Home birth with midwife as safe as hospital birth- Canadian Study!

Updated Mon. Aug. 31 2009 12:51 PM ET

CTV.ca News Staff

Giving birth at home with a midwife present is as safe as a hospital delivery accompanied by a doctor, suggests a new Canadian study, which found home births were associated with fewer adverse outcomes for both mother and baby.
The study, published Monday in the Canadian Medical Association Journal, analyzed nearly 2,900 planned home births in British Columbia that were attended by regulated midwives, more than 4,700 planned hospital births attended by the same midwives and more than 5,300 hospital births attended by physicians.
The research found that women who had a planned home birth had a lower risk of having to undergo obstetric interventions such as electronic fetal monitoring, epidural, assisted vaginal delivery and caesarean section, and adverse outcomes such as hemorrhage and infection. More...

Even a little caffeine may harm fetus, study finds

Michael Kahn, Reuters

LONDON (Reuters) - Pregnant women who consume caffeine -- even about a cup of coffee daily -- are at higher risk of giving birth to an underweight baby, researchers said on Monday.


The new findings published in the British Medical Journal (BMJ) also linked any source of caffeine, including that from tea, cola, chocolate and some prescription drugs, to relatively slower fetal growth.


The findings are the latest in mounting evidence indicating the amount of caffeine a person consumes may directly impact one's health, especially when pregnant.



n January, U.S. researchers found that pregnant women who drink two or more cups of coffee a day are at twice the risk of having a miscarriage as those women who avoid caffeine.
more:

Midwife-led versus other models of care for childbearing women

Excerpt from the Cochrane Library: Evidence for health care decision making
Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

You want to eat during labor

40

You want to eat during labor





A seeker once asked a Zen master how he knew he had attained enlightenment. "I eat when I am hungry and I drink when I am thirsty" was the reply.

Zen proverb



What we have, once again, is an obstetric belief system that defines childbirth as a medical-surgical event. Eating and drinking do not fit this model. IVs do.

Henci Goer, The Thinking Woman's Guide to a Better Birth



"I won't be any trouble, because I don't eat a thing!"

Dorothy, in Noel Langley's The Wizard of Oz





We can dispatch with this chapter in the time it takes to read what's worth reading in the weekday New York Times.

If you give birth in a hospital, you will probably be allowed to eat nothing but Jell-O cubes during labor. These Jell-O cubes will be provided by nurses who believe that Jell-O is food.

Although the majority of hospital personnel consider Jell-O to be food (a nonpoisonous ingestible substance), other nonpoisonous ingestible substances that actually are food, such as avocados, tomatoes, lettuce, tahini, apples, oranges, pears, etc., will be denied you. Thus you will find yourself spinning down the vortex of the following Catch 22 oxymorons: nourishing nonfood (Jell-O), nonnourishing food (vegetables, fruit, etc.), and noncaregiving caregivers (nonfood-providing, nourishment-withholding, nonnursing nurses).

The justification for the oxymoronic behavior of giving solely Jell-O to a laboring woman is simple and straightforward in the hospital mind. It is the belief that, because Jell-O turns quickly into liquid, you won't be likely to choke on it and die if you throw up.

Will you, by the same reasoning, be allowed to put your veggie sandwich in a blender and press "liquefy"? Sorry. Against hospital policy. What is hospital policy? A conglomeration of beliefs the majority of which have withstood the test of time but not science. (For an insightful treatise on the anti-scientific, anti-common sense nature of the Western hospital, see Robert Mendelsohn's book, Confessions of a Medical Heretic, especially his chapter, "The Temples of Doom.")

In short, although there is no reasoning behind it, Jell-O is your predictable fate in the hospital maternity ward.



Don't make me puke



Let us examine the hospital policy of "nothing by mouth" (NPO) in the light of reason and obstetric history.

Is there any rationale at all behind NPO?

Actually, once upon a time there was. NPO was an intervention created to attempt to correct a flaw, not in nature, but in another obstetric intervention – general anesthesia. In the old days, general anesthesia was given by mask. If a woman laboring on her back (also a cultural intervention) threw up into the mask, she ran a substantial risk of choking on, and dying from, her own vomit. Doctors, ever ready to save women from nature (vomiting), but not from culture (the backlying position, nauseating anesthesia, and death-dealing masks), devised the callous coup, "nothing by mouth," to remedy a much more simply remedied problem.

The unsympathetic intervention of "nothing by mouth" ostensibly ensured laboring women an empty stomach and, it was believed, risk-free retching. In fact, all it did was make women hungry.

Science, a field of endeavor given short shrift by modern medicine, was not originally given the chance to weigh in on the modern hospital policy of "nothing by mouth." Today, finally having led the horse back in front of the cart, science tells us that no amount of fasting necessarily empties the stomach. In an article interestingly titled, "Nutrition and position in labour," C. Johnson, et al. conclude: "No time interval between the last meal and the onset of labour guarantees a stomach volume of less than 100 ml." In other words, a laboring woman could fast for the entire duration of her labor, and her stomach might still carry contents enough to fatally choke her, were she unfortunate enough to throw up while lying down.

Thus, another routine hospital obstetric procedure is found to be based, not on science, but on belief. What belief? The belief in a defective nature, summarized in this way: "Since, according to nature's law, women are throwing up on themselves, we'll just have to starve them to save them from themselves."

NPO is another way for techno-advocates to cloak women in the darksome myth of female incompetence. That this myth might be turned into medical gold goes without saying, but unfortunately not without doing.



Choking down the numbers



Today, it is no longer necessary to give general anesthesia by mask. Thus, aspiration (choking on one's vomit) has become an event so rare that even as long as 30 years ago it was the sole cause of maternal death in only 2.6 out of 1,000,000 births. Today, even those 2.6 women survive labor choking-free.

These days, aspiration during labor is simply unheard of. In three large studies recently conducted in the U.S., women who ate freely during labor had no choking problems. In 78,000 cases, not a single case of aspiration occurred. Indeed, not a single case of maternal death from aspiration can be found in the medical literature in the last 30 years.

But modern-day hospital staff, ever ready to do the right thing – even if the right thing is the wrong thing – will deny you food, as your body, working overtime in the exhausting maternity ward, cries out for nourishment. On the extremely unlikely chance that at some point in your labor you might need general anesthesia (as opposed to the more commonly administered regional anesthesia, such as an epidural), hospital staff will starve you. And they will starve you in good conscience, for they live in the belief that all hospital policy has reason behind it.

But NPO has no rational foundation of any kind. No process of reason ends with the conclusion, "And therefore, NPO is medically indicated." As far as reason and science are concerned, "nothing by mouth" benefits no one.

Even if NPO did have demonstrable benefits for laboring women, one would still have to weigh those benefits against the risks. And what science tells us is that 1) NPO benefits do not exist and 2) NPO risks exist in great number. So weighing benefits against risks still sends NPO to the locker room.



"Oh, no, NPO!"



Being deprived of nourishment during labor may be hazardous to your health.

Severe restriction of oral intake can lead to ketosis. Ketosis is an abnormal increase in chemicals that your body produces after it has used up its available store of glycogen (blood sugar) and begins to burn fat. Maternal fat-burning results in acid buildup, which if allowed to proceed unchecked can result in maternal vomiting, coma, and even death.

Is your hospital staff concerned? In no way. They're happy to believe in the touted benefits of NPO, even if it could result in such "side-effects" as coma or death. (Am I making this up? I wish I were.)

Prolonged lack of food can be dangerous to your in utero baby, as well. Research shows that NPO may result in infant oxygen deprivation. Infant oxygen deprivation can lead to infant brain damage.

Although the 1999 World Health Organization report, Care in Normal Birth, informs us that ketosis and its unfavorable sequelae for both mother and fetus can be prevented by offering the mother "light meals" during labor, your obstetrician probably has not read this report. Why should he? No birth is "normal" in his eyes. His training has told him that birth is by definition pathological and that care is synonymous with intervention.

To a hospital obstetrician, the WHO report Care in Normal Birth contains an oxymoron in its title. The only normal birth your obstetrician knows is the one that miraculously didn't go wrong. And as your obstetrician's Brother In The White Coat, Dr. Robert Galser at the University of Pennsylvania Medical Center reassuringly asserts, "Only a small minority of women find not being allowed to eat stressful." This charming sentiment is backed up by . . . well . . . nothing at all.

Delving further into scientific research, far from the quick-fix quips and gymnastic quunks of the indoctrinated and madding mediclown crowd, we find that NPO may even slow the progress of labor. This makes sense. Inadequate consumption of complex carbohydrates results in low blood sugar, which results in less effective (and sometimes painful) uterine contractions. Less effective contractions slow labor and may contribute to your chances of receiving the dreaded diagnosis "failure to progress," which significantly increases your chances of receiving a cesarean section, along with its common maternal complications (hemorrhage, infection, hematoma, pneumonia, blood poisoning), as well as infant injury, infection, bond-breaking isolation, formula feeding, respiratory distress, and so on. (For a more "full-bodied" list of maternal and infant complications from cesarean section, see Reason #3, "You don't want a cesarean section.")

At this point in your labor (which has failed to progress), the intervention of NPO – itself the ostensible solution to a prior intervention – justifies yet another intervention: IV placement.

In the warm and fuzzy myth of the safety and efficacy of hospital childbirth, the cavalry IV brings life-saving "nutrients" to the depleted maternal bloodstream. In fact, an intravenous simple-sugar solution brings empty calories to an empty host, as well as a plethora of risks that justify – you guessed it – further interventions. (For a deeper look at the hazards of using IV sugar-water to remedy the "no water" part of NPO, see Reason #41, "You want to drink during labor.")



Big daddy



Since its inception, the standard policy of "nothing by mouth" has been a bad idea through and through. Like most routine hospital obstetric policies, it is based on myth and scornful of science. The best that can be said about it is that, because it results in so many additional interventions, it gives hospital staff something to do to make themselves feel useful.

NPO is another example in an endless catalog of examples of the hospital institution's attempt to dehumanize you, to turn you into a patient, to strip away your comforting and competent humanity, to force you to find identity as the daughter of an institutional father.

NPO is yet one more example of modern medicine's century-long endeavor to convince women that their bodies are not their own and that their powerful fecundity must be manhandled if creation is to occur. Starving you to the point of pain, your hospital obstetric caregivers will cheerfully show you their concern by performing further interventions to save you from their myth-based ignorance, interventions that could have been avoided with a little research and a will to care.

But research requires effort, especially effort of the mind. And effort of the mind is verboten in the mindless maternity ward, where reason long ago gave way to myth. And caring requires effort, too – effort of the heart. And the heart has no place in the modern-day hospital maternity ward, where "the standard of care," not love, runs the show.







(The above is excerpted from Jock Doubleday's book, Spontaneous Creation: 101 Reasons Not to Have Your Baby in a Hospital, Vol. 1: A Book about Natural Childbirth and the Birth of Wisdom and Power in Childbearing Women, www.SpontaneousCreation.org)

CBC News

The majority of new Canadian mothers are happy with their labour and the birth of their child, suggests new data released Tuesday by Statistics Canada, though midwife deliveries are seen in a more positive light.

http://www.cbc.ca/health/story/2007/11/27/statscan-babies.html

Questions about Prenatal Ultrasound...

Contents of Article:

Autism overview

Problems with sound and heat

Elevated MAternal Temperatures cause birth defects

Autism, Genetics and Twin studies

Ultrasound Warnings Unheeded

Hottubs, Steam rooms and Maternal Fevers

Global Autism Epidemic

The Changes in Ultrasound

Increasingly Common Birth Defects

References and research suggestions

Questions about Prenatal Ultrasound and the Alarming Increase in Autism
by Caroline Rodgers© 2006 Midwifery Today, Inc. All rights reserved.

Editor's note: This article first appeared in Midwifery Today Issue 80, Winter 2006.

In May 2006, figures from the Centers for Disease Control (CDC) confirmed what too many parents and educators already knew: The incidence of autism is high, making it an "urgent public health issue," according to Dr. JoseCordero, director of the CDC's National Center on Birth Defects and Developmental Disabilities.

Only 12 years ago autism spectrum disorder (ASD)was so rare that it occurred in just one in 10,000 births.(1) Today ASD,which is characterized by a range of learning and social impairments, nowoccurs in one in 166 children (2)—with no sign of leveling off.

The steep increase in autism goes beyond the US: It is a global phenomenon,occurring in industrialized nations around the world. In the UK, teachers report one in 86 primary school children has special needs related toASD.(3)

The cause of autism has been pinned on everything from "emotionally remote"mothers (since discredited) to vaccines, genetics, immunological disorders,environmental toxins and maternal infections. Today most researcherstheorize that autism is caused by a complex interplay of genetics andenvironmental triggers. A far simpler possibility worthy of investigation isthe pervasive use of prenatal ultrasound, which can cause potentiallydangerous thermal effects.

Health practitioners involved in prenatal care have reason to be concerned about the use of ultrasound. Although proponents point out that ultrasound has been used in obstetrics for 50 years and early studies indicated it was safe for both mother and child, enough research has implicated it in neuron-developmental disorders to warrant serious attention.

At a 1982 World Health Organization (WHO) meeting sponsored by theInternational Radiation Protection Association (IRPA) and other organizations, an international group of experts reported that "[t]here are several frequently quoted studies that claim to show that exposure to ultrasound in-utero does not cause any significant abnormalities in the offspring. …However, these studies can be criticized on several grounds,including the lack of a control population and/or inadequate sample size,and exposure after the period of major or ganogenesis; this invalidates theirconclusions…."(4)

Early studies showed that subtle effects of neurological damage linked to ultrasound were implicated by an increased incidence in left-handedness in boys (a marker for brain problems when not hereditary) and speech delays.(5) Then in August 2006, Pasko Rakic, chair of Yale School of Medicine'sDepartment of Neurobiology, announced the results of a study in which pregnant mice underwent various durations of ultrasound.(6) The brains of the offspring showed damage consistent with that found in the brains of people with autism.

The research, funded by the National Institute of Neurological Disorders and Stroke, also implicated ultrasound in neurodevelopmental problems in children, such as dyslexia, epilepsy, mentalretardation and schizophrenia, and showed that damage to brain cells increased with longer exposures.(7)Dr. Rakic's study, which expanded on prior research with similar results in2004 (8), is just one of many animal experiments and human studies conductedover the years indicating that prenatal ultrasound can be harmful to babies. While some questions remain unanswered, based on available information, health practitioners must seriously consider the possible consequences of both routine and diagnostic use of ultrasound, as well as electronic fetalheart monitors, which may be neither non-invasive nor safe. If pregnant women knew all the facts, would they choose to expose their unborn children to a technology that—despite its increasingly entrenched position in modernobstetrics—has little or no proven benefit?

Problems with Sound and Heat

One challenge that ultrasound operators face is keeping the transducer positioned over the part of the fetus the operator is trying to visualize.When fetuses move away from the stream of high-frequency sound waves, they may be feeling vibrations, heat or both. As the FDA warned in 2004,"ultrasound is a form of energy, and even at low levels, laboratory studies have shown it can produce physical effect in tissue, such as jarring vibrations and a rise in temperature."(9)

This is consistent with research conducted in 2001 in which an ultrasound transducer aimed directly at a miniature hydrophone placed in a woman's uterus recorded sound "as loud as asubway train coming into the station."(10)

A rise in temperature of fetal tissue—especially since the expectant mothercannot even feel it—might not seem alarming, but temperature increases can cause significant damage to a developing fetus's central nervous system,according to research.(11) Across mammalian species, elevated maternal or fetal body temperatures have been shown to result in birth defects inoffspring.(12)

An extensive review of literature on maternal hyperthermia in a range of mammals found that "central nervous system (CNS) defects appearto be the most common consequence of hyperthermia in all species, and cell death or delay in proliferation of neuroblasts [embryonic cells that developinto nerve cells] is believed to be one major explanation for these effects."(13)

Why should neurodevelopmental defects in rats or other mammals be of concern to expecting women? Because, as Cornell University researchers proved in2001, brain development proceeds in the same manner "across many mammalian species, including human infants."(14)

The team found "95 neural developmental milestones" that helped them pinpoint the sequence of brain growth events in different species.(15) Therefore, if repeated experiments show that elevated heat caused by ultrasound damages fetal brains in rats and other mammals, one can logically assume that it can harm human brains,too.

In fact, the FDA and professional medical associations know that prenatal ultrasound can be dangerous to humans, which is why they have consistently warned against the non-medical or "keepsake" ultrasound portrait studios that have cropped up in malls throughout the country.(16)

The risks to the baby are potentially higher in commercial enterprises due to the higher acoustic output required for high-definition images, a potentially long session—as technicians hunt for suitable images—and the employment of ultrasound operators who may have no medical background or appropriate training. These variables, along with factors such as cavitation(a bubbling effect caused by ultrasound that can damage cells) and on-screen safety indicators that may be inaccurate by a factor ranging from 2–6 (17),make the impact of ultrasound uncertain even in expert hands.

Quite simply,if ultrasound can injure babies, it can cause the same damage whether done for routine, diagnostic or "entertainment" purposes.

Elevated Maternal Temperatures Cause Birth Defects

Understanding what happens when the fetus's temperature increases, whether caused by an elevation in maternal core temperature or by the more local effect of ultrasound, is the key to appreciating prenatal ultrasound risks. An individual's body temperature varies throughout the day due to various factors such as circadian rhythms, hormone fluctuations and physical exertion. While people may have up to 1.5° F in each direction of what is considered a "normal" core temperature, the overall average among people is 98.6° F. An increase of only 1.4° F to 100° F can cause headaches, body aches and fatigue, enough to get the individual excused from work. A temperature of 107 F can cause brain damage or death. A core temperature of about 98.6° F is important because that is the point at which many important enzyme reactions occur. Temperature affects the actual shape of the proteins that create enzymes, and improperly shaped proteins are unable to do their jobs correctly.

As factors such as the amount of heat or duration of exposure increase, enzyme reactions become less efficient until they are permanently inactivated, unable to function correctly even if the temperature returns to normal.(18) Because temperature is critical to proper enzyme reactions, the body has built-in methods to regulate its core temperature. For instance, when it is too low, shivering warms it up; when it is too high, sweating wicks off the heat. For obvious reasons, fetuses cannot cool off by sweating. However,they have another defense against temperature increases: Each cell contains something called heat shock (HS) proteins that temporarily stop the formation of enzymes when temperatures reach dangerously high levels.(19)

Complicating the issue is the fact that ultrasound heats bone at a different rate than muscle, soft tissue or amniotic fluid.(20) Further, as bones calcify, they absorb and retain more heat. During the third trimester, the baby's skull can heat up 50 times faster than its surrounding tissue (21),subjecting parts of the brain that are close to the skull to secondary heatthat can continue after the ultrasound exam has concluded. Elevated temperatures that might only temporarily affect the mother can have devastating effects on a developing embryo.

A 1998 article in the medical journal, Cell Stress & Chaperones, reported that "the HS response is inducible in early embryonic life but it fails to protect embryos against damage at certain stages of development." The authors noted, "With activation of the HS response, normal protein synthesis is suspended…but survival is achieved at the expense of normal development."(22)

Autism, Genetics and Twin Studies

What does elevated body temperature have to do with autism?

Geneticists are trying to crack the DNA mysteries behind ASD. Recently researchers linked two mutations of the same X chromosome gene to autism in two unrelated families, although they do not yet understand at what stage these genes were damaged.(23)

Because sibling and twin studies show a higher prevalence of autism among children in families with one autistic child, geneticists expected to find inherited factors, but despite millions of dollars invested in the search, no clear explanation indicates that ASD is inherited.

Perhaps scientists need look no further than at the thermal effects of ultrasound for many answers. If prenatal ultrasound is responsible for some cases of autism, it stands to reason that if one twin were autistic, the other would have a high probability of being affected, since both would have been exposed to ultrasound at the same time. In both identical and fraternal twins, one twin could be more severely affected than the other if he or she happened to take the brunt of the heat or sound waves. In the case of fraternal twins, since autism strikes males between three to five times more often than females, the sex of the twins also could make a difference in outcome.

A 2002 study showed that simply being a twin substantially increased the likelihood of autism, making twinning a risk factor.(24) Could this increased twin risk factor have to do with the practice of giving mothers with multiple gestations more ultrasounds than those expecting singlebirths? While not discounting the role genetics may play in autism, the possible impact of prenatal ultrasound deserves serious consideration.

Ultrasound Warnings Unheeded

The idea that a prenatal ultrasound can be hazardous is not new. The previously mentioned 1982 WHO report, in its summary "Effects of Ultrasoundon Biological Systems," stated that

"…animal studies suggest that neurological, behavioral, developmental, immunological, haematological changes and reduced fetal weight can result from exposure to ultrasound."(25)

Two years later, when the National Institutes of Health (NIH) held a conference assessing ultrasound risks, it reported that when birth defects occurred, the acoustic output was usually high enough to cause considerable heat.(26). Although the NIH has since stated that the report "is no longerviewed…as guidance for current medical practice," the facts remain unchanged.

Despite the findings of these two major scientific gatherings, in 1993 theFDA approved an eight-fold increase in the potential acoustical output of ultrasound equipment (27), greatly increasing the possibility of disastrous pregnancy outcomes caused by overheating. Can the fact that this increase inpotential thermal effects happened during the same period of time the incidence of autism increased nearly 60-fold be merely coincidental?

Hot Tubs, Steam Rooms, Saunas and Maternal Fevers

If the culprit is heat, then what about other situations in which heat impacts pregnancy?

A 2003 study titled, "A report of heat on embryos and fetuses" in the International Journal of Hyperthermia states, "hyperthermia during pregnancy can cause embryonic death, abortion, growth retardation and developmental defects."(28) It further states, "An elevation of maternal body temperature by 2 degrees Centigrade [3.6 degrees Fahrenheit] for at least 24 hours during fever can cause a range of developmental defects."(29) The report noted that necessary data to draw conclusions on exposure timesless than 24 hours were lacking (30), leaving open the possibility that elevated maternal temperatures for shorter periods may adversely affect fetuses.

A study reported in the Journal of the American Medical Association (JAMA)found that "women who used hot tubs or saunas during early pregnancy face up to triple the risk of bearing babies with spina bifida or brain defects."(31). Hot tubs and baths present greater dangers than other heat therapies such as saunas and steam rooms because the immersion in waterfoils the body's attempt to cool off via perspiration, in much the same way fetuses cannot escape elevated temperatures in the womb. All of this taken together establishes the fact that heat, whether caused by elevated maternal temperature or by an ultrasound transducer that remained over one area too long, can set into motion damaging changes in a developing baby. Using common sense, why would anyone think that intruding upon the continuous, seamless development of the fetus, which has for millions of years completed its work without assistance, be without consequences?

Vaccine and Thimerosal Controversy

Despite long-standing evidence that ultrasound induces thermal effects and that thermal effects can harm fetal brain development, the cause of autism has remained so elusive to researchers that many autism societies use a puzzle piece as part of their logos.

Particularly confounding is the fact that ASD plagues the children of high-income, well-educated families whohave the best obstetrical care money can buy. Why would women who took theirprenatal vitamins, observed healthy diets, refrained from smoking ordrinking and attended all regularly scheduled prenatal visits bear children with profound neurologically based problems?

Some believe that childhood vaccines, at first available only to those who could afford them, cause autism. Many vaccines contained thimerosal, a mercury-based preservative, which was thought to have a cumulative neurotoxic effect on children, especially as the number of childhood vaccines increased during the same period of years that the prevalence of autism increased. However, after an exhaustive review in 1999, the FDA found no evidence of harm in the use of thimerosal in childhood vaccines.(32)Despite those findings, that same year the FDA, NIH, CDC, Health Resourcesand Services Administration (HRSA) and American Academy of Pediatrics (AAP)together urged vaccine manufacturers to reduce or eliminate thimerosal inchildhood vaccines.(33) Pharmaceutical companies complied, and ultimately reduced the infant thimerosal exposure by 98%.(34)

Interestingly, not only did autism rates fail to decrease, they continued to increase. ASD increases are between 10 to 17 percent every year, according to the Autism Society of America (35), indicating that thimerosal is not to blame.Thimerosal was not the only area of concern in the vaccine-autism controversy. Many people believed that a correlation existed between the triple vaccine MMR (mumps, measles and rubella) and ASD. However, a large,retrospective epidemiological study of more than 30,000 children in Japan between 1988 and 1996 found that the autism rate continued to climb after the vaccine was withdrawn.(36) Those results were no different than the outcome of a 1999 study published in The Lancet, that showed no corresponding jump in autism in the UK after the introduction of the MMRvaccine.(37)

A 2001 study published in JAMA examining California autism and MMR vaccination rates said the results did "not suggest an association between MMR immunization among young people and an increase in autism occurrence."(38) While concerns about vaccines and mercury exposure shouldnot be dismissed, evidence to date does not implicate either one as a major factor in the explosion of ASD cases.

Global Autism Epidemic

Statistics on the increase of autism worldwide among industrialized nationsshow that it has emerged in just the last few decades across vastly different environments and cultures. What do countries and regions with climates, diets and exposure to known toxins as disparate as the US, Japan,Scandinavia, Australia, India and the UK have in common? No common factor in the water, air, local pesticides, diet or even building materials and clothing can explain the emergence and relentless increase in this serious, life-long neuro-developmental disorder. What all industrial countries do have in common is the quiet yet pervasive change in obstetrical care:

All of them use routine prenatal ultrasound on pregnant women.In countries with nationalized healthcare, where virtually all pregnant women are exposed to ultrasound, the autism rates are even higher than in the US, where due to disparities in income and health insurance, some 30 percent of pregnant women do not yet under go ultrasound scanning.

The Changes in Ultrasound

In considering initial studies indicating that prenatal ultrasound is safe,one must factor in the ways in which the technology and its applications have continually changed and how that has altered the potential exposure o funborn children. Besides the huge increase in allowable acoustic output inthe early 1990s, the following changes have made the field of prenatal ultrasound riskier than ever:

The number of ultrasound scans conducted during each pregnancy has increased, with women often receiving two or more scans even in low-risk situations.(39)

Women in "high-risk" situations may receive many more scans—which, ironically, may raise their risk. The range of time within an embryo or fetus's development when ultrasound is performed has extended to very early in the first trimester and continues into the third trimester, right up to delivery. Fetal heart monitors that are used prior to delivery—sometimes for hours—have not been shown to reduce neurological problems and may increase them.(40)

The development of the vaginal probe, which positions the beam of sound much closer to the embryo or fetus, may put it at higher risk. The use of Doppler ultrasound, which is used to study blood flow or tomonitor the baby's heartbeat, has increased. According to the 2006 Cochrane Database of Systematic Reviews, "routine Doppler ultrasound in pregnancy does not have health benefits for women or babies and may do some harm."(41)

Increasingly Common Birth Defects

Dr. Rakic's research team, cited earlier in this article for its recent study on mouse brains and ultrasound, pointed out that "the probe was held stationary for up to 35 minutes, meaning that essentially the entire fetal mouse brain would have been continually exposed to the ultrasound for 35minutes…in sharp contrast to the duration and volume of the human fetal brain exposed by ultrasound which will typically not linger on a given tissue volume for greater than one minute."(42)

This is an excellent point, which is worth pursuing. One of the most popular non-medical uses of ultrasound, which can extend a medically indicated session, is to determine the sex of the baby. Could this have a connection to the increase in birth defects involving the genitals and urinary tract? The March of Dimes says that these types of birth defects affect "as many as 1 in 10 babies," adding that "specific causes of most of these conditions is unknown."(43)

Following this line of thought, consider what other parts of the body are scrutinized by ultrasound technicians, such as the heart, where serious defects have soared nearly 250 percent between 1989 and 1996.(44) The list of unexplained birth defects is not a short one, and in light of what is emerging about prenatal ultrasound, scientists should take another look at all recent trends, as well as the baffling 30% increase in premature births since 1981, now affecting one in every eight children (45), with many showing subsequent neurological damage.(46)

Although many claim that ultrasound benefits outweigh the risks, that statement has no basis and much evidence is to the contrary. A large randomized trial of 15,151 pregnant women, conducted by the RADIUS StudyGroup, found that in low-risk cases, high-risk subgroups and even in cases of multiple gestations or major anomalies, the use of ultrasound did not result in improved outcome in the pregnancies.(47)

The argument that ultrasound is either reassuring to the parents or provides an early opportunity for bonding pales in the face of the possible risks that are emerging as new data become available. Parents and health practitioners may not be able to easily turn away from this window on the womb and resume more traditional practices in obstetrics and midwifery. However, with the disturbing trend in autism and other equally troubling, unexplained birth-related trends, it does not make sense to blindly employ a technology that is not reliably safe for unborn babies.

Caroline RodgersEditor's Note: Read more about ultrasound on our Web site: http://www.midwiferytoday.com/

Ultrasound: Weighing the Propaganda Against the Facts - by Beverley LawrenceBeech

Ultrasound: More Harm than Good? - by Marsden Wagner

Search more about ultrasound.

References:"National Autism Treatment Plan for Excellence in IDEA" Petition to thePresident of the United States.www.petitiononline.com/natpidea/petition.html. Accessed 23 Sep 2006.

"How Common Are Autism Spectrum Disorders (ASD)?" Centers for DiseaseControl and Prevention. www.cdc.gov/ncbddd/autism/asd_common.htm. Accessed23 Sep 2006.

"Autism in schools: Crisis or challenge?" The National Autistic Society.www.nas.org.uk/nas/jsp/polopoly.jsp?d=160&a=3464. Accessed 23 Sep 2006.

"International Programme on Chemical Safety. Environmental Health Criteria22. Ultrasound." 1982. United Nations Environment Programme, InternationalLabour Organisation and International Radiation Protection Association.www.inchem.org/documents/ehc/ehc/ehc22.htm. Accessed 22 May 2006.Keiler, H., et al. 2001. Sinistrality—a side-effect of prenatal sonography:A comparative study of young men. Epidemiology 12(6): 618–23; Campbell,J.D., et al. 1993. Case-controlled study of prenatal ultrasonographyexposure in children with delayed speech. Can Med Assoc J 149: 10, 1435–40.

"Ultrasound Can Affect Brain Development." Truth Out Issues.www.truthout.org/issues_06/080806HA.shtml. Accessed 25 Sep 2006.Ibid.Eugenius, S., et al. 2006. Prenatal exposure to ultrasound waves impactsneuronal migration in mice. PNAS 103(34): 12903–10.www.pnas.org/cgi/content/abstract/103/34/12903?maxtoshow. Accessed 11 Aug2006.Rados, Carol. 2004.

FDA Cautions Against Ultrasound "Keepsake" Images. FDAConsumer Magazine. www.fda.gov/fdac/features/2004/104_images.html. Accessed11 Sep 2005.Samuel, Eugenie. 2001.

Fetuses can hear ultrasound examinations. NewScientist.www.newscientist.com/article/dn1639-fetuses-can-hear-ultrasound-examinations-.html. Accessed 11 May 2006.Miller, M.W., et al. 2002. Hyperthermic teratogenicity, thermal dose anddiagnostic ultrasound during pregnancy: implications of new standards ontissue heating. Int J Hyperthermia 18(5): 361–84.Ibid.Graham, Jr., M., M.J. Edwards and M.J. Edwards. 1998. Teratogen Update:

Gestational Effects of Maternal Hyperthermia Due to Febrile Illnesses andResultant Patterns of Defects in Humans. Teratology 58: 209–21.Clancy, B., R.B. Darlington and B.L. Finlay. 2001. Translating developmentaltime across mammalian species. Neuroscience 105(1): 7–17.Ibid.See note 9 above.See note 13 above.Wilson, D.E. 2004.

"Body Function Dependent On Body Temperature." InWilson's Temperature Syndrome—A Reversible Low Temperature Problem. eBook.www.wilsonsthyroidsyndrome.com/eBook/Chapters/02Temp.cfm. Accessed 19 Sep2006."How enzymes work." Biotopics. www.biotopics.co.uk/other/enzyme.html.Accessed 19 Sep 2006.

"The ultrasound procedure: Physical effects and research." Birth.www.birth.com.au/class.asp?class=6610&page=5. Accessed 23 Sept 2006.Barnett, S.B.

"Can diagnostic ultrasound heat tissue and cause biologicaleffects?" In S.B. Barnett and G. Kossoff, eds. 1998. Safety of DiagnosticUltrasound. Carnforth, UK: Parthenon Publishing.Edwards, M.J. 1998. Apoptosis, the heat shock response, hyperthermia, birthdefects, disease and cancer. Where are the common links? Cell StressChaperones 3(4): 213–20.Klauck, S.M., et al. 2006. Mutations in the ribosomal protein gene RPL10suggest a novel modulating disease mechanism for autism. Mol Psychiatry.advance online publication 29 August 2006. doi:10.1038/sj.mp.4001883.Betancur, C., M. Leboyer and C. Gillberg. 2002. Increased Rate of Twinsamong Affected Sibling Pairs with Autism. Am J Hum Genet 70: 1381–83.See note 4 above.

"Diagnostic Ultrasound Imaging in Pregnancy." National Institutes of HealthConsensus Statement Online. 5(1): 1–16.See note 16 above.Edwards, M.J., R.D. Saunders and K. Shiota. 2003.

Effects of heat on embryosand foetuses. Int J Hyperthermia. 19 (3): 295–324.Ibid.Ibid.Milunsky, A., et al. 1992. Maternal heat exposure and neural tube defects.JAMA 268(7): 882–85.

"Thimerosal in Vaccines." U.S. Food and Drug Administration.www.fda.gov/cber/vaccine/thimerosal.htm. Accessed 21 Sep 2006.Ibid.

"Thimerosal and Vaccines." Centers for Disease Control.www.cdc.gov/nip/vacsafe/concerns/thimerosal/faqs-thimerosal.htm#3. Accessed27 Sep 2006."Facts and Statistics

." Autism Society of America.www.autism-society.org/site/PageServer?pagename=FactsStats. Accessed 21 Sep2006.Honda, H., Y. Shimizu and M. Rutter. 2005.

No effect of MMR withdrawal onthe incidence of autism: a total population study. J Child PsycholPsychiatry 46(6): 572–79.Taylor, B, et al. 1999. Autism and measles, mumps, and rubella vaccine: noepidemiological evidence for a causal association. Lancet 353(9169):2026–29.Dales, L., S.J. Hammer and N.J. Smith. 2001.

Time Trends in Autism and inMMR Immunization Coverage in California. JAMA 285(22): 1183–85.Stephens, M.B. 2000. American Family Physician Conference Highlights:Majority of Pregnant Women Want Prenatal Ultrasound. Am Fam Physician(62)12: 2665.Wagner, M., and M.G. Wagner. 1994.

Pursuing the Birth Machine, 1st ed.French's Forest, Australia: James Bennett Pty Ltd.Bricker, L., and J.P. Neilson. 2006. "Routine Doppler ultrasound inpregnancy." The Cochrane Collaboration 3.www.cochrane.org/reviews/en/ab001450.html. Accessed 23 Sep 2006.Smith, M. 2006.

"Ultrasound Affects Development of Murine Brains." MedpageToday. www.medpagetoday.com/Radiology/GeneralRadiology/tb/3882. Accessed 13Aug 2006.

"Genital and Urinary Tract Defects." March of Dimes.www.marchofdimes.com/printableArticles/4439_1215.asp. Accessed 27 Aug 2006.

"Healthy from the Start." 1999. The Pew Charitable Trusts (EnvironmentalHealth Commission). www.pewtrusts.com/pdf/hhs_healthy_from_start.pdf.Accessed 25 Sep 2006.Behrman, R.E., and A.B. Stith, eds. 2006. Preterm Birth: Causes,Consequences, and Prevention. Washington, D.C.: National Academies Press.http://newton.nap.edu/catalog/11622.html. Accessed 20 Sep 2006.

"New research offers clues to prevent brain damage in premature babies."2006. Medical News Today.www.medicalnewstoday.com/medicalnews.php?newsid=28786. Accessed 25 Sep 2006.Ewigman, B.G., et al. 1993. Effect of Prenatal Ultrasound Screening onPerinatal Outcome. N Engl J Med 329(12):821–27.

Editor's Note:
We are interested in anecdotal evidence to support or refute this theory of ASD. Midwives or other individuals who know of cases of autism in which the mother didn't have an ultrasound are asked to contactCheryl Smith at mgeditor@midwiferytoday.com or by writing to us.----------------------------------------------------------

New Study: Epidurals may hamper breastfeeding

[New study from Australia, is generating lots of media stories, here's a couple, and the links to the actual research is at the bottom]


http://www.theaustralian.news.com.au/story/0,20867,20905801-23289,00.html

Epidural babies can't get grip on what's breast

David King

December 11, 2006

WOMEN who give birth with the aid of pain-relieving epidurals find it harder to breastfeed than those who give birth naturally, an Australian study has found.

The research suggests some of the drugs used in epidurals make their way into babies' bloodstreams, subtly affecting their brains and development for weeks afterwards -- including making them less willing to breastfeed. The study by University of Sydney epidemiologist Siranda Torvaldsen adds to a growing body of knowledge that makes a link between the use of the pain-killing drug fentanyl in epidurals and problems with breastfeeding. During an epidural a catheter is inserted into the spine to allow the infusion of pain-killing drugs. These deaden the nerves that relay sensations of pain from the lower body.
(see link for full article)

http://news.bbc.co.uk/1/hi/health/6161727.stm
Epidurals 'hamper breastfeeding'


Having an epidural to relieve labour pains is associated with problems breastfeeding, a study suggests.
Researchers said those who have the anaesthetic are more likely to have problems in the first week after birth and to stop breastfeeding early.
(see link for full article)



The research article on which the news articles are based can be found at:http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-1-24.pdf


Commentary on the research is at:http://www.internationalbreastfeedingjournal.com/content/pdf/1746-4358-1-25.pdf

Voluntary C-sections result in more baby deaths

The c-section rate in Saskatoon is currently hovering at about 24%. While I do not have the statistics to say how many if any of these are planned and voluntary, I can say that this is well above the World Health Organization standards of c-section rates for developed countries, which is 12-15%. Please consider the following if you are thinking about your c-section birth options.




September 5, 2006 New York Times

By NICHOLAS BAKALAR


**A recent study of nearly six million births has found that the risk of death to newborns delivered by voluntary Caesarean section is much higher than previously believed.

**Researchers have found that the neonatal mortality rate for Caesareandelivery among low-risk women is 1.77 deaths per 1,000 live births, whilethe rate for vaginal delivery is 0.62 deaths per 1,000. Their findings were published in this month's issue of Birth: Issues in Perinatal Care.

**The percentage of Caesarean births in the United States increased to29.1percent in 2004 from20.7 percent in 1996, according to background information in the report.

**Mortality in Caesarean deliveries has consistently been about 1½ times thatof vaginal delivery, but it had been assumed that the difference was due tothe higher risk profile of mothers who undergo the operation.

**This study, according to the authors, is the first to examine the risk of Caesarean delivery among low-risk mothers who have no known medical reasonfor the operation.

**Congenital malformations were the leading cause of neonatal death regardless of the type of delivery. But the risk in first Caesarean deliveries persisted even when deaths from congenital malformation were excluded from the calculation.

**Intrauterine hypoxia - lack of oxygen - can be both a reason for performinga Caesarean section and a cause of death, but even eliminating those deathsleft a neonatal mortality rate for Caesarean deliveries in the cases studied at more than twice that for vaginal births.

**"Neonatal deaths are rare for low-risk women - on the order of about onedeath per 1,000 live births - but even after we adjusted for socioeconomic and medical risk factors, the difference persisted," said Marian F.MacDorman, a statistician with the Centers for Disease Control and Prevention and the lead author of the study.

**"This is nothing to get people really alarmed, but it is of concern giventhat we're seeing a rapid increase in Caesarean births to women with norisks," Dr. MacDorman said.

**Part of the reason for the increased mortality may be that labor,unpleasant as it sometimes is for the mother, is beneficial to the baby inreleasing hormones that promote healthy lung function. The physical compression of the baby during labor is also useful in removing fluid fromthe lungs and helping the baby prepare to breathe air.

**The researchers suggest that other risks of Caesarean delivery, like possible cuts to the baby during the operation or delayed establishment of breast-feeding, may also contribute to the increased death rate.

**The study included 5,762,037 live births and 11,897 infant deaths inthe UnitedStates from 1998 through 2001, a sample large enough to draw statistically significant conclusions even though neonatal death is a rare event.

**There were 311,927 Caesarean deliveries among low-risk women in the analysis.

**The authors acknowledge that the study has certain limitations, including concerns about the accuracy of medical information reported on birth certificates.

**That data is highly reliable for information like method of delivery andbirth weight, but may under report individual medical risk factors.

**It is possible, though unlikely, that the Caesarean birth group was inherently at higher risk, the authors said.

*Dr. Michael H. Malloy, a co-author of the article and a professor ofpediatrics at the University of Texas Medical Branch at Galveston, said that doctors might want to consider these findings in advising their patients.

*"Despite attempts to control for a number of factors that might have accounted for a greater risk in mortality associated with C-sections, we continued to observe enough risk to prompt concern," he said.

**"When obstetricians review this information, perhaps it will promote greater discussion within the obstetrical community about the pros and cons of offering C-sections for convenience and promote more research into understanding why this increased risk persists."*

Estatic Birth: The Hormonal Blueprint of Labour

By Sarah J. Buckley
I am sharing this piece with you because I feel that the research presented is solid and challenges our preceptions of 'normal' birth. -Lisa

Giving birth in ecstasy: this is our birthright and our body's intent. Mother Nature, in her wisdom, prescribes birthing hormones that take us outside (ec) our usual state (stasis) so that we can be transformed on every level as we enter motherhood. This exquisite hormonal orchestration unfolds optimally when birth is undisturbed, enhancing safety for both mother and baby. Science is also increasingly discovering what we realize as mothers- that our way of birth affects us life-long, mother and child, and that an ecstatic birth, a birth that takes us beyond our Self, is the gift of a lifetime.

Four major hormonal systems are active during labor and birth. These involve oxytocin, the hormone of love; endorphins, hormones of pleasure and transcendence; epinephrine and norepinephrine, hormones of excitement; and prolactin, the mothering hormone. These systems are common to all mammals and originate in our mammalian or middle brain, also known as the limbic system. For birth to proceed optimally, this part of the brain must take precedence over the neocortex, or rational brain. This shift can be helped by an atmosphere of quiet and privacy, with, for example, dim lighting and little conversation, and no expectation of rationality from the laboring woman. Under such conditions a woman intuitively will choose the movements, sounds, breathing, and positions that will birth her baby most easily. This is her genetic and hormonal blueprint.

All of these systems are adversely affected by current birth practices. Hospital environments and routines are not conducive to the shift in consciousness that giving birth naturally requires. A woman's hormonal physiology is further disturbed by practices such as induction, the use of painkillers and epidurals, caesarean surgery, and separation of mother and baby after birth.
Hormones in Birth

Oxytocin
Perhaps the best-known birth hormone is oxytocin, the hormone of love, which is secreted during sexual activity, male and female orgasm, birth, and breastfeeding. Oxytocin engenders feelings of love and altruism; as Michel Odent says, "Whatever the facet of Love we consider, oxytocin is involved."1
Oxytocin is made in the hypothalamus, the "master gland" deep in our brains, and stored in the posterior pituitary, from where it is released in pulses. It is a crucial hormone in reproduction and mediates what have been called the ejection reflexes: the sperm ejection reflex with male orgasm (and the corresponding sperm introjection reflex with female orgasm); the fetal ejection reflex at birth (a phrase coined by Odent for the powerful contractions at the end of an undisturbed labor, which birth the baby quickly and easily);2 and, postpartum, the placental ejection reflex and the milk ejection, or let-down reflex, in breastfeeding.
As well as reaching peak levels in each of these situations, oxytocin is secreted in large amounts in pregnancy, when it acts to enhance nutrient absorption, reduce stress, and conserve energy by making us more sleepy.3 Oxytocin also causes the rhythmic uterine contractions of labor, and levels peak at birth through stimulation of stretch receptors in a woman's lower vagina as the baby descends.4 The high levels continue after birth, culminating with the birth of the placenta, and then gradually subside.5

The baby also produces oxytocin during labor, perhaps even initiating labor;6 so, in the minutes after birth, both mother and baby are bathed in an ecstatic cocktail of hormones. At this time ongoing oxytocin production is enhanced by skin-to-skin and eye-to-eye contact and by the baby's first suckling. Good levels of oxytocin also protect against postpartum hemorrhage by ensuring good uterine contractions.7 In breastfeeding, oxytocin mediates the let-down reflex and is released in pulses as the baby suckles. During the months and years of lactation, oxytocin continues to keep the mother relaxed and well nourished. One researcher calls it "a very efficient antistress situation which prevents a lot of disease later on." In her study, mothers who breastfed for more than seven weeks were calmer than mothers who did not.8 Outside its role in reproduction, oxytocin is secreted in other situations of love and altruism, for example, sharing a meal.9 Researchers have implicated malfunctions of the oxytocin system in conditions such as schizophrenia,10 autism,11 cardiovascular disease,12 and drug dependency,13 and have suggested that oxytocin may mediate the antidepressant effect of drugs such as Prozac.14

Beta-endorphin
As a naturally occurring opiate, beta-endorphin has properties similar to meperidine (pethidine, Demerol), morphine, and heroin, and has been shown to work on the same receptors of the brain. Like oxytocin, beta-endorphin is secreted from the pituitary gland, and high levels are present during sex, pregnancy, birth, and breastfeeding. Beta-endorphin is also a stress hormone, released under conditions of duress and pain, when it acts as an analgesic and, like other stress hormones, suppresses the immune system. This effect may be important in preventing a pregnant mother's immune system from acting against her baby, whose genetic material is foreign to hers.
Like the addictive opiates, beta-endorphin induces feelings of pleasure, euphoria, and dependency or, with a partner, mutual dependency. Beta-endorphin levels are high in pregnancy and increase throughout labor,15 when levels of beta-endorphin and corticotrophin (another stress hormone) reach those found in male endurance athletes during maximal exercise on a treadmill.16 Such high levels help the laboring woman to transmute pain and enter the altered state of consciousness that characterizes an undisturbed birth.
Beta-endorphin has complex and incompletely understood relationships with other hormonal systems.17 In labor, high levels will inhibit oxytocin release. It makes sense that when pain or stress levels are very high, contractions will slow, thus "rationing labour according to both physiological and psychological stress."18 Beta-endorphin also facilitates the release of prolactin during labor,19 which prepares the mother's breasts for lactation and also aids in the final stages of lung maturation for the baby.20 Beta-endorphin is also important in breastfeeding. Levels peak in the mother at 20 minutes,21 and beta-endorphin is present as well in breastmilk,22 inducing pleasure and mutual dependency for both mother and baby in their ongoing relationship.
Fight-or-Flight Hormones
The hormones epinephrine and norepinephrine (adrenaline and noradrenaline) are also known as the fight-or-flight hormones or, collectively, as catecholamines (CAs). They are secreted from the adrenal gland, above the kidney, in response to stresses such as fright, anxiety, hunger, or cold, as well as excitement, when they activate the sympathetic nervous system for fight or flight.
In the first stage of labor, high CA levels inhibit oxytocin production, therefore slowing or inhibiting labor. CAs also act to reduce blood flow to the uterus and placenta, and therefore to the baby. This makes sense for mammals birthing in the wild, where the presence of danger would activate this sympathetic response, inhibiting labor and diverting blood to the major muscle groups so that the mother can flee to safety.
In humans, high levels of CAs have been associated with longer labor and adverse fetal heart rate patterns.23 After an undisturbed labor, however, when the moment of birth is imminent, these hormones act in a different way. There is a sudden increase in CA levels, especially noradrenaline, which activates the fetal ejection reflex. The mother experiences a sudden rush of energy; she will be upright and alert, with a dry mouth and shallow breathing and perhaps the urge to grasp something. She may express fear, anger, or excitement, and the CA rush will cause several very strong contractions, which will birth the baby quickly and easily.

Some birth attendants have made good use of this reflex when a woman is having difficulties in the second stage of labor. For example, an anthropologist working with an indigenous Canadian tribe recorded that when a woman was having difficulty in birth, the young people of the village would gather together to help. They would suddenly and unexpectedly shout out close to her, with the shock triggering her fetal ejection reflex and a quick birth.24

After the birth, CA levels drop steeply. The new mother may feel shaky or cold as a consequence. A warm atmosphere is important, as ongoing high CA levels will inhibit oxytocin and therefore increase the risk of postpartum hemorrhage.25

Noradrenaline, as part of the ecstatic cocktail, is also implicated in instinctive mothering behavior. Mice bred to be deficient in noradrenaline will not care for their young after birth unless noradrenaline is injected back into their system.26

For the baby also, birth is an exciting and stressful event, reflected in high CA levels.27 These assist the baby during birth by protecting against the effects of hypoxia (lack of oxygen) and subsequent acidosis. High CA levels at birth ensure that the baby is wide-eyed and alert at first contact with the mother. The baby's CA levels also drop rapidly after an undisturbed birth, being soothed by contact with the mother.

Prolactin
Known as the mothering hormone, prolactin is the major hormone of breastmilk synthesis and breastfeeding. Traditionally it has been thought to produce aggressively protective behavior (the "mother tiger" effect) in lactating females.28 Levels of prolactin increase in pregnancy, although milk production is inhibited hormonally until the placenta is delivered. Levels further increase in labor and peak at birth. Prolactin is also a hormone of submission or surrender (in primate troops, the dominant male has the lowest prolactin level) and produces some degree of anxiety. In the breastfeeding relationship, these effects activate the mother's vigilance and help her to put her baby's needs first.29 The baby also produces prolactin while in the womb, and high levels are found in amniotic fluid, possibly of uterine or placental origin.30 The function of prolactin in the baby is unknown.

Undisturbed Birth Undisturbed birth is exceedingly rare in our culture, even in birth centers and homebirths. Two factors that disturb birth in all mammals are firstly being in an unfamiliar place and secondly the presence of an observer. Feelings of safety and privacy thus seem to be fundamental. Yet the entire system of Western obstetrics is devoted to observation of pregnant and birthing women, by both people and machines; when birth isn't going smoothly, obstetricians respond with yet more intense observation. It is indeed amazing that any woman can give birth under such conditions. Some writers have observed that, for a woman, having a baby has a lot of parallels with making a baby: same hormones, same parts of the body, same sounds, and the same needs for feelings of safety and privacy. How would it be to attempt to make love in the conditions under which we expect women to give birth?

For birthing Maia Rose, my fourth baby, I arranged a situation where I felt very safe and very private, and I had my shortest, easiest, and most ecstatic labor and birth--one and a half hours with an 8-pound, unexpectedly breech baby. I believe this birth proceeded optimally because I was totally free to follow my instincts, and because I felt safe and private. Each woman must labor where, and with whom, she feels safest, and my situation would not suit everyone. But it underscores the huge gap between what was ideal for me and my baby, physiologically and hormonally, and the standard care offered in most hospitals.

Impact of Drugs and Procedures
Induction and AugmentationIn Australia, approximately 20 percent of women have induced labor, and another 20 percent have an augmentation--stimulation or speeding up of labor--with synthetic oxytocin (Syntocinon, Pitocin).31 In the US, these rates are 19.8 percent and 17.9 percent,32 adding up in both countries to around 40 percent of birthing women being administered synthetic oxytocin by IV during labor.
Synthetic oxytocin administered in labor does not act like the body's own oxytocin. First, Syntocinon-induced contractions are different from natural contractions, and these differences can cause reduced blood flow to the baby. For example, waves can occur almost on top of each other when too high a dose of synthetic oxytocin is given, and it also causes the resting tone of the uterus to increase.33

Second, oxytocin, synthetic or not, cannot cross from the body to the brain through the blood-brain barrier. This means that Syntocinon, introduced into the body by injection or drip, does not act as the hormone of love. However, it does provide the hormonal system with negative feedback--that is, oxytocin receptors in the laboring woman's body detect high levels of oxytocin and signal the brain to reduce production. We know that women with Syntocinon infusions are at higher risk of bleeding after the birth, because their own oxytocin production has been shut down. But we do not know the psychological effects of giving birth without the peak levels of oxytocin that nature prescribes for all mammalian species.

As for the baby, "Many experts believe that through participating in this initiation of his own birth, the fetus may be training himself to secrete his own love hormone."34 Michel Odent speaks passionately about our society's deficits in our capacity to love self and others, and he traces these problems back to the time around birth, particularly to interference with the oxytocin system.

Opiate Painkillers
The most commonly used drug in Australian labor wards today is pethidine (meperidine, Demerol). In one state, 34 percent of laboring women in 1998 were given this drug.35 In the US, several opiate-like drugs have been traditionally used in labor, including meperidine nalbuphine (Nubain), butorphanol (Stadol), alphaprodine (Nisentil), hydromorphone (Dilaudid), and fentanyl citrate (Sublimaze). The use of simple opiates in the labor room has declined in recent years, with most women now opting for epidurals, which may also contain these drugs (see below).36 As with oxytocin, use of opiate drugs will reduce a woman's own hormone production,37 which may be helpful if levels are excessive and inhibiting labor. The use of pethidine, however, has been shown to slow labor, more so with higher doses.38

Again we must ask: What are the psychological effects for mother and baby of laboring and birthing without peak levels of these hormones of pleasure and mutual dependency? Some researchers believe that endorphins are the reward we get for performing reproductive functions such as mating and birthing; that is, the endorphin fix keeps us having sex and having babies.39 It is interesting to note that most countries that have adopted Western obstetrics, which prizes drugs and interventions in birth above pleasure and empowerment, have experienced steeply declining birthrates in recent years.

Of greater concern is a study that looked at the birth records of 200 opiate addicts born in Stockholm from 1945 to 1966 and compared them with the birth records of their non-addicted siblings. When the mothers had received opiates, barbiturates, and/or nitrous oxide gas during labor, especially in multiple doses, the offspring were more likely to become drug addicted. For example, when a mother received three doses of opiates, her child was 4.7 times more likely to become addicted to opiate drugs in adulthood.40

This study was recently replicated with a US population, with very similar results.41 The authors of the first study suggest an imprinting mechanism, but I wonder whether it may be a matter of ecstasy: if we don't get it at birth, as we expect, we look for it later in life through drugs. Perhaps this also explains the popularity (and the name) of the drug Ecstasy.

Animal studies suggest a further possibility. It seems that drugs administered chronically in late pregnancy can cause effects in brain structure and function (e.g., chemical and hormonal imbalance) in offspring that may not be obvious until young adulthood.42-45 Whether such effects apply to human babies who are exposed for shorter periods around the time of birth is not known; but one researcher warns, "During this prenatal period of neuronal [brain cell] multiplication, migration and interconnection, the brain is most vulnerable to irreversible damage."46

Epidural Drugs
Epidural drugs are administered over several hours via a tube into the space around the spinal cord. Such drugs include local anaesthetics (all cocaine derivatives, e.g., bupivicaine/marcaine), more recently combined with low-dose opiates. Spinal pain relief involves a single dose of the same drugs injected through the coverings of the spinal cord and is usually short-acting unless given as a combined spinal-epidural (CSE). Epidural pain relief has major effects on all of the previously mentioned hormones of labor. Epidurals inhibit beta-endorphin production47 and therefore also inhibit the shift in consciousness that is part of a normal labor. (This may be one reason why epidurals are so acceptable to hospital birth attendants, who are not prepared, practically or professionally, to deal with the irrationality, directness, and physicality of a woman laboring on her own terms.) When an epidural is in place, the oxytocin peak that occurs at birth is also inhibited because the stretch receptors of a birthing woman's lower vagina, which trigger this peak, are numbed. This effect probably persists even when the epidural has worn off and sensation has returned, because the nerve fibers involved are smaller than the sensory nerves and therefore more sensitive to drug effects.48

A woman giving birth with an epidural will thus miss out on the fetal ejection reflex, with its strong final contractions designed to birth her baby quickly and safely. She must then use her own effort, often against gravity, to compensate. This explains the increased length of the second stage of labor and the extra need for forceps when an epidural is used.49 Use of epidurals also inhibits catecholamine release,50 which may be advantageous in the first stage of labor; close to the time of birth, however, a reduction in CA levels will, as with oxytocin, inhibit the fetal ejection reflex and prolong the second stage.

Another hormone also appears to be adversely affected by epidurals. Prostaglandin F2 alpha helps to make a laboring woman's uterus contractible, and levels increase when women labor without epidurals. In one study, women with epidurals experienced a decrease in PGF2 alpha, and average labor times were increased from 4.7 to 7.8 hours.51 Drugs administered by epidural enter the mother's bloodstream immediately and go straight to the baby at equal, and sometimes greater, levels.52,53 Some drugs will be preferentially taken up into the baby's brain,54 and almost all will take longer to be eliminated from the baby's immature system after the cord is cut. One researcher found bupivacaine and its breakdown products in the circulation of babies for the first three days.55

Another indication of the effects of epidurals on mother and baby comes from French researchers who gave epidurals to laboring sheep.56 The ewes failed to display their normal mothering behavior; this effect was especially marked for the ewes in their first lambing that were given epidurals early in labor. Seven out of eight of these mothers showed no interest in their offspring for at least 30 minutes.
Some studies indicate that this disturbance may apply to humans also. Mothers given epidurals in one study spent less time with their babies in hospital, in inverse proportion to the dose of drugs they received and the length of the second stage of labor.57

In another study, mothers who had epidurals described their babies as more difficult to care for one month later.58 Such subtle shifts in relationship and reciprocity may reflect hormonal dysfunctions and/or drug toxicity and/or the less-than-optimal circumstances that often accompany epidural births--long labors, forceps, and cesareans.

Incredibly, there have been no good studies of the effects of epidurals on breastfeeding, although there is evidence that babies born after epidural have a diminished suckling reflexes and capacity.59,60

Cesarean Surgery
Cesarean section involves major abdominal surgery and increases the risk of maternal death by about four times,61 as well as possibly affecting mother and baby's health in subsequent pregnancies.62 Cesarean rates are currently 21.1 percent in Australia63 and 22.9 percent--the highest level on record--in the US.64 Obviously there is a shorter or absent labor with cesarean birth, and the peaks of oxytocin, endorphins, catecholamines, and prolactin are absent. Furthermore, mothers and babies are usually separated for some hours after birth, so breastfeeding is usually delayed. Both will also be affected to some extent by the drugs used in the procedure (epidural, spinal, or general anaesthetic) and for postoperative pain relief.

The consequences of such radical departures from our hormonal blueprint are suggested in the work of Australian researchers who interviewed 242 women in late pregnancy and again after birth. The 50 percent of women who had given spontaneous vaginal birth experienced a marked improvement in mood and an elevation of self-esteem after delivery. By contrast, the 17 percent who had cesarean surgery were more likely to experience a decline in mood and self-esteem. The remaining women had forceps or vacuum assistance, and their mood and self-esteem were, on average, unaltered.65

Another study looked at the breastfeeding hormones prolactin and oxytocin on day two, comparing women who had given birth vaginally with women who had undergone emergency cesarean surgery. In the cesarean group, prolactin levels did not rise as expected with breastfeeding, and the oxytocin pulses were reduced or absent. In this study, first suckling had been at 240 minutes average for cesarean babies, and 75 minutes average for babies vaginally born. Duration of breastfeeding was not significantly different for the mothers, and the authors conclude that "other factors" can compensate for deficient hormonal release."66 Other research has shown that early and frequent suckling positively influences milk production and the duration of breastfeeding.67,68 The authors of the hormonal study above add, "These data indicate that early breastfeeding and physical closeness may be associated not only with more interaction between mother and child, but also with endocrine [hormonal] changes in the mother."69

These studies not only indicate important links between birth and breastfeeding but also show how an optimal birth experience can influence the long-term health of mother and baby. For example, successful breastfeeding confers advantages such as reduced risk of breast cancer and osteoporosis for the mother and reduced risk of diabetes and obesity long-term for the child. And enhanced self-esteem after a natural birth--a lifelong effect, in my experience--is a solid base from which to begin our mothering.

The connections between events at birth and long-term health certainly deserve more study. (See Michel Odent's Primal Health Database, www.birthworks.org/primalhealth, for a summary of current research.) But we cannot afford to wait for years for researchers to "prove" the benefits of an undisturbed birth. Perhaps the best we can do is trust our instincts and vote with our birthing bodies, choosing models of care that increase our chances of undisturbed--and ecstatic--birthing.

Early Separation
Even in non-interventionist settings, it is uncommon for a baby to remain in his mother's arms for the first one to two hours. And yet nature's blueprint for this time includes a specific and genetically encoded activation of the brain and nervous system for both mother and baby. For example, when the newborn baby is in skin-to-skin contact at the mother's left breast (which is where new mothers in all cultures instinctively cradle their babies) and in contact with her heart rhythm, "a cascade of supportive confirmative information activates every sense, instinct and intelligence needed for the radical change of environment…. Thus intelligent learning begins at birth."70

For the mother also, "A major block of dormant intelligences is activated" the mother then knows exactly what to do and can communicate with her baby on an intuitive level."71 This awakening of maternal capabilities is well known among animal researchers, who link it to the action of pregnancy and birth hormones on the brains of mothers who have recently delivered.72 Such intuitive capacities are sorely needed in our human culture, where we rely so heavily on outside advice from books and "experts" to tell us how to care for our babies.

According to Joseph Chilton Pearce (see Note 70), when these activations do not occur within about 45 minutes of birth, "cut off from his mother's nurturing and with none of the encoded expectancies met, the newborn's adrenals continue to release steroids in the face of maximum fear and abandonment. The infant screams for a short time and then silence falls." The damage caused by separation, Pearce writes, is "massive and past the point of repair." Like Odent, he believes that our current birth practices are psychologically crippling to babies, mothers, and society as a whole, and the evidence in his book Evolution's End: Reclaiming the Potential of Our Intelligence is compelling.

Optimizing the Ecstasy
The following suggestions will help a woman use her hormonal blueprint and so optimize the experience and safety for herself and her baby.
Take responsibility for your health, healing, and wholeness throughout the childbearing years.
Choose a model of care that enhances the chance of a natural and undisturbed birth (eg, homebirth, birth center, one-on-one midwifery care).
Arrange support according to an individual woman's needs; trust, a loving relationship, and continuity of care with support people are important.
Consider having an advocate at a hospital birth, e.g., a private midwife or doula.
Ensure an atmosphere where the laboring woman feels safe, unobserved, and free to follow her own instincts.
Reduce neocortical stimulation by keeping lighting soft and reducing words to a minimum.
Cover the clock and any other technical equipment.
Avoid drugs unless absolutely necessary.
Avoid procedures (including obvious observations) unless absolutely necessary.
Avoid cesarean surgery unless absolutely necessary.
Don't separate mother and baby for any reason, including resuscitation, which can be done with the cord still attached.
Breastfeed and enjoy it!

One way to ensure minimum interference in the third stage is to practice Lotus Birth, or nonseverance of the cord. This is only compatible with a physiological third stage, and also keeps mother and baby together and secluded in the hours and days after birth. It is the subject of a new book and, having had three Lotus-born babies myself, I highly recommend both the practice and the book.73.

Giving birth is an act of love, and each birth is unique to the mother and her baby. Yet we also share the same womanly physiology and the same exquisite orchestration of our birthing hormones. Our capacity for ecstasy in birth is also both unique and universal, a necessary blessing that is hard-wired into our bodies but that requires, especially in these times, that we each trust, honor, and protect the act of giving birth according to our own instincts and needs.

Dutch professor of obstetrics G. Kloosterman offers a succinct summary, which would be well placed on the door of every hospital birth room:
Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine--nil nocere [do no harm].74



Notes 1. M. Odent, The Scientification of Love (London: Free Association Press, 1999). 2. M. Odent, "The Fetus Ejection Reflex," in The Nature of Birth and Breastfeeding (Westport, CT: Bergin and Garvey, 1992). 3. K. Uvnas Moberg, quoted in report of Australian Lactation Consultant's Conference, Gold Coast, Australia 1998, published in Australian Doctor (July 8, 1998): 38. 4. M. Y. Dawood et al., "Oxytocin in Human Pregnancy and Parturition," Obstetrics and Gynecology 51 (1978): 138-143. 5. E. Nissen et al., "Elevation of Oxytocin Levels Early Post-partum in Women," Acta Obstetricia et Gynecologica Scandanavica 74, no. 7 (1998): 530-533. 6. T. Chard et al., "Release of Oxytocin and Vasopressin by the Human Fetus during Labour," Nature 234 (1971): 352-354. 7. M. Odent, "Don't Manage the Third Stage of Labour!" Practising Midwife 1, no. 9 (1998): 31-33. 8. See Note 3. 9. J. G. Verbalis et al., "Oxytocin Secretion in Response to Cholecystokinin and Food: Differentiation of Nausea from Satiety," Science 232 (1986): 1417-1419. 10. P. Feifal and T. Raza, "Oxytocin Modulates Psychomimetic-induced Deficits in Sensorimotor Gating," Psychopharmacology 141, no. 1 (1999): 93-98 11. T. R. Insel, "Vasopressin and Autism: Is There a Connection?" Biological Psychiatry 45, no. 2 (1999): 145-147. 12. S. Knox et al., "Social Isolation and Cardiovascular Disease: An Atherosclerotic Pathway," Psychoneuroendocrinology 23, no. 8 (1998): 877-890. 13. S. Sarnyai and G. L. Kovacs, "Role of Oxytocin in the Neuroadaptation to Drugs of Abuse," Psychoneuroendocrinology 19, no. 1 (1994): 85-117. 14. K. Uvnas Moberg et al., "Oxytocin as a Possible Mediator of SSRI-induced Antidepressant Effect," Psychopharmacology 142, no. 1 (1999): 954-1001. 15. M. Brinsmead et al., "Peripartum Concentrations of Beta Endorphin and Cortisol and Maternal Mood States," Australian and New Zealand Journal of Obstetrics and Gynaecology 25 (1985): 194-197. 16. R. S. Goland et al., "Biologically Active Corticotrophin-releasing Hormone in Maternal and Fetal Plasma during Pregnancy," American Journal of Obstetrics and Gynecology 159 (1984): 884-890. 17. T. Laatikainen, "Corticotrophin Releasing Hormone and Opioid Peptides in Reproduction and Stress," Annals of Medicine 23, no. 5 (1991): 489-496. 18. M. Jowitt, "Beta-endorphin and Stress in Pregnancy and Labour," Midwifery Matters 56 (1993): 3-4. 19. C. Rivier et al., "Stimulation in Vivo of the Secretion of Prolactin and Growth Hormone by Beta-endorphin," Endocrinology 100 (1976): 238-241. 20. C. R. Mendelsen, "Prolactin May Be Stimulus in Fetal Lung Development," Ob-Gyn News, July 1, 1978. 21. R. Franceschini et al., "Plasma Beta-endorphin Concentrations during Suckling in Lactating Women," British Journal of Obstetrics and Gynaecology 96, no. 6 (1989): 711-713. 22. V. Zanardo et al., "Beta Endorphin Concentrations in Human Milk," Journal of Pediatric Gastroenterology and Nutrition 33, no. 2 (2001): 160-164. 23. R. Lederman, E. Lederman et al., "Anxiety and Epinephrine in Multiparous Women in Labor: Relationship to Duration of Labor and Fetal Heart Rate Patterns," American Journal of Obstetrics and Gynecology 153, no. 8 (1985): 870-877. 24. This incident is described by Michel Odent in "The Fetus Ejection Reflex," in The Nature of Birth and Breastfeeding (Westport, CT: Bergin and Garvey, 1992). 25. Manabu Saito et al., "Plasma Catecholamines and Microvibration as Labour Progresses," Shinshin-Igaku 31, no. 3 (1991): 81-89 (abstract in English). 26. S. A. Thomas and R. D. Palnuter, "Impaired Maternal Behavior in Mice Lacking Norepinephrine and Epinephrine," Cell 91 (1997): 583-592. 27. H. Lagercrantz and H. Bistoletti, "Catecholamine Release in the Newborn Infant at Birth," Pediatric Research 11, no. 8 (1977): 889-893. 28. M. Odent, The Nature of Birth and Breastfeeding (Westport, CT: Bergin and Garvey, 1992). 29. Ibid. 30. G. Daniels and J. Martin, "Neuroendocrine Regulation and Diseases of the Anterior Pituitary and Hypothalamus," in Harrison's Principles of Internal Medicine, 13th ed. (New York: McGraw-Hill, 1994). 31. Australian Institute of Health and Welfare National Perinatal Data Statistics Unit, www.aihw.gov.au, retrieved October 2001. 32. National Center for Health Statistics, www.cdc.gov/nchs, retrieved November 2001. 33. See Note 15. 34. See Note 28. 35. Queensland Health Perinatal Statistics 1998, www.health.qld.gov.au/hic/1998peri/home.htm, retrieved November 2001. 36. American College of Obstetricians and Gynecologists, Obstetric Analgesia and Anesthesia, Technical Bulletin No. 225 (July 1996). 37. T. A. Thomas et al., "Influence of Medication, Pain and Progress in Labour on Plasma Beta-endorphin like Immunoreactivity," British Journal of Anaesthesia 54 (1982): 401-408. 38. A. M. Thomson, "A Re-evaluation of the Effect of Pethidine on the Length of Labour," Journal of Advanced Nursing 19, no. 3 (1994): 448-456. 39. C. D. Kimball, "Do Endorphin Residues of Beta Lipotrophin in Hormones Reinforce Reproductive Functions?," American Journal of Obstetrics and Gynecology 134, no. 2 (1979): 127-132. 40. B. Jacobsen et al., "Opiate Addiction in Adult Offspring through Possible Imprinting after Obstetric Treatment," British Medical Journal 301 (1990): 1067-1070. 41. K. Nyberg et al., "Perinatal Medication as a Potential Risk Factor for Adult Drug Abuse in a North American Cohort," Epidemiology 11, no. 6 (2000): 715-716. 42. B. J. Myerson, "Influence of Early B-endorphin Treatment on the Behavior and Reaction to B-endorphin in the Adult Male Rat," Psychoneuroendocrinology 10 (1985): 135-147. 43. C. K. Kellogg et al., "Sexually Dimorphic Influence of Prenatal Exposure to Diazepam on Behavioral Responses to Environmental Challenge and on Gamma Aminobutyric Acid (GABA)-Stimulated Chloride Uptake in the Brain," Journal of Pharmacology and Experimental Therapeutics 256, no. 1 (1991): 259-265. 44. M. Mirmiran and D. F. Swaab, "Effects of Perinatal Medication on the Developing Brain," in Fetal Behaviour, J. G. Nijhuis, ed. (Oxford, England: Oxford University Press, 1992). 45. G. T. Liversay et al., "Prenatal Exposure to Phenobarbital and Quantifiable Alterations in the Electroencephalogram of Adult Rat Offspring," American Journal of Obstetrics and Gynecology 167, no. 6 (1992): 1611-1615. 46. See Note 44. 47. See Note 15. 48. C. F. Goodfellow et al., "Oxytocin Deficiency at Delivery with Epidural Analgesia," British Journal of Obstetrics and Gynaecology 90 (1983): 214-219. 49. C. E. McRae-Bergeron et al., "The Effect of Epidural Analgesia on the Second Stage of Labour," Journal of the American Association of Anesthetic Nurses 66, no. 2 (1998): 177-182. 50. A. D. Falconer and A. B. Powles, "Plasma Noradrenaline Levels during Labour: Influence of Elective Lumbar Epidural Blockade," Anaesthesia 37 (1982): 416-420. 51. O. Behrens et al., "Effects of Lumbar Epidural Analgesia on Prostaglandin F2 Alpha Release and Oxytocin Secretion during Labour," Prostaglandins 45, no. 3 (1993): 285-296. 52. R. Fernando and E. Bonello, "Placental and Maternal Plasma Concentrations of Fentanyl and Bupivacaine after Ambulatory Combined Spinal Epidural (CSE) Analgesia during Labour," International Journal of Obstetric Anesthesia 4 (1995): 178-179. 53. M. Brinsmead, "Fetal and Neonatal Effects of Drugs Administered in Labour," Medical Journal of Australia 146 (1987): 481-486. 54. T. Hale, "The Effects on Breastfeeding Women of Anaesthetic Medications Used during Labour," paper presented at Passage to Motherhood Conference, Brisbane, Australia, 1998. (Contact CAPERS bookshop, Brisbane, for abstracts or tape, www.capersbookstore.com.au) 55. P. Belfrage et al., "Lumbar Epidural Analgesia with Bupivacaine in Labor," American Journal of Obstetrics and Gynecology 123 (1975): 839-844. 56. D. P. Krehbiel et al., "Peridural Anesthesia Disturbs Maternal Behavior in Primiparous and Multiparous Parturient Ewes," Physiology and Behavior 40 (1987): 463-472. 57. C. B. Sepkoski et al., "Effects of Maternal Epidural Anesthesia on Neonatal Behavior during the First Month," Developmental Medicine and Child Neurology 34 (1992): 1072-1180. 58. A. D. Murray et al., "Effects of Epidural Anaesthesia on Newborns and Their Mothers," Child Development 52 (1981): 71-82. 59. J. Riordan et al., "Effect of Labor Pain Relief Medication on Neonatal Suckling and Breastfeeding Duration," Journal of Human Lactation 16, no. 1 (2000): 7-12. 60. A. B. Ransjo-Arvidson et al., "Maternal Analgesia during Labor Disturbs Newborn Behavior: Effects on Breastfeeding, Temperature, and Crying," Birth 28, no. 1 (2001): 20-21. 61. M. Enkin et al., A Guide to Effective Care in Pregnancy and Childbirth, 3rd ed. (Oxford, England: Oxford University Press, 2000). 62. E. Hemminki and J. Merilainen, "Long-term Effects of Caesarean Sections: Ectopic Pregnancies and Placental Problems," American Journal of Obstetrics and Gynecology 174, no. 5 (1996): 1569-1574. 63. See Note 31. 64. See Note 32. 65. J. Fisher et al., "Adverse Psychological Impact of Operative Obstetric Interventions: A Prospective Longitudinal Study," Australia and New Zealand Journal of Psychiatry 31 (1997): 728-738. 66. E. Nissen et al., "Different Patterns of Oxytocin, Prolactin but Not Cortisol Release during Breastfeeding in Women Delivered by Caesarean Section or by the Vaginal Route," Early Human Development 45 (1996): 103-118. 67. E. M. Salariya et al., "Duration of Breastfeeding after Early Initiation and Frequent Feeding," The Lancet 2, no.8100 (1978): 1141-1143. 68. P. De Chateau and B. Wiberg, "Long-term Effect on Mother-Infant Behaviour of Extra Contact during the First Hour Postpartum," Acta Paediatrica Scandanavia, 66 (1977): 145-151. 69. See Note 66. 70. J. C. Pearce, Evolution's End: Reclaiming the Potential of Our Intelligence (San Francisco: HarperSanFrancisco, 1995): 178-179. 71. Ibid. 72. J. A. Russell et al., "Brain Preparations for Maternity- Adaptive Changes in Behavioral and Neuroendocrine Systems during Pregnancy and Lactation," Progressive Brain Research 133 (2001): 1-38. 73. Shivam Rachana, ed., Lotus Birth (Melbourne, Australia: Greenwood Press, 2000), golden@xtreme.net.au. 74. G. J. Kloosterman, "Universal Aspects of Birth: Human Birth as a Socio-psychosomatic Paradigm," Journal of Psychosomatic Obstetrics and Gynecology 1, no. 1 (1982): 35-41.
(Note: A similar version of this article was presented at the Circle of Life Conference of the National Association of Childbirth Educators, Queensland, Australia, April 2001.) Issue 111/ march/April 2002

Sarah J. Buckley trained as a family MD and GP-obstetrician in New Zealand. Giving birth to her children Emma (11), Zoe (8), Jacob (6), and Maia Rose (1), all born ecstatically at home, has fueled her passion for birth and motherhood, and she is currently fully occupied in mothering, writing, and lecturing. She lives in Brisbane, Australia, with Nicholas, the love of her life, and can be reached at sarahjbuckley@yahoo.com.

Labour Drug Assailed

Labor Drug Assailed

Article Challenges Mag Sulfate Use

By Sandra G. Boodman
Washington Post Staff Writer

Tuesday, October 10, 2006; HE01



For the past 30 years or so, doctors have routinely given pregnant women intravenous infusions of magnesium sulfate to halt contractions that can lead to premature labor.Now a prominent physician-researcher is calling on his colleagues to stop using the drug for this purpose, saying that the treatment is unproven, ineffective and potentially deadly -- an artifact of an earlier era when the standard of care was based more on pronouncements than on clinical trials.

The drug, sold commercially as Epsom salts and known to doctors as mag sulfate, causes side effects that range from highly unpleasant to lethal: nausea, blurred vision, headache, profound lethargy, a burning sensation and, in rare cases, life-threatening pulmonary edema, in which the lungs fill with fluid."Why has it persisted? Tradition," said David Grimes, vice president of biomedical affairs for the nonprofit public health group Family Health International, who co-authored the provocative commentary "Time to Quit" in the current issue of the journal Obstetrics & Gynecology.Magnesium sulfate for preterm labor, Grimes said, is a "North American anomaly" confined to the United States and Canada whose continued use is predicated on "good hopes and good wishes rather than good data."

The American College of Obstetrics and Gynecology does not endorse use of the drug for this purpose, he noted.Four years ago a team of researchers from Australia reached similar conclusions in a report published by the Cochrane Collaboration, a respected international organization that evaluates scientific studies. The Australian team reviewed 23 clinical trials worldwide involving 2,000 women who had received the drug to quell contractions. They found that it did not reduce preterm labor and that more babies died when their mothers took the drug than in a control group where the mothers had not been given it.

Mag sulfate is typically administered between the 26th and 34th weeks of pregnancy for about 48 hours to stall contractions long enough to permit the injection of steroids, which speed fetal lung development.Grimes said he and Kavita Nanda wrote the commentary to promulgate the Cochrane findings among the nation's OB-GYNs. "The Cochrane review hasn't received wide visibility, so that's why we wanted to put this in a journal all OB-GYNs get."Continued use of the drug, Grimes and other critics of the practice say, exemplifies the slow pace of change in obstetrics, where it is hard to conduct clinical trials because the stakes are regarded as so high.

Doctors seeking to use a drug to stave off premature contractions that can trigger labor are better off using a calcium channel blocker such as nifedipine, which has been proven effective, Grimes said.Grimes and Nanda estimate that about 120,000 American women receive mag sulfate each year for premature contractions, and they say some evidence suggests it may be associated with 1,900 to 4,800 fetal deaths annually in the United States.

The latter figure is derived from a 1998 study in Obstetrics & Gynecology.But jettisoning a long-standing practice in obstetrics involves factors other than evidence, some doctors say.They note that the standard of care -- a benchmark of evidence in malpractice cases -- as well as patients' wishes and the desire to prevent a bad outcome such as premature birth -- all contribute to continued use of the drug.

"There is a current practice [to use the drug] that is the community standard," said Michael Gallagher, a specialist in maternal-fetal medicine, or high-risk pregnancy, who practices at Shady Grove Adventist and Holy Cross hospitals. Gallagher said he regards mag sulfate as a viable and safe option in some cases -- and not as an ineffective and potentially dangerous drug."Suppose we don't use it and a patient delivers," Gallagher said, noting that might violate the prevailing standard among OB-GYNs. "You find yourself in lonely places."

"Medical practice," he added, "doesn't move overnight." Nor, Gallagher said, does he think the evidence is "as cut and dried as Grimes says. This is his opinion."But, Gallagher said, he and many of his colleagues are careful to present the option of using the drug with plenty of caveats."We do a lot of 'we think' and 'maybes' and let women decide whether to take it," he noted.Not surprisingly, few refuse -- fearing the possibility of a bad outcome, he added.

For doctors, "there is pressure to use it from patients, as well as peer pressure" from other physicians, said Dallas OB-GYN Gary Cunningham, a professor at the University of Texas Southwestern Medical Center who noted that doctors are desperate to find something that works to stop preterm labor and prevent a premature birth with possibly devastating results."This drug has a powerful constituency," he said, adding that he is not part of it. The drug, he added, is an effective treatment for preeclampsia or eclampsia, pregnancy-induced hypertension that can be fatal to mothers and babies.

Before mag sulfate became widely used in the 1970s, Cunningham noted, doctors gave women intravenous alcohol to quiet contractions."All we got was a bunch of drunk patients who vomited and aspirated, and some died," he recalled. Before that, doctors used morphine, which was abandoned for similar reasons.Alessandro Ghidini said it took him years to persuade colleagues at Inova Alexandria Hospital to stop using mag sulfate after his arrival about a decade ago."This is a medicine that American doctors are very familiar with," said Ghidini, a maternal-fetal medicine specialist. "It took a long time" to convince doctors the evidence was lacking, he said.In their commentary, Grimes and Nanda wrote that the popularity of the drug has been reinforced by "pronouncements in prestigious medical journals or from famous medical institutions.

" They cite a 1999 review article in the New England Journal of Medicine that stated "magnesium sulfate is safe and has become the first-line treatment for preterm labor in North America."" 'Overgrazing' of ineffective and harmful practices on the 'medical commons' is a stubborn problem in obstetrics," they wrote.

Cunningham said he still vividly recalls the time years ago that he took the drug to see what female patients experienced."It was scary," he said. "You feel like you're burning up."

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