology and Angiogenesis in the Department of Pathology at BIDMC. "Now we have to start thinking of a tumor as complex tissue, and therefore, also look at the cells that form the tumor's '"microenvironment.'"
TSP-1 was the first protein to be identified by scientists as an angiogenesis inhibitor. But, according to Lawler, until now it was unknown how it actually worked. The November issues of Cancer Research and the American Journal of Pathology contain studies by Lawler and his colleagues which show for the first time how spontaneously occurring tumors in mice are influenced by TSP-1. And in the Oct. 23 issue of the Proceedings of the National Academy of Sciences, Lawler and scientists from the University of California-Los Angeles created special strains of breast-cancer prone mice to help in understanding the protein's influence.
During the process of angiogenesis, endothelial cells lining the inside of blood vessels divide and move outside by way of a series of "holes," created when enzymes remodel the outer layers of the blood vessel. The newly divided endothelial cells form sprouts that grow in the direction of the diseased tissue (tumor), ultimately forming tubes that become new capillaries to "feed" the tumor. In the AJP study, conducted at BIDMC, researchers established that the TSP-1 protein functions as a "modifier" or "landscaper" gene to make the tumor's microenvironment less hospitable to growth. When TSP-1 was removed, constraints on endothelial cells were released, making it easier for tumors to develop.
The other studies help explain the molecular mechanisms of TSP-1. The PNAS study found that the protein suppresses the activation of MMP9, a molecule that promotes both the formation of new blood vessels and tumor invasiveness. The report in Cancer Research further elucidates the role of TSP-1, this time in inhibiting the growth of experimental melanomas and lung carcinomas through the creation of recombinant proteins.
"Although previous research had identified TSP-1 as an angiogenesis inhibitor, these recent studies represent the first time that the mechanisms of action have been identified in the context of the actual tumor," Lawler explains.
New Drug Prevents Clotting During Orthopedic Surgery
A new class of synthetically produced anticoagulant has proven more effective than existing medications in preventing the development of potentially life-threatening blood clots in patients who have undergone major knee surgery or hip fracture surgery, according to two separate studies which appeared in the Nov. 1 issue of The New England Journal of Medicine.
"Venous thromboembolism is a major risk of orthopedic surgery," according to Kenneth A. Bauer, M.D., director of Thrombosis Clinical Research in the Division of Hematology/Oncology at Beth Israel Deaconess Medical Center and Chief of the Hematology Section at VA Boston Healthcare System. "The results of these studies show the new agent fondaparinux, started four to eight hours after surgery, to be better than our best existing therapy."
An estimated 289,000 knee surgeries are performed each year in the United States, while surgeries for hip fractures total 329,000. These figures are expected to increase as our population ages and life expectancy increases.
Deep-vein thrombosis and pulmonary embolism are common and potentially life-threatening complications of orthopedic surgery. To help prevent the development of these blood clots, blood-thinning agents are routinely administered prior to or shortly after surgery. Without such intervention, the incidence of deep-vein thrombosis is 40 to 84 percent.
Fondaparinux is a new compound made up of a molecule that works by inhibiting a single enzyme, Factor Xa, to prevent blood coagulation. This is in contrast to the widely used anticoagulant heparin, which prevents clotting by interacting with a number of plasma components. It is this targeted mechanism which may be responsible for the drug's superior effectiveness. Like other anticoagulants, fondaparinux poses a risk of bleeding.
However, these studies found the rate of clinically important bleeding among patients receiving fondaparinux to be comparable to bleeding rates of existing anticoagulant agents. The studies were funded by the drug companies NV Organon and Sanofi-Synthelabo, for which Bauer served as a consultant.