The Use of Drugs During Labor and Childbirth

Mothers-in-waiting who read all the nice things being written in the news about receiving an early epidural would be best advised to also read the full report as it appeared in the NEJM, under the more cautious title: "Risks of Cesarean Delivery with Neuraxial Analgesia Given Early versus Late in Labor."

Those who do so may come to the conclusion (as I did) that if this test trial proved anything at all, it was that all epidural combinations lead to more c-sections, whenever they're given-early or late in labor. The high rates of c-sections in both the "early" and "late" epidural groups, indicated as much.

Only carefully screened and selected first-time mothers were allowed to participate in this study. No breech babies, multiples or mothers with diabetes mellitus or other conditions were studied. Nevertheless, 17.8% of the women in the early epidural group and 20.7% in the control group delivered their babies by c-section. Although the difference was deemed statistically insignificant, the c-section rate for each group was unusually high for healthy, first-time moms.

From
Just Say No to Drugs - by Esther Marilus. This article first appeared in Midwifery Today Issue 76, Winter 2005.

Without adequate testing of Cytotec (misoprostol) for labor induction, obstetricians simply began to use it on their birthing women. They were taking advantage of a huge loophole in our drug regulatory system. Once a drug is approved by the FDA for a specific medical indication and put on the market, there is absolutely nothing to prevent any doctor from using that drug for any indication, in any dose, for any patient he or she chooses. Since the label of the drug contains the indications approved by the FDA, this is called "off-label" use of a drug.

When obstetricians using Cytotec induction are confronted about their willingness to use a drug "off-label," they inevitably answer: "We use drugs off-label all the time." There are several serious problems with this answer. First, in reality, using Cytotec for induction is not "off-label" at all-it is "on-label contraindicated." On the Cytotec label it is explicitly written that this drug is contraindicated for use on pregnant women. Contraindication would not be on the label unless data exist suggesting possible serious risks from such use. "On-label contraindicated" is a whole different level of risk-taking than a use that is not mentioned one way or the other on the label.

From Cytotec Induction and Off-Label Use - by Marsden Wagner, MD, MS. This article first appeared in Midwifery Today Issue 67, Fall 2003.

Instead of urging non-pharmacological methods of pain relief (for example, water pools), the latest research paper to reveal the inadequacy of Demerol's pain-relieving effects suggests that epidural anaesthesia should now be widely available (Olofsson, 1996). The authors have few worries about the adverse effects of this drug.

In 1981 Rosenblatt published a six-week follow-up of the effects of epidural anaesthesia, which showed that immediately after delivery, infants with greater exposure to bupivacaine in utero were most likely to be cyanotic and unresponsive to their surroundings. Visual skills and alertness decreased significantly with increases in the cord-blood concentration of bupivacaine, particularly on the first day of life but also throughout the next six weeks. Adverse effects of bupivacaine levels on the infant's motor organisation, his ability to control his own state of consciousness and his physiological response to stress were also observed. Interestingly, this study considered six weeks to be "long-term," but what are the long-term effects at 5, 10, 20 or 50 years?

Women who choose water for pain relief have been warned that a rise in the water temperature over 37° C could cause a rise in the mother's temperature and result in brain damage in the babies, with no research evidence whatsoever to support that suggestion. As a result, many UK hospitals have refused women access to water pools. However, research by Lieberman (1997) revealed that intrapartum fever greater than 100.4° F occurred in 14.5 percent of women receiving an epidural. If the labours lasted longer than 18 hours the rate increased to 36 percent. Not a single paediatrician has expressed concern about this risk

From Drugs in Labour - by Beverley Lawrence Beech. This paper was presented at the Midwives of North America (MANA) Conference in November 1998, and appeared in Midwifery Today Issue 50, Summer 1999.

Order Midwifery Today 71 (Autumn 2004) and read what Marsden Wagner has to say about misoprostol induction of labor. You'll also find an overview of drugs in labor by Sarah J. Buckley. Other articles include HIV and Pregnancy, Compassionate C-section, and Did Immunizations Kill My Babies?. This issue is an important resource for anyone who wants to learn more about this pressing topic.

Epidural Epidemic with Marsden Wagner, M.D. and Penny Simkin, PT

Epidemics: Epidural, Ultrasound, Cytotec and More with Penny Simkin and Judy Edmunds

Non-Pharmacological Methods of Pain Relief with Penny Simkin, PT

Strategies for Keeping Birth Normal in First Stage with Penny Simkin, PT, Anne Frye, Virginia Jackson, CNM, Valerie El Halta, Jan Tritten and Mabel Dzata

The cost of medicalization is both monetary and emotional, depriving mothers of a powerful and miraculous birth experience. An experience that sets the foundation for motherhood. The baby's house is now totally invaded, unless the mother flatly refuses to step into the medical culture. Where is there an island of light?

Why does the newspaper have an article about a baby who died during a midwife-attended birth? Doctors routinely induce, drug and numb motherbaby-where are the headlines for the deaths they directly cause? Why are they not held to a standard-a simple one, like don't damage mothers or babies iatrogenically? My niece just stomped out of an obstetrician's office because when she told him she was talking to her aunt, a midwife, he said, "You mean, baby killer?" What ever gave doctors the right to take over our birth culture and rob us of our miracle? What ever gave them the right to steal a woman's experience and her power and cause no end of health sequelae for mothers and babies? Where are their standards? Where are their ethics? Why this war against motherbaby and midwives? Why do we ask kids to just say no to drugs, when we flood them with drugs at birth? Why do we have to keep fighting this battle? Why are we losing?

From Editorial: Drugs in Labor - by Jan Tritten. This editorial first appeared in Midwifery Today Issue 71, Autumn 2004