Addiction

Drugs and anaesthetics Before accepting any drugs their possible effects should be considered carefully. Questions to ask What to ask if you are offered drugs for easing pain in labour Drugs and their effects How drugs can effect you and your baby. Anaesthetic injections Anaesthetic drugs can be given by injection to relieve pain during labour.

The link between drugs for pain in labour and later drug addiction in the child.

Many women are offered drugs from the opiate family to ease their pain during labour and birth. The most commonly prescribed drug is pethidine (known as Demerol in the US) but sometimes heroin (diamorphine) is also used. All drugs in the opiate family have effects on the mother and baby. These are fully explained in the secton "Drugs and their effects" and are related to the dosage used and the length of time the woman and her baby are exposed.

Other women, particularly those who have heard of the possible short term problems for the baby associated with pethidine and other opiates, opt instead for using the mask (a mix of nitrous oxide and oxygen) in the belief that it has no effects on the baby, whilst being of known benefit in easing labour pain.

There is limited research on the effects of any of these drugs on the baby and most of it has concentrated on the immediate effects after birth or in the first days and weeks of the baby's life. There have been some studies done on the potential for exposure to these drugs in the time around birth and the development of long term problems for the baby/child, especially in relation to the increased likelihood of the development of an addiction to opiate drugs or amphetamines.

It must be stressed that exposing the unborn baby to any of these drugs will not mean the baby will become a drug addict in later life: it just increases their risk by a factor of five. There will be other influences that also have a bearing on the development of an addiction, such as genetic predisposition, the level of experimentation undertaken by the teenager (not all children experiment with drugs, thus reducing their exposure to the potential trigger of the imprinted memory of euphoria experienced by some unborn babies), and some babies will have experienced their exposure to these drugs as unpleasant, which would be a disincentive to taking similar acting drugs later on in life.

There is no doubt that the increasing problem of drug dependence in teenagers parallels the increasing reliance on opiate and other drugs during labour and birth. The potential link between the two is an issue that is rarely raised and it is a difficult area in which to research (especially using randomised control trials), given that they are expensive and require long-term commitment. There may also be an unwillingness to face the possible unpalatable truth that obstetric practices may be harming our children and that women are being misled into thinking that drugs given during labour have no long term effects for their baby. Tacit acknowledgement of this fact, however, may underlie the current trend to promote epidurals as safer alternatives. Parents, however, are rarely aware that the drugs used for epidurals are a mixture of a local anaesthetic and an opiate drug, which still means exposure for the baby to a potentially addictive agent. Since newborn care is not the province of the anaesthetist, the potential short and long term risks of the drugs to the baby may not be explained to the parents. In any case, a women in pain during labour is unlikely to care, at that point, what she is given, raising the issue of whether truly informed consent has been obtained before the epidural is administered. This is an issue that needs extensive discussion during the pregnancy and is an ideal topic for inclusion during the pre-natal education program (but not by an anaesthetist!).

For those who would like to explore these issues further, the following references may be helpful:

1. Jacobson B et al. Opiate addiction in adult offspring through possible imprinting after obstetric treatment. British Medical Journal, (1990), Vol301, p1067-1070.

2. Jacobson B, Nyberg K, Eklund G, Bygdeman M and Rydberg U. Obstetric pain medication and eventual adult amphetamine addiction in offspring. Acta Obstet Gynaecol. Scand. (1988), 67, p677-682.

3. Jacobson B et al. Perinatal origin of adult self-destructive behaviour, Acta psychiatr. scand. 198776, pp364-371.

4. Nyberg K et al. Obstetric medication versus residential area as perinatal risk factors for subsequent adult drug addiction in offspring. Paediatric and Perinatal Epidemiology, (1993), 7, p23-32.

5. Nyberg K et al. Socio-economic versus obstetric risk factors for drug addiction in offspring. British Journal of Addiction, (1992), 87, p1669-1676.

6. Nyberg, K et al. Perinatal medication as a potential risk factor for adult drug abuse in a North American cohort. Epidemiology, 2000, vol 11, p715-6.

7. Odent M. Between circular and cul-de-sac epidemiology, Lancet 15 April 2000, 355, p1371

You should be able to obtain these references through any medical or university library.