Should we have lied to newly preggy friend about what birth was like? Is it wrong to join the conspiracy?

[Ushy]

Think I have an ethical dilemma

Five of us went for an evening out with newly preggy friend. When it came to discussion of what the birth was like the ONLY one of us who had had an uncomplicated birth went on and on about how wonderful it was and what an overwhelmingly life changing experience and how she should have the baby at home and resist all the interventions etc etc....
The rest of us said nothing or muttered 'it was ok' because we did not want to scare her. We had all had horrific experiences of childbirth and the three of us that have had elective caesareans have all said, between ourselves, it was far better than the 'intervention free' birth.

We chatted about it afterwards. Do we conspire to lie? I now actually feel quite bad because I remember - after my first birth -thinking why didn't someone tell me how awful 'natural' birth could be? I would have insisted on an early epidural and got DH to drag the doctor in to do a caesarean much earlier.

Somehow I feel I have been seduced into a conspiracy and I feel incredibly bad about it. She's a good friend, asked us a straight question and we lied.

Anyone else had this dilemma?

But it still isn't heroin, and it is over-dramatic (and, while we're bandying the word about, disingenuous) to say that "it is heroin really isn't it?".

Whether it's desirable or not, and in particular whether it's desirable towards the end of labour as opposed to early on in a long labour, is a whole other question.

Why is it over dramatic? Same family of drugs. Same effect.

Call a spade a spade.

Babies whose mothers have pethidine are being given a powerful sedative, a few hours before birth.

Drugs in the same family do not have the same effect. They have different chemical compounds, different names and different effects.

It's also not a sedative. It's a opiate which works on the brain to block
pain receptors. There is nothing low or base about it. Every single person having an operation, including a CS will be given strong pain killing drugs.

If you don't want to take it then don't but please research the facts before you make any more outrageous statements about it. Thirty co-codamol does not pethidine make and a double dose of pethidine does not heroin make.

Also, you might want to look up the role of the placenta.

Jesus spudulika, this thread has moved on a bit since I last looked .

Heroin is diamorphine as I recall - no-one is given diamorphine in labour are they? Pethidine is only "the same" in that it is also a strong painkiller - not at all the same drug. As someone else so eloquently said "a cat is not a tiger" .

Also re: "It bothers me that women are so accepting of our high levels of intervention as 'normal' and 'unavoidable'" In my case, if I hadn't had "intervention" in my first pregnancy (in my case emergency induction due to pre-eclampsia) then the lives of both myself & DS1 would have been severely at risk. It bothers me that so many people are determined to convince pregnant women - especially first time mums - to refuse all intervention. IME intervention has always been offered as a last resort for a VERY good reason. I would not advise anyone to ignore/refuse their consultant's advice - the consultant surely knows better than I do!

"It's also not a sedative. It's a opiate which works on the brain to block
pain receptors."

It's 'sold' to mothers as an analgesic but its analgesic properties are poor for many women, which is why it's no longer being routinely offered by many hospitals.

It has a STRONG sedative effect. Anybody who has witnessed mothers in the hours after the administration of this drug would have no doubt that this is the case. Most women aren't mobile after a full dose of pethidine. Many drift in an out of sleep, become incoherent, and suffer from amnesia afterwards which distorts their memories of the efficacy of their pain relief, which is what's believed to account for the belief that pethidine and other opioids provide better pain relief than they actually do, something that's now being challenged by evidence from better constructed research.

From "Does pethidine relieve pain? A critical review of the evidence" from Practising Midwife 2005:
"Nerve and smooth muscle activity is inhibited, leading to the following possible side effects: sedation, reduction of anxiety, euphoria, respitory depression, nausea and vomiting, bradycardia and hypotension, prolonged labour, urinary retention and dysuria, gastric stasis and constipation, and hallucinations"

As for its pain relieving qualities - In the studies looked at in the review, "pain relief reported at 60 minutes post-pethidine - at best, one in five women had 'no' or 'slight' pain relief, at worst, 3 out of 4 had 'no' or 'slight' relief. "These findings seem to confirm the concerns expressed by midwives, doctors and the women themselves. Midwives are left with the uncomfortable evidence that the most common form of intramuscular analgesia they offer may not consistently achieve its purpose'

Hmmm. Haven't had heroin, but having gone out with a junkie, pethidine seems to share many of the same qualities and side effects that he described when taking heroin - sedation, disassociation, hallucinations, euphoria, constipation, nausea, disorientation.

How is pethidine essentially different from heroin then to the lay person who isn't aware of the finer differences in terms of its molecular structure, and is just judging it in terms of the recognised physiological and psychological effects of taking the drug?

"Also, you might want to look up the role of the placenta."

From the same review: "Pethidine rapidly crosses the placenta and is metabolised to the active norpethidine. Kuhnert et al suggest that the previously accepted 3 to 7 hour half life for pethidine in the mother may be an underestimate and also that norpethidine has a mean half life of more than 20 hours. They further suggest a half life of pethidine in the neonate of 11 to 17 hours and a half life of norpethidine of 29 to 85 hours. Neonatal effects of maternal pethidine use have been shown to include reduced Apgar scores and increased respitory depression, reduced early neonatal neurobehavioural scores, reduced early suckling behaviour, increased heart rate and reduced crying times."

And never mind the research - you can see it. I've seen it, and not just in my own babies.

And wasn't there research linking it with a four to fivefold increase in the odds of adult drug abuse and dependence?

On the other hand, it's very cheap and it does keep mothers nice and docile in labour, which makes them easier to look after when you're trying to stretch one midwife between two or three women.

"no-one is given diamorphine in labour are they?"

Yes they are. It's given in preference to pethidine in some hospitals because it's more effective and has fewer nasty side effects.

Pethidine is only "the same" in that it is also a strong painkiller - not at all the same drug.

It's a very strong synthetic opioid. Some women experience good analgesia with it. Many do not. It has a very strong sedative effect in many women who take it.

"It bothers me that so many people are determined to convince pregnant women - especially first time mums - to refuse all intervention. IME intervention has always been offered as a last resort for a VERY good reason."

Nobody is trying to 'convince' women to 'refuse' intervention. Just to think hard about putting themselves in a situation where intervention becomes necessary - as it so often does with hospital births. It's silly you pointing to your own situation as some sort of proof that refusing intervention is foolhardy. I have never come across ANYONE encouraging a mother with serious health problems to refuse the medical care that she needs. Have you? That is not what we're talking about here.

Do you really think that only a third of first time mums are capable of giving birth safely without interventions? How do you account for the MASSIVE disparities in c/s and instrumental rates between hospitals serving similar populations in the UK? And the fact that in 15 years the c/s rate in the UK has DOUBLED while there's been no decrease in the number of forceps and ventouse births?

Even doctors and midwives acknowledge that women are having avoidable interventions in UK hospitals, as does the World Health Organisation.

I find it incredibly odd that while the establishment is acknowledging that this is a problem, women themselves are being so passive about the situation. Don't you think it matters that thousands of mums are spending their first weeks as mothers having to deal with avoidable birth injuries?

Careful not to crack your soapbox while you're ranting on like that.

You don't see the difference between your junkie ex boyfriend getting wrecked on heroin and me having pethidine during my labour? Which was twenty minutes pushing, three hours in total from start to finish, slight tear but nothing serious and a baby with an apgar of 10. By the way.

If you listen quietly you might hear the thud when my face hits the desk.

I'm out!

I think as an encore I might go try and explain cold fusion to my cat. Tiger? Cat..? Ah you know it's all much of a muchness in the feline family.

was thinking about this in my pg insomnia and thinking that for me the really sad thing about women expecting a crap time in labour is that it stops them pushing for better maternity services.

I am glad we can intervene when necessary (like emma's post above) but that doesn't mean all intervention is necessary or desirable.

For instance my friends induction which was a classic cascade ending in episiotomy and forceps (nearly cs). Had she been supported to avoid an epidural as she wanted, rather tha scared into having one at the start, there is a good statistical chance she might have avoided intervention and been much happier.

(as an aside why are mws so insistant on epidurals in inductions? Couldn't they just run the drip slower to allow women time to adjust as when labour starts naturally?)

Anyway... I've no doubt that while mws see such high levels of intervention they will find it hard to keep in mind how emotionally and physically difficult they can be for the women involved. Seeing pain relief/intervention as the norm seems to make some hpcs less willing or able to support women who wish to avoid those things.

diamorphine is used at my local hospital (st james's...europe's largest teaching hospital or summat). I'd also be interested to hear what the practical differences are between various opiates

The truth is that there is no one 'truth' about childbirth. It varies hugely from woman to woman. My first was a traumatic experience because of going way overdue, labour starting after the first induction gel, midwives telling me it wasn't labour when it was, so I was alone in a hospital room at night, after they sent DH home, got very painful very quickly, ended in EMCS, which was very traumatic. The hospital shove you out with no advice on recovery from what is quite a major surgery. Two years later I had a home VBAC, not even gas and air as I found it distracting, had used a hypnobirthing CD so was very calm, was lucky to have an excellent community mw. Yes it hurt like hell, but it was worth it, and I know which experience I preferred.

Moonface I'm happy to explain it but this will be a bit long! :)

The practical difference is very basically a feeling of euphoria and the capacity for addiction.

Pethidine, fentanyl (which is a type of morphine given to people with chronic pain), dyhydrocodeine and codeine are just a few of many opoid based painkillers regularly taken in this country. Dyhydrocodeine and codeine are both available over the counter in any pharmacy. Their purpose is to relieve pain, not to get anyone high.

You can understand the difference if you think of heroin and methadone. Methadone has a similar chemical compound to heroin but does not produce feelings of euphoria. So it isn't any fun. It is prescribed to heroin users to relieve the withdrawal symptoms only.

Diamorphine will be available at hospitals but it is a strictly controlled substance used in palliative care.

Diamorphine is heroin in it's purest form but it certainly is a long way from street heroin. In the same way that pure MDMA and ecstasy tablets will not be comparable. It really isn't cost effective for drug dealers to supply street drugs in their purest forms! Which is a further reason why street drugs are extremely dangerous.

Morphine is given out much more frequently. Paramedics use it to instantly relieve suffering and it is almost always used to alleviate post operative pain.

This is why indicating that any of the millions of people taking or who have taken opiates of any description are no better than junkies is inaccurate and offensive.

"You don't see the difference between your junkie ex boyfriend getting wrecked on heroin and me having pethidine during my labour?

No - you were arguing that pethidine and heroin are not comparable in terms of their physiological impact. I was pointing out that they are.

You are determined that pethidine and heroin have nothing in common - despite the fact that they are actually very similar.

Don't forget - I took pethidine in labour too.

Why are you so desperate to defend a drug which has caused such concerns among health professionals that it's no longer routinely used for women in labour in many UK hospitals? I've heard doctors say that if pethidine was a new drug, it would never be licenced for use in childbirth because of poor evidence of its efficacy and strong evidence of unpleasant side effects.

pethidine

"the really sad thing about women expecting a crap time in labour is that it stops them pushing for better maternity services."

This is so true. Instead they push for c/s and epidurals on demand. I suppose in the absence of more humane care, that's one answer to how unbearable labour has been made for so many women.

moonface:

Information comparing meptid (another commonly used opioid) and pethidine:

here

"any of the millions of people taking or who have taken opiates of any description are no better than junkies"

Except I didn't say that did I?

I didn't say anything with any moral inferences at all. As you know.

I'm not interested in engaging with you any further spudulika. You seem determined to cause a row. I don't have any more to add. Street heroin and pethidine are not the same thing. End of.

Obviously touched a sore spot there.

Won't say any more.

Did you say you had a child or you were one?

michelle - you're the one who's being immature here. I'm happy to admit that in pharmacological terms pethidine and heroin are different. Fact remains they are both powerful drugs with addictive qualities, which can cause sedation, euphoria, respitory depression, amnesia, hallucinations, nausea, and disorientation. As such I feel as uneasy about my dd being exposed to pethidine at birth as I would feel had I been given heroin (had heroin been in clinical use for childbirth). I have a right to express this point of view without you taking umbrage.

I'm not casting any aspersions on your character or your parenting or comparing you or anyone else to a junkie.

OK?

Should add, I've learned something through engaging in this discussion with you. I've discovered that diamorphine, which has replaced pethidine as the opioid of choice in many maternity units, IS actually just another name for heroin. Which I didn't know before.

From Wikipedia:

"Heroin (diacetylmorphine (INN)), also known as diamorphine (BAN), or, especially in older literature, as morphine diacetate, is a semi-synthetic opioid drug synthesized from morphine, a derivative of the opium poppy. It is the 3,6-diacetyl ester of morphine (di-acetyl-morphine) and a morphine prodrug.[4] The white crystalline form is commonly the hydrochloride salt diacetylmorphine hydrochloride, though, when supplied illegally, it is often adulterated, thus dulling the sheen and consistency from that to a matte white powder, which diacetylmorphine freebase typically is.[5] 90% of illicit diamorphine (heroin) is thought to be produced in Afghanistan.[6]
As with other opioids, diacetylmorphine is used as both an analgesic and a recreational drug. Frequent and regular administration is associated with tolerance and physical dependence, which may develop into addiction. Internationally, diacetylmorphine is controlled under Schedules I and IV of the Single Convention on Narcotic Drugs.[7] It is illegal to manufacture, possess, or sell diacetylmorphine without a license in almost every country.
Under the chemical name diamorphine, diacetylmorphine is a legally prescribed controlled drug in the United Kingdom"

I'm thrilled that you are now happy to admit that they are not the same thing. I've had a general anesthetic too. I'm sure you'll agree that I haven't essentially taken ketamine despite the fact that ketamine is also an anesthetic.

We can both sleep easy tonight knowing that our pristine, perfect babies weren't born narcked off their faces on the brown.

This thread seems to have gone pear-shaped.

But, I have to add that in two of my labours at two different hospitals I had diamorphine. In many hospitals it is preferred over pethidine. In one of the hospitals, pethidine wasn't even on offer; they only offered diamophine.

I'm not a medic so unsure as to the difference between diamorphine and morphine but it was very definitely diamorphine I received in both those labours.

littlewheel, just for the benefit of other people who've been told their baby has a big head, as I was, intervention and serious tearing isn't inevitable. My DS's head was 91% centile and he was born with his hand on his head - he needed some supportive wiggling from the midwife, but I had 15 minutes pushing and a problem-free minor 2nd degree tear. So intervention isn't inevitable whatever the size of the baby, though of course it's wise to accept you may need it!

Thanks for the info michelle and spud. I really appreciate you taking the time to provide it.

Can i just clarify michelle...are you saying the difference is that heroin is addictive and gives feelings of euphoria, where as pethadine is not addictive or euphoric? Sorry i'm trying to understand the differance as it would matter to me rather than on a molecular level iyswim.

Yes diamorphine is def used in labour here. It's one of the ways people choose between the two hospitals in leeds..
I'm a bit confused as to why diamorphine is used in preference to pethadine if people are at such pains to draw a line between pethadine and heroin.

Tis a mine field...will hope to do without again this time as making decisions re pain relief seems painfull in of its self.

If you think of the brain as full of doors and morphine as a key that opens or closes certain doors within the brain. Opoids are used to close doors within the brain that signal pain to you. They can also open doors that send pleasure signals to you. The molecules or keys open different doors because they are different shapes. So you can see how the use of some keys would be more addictive than others.

That's about as simply as I can explain it.

It's also worth pointing out that in controlled doses, opening and closes these doors does not cause harm. Spudulika erroneously stated that opiates are not given to children and babies. It would be very cruel to operate on a young baby and not give them the appropriate pain relief.

Street heroin does contain diamorphine but it can be as little as 20%. The remaining portion can be made out of anything including some extremely unpleasant and toxic substances like brick dust and rat poison. There are a lot of contributing factors to street heroin being really dangerous and diamorphine is actually quite low on the list. You'd be safer injecting yourself with morphine than brick dust.

I can't comment on the discussion about painkillers, so I'm just going to answer the OP. My friend who's planning on having kids soon asked me about my DS's birth and I was as honest as I could be. It was a very straightforward birth, about 9 hours in total with G and A. I told her it was incredibly painful but that the only advice I could give is to go in expecting that and not to panic. I think the fact that I was mentally able to keep on top of the pain really helped me. I told her I screamed at the top of my voice, it was hard going, but it was worth it, which is all true. I told her it was gunky and horrible and that one of the worst bits (which no one told me about) was all the messing about afterwards with the placenta injection, yanking the placenta out (still gives me shudders), local injection, stitches, having a shower while feeling shaky (though very welcome), peeing (fucking hell) and the general feeling run over by a truck.

I honestly think that while physically childbirth is an absolute marathon to the moon and back, mentally it is just as hard if not more so. We're programmed to shy away from pain and to tense up when pain comes but in childbirth you have to embrace the pain (sorry to sound all hippyish) and it's a real mental challenge to do that. Once I'd got my head around the fact that the pain was normal and it was all necessary I found the rest of the labour pretty doable.

In the end all I said to her is that I wouldn't do it every day but it's not the end of the world and really it has to be done if you want a baby. I did advise her to be as informed as she could be beforehand as I feel being armed with information (much of it gleaned from MN!) really really helped. Watching birth videos was helpful too as it prepared me by taking the mystery out of the whole thing.

You see, Michelle, that's interesting but I've had diamorphine for 2 of my 3 labours and in neither case did it shut off my pain receptors, not even a little bit. Both times, all it did was make me less aware as if I was stoned or very drunk-but still in the same pain nevertheless. It didn't make me sleepy either but then I've never gone to hospital early and always waited until my contractions were practically on top of each other so maybe it helps you sleep if you go in at just 2 or 3cms.

For my 3rd labour I opted not to have it and although that was still bloody painful I felt I could cope with it better because I was in control and not out of it in the way I was for the first two. Maybe it has a different affect on different people but I'd hesitate to recommend it as it wasn't at all pleasant or even useful for pain.