By Dr. Jim Ferguson

We tend to take the natural processes of life for granted.  I don’t think about breathing or even sleeping very often because they are under the control of subconscious areas of my brain.  Actually, patients not infrequently consult me about “breathlessness.”  Of course shortness of breath can be caused by heart failure and other serious problems, but commonly it’s caused by anxiety, which often manifests as breathlessness and excessive “sighing.”  And most of the time I sleep fine if I just let my nervous system do what it is designed to do, and let go of the cares of the world.  Admittedly, that’s sometimes easier to say than to do these days.

Everyone has a mother, who once was pregnant and then gave us life through birth.  Scientists continue to study the phenomenon of life and even strive to create life by organizing its building blocks.  I’m not talking about test tube babies where a human egg is injected with human sperm and the resulting fertilized zygote is then implanted into a woman’s womb or uterus.  Scientists have not been able to create life, perhaps because we don’t have the technology.  I would argue that we lack the maturity to handle the implications of this feat.  And maybe we are not intended to create life outside of natural processes.

I believe we sometimes take pregnancy for granted.  I maintain that it takes almost nothing to father a child, but much more to carry a baby to term and deliver the child into the world.  And, it takes even greater efforts to be a parent and raise a child to independence.

I’m certainly not an obstetrician/gynecologist.  However, I am an internist who remains fascinated by the intricacies of life and its mechanisms.  Recently, an essay in the New England Journal of Medicine (NEJM) caught my eye because it purported to explain a great mystery of why pregnant women go into labor.  I’ve often pondered this question and so have many other scientists.  We may be closer to the answer.

Pregnancy is a natural process and yet, why does a mother’s immune system not attack and destroy the baby in her uterus?  The uterine placenta is the organ through which the baby is provided nourishment and oxygen from the mother.  Within the placenta a baby’s blood vessels are juxtaposed to the mother’s and inevitably their blood streams and immune systems co-mingle.

One reason the baby is not attacked is that pregnancy is a state of “altered immunity.”  The mother’s body “tolerates” the baby even though the child is genetically different, possessing both the mother’s and the father’s DNA.  If you receive an organ transplant you must take immune system suppressing drugs for the rest of your life or the organ will be attacked by the immune system and destroyed.  This is called “rejection” and is a dreaded complication of transplantation which can result in death.  And yet the baby lives and grows because the mother’s immune system tolerates this different person inside her womb, at least until parturition.

The altered state of immunity in pregnancy has other implications.  Pregnant women are at increased risk of infections including influenza virus.  I once treated a pregnant woman who developed an infection with an unusual bacterium called listeria. The bacterium was acquired through the ingestion of feta cheese which traditionally was made from unpasteurized goats’ milk.  Feta cheese now is safe if purchased in a supermarket and made from pasteurized milk.  Certain French cheeses like Brie and Camembert should be avoided in pregnancy as well as raw seafood such as sushi and raw oysters.  Appropriate vaccinations for measles and influenza are also advisable. The NEJM article is mechanistic and arcane, but offers clues to explain labor and child birth.  Multiple researchers have shown that as pregnancy progresses levels of fetal (baby) DNA rise in the mother’s blood stream.  Interestingly, this DNA circulates outside of cells in a “free” state.  It is thought that the DNA is released from the maturing or aging placenta.  The rising levels of fetal DNA stimulate receptors on white blood cells and activate an inflammatory process modulated by signaling proteins called cytokines.  In concert, the balanced inflammatory process softens the cervix allowing dilation, produces uterine contractions, membrane rupture (water breaking) and parturition or child birth.

Few would challenge the notion that men and women are different.  It was my grandson Oakley who reminded me of the differences between boys and girls.  Becky and I were blessed with two healthy girls who exuded “sugar and spice and everything nice.”  My mother had three boys and swears to this day that books would fly off a shelf as her boys entered a room.  And the differences of the sexes become more obvious at puberty and beyond.  As a side bar, did you realize that all of us are female in the womb until sex hormones begin to be produced and cause differentiation of the sexes?

I am a rational man, so I suspect it’s my genes at work that cause me to see a pregnant woman as beautiful.  Women find this observation unfathomable because they perceive themselves as bloated when pregnant.  While it be said that a pregnant woman’s body is not beautiful by “runway standards,” it was Plato who observed that “beauty lies in the eyes of the beholder.”  (And Plato was no shabby observer.)

July is blackberry picking time in our part of the world and is ordinarily solitary work.  Consequently, a dense patch of berries affords a contemplative time for reflection.  One of my favorite books is Pilgrim at Tinker Creek by Annie Dillard.  This modern-day Thoreau at her Walden Pond observed that “nature is profligate.”  I see what she means as thousands of berries are produced with the hopes that a few survive to produce more fruit.

By nature men are somewhat like dandelions.  Both are profligate, though reason and a good woman have civilized this man.  Evolution demands more of a woman who must choose the best for her consort.  Maurice Chevalier said it best, “Thank God for little girls” who grow up to bring life into the world and Grace to their men.