[Address for correspondence: Suzan Kardong-Edgren, RNC, MS, University of Texas at Arlingtony School of Nursing, Box 19407, Arlington, TX 76019.

Abstract

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?

[This is a very valid question and one that has concerned me greatly. It may well be that a class action law suit may have to be started before any action will been taken. I am looking in to this. Until recently noone has even bothered to answer my letters etc., Except for Midwifery Today who have been most kind in printing my articles. Those unfortunately evoke little response. R. ]

Now I have posted this on [Who's too posh to push?] and I think that this is the crux of the matter. The above is over ten years old and absolutely no-one who has any influence on changing medical practice has commented, suggested controlled trials or even given the Swedish research any passing mention.

Now the reason why the Swedish research is so important is that they have medical records compiled by qualified midwifes that go back for over fourty years. They compared two groups of mothers. One group gave birth in a hospital and received an anaesthetic, the other group gave birth at home and didn't receive an anaesthetic.

They them compared the two groups and found that when the infants from both groups acheived maturity, they compared them and found that the group that was home birthed but attended by a qualified midwife was not drawn to drugs in later life.

The group that did receive drugs at birth were drawn to becoming addicted to drugs. Now read these trials, there are plenty of them as opposed to trials which show anaesthesia at birth has no long-term effects. I have not been able to find any of those.

The importance of imprinting has been grossly undervalued and not completely understood. It is not only the imprinting to their mother's anaesthesia that is so critical but imprinting with any object, [remember peanut's blankie?] or person when the new-born has been separated from it's mother. When an infant is separated from it's mother, after a few minutes it will usually instinctively bond/imprint with anything or anyone who is in it's immediate vicinity.

It is absolutely critical for the infant to be allowed to bond/imprint with it's mother. At last we have recognised the importance of this primary bond. Let the mother reach for her own infant, [If at all possible. The cord is long enough for the infant to reach the breast. Not every mother will be able to do this of course.]

Leave the cleaning of the vernix, blood and bodily fluids till later, it won't hurt the infant to be put to the breast undisturbed while it is establishing this most vital interaction. You can always wipe your infant down later. A great job for the husband or whoever you have as a birth attendent. A good opportunity for him to establish his bond.

Rayner

Now I am not sure if the following article is over the 1,000 words limit. If it is, I apologise in advance and this will be the last article that I will send to Salon. I am sure that the majority of you will be becoming bored and will want to get back to more interesting chat.

But this article is very well written, [I wish that I had written it] and taken from a site in Australia. The references at the end come from impeccable sources. British Medical Journal etc., and will be hard to refute. They are easy to check out, and a medical or other library will help you. So go to it, and let the dogs of war be unleased. [Something from Shakespeare I believe.]

No author is listed at this site, that doesn't surprise me, he/she probably wants to keep their anominity which I should probably have done too.

Happy nurturing,

Rayner

The link between drugs for pain in labour and later drug addiction in

the child.

Many women are offered drugs from the opiate family to ease their pain

during labour and birth. The most commonly prescribed drug is pethidine

(known as Demerol in the US) but sometimes heroin (diamorphine) is also

used. All drugs in the opiate family have effects on the mother and

baby. These are fully explained in the secton "Drugs and their effects"

and are related to the dosage used and the length of time the woman and

her baby are exposed.

Other women, particularly those who have heard of the possible short

term problems for the baby associated with pethidine and other opiates,

opt instead for using the mask (a mix of nitrous oxide and oxygen) in

the belief that it has no effects on the baby, whilst being of known

benefit in easing labour pain.

There is limited research on the effects of any of these drugs on the

baby and most of it has concentrated on the immediate effects after

birth or in the first days and weeks of the baby's life. There have been

some studies done on the potential for exposure to these drugs in the

time around birth and the development of long term problems for the

baby/child, especially in relation to the increased likelihood of the

development of an addiction to opiate drugs or amphetamines.

It must be stressed that exposing the unborn baby to any of these drugs

will not mean the baby will become a drug addict in later life: it just

increases their risk by a factor of five. There will be other influences

that also have a bearing on the development of an addiction, such as

genetic predisposition, the level of experimentation undertaken by the

teenager (not all children experiment with drugs, thus reducing their

exposure to the potential trigger of the imprinted memory of euphoria

experienced by some unborn babies), and some babies will have

experienced their exposure to these drugs as unpleasant, which would be

a disincentive to taking similar acting drugs later on in life.

There is no doubt that the increasing problem of drug dependence in

teenagers parallels the increasing reliance on opiate and other drugs

during labour and birth. The potential link between the two is an issue

that is rarely raised and it is a difficult area in which to research

(especially using randomised control trials), given that they are

expensive and require long-term commitment. There may also be an

unwillingness to face the possible unpalatable truth that obstetric

practices may be harming our children and that women are being misled

into thinking that drugs given during labour have no long term effects

for their baby. Tacit acknowledgement of this fact, however, may

underlie the current trend to promote epidurals as safer alternatives.

Parents, however, are rarely aware that the drugs used for epidurals are

a mixture of a local anaesthetic and an opiate drug, which still means

exposure for the baby to a potentially addictive agent. Since newborn

care is not the province of the anaesthetist, the potential short and

long term risks of the drugs to the baby may not be explained to the

parents. In any case, a women in pain during labour is unlikely to care,

at that point, what she is given, raising the issue of whether truly

informed consent has been obtained before the epidural is administered.

This is an issue that needs extensive discussion during the pregnancy

and is an ideal topic for inclusion during the pre-natal education

program (but not by an anaesthetist!).

For those who would like to explore these issues further, the following

references may be helpful:

1. Jacobson B et al. Opiate addiction in adult offspring through

possible imprinting after obstetric treatment. British Medical Journal,

(1990), Vol301, p1067-1070.

2. Jacobson B, Nyberg K, Eklund G, Bygdeman M and Rydberg U. Obstetric

pain medication and eventual adult amphetamine addiction in offspring.

Acta Obstet Gynaecol. Scand. (1988), 67, p677-682.

3. Jacobson B et al. Perinatal origin of adult self-destructive

behaviour, Acta psychiatr. scand. 198776, pp364-371.

4. Nyberg K et al. Obstetric medication versus residential area as

perinatal risk factors for subsequent adult drug addiction in offspring.

Paediatric and Perinatal Epidemiology, (1993), 7, p23-32.

5. Nyberg K et al. Socio-economic versus obstetric risk factors for drug

addiction in offspring. British Journal of Addiction, (1992), 87,

p1669-1676.

6. Nyberg, K et al. Perinatal medication as a potential risk factor for

adult drug abuse in a North American cohort. Epidemiology, 2000, vol 11,

p715-6.

7. Odent M. Between circular and cul-de-sac epidemiology, Lancet 15

April 2000, 355, p1371

You should be able to obtain these references through any medical or

university library.