Brave New World of Evidence-based Maternity care ~ Chapter 10

by faithgibson on September 8, 2013

Chapter 10

~ Autism and Pitocin Induction, Operative Delivery and PP Depression ~

faith gibson, LM (2005)

Several times a year news magazines and television broadcasts report on various health-care related topics that raise questions about  “obstetrics as usual” but never seem to explore any of the potential answers or include any follow-up stories. For example, a July 2000 cover story for Newsweek was about an explosive increase in childhood autistic disorders, a severe problem in which the majority of these children wind up institutionalized by the age of 13. One of the possible explanations mentioned was a statistical link between the increase in autism and the increase in labors induced with Pitocin. It quoted Dr. Eric Hollander (director of an autism clinic at Mt Sinai Medical Center in New York) as reporting that 60% of his patients were the product of a Pitocin-induced labor. To my knowledge, not another word has been raised in public or in print about this potential drug connection, even thought the article identified that more children suffer from the scourge of autism than childhood cancer or Downs Syndrome – as high as 1 out of 500. I can appreciate the litigious nightmare for Parke-Davis if that observation turns out to have merit, as a lot of “Vitamin P” (as L&D nurses jokingly refer to it) is being used these days.

In the last few years, public health authorities have identified an enormous increase in the incidence of childhood autism. In California, the number of kids receiving state services for autistic disorders has nearly quadrupled since 1987. (1) A recent news report on National Public Radio noted 775 news cases, a 33% increase over the previous quarter in which only 550 new cases were identified. This brain development disorder results in a lack of normal language skills and inability to form human bonds of affection with parents and other people. The majority of its victims are boys. Many also suffer from epilepsy. The physical, mental, emotional and social disabilities combined are so sever that most autistic children end up in institutions by the age of 13.  This is a tragedy for the child and its parents, a loss to society and an economic burden of great proportion. Autism is now thought to affect one person in 500, making it more common than Downs syndrome or childhood cancer. According to Dr Marie Bristol Power from the National Institute of Child Health and Human Development, it is a not a rare disorder but a “pressing public-health problem”. (1)

Neither the cause of this disorder nor the reason for its exponential increase is well understood by researchers at this time.  However there is data associating autistic disorders with the use of an artificial hormone (Pitocin) which is given to pregnant women to induce or speed up labor (1, 2). Pitocin is a synthetic exogenous source of the natural hormone oxytocin which stimulates the gravid uterus to contract. It was developed as a drug by the Parke-Davis pharmaceutical company in 1953 and put into general use in 1955. It comes from the pituatary glands of cattle and includes acetic acid for pH adjustment and .5 percent chloretone as a preservative. The lead story in the July 31, 2000 issue Newsweek magazine was devoted to exploring this growing health problem. The Newsweek reporter, Geoffrey Cowley, interviewed Dr Eric Hollander of New York’s Mount Sinai School of Medicine, a physician who specializes in treating autistic kids. Dr Hollander reported that several years ago he noticed that 60% of the autistic patients in his clinic had been exposed to this drug as a fetus. Material published by the World Health Organization also notes an association between the use of Pitocin and autistic disorders (2).

In spontaneous labors the mother’s pituitary gland makes an endogenous (i.e. internal) oxytocin that triggers the physiological onset and progress of labor. The hormone oxytocin is also produced during breastfeeding (causing the let-down of breast milk) and it accompanies sexual orgasm. For this reason it is referred to as the “love hormone” by obstetrician Christian Northrop, MD as each of these biological events are associated with experiences of great emotional bonding and include meaningful social interaction between the individuals involved. Since autistic disorders produce an inability to make or maintain affectionate bonds or have normal social relationships, one cannot help but wonder if perhaps there is an causal relationship between these disorders and exogenous sources of an artificial form of oxytocin. Perhaps flooding the immature body of the fetus (especially boy babies) with this gender-specific synthetic hormone from animals somehow interferes with the eventual function of these psychological systems. It is an intriguing question.

However, Pitocin is not the only drug received by women whose labors are being induced or augmented. The use of Pitocin requires that the mother also be given IV fluids, have continuous electric fetal monitoring in place and remain sedentary in her hospital bed while connected to this equipment. Pitocin-induced uterine contrations and enforced maternal immobility makes labor more painful, so much so that under these circumstances most laboring women also receive narcotic pain relievers and/or epidural anesthesia. The use of these drugs and anesthetics is also associated with an increase in operative deliveries (vacuum extraction or forceps). It is possible that the causative agent or trigger event for autism is a particular combination of drugs or certain physical problems or propensity for either the mother or baby, in combination with certain drugs, rather than a simple direct effect of Pitocin per se.

The use of Pitocin to induce or augment labors and concomitant use of epidural anesthesia has been steadily climbing for the last 20 years – about the same period that the increase in autism has been reported. Estimates of the use of Pitocin in laboring women over the last 2 decades range from 12% to 60%. However, a 1992 survey by a medical anthropologist at the University of Texas found that 81% of women in US hospital receive Pitocin to either induce or augment labor. Epidural use is as high as 95% in many urban hospitals. When one factors in a Cesarean rate of 23% (acknowledging some overlap), the proportions of these facts is staggering as virtually 100% of medically-managed births are subjected to a high level of pharmaceutical interventions that have never been approved for use in fetuses. It certainly seems prudent to research the possible association with pharmaceutically-augmented labors in an attempt to discover the cause of the rising tide of autistic disorders. It may be necessary to amend our current obstetrical practices to prevent an epidemic of this expensive and emotionally-crippling  disorder.

Existing data on babies born at home under the care of midwives
as a control group in Autism research

For research purposes it seems logical to utilized the subset of healthy childbearing women who experience no medical treatments during the labor and birth (i.e. – no Pitocin or other labor-inducing drugs, no narcotic pain medications, no general or regional anesthetics and no operative deliveries, etc) as a control to determine if intrapartum medical treatments are causative or contributory to the development or acerbating of autism disorders.  In the early 1990s the Midwives Alliance of North America (MANA) embarked on a retrospective statistical study of domiciliary birth outcomes. More recently they have been conducting a prospective study by enrolling nationally certified professional midwives as a requirement of their re-certification. To date they have compiled statistics on about 15,000 births.  This would provide the demographic data for follow-up questionares to ascertain the rate of autism within this substantial group of babies who were unmedicated during the labor. Also a recent change in the California birth registration law authorizes for the first time since 1915 the filing of birth certificates by professional midwives providing community-based birth services (client home and free-standing birth centers) so that the gathering of statistical data in California on this subset of births is now possible.

(1)    Newsweek Magazine, July 31, 2000
(2)    Care in Normal Birth: A Practical Guide—W.H.O’s “Safe Motherhood” series
(3)  Mothering Magazine, Spring Issue, 2001

Intrapartum Narcotics and Drug Addiction in the Next Generation

Drugs and surgery have many consequences beyond those desired in the moment. Genomic research has identified that some individuals have small errors in their DNA that result in a paradoxical or toxic effect from drugs that are otherwise helpful or at least without harmful side-effects. Just last week Newsweek (July 9 issue) carried a story about “Designer Drugs” in which it identified a study in which .3% of the population had a missing letter in their DNA code for a particular drug. People with this error had potentially fatal reactions to this drug.

Mothers in labor are routinely given several different drugs without any way to know if their unique DNA code makes them or their unborn baby vulnerable to toxic side effects. The propensity to have an adverse reaction must be multiplied by the number of drugs received, and then must be doubled as they are being given directly to the mother and delivered to the baby via the umbilical cord. For the baby, whose virgin brain is being influenced by these substances, the risk of side effects is both immediate and life long. Studies done in Scandinavia have concluded that narcotic use during labor (within 10 hours of birth) results in a statistically significant increase in drug abuse and addiction of narcotized fetusus as they become teens and young adults. (Jacobson, et al, 1990, Jacobson, Nyberg, Eklund, Bygdeman & Rydberg, 1988)

According to research by Doctors Thorpe & Breedlove, (1996), “80% of US women receive epidurals … narcotics are added to epidural analgesia to speed and enhance pain relief. These drugs cross the placenta to the fetus”.  In addition there is an increased risk of drug interactions when more than one drug is present at the same time, frequently the case during labor. Perhaps the epidemic increase in childhood autistic disorders is a result of drug interactions between pitocin used to accelerate labor and the cocaine-based drugs and narcotics used in epidural anesthesia that normally accompany induced or augmented labors. It should be noted that there is absolutely no testing of drugs on children less than 6 years of age. All drugs used on pregnant women have never been tested to determine if they are safe for fetuses and neonates. Not a single one. No one has a clue about the long-term consequences. Sadly there is no media coverage of these facts and their implications.

Operative Deliveries and Postpartum Depression

Not least in this litany of missed opportunities is the heartbreaking story of Andrea Yates and the fatal consequences of unacknowledged, untreated postpartum depression turned PP psychosis, which resulted in the death of all five of her children. According to Newsweek, these unimaginable demons cause mothers to kill some 200 children in the US each year. PPD can occur after the most normal of pregnancies but is more common and more sever after the added stress of a Cesarean or other operative delivery and when a baby is premature or must be in the intensive care nursery after the birth. (22. Predictors, prodromes and incidence of postpartum depression. Obstet Gynaecol 2001 Jun)  On psychological tests, the self esteem of first-time mothers improves and measures highest for women who have normal vaginal births while showing a deterioration for mothers who delivery by Cesarean surgery. (20. Adverse psychological impact of operative obstetric interventions: a prospective longitudinal study Aust N Z J Psychiatry In spite of this we have an obstetrically-configured, highly medicalized system that induces or augments labor with pitocin up to 80% of all labors (21. Robbie DavisFlyod, PhD, Mothering Magazine Jan 2001), has as much as a 95% epidural rate in some hospitals and wants to raise our CS rate by returning to mandated repeat C-Sections and instituting “Cesarean on demand” – all things that predictably increase maternal stress and the number of babies separated from their mothers in intensive care nurseries. This is a recipe for future disasters.

The public erroneously assumes that detection and prevention of PPD is an important aspect of standard obstetrical care but is it not. With the exception of a single 6 weeks check-up, obstetricians don’t provide any postpartum care to a new mother nor does the baby’s pediatrician, despite a PPD rate of 12 to 20%. (22. Predictors, prodromes and incidence of postpartum depression. Chaudron LH, J Psychosom Obstet Gynaecol 2001) Except for community-based midwifery, there is no continuity of care for childbearing women or functional safety net to prevent PPD or to catch it early on, before it damages the parent-child bond, the woman ’s relationship with her husband or results in harm to herself or others. (23. Do not minimize signs of postpartum depression! Early intervention essential to prevent negative consequences for the child. [Article in Swedish] Wickberg B, Hwang P. 2001) There are also no studies to see if there is a connection between the many drugs routinely used in labor during the last half century and the development of postpartum depression (perhaps Andrea Yates mother was heavily drugged during her labor with Andrea, which made Andrea more vulnerable to the effect of drugs used during the fives labors with her own children – an adverse reaction of intergenerational proportion!).

While 70% of all births are normal and do not require the standard (interventive) obstetrical care (24. The Safety of Alternative Childbirth Methods, Peter Schlinzka, 1999), 95% of the many billions spent each year on maternity services go to support an obstetrical model of care which has no time or money for meaningful follow-up for new mothers. Unfortunately, when we spend the whole economic enchilada on the few hours of labor (with no improvement in perinatal outcome) it leaves nothing to address the social and psychological needs of new-mother-baby dyad, during the equally important first weeks and months of the postpartum.  Again, a cone of media silence covers up the sins of obstetrical excess and omission.