Dr. Moeun Son, an OB/GYN and Maternal-Fetal Medicine Specialist at NewYork-Presbyterian and Weill Cornell Medicine, explains how she cares for patients whose high-risk pregnancy increases the likelihood of requiring a cesarean delivery. Dr. Son tells the story behind a recent study that analyzed the use of nipple stimulation via breast pump as a means of facilitating natural labor induction. The results of her research indicate that this method is a promising alternative to synthetic medications.
On this episode of Advances in Care, host Erin Welsh and Dr. Moeun Son, OB/GYN and Maternal-Fetal Medicine Specialist at NewYork-Presbyterian and Weill Cornell Medicine, discuss Dr. Son’s perspective on treating patients who face a high-risk pregnancy and might need a caesarian delivery.
Dr. Son explains that even though c-sections are a highly common and safe delivery option for many women, they’re not often not the top option in a woman’s birth plan, and don’t carry the same benefits as natural labor. She outlines the standard methods for labor induction to prevent the necessity of a c-section, which includes the administration of a synthetic form of the hormone oxytocin.
Beyond her work with patients, Dr. Son is also passionate about researching alternative methods for labor induction and preventing unnecessary c-sections. She and her colleagues designed a study to promote natural oxytocin release through nipple stimulation – mimicking breastfeeding through the use of a hospital grade breast pump. The success of that treatment eventually led to the The Stimulation To Induce Mothers Study – or STIM Study. Today, it’s an ongoing trial that aims to compare the effectiveness of natural oxytocin versus synthetic oxytocin in helping women give birth vaginally.
Dr. Son hopes that this research will broaden birthing options for women experiencing a high-risk pregnancy, and add more safe and effective treatment methods to the field of women’s health.
***
Dr. Moeun Son is board-certified in Obstetrics and Gynecology and Maternal-Fetal Medicine. In her practice, she focuses on women with high-risk pregnancies, from pre-existing maternal conditions to babies with health anomalies. She is the principal investigator on many clinical research projects, including various randomized clinical trials. Dr. Son also serves as the Program Director of the MFM Fellowship Program at Weill Cornell
For more information visit nyp.org/Advances
Dr. Moeun Son: When we're trying to medically stimulate uterine contractions, the standard medication that we use is synthetic oxytocin hormones.
Erin: This is Dr. Moeun Son, an OB/GYN who specializes in high-risk pregnancies. When she has a patient whose labor is stalled, she follows the typical protocol – administer them a drug called pitocin, which is synthetic oxytocin.
It’s an important part of the process for mothers who want to have a vaginal delivery rather than a cesarean section. But it’s not the only way to elevate oxytocin levels.
Dr. Moeun Son: There are really two ways in which oxytocin is stimulated. One is through labor, and the other way that we know that it's stimulated naturally is in the postpartum period when mothers try to breastfeed. So, nipple stimulation also elicits oxytocin.
Erin: That natural stimulation of oxytocin inspired Dr. Son to develop a study called The Stimulation To Induce Mothers Study, or STIM Study.
It's an ongoing trial that aims to reduce the odds of patients needing C-sections by using medical grade breast pumps to help mothers release oxytocin, and have a smoother labor.
Dr. Moeun Son: What we were really excited about is in the pilot study, we found that there was a trend towards less cesarean deliveries in patients who were getting the nipple stimulation therapy.
Erin: I'm Erin Welsh and this is Advances in Care, a podcast about groundbreaking developments in modern medicine.
In today's episode, I speak with Dr. Moeun Son, an OB/GYN and Maternal-Fetal Medicine Specialist at NewYork-Presbyterian and Weill Cornell Medicine, about how she hopes her research will improve the odds for patients with complicated pregnancies, and for all expectant mothers.
Erin: Dr. Son, it is so wonderful to meet you. Thank you so much for taking the time to chat with me today.
Dr. Moeun Son: Thank you so much for having me today. I'm really excited to be here.
Erin: So to start things off, could you tell me a little bit about why you chose to pursue a career in obstetrics and gynecology.
Dr. Moeun Son: Yeah. Pregnancy is often viewed as such an exciting, happy, wonderful, beautiful time in a woman's life and in the family's life. But it's actually a pretty scary time. And especially with my field, which is maternal fetal medicine, where we take care of particularly high risk pregnancies, you know, this is a time in a woman's life when they can be particularly vulnerable and it's not only about the medicine or the science or the physiology or the treatment, but it's the whole human.
Erin: I think that's a really excellent way to look at it. Especially because every mother has her own expectations and her own birth plan. And so I’m wondering if you can talk a little bit about that in the context of cesarean sections. Because I know that over the past few decades, the rates of C-sections, both in the US as well as around the world, have really shot up. So what do you think is behind this rise in C-section rates?
Dr. Moeun Son: Yeah. I mean, there are many reasons for why the cesarean delivery rate has increased. Almost a third of mothers in the United States will deliver by cesarean. The sort of characteristics of the pregnant population has really changed, you know, women are a little older now, might have more chronic medical conditions, they might have more complicated labors.
Erin: Right. And many of these patients will need to have their labor induced, which I know is a contributing factor for C-sections. So how do you weigh that possibility of a C-section for your patients? What exactly are the risks?
Dr. Moeun Son: Sometimes a cesarean is needed, but the reality is that a cesarean delivery is a major abdominal surgery, and major abdominal surgery comes with its own inherent risks. You know, if somebody has had a prior cesarean, it certainly puts them at increased risk for severe complication related to how the placenta implants and can have significant bleeding risk and even, you know, death if we're not careful.
And so, a lot of my research and care is always around what can we do to safely prevent or reduce the risk of the first C-section, because it can have implications for the future.
Erin: Yeah, of course. I would love to hear your perspective on the institution where you work, on NewYork-Presbyterian and Weill Cornell Medicine. How do you feel the patient population has set you up to examine different ways to protect maternal and fetal health?
Dr. Moeun Son: I feel very fortunate as a physician and a clinical researcher to be able to work at NewYork-Presbyterian Hospital and the Alexander Cohen Hospital for Women and Newborns. Everyone here I think is here because they really believe in like, what can we do to take better care of patients? Are there innovative ways? Are there other strategies that we can employ to continue to make patient care and women's health better?
And so patients have a lot of trust in these institutions. That helps me as a researcher because when patients come through our doors, you know, labor and childbirth, it's a scary time. They're very vulnerable and again, that's the patient population that I tend to focus on. It's very scary to say, yes, I'll do a research study. So I think that's helped a ton with our patients just sort of giving their trust more easily to me and my research team.
Erin: Yeah and I’d love to get into some of that research. So, I know that in the STIM study you’re using nipple stimulation to help mothers produce more oxytocin and have stronger contractions. Can you give me a little more background there, on how you got the idea to do this study?
Dr. Moeun Son: Yeah. When we're trying to medically stimulate uterine contractions, the standard medication that we use in the United States and globally is synthetic oxytocin hormones. Synthetic oxytocin hormone is basically a man made version of endogenous oxytocin hormone, and at a molecular level, it looks identical. The difference, though, is that it can only be administered intravenously. There's a lot of other benefits that endogenous oxytocin hormone has because of the way that it's naturally produced and released in the brain. And it's been shown to be very important for things like mood and bonding.
There are really two ways in which oxytocin is stimulated. One is through labor, and the other way that we know that it's stimulated naturally is in the postpartum period when mothers try to breastfeed. So, nipple stimulation also elicits oxytocin.
And so this whole study idea came from a night when I was on call. One of my colleagues had a patient who had been induced and she was on synthetic oxytocin. She was doing pretty well with it, but kept going up on the dose rate. She was contracting, but she wasn't contracting enough.
My colleague came to me and said, you know, I don't know what to do. This patient, she's a first time mom. She really wants to have a vaginal delivery. Baby looks great. Mom's doing great. We just can't get these contractions to be stronger. They're too far apart.
And I said, well, hmm, she's, she's obviously, you know, responding to the synthetic oxytocin hormone, but she's just not making enough contractions. So I said, you know, why don't we try the breast pump?
I mean, there's a hospital grade breast pump that's just on the labor floor and maybe she just needs a little more oxytocin, but maybe endogenous oxytocin will help her a little more. So, you know, we help the patient put on the breast pump and, six hours later, she had a vaginal delivery. It was really amazing.
Erin: Yeah, so, introducing more natural oxytocin moved the process along and helped this patient get out of a stalled labor. I mean, what a simple solution. That is, that is really incredible.
Dr. Moeun Son: It was incredible. And so, you know, that's kind of what started this whole idea of like, we have really great medications, but there are limits sometimes to medical interventions, they don’t always work perfectly.
Erin: I love that it’s like one patient gave you this idea of how do we compare endogenous oxytocin with synthetic oxytocin? And so you, from this one patient, you planned out the study. Can you tell me about what you found?
Dr. Moeun Son: First we wanted to sort of test it out and see, one, are patients interested in this, because ultimately this is not only to improve their outcomes, but it's also, we wanted to be patient centered. And so we actually tested it in both first time moms and moms who've had deliveries before, because we've kind of figured that patients who had babies before, who've breastfed before, who've used a pump before would be more familiar and might be more willing. I was actually more nervous that first time moms who've usually never used a breast pump before, who've never gone through labor before, would be hesitant. And what we actually found was that they were very willing.
Erin: And so you started getting those results and the trial is ongoing. Could you tell me more about the process and the status as of now?
Dr. Moeun Son: So the STIM study is a randomized clinical trial. It is comparing patients who are getting sort of what we would consider standard of care treatment for labor induction, which is administration of synthetic oxytocin hormone, versus the intervention, which is that they would start out with nipple stimulation therapy with an electric breast pump.
So just like any randomized clinical trial, we can't really look at the data, you know, or analyze the data until enrollment is complete. And we're about a little more than halfway through the study. But anecdotally, we're really encouraged by what we're seeing. And what we were really excited about is, in the pilot study, we found that there was a trend towards less cesarean deliveries in patients who were getting the nipple stimulation therapy.
And in our preliminary pilot study, we actually found that while it took a little more time for them to have really strong contractions, their overall labor induction was actually almost two hours shorter. And we also found that even though a majority of patients still needed synthetic oxytocin hormones, even if they started off with nipple stimulation therapy, they actually needed synthetic oxytocin hormone for less time, and they reached a lower dose rate, which means that not only was their labor induction overall shorter, but they needed less synthetic oxytocin.
But the biggest exciting thing that we saw was that, these are generally first time moms, was who we were studying, and 65 percent of patients were actually getting milk let down during labor. So they were getting colostrum and early breast milk let down.
You know, breastfeeding success is a huge problem in the United States, where less than 50 percent of patients who want to breastfeed their child actually do it for up to one year postpartum, which is what the recommendation is from the CDC. And the people who have the hardest time are first time moms who are unfamiliar, where they often takes longer for their breast milk to come in. And when we saw that in the pilot study, they were getting milk let down and able to collect the colostrum and breast milk, that actually became a major outcome for our main trial. So in this funded study, the lactation outcomes is, is another big focus.
Erin: And so, from this study to naturally induce labor you found this other benefit of improved success with breastfeeding. And I know that you’re working on another project for expectant mothers that involves using calcium carbonate to combat muscle fatigue during labor. Can you talk me through the mechanism of that, and some of the broader implications for women's health?
Dr. Moeun Son: Yeah, so labor contractions is essentially contractions of a big muscle and just like all other muscles, a muscle contraction requires large amounts of calcium, intracellular and extracellular calcium. The other thing that happens with muscle contractions, especially during, like, rigorous or intense exercise – which I would argue labor is – that muscles start to fatigue. And, you know, in other areas of sports medicine, it's very common that they'll use, like bicarbonate supplementation, for example.
And so I kept thinking, you know, calcium and bicarbonate, and I realized that's calcium carbonate, which is essentially TUMS, which you buy over the counter, it's an antacid. You know, usually during labor, when I see all these patients who are going through the labor process or the induction process, we often don't let them eat anything. We give them some IV fluids, but we, you know, they don't drink a lot. And I'm thinking, you know, in every other exercise form, they're hydrating, you know, they're using all these electrolytes, they're getting all this bicarb, they're doing all this stuff.
And, you know, in the most intense exercise of a woman's life, where, you know, we're not doing a lot of that. And so in this pilot study, it's the co-administration of synthetic oxytocin hormone and calcium carbonate, during the labor process to see if the addition of additional calcium and bicarbonate would actually help with a lot of the muscle fatigue, and the ineffective labor contractions.
So we're really excited about it and we're just completing the pilot study now and hopefully it'll become a funded large trial.
Erin: Wow, yeah I really love this idea that cutting edge doesn't have to be this super high tech thing, it can just be the solutions that are right in front of us and available to us... I'm wondering now, if you can share any thoughts on your overall goals for how you would like this kind of research to influence the field of women's reproductive health, just across the board.
Dr. Moeun Son: Yeah, I think for too long, women's health has not been a priority. And that has changed over the last couple decades. But I feel like as a clinical researcher, we've always been behind, behind many other fields of medicine and especially women's health and obstetrics. I mean, literally it's been since the beginning of humankind. It's a disservice to women that we still don't really understand how a lot of this works, and I really think that there are just too many unanswered questions, and, I hope that people will continue to recognize the importance of women's health and making not just childbirth and obstetric outcomes better, but outcomes better for all women.
Erin: Well, Dr. Son, it has been so great to meet someone who is actually making material changes to the way that women's health is viewed and these experiences that are so meaningful and important. And so, I just want to thank you so much for taking the time to chat with me today.
Dr. Moeun Son: Thank you so much. I had so much fun talking about all of this, and I'm really excited for the opportunity.
Erin: Huge thanks to Dr. Moeun Son for taking the time to speak with me about how she's improving outcomes for women with high-risk pregnancies.
I’m Erin Welsh.
Advances in Care is a production of NewYork-Presbyterian Hospital. As a reminder, the views shared on this podcast solely reflect the expertise and experience of our guests. To listen to more episodes of Advances in Care, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get your podcasts. And to learn more about the latest medical innovations from the pioneering physicians at NewYork-Presbyterian, go to nyp.org/advances.