March 14, 2003

Are pethidine and heroin in labour setting our children up for drug addiction?

When I am working in Scotland, the issue of pethidine and diamorphine for labouring women invariably comes up - mostly because I always work it into the program somewhere. It is a thorny issue and one that inevitably causes hackles to rise and some anguish forgroup members.

We talk about the link between exposure to opiate drugs during birth and the increased of the baby becoming addicted to opiates later in life and also the parallel research showing similar results for babies exposed to nitrous oxide and a later addiction to amphetamines. Use of these drugs is very common in Scottish hospitals and diamorphine (heroin) is particularly favoured. When I talk about the work of Jacobsen in Sweden and the research that has been done to date, there are always one or two in the group who try to dispute its quality and dismiss its findings. Whilst we certainly need more research, we cannot overlook the findings so far, even if it is just to acknowledge that drugs given to babies during birth will have an impact on the newborn and perhaps their later health and well being. I have written about this research and the information that parents need elsewhere.

Much money is being spent in Scotland to try and improve the breastfeeding rates, which are very low. Until they do something to reduce the opiates given to labouring women it will be very difficult (perhaps impossible) to have much impact on facilitating the establishment of breastfeeding. The links between early breastfeeding (the first hour) and long term milk supply, obstetric drugs and depressed newborn responses and labour medications and neonatal jaundice are well documented. We must see that pregnancy, labour, birth and breastfeeding are all part of a continuum, with each phase linking to and dependent on, the other stages of the process.

Midwives must put their own personal feelings aside when it comes to labour medications. Yes, it can be threatening to discover that the way one handled labour may have put the baby at unintended risk of later consequences. No mother willingly risks her baby and can only work with the information, knowledge and skills that she has at the time. We certainly know more now about the effects of obstetric medication that we did in the past and would probably make different decisions if we were faced with similar situations in labour today. What we may have done ourselves in the past certainly colours the way we perceive similar situations that others are facing - perhaps this is a very good reason to embrace what we now know about labour drugs and ensure that other women are not placing themselves and their babies at unnecessary risk (as we were forced to do because of general ignorance).

Posted by andrea at March 14, 2003 09:43 PM

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