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| Rayner on the porch of his hut on the beach of Koh Phangan, Thailand. |
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 Rayner has long lamented the use of drugs on women about too give birth. He
discovered in the 1950’s that the use of drugs, including alcohol, to “help” a woman as she gave birth produced
in the child a propensity towards drug addiction (including alcoholism) later in life.
Now, finally, the rest of the world is catching up with Rayner’s thinking. Below is a message
from Rayner to a friend in May, 2007. This message included medical facts which are incredible given what is still normal
medical practice in the West today.
Hi ____,
Can't believe that this was published in 1999 in
Midwifery Today.
Before the main article , here is another tidbit that just came in form the head of a school of
nursing in the USA.
Published research has suggested that infants whose mothers received opiates, barbiturates,
or nitrous oxide gas during labor are significantly more likely to become addicted to opiates if they experiment with drugs
in later life.
Why has no one further investigated this hypothesis? What if these researchers are correct? In
the future will there be class action lawsuits against the medical and nursing research communities for failure to follow
up on this question? Is it time to change the research paradigm?
The answer to this is of course, “Yes,
and how.”
Now here’s the great article:
Drugs in Labour: What Effects Do They Have 20 Years Hence?
by Beverley Lawrence Beech
©
1999 Midwifery Today, Inc. All Rights Reserved.
[Editor's
note: This paper was presented at the Midwives of North America (MANA) Conference in November 1998, and appeared in Midwifery
Today Issue 50, Summer 1999.]
Demerol
One of the most common
drugs used in the labour ward is pethidine, a synthetic, addictive, narcotic drug that is similar to morphine. In Britain
it is also known as meperidine, and in America it is known as Demerol. It has become the drug of first choice for the majority
of UK midwives, mainly because it is the only pharmacological narcotic they are licensed to prescribe.
Commonly, women are given a dose of 150 mg, yet those midwives who use Demerol sparingly often give a much smaller dose—25
mg, for example— and claim it is just as effective.
Demerol readily crosses the placenta.
The baby may have greater sensitivity to the drug because of the immaturity of the blood-brain barrier and the circulatory
bypass of the liver (Burt,1971). If the baby is expected to be born within an hour, most midwives try to ensure that Demerol
is not given because of the risk that the drug will be present in the baby. However, research shows that Demerol is most likely
to have a depressant effect on the fetal respiratory system if the dose is
administered two or three hours before birth.
The higher the dose to the mother, the greater the effect on the fetus (Yerby, 1996). Because the baby's liver is immature,
it takes a great deal longer—18 to 23 hours—to eliminate the drug from its system.
Although 95 percent of the drug is excreted in two to three days, this can have significant implications for breastfeeding.
Rajan demonstrated that "Demerol proved to be the (drug) most inhibiting to breastfeeding."
By breastfeeding, the mother often unknowingly gives the baby a second dose of Demerol,
as the drug is transferred to the baby through the breast milk. She may not be aware that Demerol is the cause of her "sleepy"
baby and her problems with getting the baby latched on.
Little research has been done into the
long-term effects of Demerol. However, infants with high Demerol exposure were more likely to cry when handled on days seven,
21 and 42, as were those with a high cord-blood concentration on day 21. Demerol also reduced the infant's ability to
quiet himself once aroused. This was still observed at three and six weeks (Belsey, 1981). It is interesting that researchers
consider three to six weeks to be "long-term." Our definition would be in years.
For
those babies whose breathing is depressed at delivery, naloxone is given to reverse the effects, but the reversal is only
temporary unless it is given in an adult dose (Weiner, 1977). We know of no research that investigates the short- or long-term
effects of naloxone on the baby.
The Pain of Labour
A consistent
criticism Association for Improvements in the Maternity Services (AIMS) members make of obstetrically managed
births is that there is pressure to deliver all babies as quickly as possible, as if this were a benefit to both mother and
baby. We know of no study that asked women whether they wanted a faster, but more painful, labour.
It is extremely difficult to assess the level of pain a woman experiencing; different women react different ways. Interestingly,
when a woman fails to experience pain relief from Demerol or other drugs, she will often be told that she has a "low
pain threshold." I have yet to hear the problems described as a failure of the drug to act effectively. In a survey of
pain relief in childbirth (Chamberlain, 1993) 84 percent of midwives rated Demerol as very good or good, compared with only
71 percent of women and 72 percent of partners. The authors speculated:: "Perhaps the drowsiness of the women following
the administration of pethidine (Demerol) iis associated with effective pain relief by the midwife." From the woman's
perspective Demerol has been described as causing a loss of control, disorientation and dizziness. As one mother described
it: "I felt that my brain had gone out to lunch. I could not put a sentence together, but it did nothing for the pain—it
just shut me up."
Women who end up with caesarean sections have often experienced induced
or accelerated labours, and Demerol is often one of the many drugs they have been given during that time. However, Demerol
delays maternal gastric emptying and, in concert with sedation, increases the risk of aspiration and thus the danger of general
anaesthetic (Olofsson, 1997).
Chamberlain's Study Pain and Its Relief in Childbirth found
that Demerol appeared last on a list associated with enjoyment of labour, being in control of labour and delivery, and physical
and mental health afterward. Demerol was unlikely to be wanted for future delivery and was most strongly associated with problems
in the baby, such as side effects, temperament and feeding difficulties. It gave low satisfaction for pain in labour—and
especially pain during delivery—was associated with poor physical and mental health in the mother after delivery, and
had a fairly low rating for enjoyment of labour and control.
Epidural Anaesthesia
Instead of urging non-pharmacological methods of pain relief (for example, water pools), the latest
research paper to reveal the inadequacy of Demerol's pain-relieving effects suggests that epidural anaesthesia should
now be widely available (Olofsson, 1996). The authors have few worries about the adverse effects of this drug.
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| Rayner Garner |
In 1981 Rosenblatt published a six-week follow-up of the effects of
epidural anaesthesia, which showed that immediately after delivery, infants with greater exposure to bupivacaine in utero
were most likely to be cyanotic and unresponsive to their surroundings. Visual skills and alertness decreased significantly
with increases in the cord-blood concentration of bupivacaine, particularly on the first day of life but also throughout the
next six weeks. Adverse effects of bupivacaine levels on the infant’s motor organisation, his ability to control his
own state of consciousness and his physiological response to stress were also observed. Interestingly, this study considered
six weeks to be "long-term," but what are the long-term effects at 5, 10, 20 or 50 years?
Women who choose water for pain relief have been warned that a rise in the water temperature over 37° C could cause a
rise in the mother's temperature and result in brain damage in the babies, with no research evidence whatsoever to support
that suggestion. As a result, many UK hospitals have refused women access to water pools. However, research by Lieberman (1997)
revealed that intrapartum fever greater than 100.4° F occurred in 14.5 percent of women receiving an epidural. If the
labours lasted longer than 18 hours the rate increased to 36 percent. Not a single paediatrician has expressed concern about
this risk.
Brain Development
In her submission to the Food and Drug Administration (FDA), Yvonne Brackbrill commented that at that time there had been
at least 40 studies of neurobehavioural changes in human infants that were observed after administration of anaesthetic and
pre-anaesthetic agents to their mothers during labour and delivery. "None has shown that drugs enhance or improve behavioural
functioning in infants," she wrote (Brackbrill, 1979).
In the human being, the period of
vulnerability to central nervous system damage from exposure to drugs and chemicals lasts a long time. Even after birth, important
areas of the brain are still developing and differentiating at a very rapid rate, and because of this rapid period of growth
they are maximally vulnerable to damage. It has been estimated, for example, that the brain growth spurt in the cerebellum
lasts for 18 months after birth and in the hippocampus for about four and one-half years.
Some
parts of the brain are fairly well developed at the time a human being is born, but other parts are not. Some parts, particularly
the cerebellum, are very underdeveloped; and the introduction of toxic substances during this period of rapid development,
even for a single acute administration, can either kill cells or cause aberrations in them. When cells proliferate in the
cerebellum, that’s not the end of it—they have to migrate into their final position and link up with other cells.
Both the rate of cell death and the patterns of migration of cells in the cerebellum have been shown to be very sensitive
to the introduction of toxic substances (Brackbrill, 1979).
Desmond Bardon, a respected British
psychiatrist, asked what prolonged exposure to maternally administered drugs means to the later neurologic development and
behaviour of the offspring. Drug-induced biochemical alterations within the brain of the about-to-be-born or newly born infant
have the potential for permanently disrupting the normal link-up of the baby's brain cells by altering the biochemical
markers that guide the cells into their proper places. It is somewhat analogous to the unintentional spilling of a chemical
over telephone wires that are being connected according to the colour code at the end of each wire. The chemical removes the
colour from the wire ends. The technician must continue to connect the wires, not knowing exactly which wires to connect with
what. The circuitry is completed: It functions, but imperfectly.
While the process of cell migration
is not yet fully understood, present knowledge of neurobiology suggests that the normal biochemical message left along the
pathway of the neuron by the preceding cell (as it travels to its proper place within the central nervous system) serves to
direct the next brain cell into place. Drug-induced changes in the biochemical message can disrupt this vital process. Could
dyslexia be the result?
Drug Addiction
In the developed world there is
an epidemic of dyslexia, drug addiction and behavioural problems. I suggest that one of the reasons for this is the overuse
of powerful drugs in labour.
I find the hypocrisy about drug use quite astonishing. In the United
States, it appears that women who smoke or drink alcohol in pregnancy can be publicly chastised; if they take heroin, or other
street drugs, they can find themselves in jail or threatened with removal of the baby and their other children. But no one
raises even a murmur about the far more powerful addictive drugs that are used on the labour ward, and no one appears concerned
about the effects these drugs can have on a still-developing fetal brain.
There are plenty of
studies examining the immediate effects of drugs in labour, but where are the studies examining the long-term effects? By
that I mean effects that can emerge, 5, 10, 20 or even 50 years later.
I suggest we are sitting
on a time bomb, and we persist in ignoring the research because of the horrendous implications. No one wants to admit that
their care is creating drug addicts, but I believe the overuse of drugs in pregnancy and childbirth is doing just that.
In a well-designed case control study at the Karolinska Institute in Stockholm in 1990, researchers
compared children exposed to
pain-relieving drugs in labour with those who were not exposed and discovered an increased
risk of drug addiction later in life (Jacobson et al., 1990). In 1988 they showed that when nitrous oxide was given to the
mother the child was five and one-half times more likely to become an amphetamine addict than a brother or sister born to
the same parents. In their paper in the British Medical Journal(1990), patients who had died from opiate addiction were compared
with brothers and sisters, the researchers found thata if the mothers had been given opiates or barbiturates or larger doses
of nitrous oxide, the risk to the child of opiate addiction in later life was increased 4.7 times.
In a further study, researchers discovered that the risk of drug addiction was related to the
hospital in which they were born. In other words, the likelihood of a child developing drug addiction in later life depended
on the labour ward policies of the hospital the mother chose for the birth, and I quote: "For the amphetamine addicts,
hospital of birth was found to be an important risk factor even after controlling for residential area" (Nyberg, 1993).
Jacobson and Nyberg’s research suggests that the use of opiates, barbiturates and nitrous oxide in labour causes imprinting
in the babies, and we are now reaping the whirlwind.
The U.S. Department of Health and Human
Services estimated that one out of every nine American children is significantly learning disabled despite having normal intelligence.
Seventy-five percent of these children are born at full term into middle- and upper-class families. The U.S. National Institute
of Health estimates that 75 percent to 85 percent of all disabled children in the United States were born within the normal
range of birth weight and gestational age and had no familial or sociologic predisposing factors (Haire, 1989).
In 1984, Desmond Bardon suggested that a significant proportion of the millions of children and youths in the United States
who are afflicted with significant mental and neurologic dysfunction are the victims of obstetric medications administered
with the very best of intentions to the mother during labour and birth in medicalised maternity units. Not only have Bardon’s
concerns not been addressed, but since that time even more women and babies have been subjected to high levels of drugs in
pregnancy and labour, and little has been done to investigate the possibility that the huge increases in drug addiction and
associated crime are a direct result of the drugs used on the labour wards. WHile various agencies work hard to pull the bodies
out of the river, no one is investigating who is pushing them upstream. It is time someone did. Beverley A. Lawrence Beech, honourary chairwoman of the Association for Improvements in the Maternity
Services (AIMS), is a freelance writer and lecturer and lives in the United Kingdom.
References
* Belsey, M.E. et al. (1981, April). The influence of maternal
analgesia on neonatal behaviour: 1. Pethidine, British Journal of
Obstetrics and Gynaecology, 88:
398-406.
* Brackbill Y. (1979, Nov.). Effects of obstetric drugs on human
development. Paper presented at the conference Obstetrical
Management and Infant Outcome arranged
by the American Foundation
for Maternal and Child Health, New York.
* Burt,
R. (1971). The fetal and maternal pharmacology of some of
the drugs used for pain relief in labour.
British Journal of
Anaesthesia, 43: 824-836.
* Chamberlain, G. ed. et al.
(1993). Pain and its relief in
childbirth: the results of a national survey conducted by the
National Birthday Trust. Edinburgh: Churchill Livingstone.
* Haire, D. (1989, May 30). Obstetric Related
Drugs: Their effects
on parturition. Paper presented to the ISPOG Conference, Amsterdam.
* Jacobson, B. et al. (1988).Obstetric pain medication and eventual
adult amphetamine addiction in
offspring. Acta Obstet Gynaecol.
Scand., 67: 677-682.
* Jacobson, B. et al.
(1990). Opiate addiction in adult offspring
through possible imprinting after obstetric treatment.
British
Medical Journal, 301:1067-1070.
* Lieberman, E. et al. (1997, March).
Epidural analgesia,
intrapartum fever, and neonatal sepsis evaluation. Pediatrics,
99(3): 415-419.
* Nyberg, K. et al. (1993). Obstetric medication versus residential
area as perinatal risk factors for subsequent adult drug addiction
in offspring. Paediatric and Perinatal
Epidemiology, 7: 2332.
* Olofsson, Ch. et al. (1996, Oct.). Lack of analgesic effect of
systemically administered morphine or pethidine on labour pain.
British Journal of Obstetrics and
Gynaecology, 103(10): 968-972.
* Rajan, L. (1994). The impact of obstetric procedure and analgesia
during labour and delivery on breast feeding. Midwifery, 10(2):
87-103.
* Rosenblatt, D. B. et al. (1981).The influence of maternal
analgesia on neonatal behaviour: 11 Epidural
bupivacaine. British
Journal of Obstetrics and Gynaecology, 88: 407-413.
*
Stillman, R. J. (1982, April 1). In utero exposure to
diethylstilbestrol: adverse effects on the reproductive
tract and
reproductive performance in male and female offspring. American
Journal Obstetrics and Gynecology, 142(7), pp 905-921.
* Vessey, M. P. et al. (1983). A randomised
double-blind controlled
trial of the value of stilboestrol therapy in pregnancy, and
long-term follow-up of mothers and their offspring. British Journal
of Obstetrics and Gynaecology,
90: 1007-1017.
* Wiener, P.C. et al. (1977). Effects of naloxone on pethidine
induced neonatal depression. British Medical Journal, 11: 228-231.
* Yerby, M. (1996, May). Managing
pain in labour Part 3:
pharmacological methods of pain relief. Modern Midwife: 22-25.
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