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?

If you want to get a flavour of women's experiences of pethidine have a look at this thread on mumsnet:

here

There are some positive comments on the thead, but also PLENTY of negative ones:

"it did nothing for me, no pain relief, just intense itching"

"I felt drugged up in the worst possible way. Really out of it and not like myself at all, very hazy memories of that period of my labour."

"I was totally spaced out. I've never taken any sort of hallucinogenic drugs but I now have a pretty good idea what they do! I only had a 4 hr labour but all I remember is asking DH for water and not much else. It was all very hazy and I have no idea about anything else that happened. I came to a bit for the actually delivery but even then I don't remember much about it. I don't remember when I first saw her, I don't remember who dressed her, any of that."

"the not being able to communicate thing was the worst. I lost myself completely."

"pointless as was the pethidine. Neither touched the sides so to speak.
Didn't feel any less pain whatsoever."

"I had pethidine, did nothing for the pain of the contractions at all and just made me completely out of it."

"Had it when dd1 was born, was awful. Made me vomit all the time, was totally out of it, couldn't push, kept crying, made the labour an awful experience. "

"wful, made me vomit, pass out between still painful contractions and generally feel terrible."

"I kept talking about chasing cats up trees and then the midwives waited until DH left the room and offer me some experimental new drug which I apparently agreed to have but have no recollection of the conversation.
"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"

Didn't count the posts, but I think about a third to a half were strongly negative, along the lines of the ones I've c&p'd from above.

As to the assertion that pethidine can't in any way compare with heroin - well sorry, reading the above, and having seen people under the influence of heroin I really can't see how pethidine is so different in its impact to heroin (when it hasn't been adulterated or administered in a dangerous way).

I said "we'd never sanction its use on a healthy infant in any other circumstance"

Children who are being given it for pain relief are ill or injured, which justifies its use.

But newborn babies are usually neither unwell nor have injuries which justify medicating with powerful drugs.

In any case, I don't think you understand my concerns at all. You have been very literal minded in assuming I don't like pethidine because I feel it puts my baby at serious risk - like a dose of street heroin. Actually I'm aware that pethidine has been in use in childbirth for many, many years and has a pretty good safety record. What saddens me about my daughter having it is the thought that her first interactions with me and her father, her first attempts at breastfeeding, her first experiences of life outside the womb, were done under the influence of a sedative and mood altering drug which altered her perception of what was going on around her, and blunted her ability to act on her instincts.

carpet lover - your experience with diamorphine in labour is not uncommon. In some studies between a third to a half of women report 'little' or 'no' relief of pain after having it.

I wouldn't tell her horror stories, what happened to you and your friends won't necessarily happen to her. But I also wouldn't let her believe that all you have to do is go for a waterbirth and you're guaranteed a lovely, painfree labour. I thought I wanted a waterbirth and told the MW so when I arrived in the delivery suite. She sent me off to have a deep bath while the pool was being prepared and I absolutely hated being in the water. I couldn't get out quickly enough.

If I were you I would just tell her to make sure she is fully informed about labour, and as fit and healthy as she can be. She can discuss it with her MW, read internet forums and go to antenatal/NCT classes.

It is metabolised differently in individuals. Some simply won't find it as effective as others or some will find the effects overwhelming. That's a fact.

Emotive statements like the suggestion that babies of women given opiates during labour are more likely to grow up to be drug addicts is not a fact.

Well I'm very much in the 'whatever gets you thru the night' camp. I just found it useless for me.

"It is metabolised differently in individuals. Some simply won't find it as effective as others or some will find the effects overwhelming. That's a fact."

Yes. And in the case of pethidine it's ineffectual and/or downright unpleasant for a very large minority of women.

"Emotive statements like the suggestion that babies of women given opiates during labour are more likely to grow up to be drug addicts is not a fact."

Once again - why do you feel the need to distort what I said? Can't you come up with any decent arguments?

I didn't say 'the babies of women given opiates during labour are more likely to grow up to be drug addicts'.

I said there was research showing a link between neonatal exposure to opioids and adult drug addiction. And it's research of sufficient quality to be referred to in many NHS sponsored patient information leaflets on pethidine.

Another point not touched on yet is that of endorphins which are produced naturally in the brain and actually have exactly the same effect as opoids. The word endorphin is derived partly from the word morphine.

A natural labour with no artificial painkillers will still produce endorphins and still produce the same effect on the pain receptors in the brain.

Yes - you are right. Endorphins produced in labour also have a powerful impact on perception, motor skills and memory. Of the mother. Not the baby.

So morphine crosses the placenta but endorphins don't you think?

sorry still confused...does pethadine cause feelings of euphoria and is it addictive? Sorry if i'm missing something here...that's my question though i appreciate the other info provided.

Yes it is addictive and can produce feeling of euphoria but much less so than morphine and the euphoric effects will be greatly reduced by the fact that you are unlikely to be having a great time of it when you have it. It also has a very short span of efficacy so it wears off relatively quickly.

Taking it once is not going to cause addiction though. Especially because you'd have to be in labour to be given it again!

To me then there's not much in it. I understand they are not identical on a molecular level but they work in a similar way and have similar effects. You seen to be at great pains to put distance between them and i don't really get why. If it's ok to use diamorphine in a medical setting surely it's ok to use something that is similar but not the same. No one is seriously comparing street heroin with hospital grade opiates in any sense other than possibly how it feels to the user (and how this is manifest to an observer which hardly matters). Thanks for taking the time to discuss this with me btw. Are you a pharmasist?

Can I interrupt with a quick question, sorry -

spudulika, you say there is "... research showing a link between neonatal exposure to opioids and adult drug addiction. And it's research of sufficient quality to be referred to in many NHS sponsored patient information leaflets on pethidine."

Would you be able to link to some of these NHS leaflets pls? I'm just curious because I've never seen it mentioned, but then each PCT seems to have its own differing patient info.

PS I know I posted way down thread - but re: birth experiences, surely if someone asks you about yours, it's okay to describe it honestly, in the expectation that you will not be the only woman your friend is asking?

It's not like a friend is asking for a universal view or manifesto about birth in general (well, unless they are, and they'd probably be better off asking someone professionally experienced in that case). They just want to know about you.

I don't think anyone can describe what birth in general is like, only what ours was like. But that's fine. I do see some women on MN universalising their own experience and assuming it was the same for everyone, and it creates some very unsympathetic exchanges.

You know Fruitybread - I was wrong. I've seen a good number of references to it in midwifery journals and textbooks over the years and got confused. I was thinking of in particular the MIDIRS Informed Choice series of leaflets - sponsored by the RCOG, NHS and RCM. Having looked through them just now I see that these studies are only referred to in the leaflet on pain relief aimed at health professionals - not that written for mothers.

Okay - I thought I hadn't seen any patient info that mentioned a link between neonatal exposure to opiods and adult drug addiction, but as I say, patient info varies so much, that doesn't mean much.

If that info exists as part of NHS advice (or RCOG advice, or similar) in leaflets about pain relief aimed at professionals rather than patients, is it possible to link to any of them? TIA.

No not a pharmacist. I studied chemistry and I find medicine really interesting. I very nearly went into it but I missed a lot of school. I was really ill at one point and taking morphine and dihydrocodeine and all sorts. I had a lot of time on my hands so I went back over opiates in particular. It's really interesting! I can also bore you rigid about sedatives, hallucinogens and hypnotics etc too but that's another story! I just think it's fascinating. It's amazing that we've developed such controlled medicines as to be able to help relieve the pain of childbirth without doing harm. They used to use ether and chloroform! Now that really is crazy!

"So morphine crosses the placenta but endorphins don't you think?"

Yes - I should imagine they do.

But unlike opioids, they don't result in abnormal newborn responses and an inability to breastfeed well, as opioids so often do.

Seriously -why are you so keen to dismiss the risks and downsides of using strong drugs in labour? Particularly for babies? Is it because you've used pethidine yourself and thought it was great?

Nothing that I've said in any of my posts here is controversial - the problems associated with the use of opioids in labour are well documented.

But for some reason it seems to really bother you. You've gone all out to argue the case that pethidine is an innocuous drug compared to diamorphine, and - bizarrely - imitates the effects of normal birth hormones. Surely you can't actually BELIEVE this?

"It's amazing that we've developed such controlled medicines as to be able to help relieve the pain of childbirth without doing harm"

Are you really making the case for pethidine in labour being a) highly effective and b) without any unpleasant side effects for mothers and babies?

Why do you think so many hospitals have stopped routinely offering these drugs to labouring women?

[[http://www.australianprescriber.com/magazine/27/2/34/5/ here]

Really good article from the Australian Prescriber which explains why research into the pain relieving effects of opioids for general pain can't be extrapolated to the pain experienced by labouring women, and why previous research suggesting it was efficacious for this group was misleading because it was poorly designed.

It concludes by saying:

"Pethidine administered systemically has little place in the management of labour pain because it is minimally effective, has significant adverse effects for mother and baby, and does little more than sedate the patient. There is limited evidence supporting the use of any systemically administered analgesic in labour; epidural analgesia is a better option."

Ok if you need my points spelling out again.

Pethidine is not 'essentially heroin'.

Endorphins are opoids. Morphine and endorphins both work in the same way. You will have to transfer your umbrage regarding painkillers to endorphins also I'm afraid.

It CAN affect breathing in a newborn but antidotes are available and pethidine has a very short span of effectiveness and is partially filtered out by the placenta. It is not given after seven centimeters dilation for this reason. So your wild claim about pristine newborns being given huge doses of it is inaccurate.

Even diamorphine is not generally harmful in controlled amounts anyway.

Pethidine helps a lot of women. It's got absolutely nothing to do with your junkie ex boyfriend.

If you don't like it, don't take it. You can read as many 9 out of 10 cats style surveys about it as you like on google but I'd rather have the facts over hyperbole.

"It CAN affect breathing in a newborn but antidotes are available and pethidine has a very short span of effectiveness and is partially filtered out by the placenta. It is not given after seven centimeters dilation for this reason. So your wild claim about pristine newborns being given huge doses of it is inaccurate."

So all the research showing impaired responses and poorer breastfeeding in newborns whose mothers have had pethidine in labour is .... what - hype? Scaremongering?

From the article I've linked to above:

"It accumulates in both the mother and fetus with a half-life of 20.5 hours and is thought to be responsible for adverse neonatal effects14 including respiratory depression. Newborns exposed to pethidine have significantly impaired normal infant behaviours such as hand and mouth movements, nipple touching before suckling, and licking movements. Half of the infants exposed to pethidine fail to breastfeed and cry more in the neonatal period.15 In addition to the maternal sedating effects of pethidine, there is also the theoretical risk of maternal delayed gastric emptying, aspiration and respiratory depression. Norpethidine can also induce seizures."

"Pethidine is not 'essentially heroin'"

Well - if we're being literal minded, no it's not.

"Pethidine helps a lot of women."

Why are you disregarding the research which concludes that it's actually NOT very effective as pain relief for the majority and is down-right useless for a large minority?

It's clear to me that you've made up your mind about this drug based on outdated and irrelevant research, and on the strength of your own positive experience with it.

My feelings about pethidine use are born of watching the behaviours of dozens of mothers and newborns on the labour and postnatal ward, reading the stories about women's birth and breastfeeding experiences here on mumsnet, and from reading midwifery textbooks and journals.

I stand by my views.

"but I'd rather have the facts over hyperbole."

So put your money where your mouth is Michelle - where are your references?

I'm happy to give mine as they come from good quality sources like the Royal College of Midwives and NHS choices. The information on the efficacy of pethidine is from a peer reviewed study published in a mainstream UK midwifery journal this year.

And it's you who've taken comments of mine and twisted them to make them sound like hyperbole.