Monday, October 18, 2010

Bypassing the Natural Protection of the Placenta: Drugs in Labour.

Ah, the placenta. That wonderful organ which sustains, oxygenates and protects the fetus through its gestation. The placenta is the only temporary organ that the human body grows, for the express purpose of making a healthy baby. The placenta also performs a complex function which allows the mother and baby’s blood to transfer nutrients and waste without ever mingling. This process is referred to as the placental barrier. The fetus is protected from much potentially harmful stuff that may be present in the mother’s body by the placental barrier. This marvellous organ can even prevent a fetus from catching HIV from an infected mother. As much as the placenta proects the baby its protection is not perfect. Pregnant women are encouraged not to drink or smoke – as some of these toxins can cross the placental barrier. Listeria, Toxoplasmosis and Salmonella can also cause fetal problems or miscarriage so women are told to avoid everything from sushi and soft cheese to cat pooh. Some illnesses can also infect and damage the baby – Rubella is a prime example.  Many medications can cross the placental barrier too, hence women are encouraged not to take most medicines. Even some vitamins supplements are considered too dangerous to risk. So the average woman will go through her entire pregnancy avoiding caffeine, medicine, alcohol, and camembert to protect her fetus from the dangers inherent in these substances, however tiny the risks may be.

However, as soon as the mother is in labour – arguably the most dangerous time in the fetus’s existence, doctors and nurses are quick to introduce a host of substances which – in their insidious chemical nature – cross the placental barrier easily. The first is often a ‘prophylactic’ intravenously administered antibiotic, which can cause thrush in both mother and baby, potentially damaging the breastfeeding relationship. It has been shown that antibiotics are usually completely ineffective at combating GBS which is the major reason they are given, so this is a completely unnecessary procedure. What it does do, however, is provide the doctors and nurses with direct entry, via the IV, to the mothers bloodstream so that they can start to administer all the drugs they want. Next they give the labouring mother Syntocin or Pitocin which is a synthetic version of Oxytocin, the naturally occurring hormone that causes contractions. Oxytocin has no detrimental effect on the baby and is released in waves so it causes a gentle ebb and flow of contractions. Pitocin on the other hand, is given continuously and in high doses and causes intense and extremely painful contractions. For the baby Pitocin is very unpleasant. Oxytocin – the love hormone – causes warm and happy feelings which comfort the baby during labour, but the synthetic version does not produce any feeling of wellbeing. Also a Pitocin labour is very intense and painful for the baby as the contractions are longer and harder with less recovery time between. Doctors have been know to use this to their advantage when they want to get the mother to agree to a c section.  Pitocin has also been linked to fetal asphyxia and neonatal asphyxia, physical injusy and jaundice. The use of Pitocin may also be a factor in cerebral palsy and autism from fetal oxygen deprivation during the long and unrelenting contractions. Some hospitals are using a drug called Cytotec or Misoprostal vaginally. These drugs can cause uterine rupture and are not indicated for use in pregnancy, in fact the makers of these drugs have warned that they cause uterine rupture and should NEVER be used as a labour inducing drug.


These powerful and painful contractions soon cause the labouring mother – who is usually flat on her back by now – the most painful position for labour – to ask for an epidural. The epidural blocks out the pain from the chest down so relieves the mother’s pain, but has a serious side effect for the baby. Natural contractions cause a degree of discomfort and pain in the mother. In response, the mother’s brain releases natural endorphins – which have a similar but much stronger pain relieving effect than pethadine – and these endorphins, which are non toxic and non narcotic, cross the placental barrier and flood the baby too, so the baby also is protected from the discomfort of contractions, which can be uncomfortable and cause fetal distress. When the epidural is placed the mother’s body no longer produces these endorphins, which means the baby is now feeing the brunt of labour with no pain relief. This, coupled with the lack of happy Oxytocin hormones due to the use of Pitocin or Syntocin, means that the baby is getting no relief of any kind and is much more likely to go into fetal distress. The anaesthetic effect of the epidural also crosses the barrier and is likely to cause breathing difficulties for the baby. Anyone who argues that the effect of drugs on the fetus during labour is negligible needs to watch this video. The babies who were a product of unmedicated labours were all able to self attach and suckled well while most of the medicated babies didn’t manage to breast crawl or self attach. All the medicated babies sucked badly. 

If the mother is lucky enough to have avoided an IV and any of the other interventions, she may be offered Pethidine or gas and air – laughing gas. Both of these drugs will cross the placental barrier and enter the baby’s bloodstream. Pethidine may also cause extreme nausea - one in three women has an unpleasant reaction to it. It can cause breathing difficulties in the baby. It can also cause neonatal drowsiness which can last for days and seriously affect the breastfeeding relationship. Gas and air (Nitrous Oxide) is less invasive. Doctors have maintained for many years that it does not cross the placental barrier, however gas and air babies are also liable to be drowsy. New studies have shown that it may have side effects for the baby but it is nevertheless the least harmful painkiller of all the drugs used in birth. Its effects are also usually short lived.

Western medicine has saved thousands of mothers and babies in labour. Induction – when necessary, can save a mother and baby. In a very tiny percentage of cases, induction is a necessary intervention. However, when drugs are used inappropriately – or as in many hospitals, routinely, a domino effect occurs which leads to more and more interventions. Up to 70% of women who give birth in American hospitals have their labours augmented by Pitocin or cervical ripening agents like Cytotec. Doctors like to be in control of their patients in the hospital environment. They apply time frames to labour and issue ultimatums. Unfortunately for women, labour is an uncontrollable event. The drugs that are routinely administered during labour have been proven to lead to a much higher c- section rate.

Painkilling drugs are also more necessary in hospital labours because women are often still forced to labour on their backs, whether due to being hooked up to the electronic fetal monitor or because their doctors don’t “allow” women to labour in any other position than the lithotomy position.  Lying on ones back restricts the pelvis by up to three centimetres. So naturally labour will be more painful for a woman whose movements are restricted and who spends most of her labour flat on her back. It takes an unusually strong woman to labour drug free in those circumstances.

Thursday, October 14, 2010

Artificial Parenting VS Monkey Mothering.

pic courtesy of
It never ceases to amaze me how humans in the 'civilised' world are so eager to distance themselves from most aspects of natural parenting. It’s as though we are trying to rise above our primate cousins and remove all traces of the ape in our children. I recently watched a nature show which told the story of an orphaned monkey. Its human foster parents took it to bed with them, fed it on demand, cuddled it and wore it in a sling constantly. They said they were just trying to provide it with as natural a monkey experience as possible. The first thing I thought was that I am instinctively being a monkey mother to my daughter. This led me to compare the parenting styles of other primates to our own.

Monkey babies are usually born at night and are immediately cradled by their mothers and brought to the breast. When the placenta detaches naturally and is expelled, the monkey mother eats it and the cord, so the baby is attached to it’s original source of oxygen for the first few crucial minutes of life.  In their first few days of life they are not held by any other monkey. The matriarch will generally come for an inspection but even she is not allowed to hold the baby. Monkey mothers sleep with their babies and feed them all the time. They carry them wherever they go. Monkeys in the wild rarely or never abandon their babies. On the other hand, monkeys in captivity regularly abandon their babies – which shows how easily human intervention – sometimes just human observation – can disrupt the delicate balance between good and bad monkey parenting.

Photo ©2010 Patti Ramos Photography. Used with permission.
In most of the western world the human baby, instead of being welcomed into warm, loving arms and a softly lit environment, is usually born into the sterile, bright, loud and very unnatural environment of a hospital. If the baby has been lucky enough to have been born vaginally, she or he is still likely to have their head yanked on as they emerge, their cord prematurely cut, forcing the brand new creature to gasp for air, and for the first face it sees to be one of a stranger with a mask and cap on. When the baby is born by c – section, it is given an even ruder awakening, and none of the chemical and physiological advantages of a natural birth. Whatever the method of birth, baby is then usually removed from its mother, scrubbed, weighed, given painful eye drops, injected with vitamin K and wrapped before it is finally allowed to be held by its mother. It can take as long as four hours before mother and baby are reunited. The tiny thing is often groggy from the painkillers given to the mother during labour, or stressed from unnaturally intense contractions caused by Pitocin. Although some hospitals are allowing mothers to stay with their babies, it is still unusual for babies to be laid skin to skin with their mothers. And almost none will allow mother and baby to forego the weighing and other ‘checks’ that happen at birth.

Breastfeeding – if it happens at all – is considered non essential. Mothers are still encouraged to send their tiny new babies to the nursery where they may or may not be given formula or glucose water by the nurses, thereby potentially destroying the breastfeeding relationship. If the baby is allowed to room in with the mother, co sleeping is usually frowned upon and plastic bassinets are placed at the mothers bedsides. Mothers are often told that they need to train their new babies, that they can be put on a schedule and fed four hourly from birth. Mothers who ignore this advice and feed on demand are often told they are ‘spoiling their new babies. Babies are given pacifiers, dummy breasts that they are encouraged to suck on between feedings to ‘satiate their suckling urge’, further undermining breastfeeding by potentially causing nipple confusion.

Human babies are also artificially immunised and given routine blood checks, these can be painful and traumatic and are arguably totally unnecessary. In some parts of the world mothers of boys are asked if they want to have their newborn’s perfectly healthy foreskins removed – this is usually done without sufficient anaesthetic or even with no anaesthetic at all as doctors are often told in medical school that newborns don’t feel pain.

When the parents finally go home the baby is usually placed in a separate room from its parents, in a crib or cot. Some parents will force their babies from birth to feed according to a schedule and ignore the cries between scheduled feedings. Even the parents who don’t grit their teeth and let their little one cry will usually feed the baby and then leave it to sleep alone, without the comforting smell and voice of its mother nearby.

What would a monkey say if it could talk? Imagine a chimp mother who had the ability to comment on human parenting. Would she applaud the fact that we have managed to train our babies to eat only when we are willing to allow them to, and to sleep far enough away that we aren’t bothered by their night time noises? Would she marvel at the technology that has allowed us to forego natural childbirth? Would she congratulate us on inventing a substitute for breast milk so that we can leave our babies with other humans and go back to work?  Somehow I think not. I think she would tell us that as a species, we aren’t very good at mothering.