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?

Sorry to butt in again, but just in case this thread blows itself out soon -

spudulika, this link between neonatal exposure to opioids and adult drug addiction, that's sound enough to be included in NHS or RCOG advice to health professionals, in relation to pethidine use -

Can you point me towards some info?

I'm no fan of pethidine, but I'm even less of a fan of misinformation. Apologies in advance if this turns out to be a cross post, and you are busy linking away.

You haven't stood by your view that pethidine is essentially heroin.

That'll do me.

I think you've proven you can find your own way around google. You can easily find all the facts about opoid painkillers I've mentioned. You can even look up their chemical compounds if the fancy takes you.

"relieve the pain of childbirth without doing harm"...what does that then? I thought all pain relief had potential side affects?

I don't mean in every instance moonface. I mean that it is possible is an amazing achievement. We've come a long way from a bottle of whiskey and a bit of wood.

"You haven't stood by your view that pethidine is essentially heroin.

That'll do me."

I see you'll grasp at any small scrap of comfort, having been out argued in every other respect.

"I think you've proven you can find your own way around google"

I'm sitting here looking at a pile of midwifery textbooks and journals. As I said - this isn't controversial or obscure. It's all there in the textbooks.

"You can easily find all the facts about opoid painkillers I've mentioned. You can even look up their chemical compounds if the fancy takes you."

Why would I do that? This is clearly how you've ended up being so wrong headed on this issue: by looking at general information about opioids and their medical uses, and extrapolating it to labouring women.

"Can you point me towards some info?"

Jacobson, B. et al. (1988).Obstetric pain medication and eventual adult amphetamine addiction in offspring. Acta Obstet Gynaecol. Scand., 67: 677-682.
Jacobson, B. et al. (1990). Opiate addiction in adult offspring through possible imprinting after obstetric treatment. British Medical Journal, 301:1067-1070.

Also look here:

Midwifery: Best Practice, Volume 5 By Sara Wickham

here

"I don't mean in every instance moonface. I mean that it is possible is an amazing achievement. We've come a long way from a bottle of whiskey and a bit of wood."

What - by offering women a drug which a) often doesn't work and b) often makes them sick c) often damages their babies' ability to breastfeed?

We're talking COMMON side effects here. Not rare.

Women have used opioids in labour for centuries. Pethidine is no great advance on that.

i would imagine that if you are the one the odds pick to have a shit time the fact that that doesn't happen in every instance is little consolation. But that's the risk you take. Just as long as you go in to it knowing that and not under the impression that "pain relief is without harm"

I think you'll find my scrap of comfort is precisely the point I was making.

I don't believe I mentioned the word breastfeeding once. Nor did I need to resort to random quotes such as 'I took pethidine and I had a real whale of a time.' I don't need any anecdotal evidence to support me.

We could equally have gone on about epidurals and their complications and risks also but the chemical structure of anesthetic will remain the same no matter how much you wring your hands about it.

And goodness me are you going to claim that pethidine is no better than downing Jack Daniels next?

Well if it's all the same, I'll avoid the whiskey. I wouldn't want my baby to grow up to be an alcoholic.

Of course moonface. You can't guarantee you'll wake up from a general anesthetic but it's still an amazing feat of science. That's the point I'm making. Not get thyself to the chemist and down the lot!

not if you're dead it's not.

Don't get me wrong,modern medicine is a great thing. But too much awe leads to complacency and there is still a long way to go imo. Esp in labour where we seem to kowtow to technology rather than support women in more positive and less risky ways.

Definitely agree with that moonface. Childbirth has much to be improved on.

Sorry spudulika, but the one link you provide links to a chapter where, after reading it twice, I can't see any reference to neonatal exposure to opioids being linked to adult drug addiction. Have I missed it?

This is a very big claim to be making. We've gone from you saying it was research mentioned in 'many NHS sponsored patient information leaflets' about pethdine, which it isn't. And fair enough, you do say you got that wrong and were confused - fine, happens to us all.

But then you say it's in leaflets aimed at health professionals, sponsored by the NHS, RCOG and RCM. I understand it might be hard to access these leaflets - but if there's an established causal relationship, and it's widely known, surely there'll be something to link to??

You've cited 2 bits of research by the same person, both over 20 years ago. Is this link between pethidine use and adult drug addiction really accepted by the NHS, RCOG and RCM? Enough that they brief health professionals about it?

"Is this link between pethidine use and adult drug addiction really accepted by the NHS, RCOG and RCM? Enough that they brief health professionals about it?"

The two studies I mentioned which I listed above are referenced in both the midwifery textbooks produced by the RCM which are on the top of every student midwife's reading list.

And they are also referenced in the MIDIRS Informed Choice leaflet on non-epidural pain relief:

here

Not sure whether it's 'accepted' - certainly the textbooks I've come across that give this information don't refer to more recent research refuting these findings.

"I don't believe I mentioned the word breastfeeding once."

No - in your insistence that pethidine and other opioids are reliable and effective forms of pain relief you completely ignore the impact they undoubtedly have on baby's ability to breastfeed and on mothers experiences of breastfeeding failure linked to pethidine use. I can only assume it's because you don't think either of these things is very important to mothers or to babies.

"but the chemical structure of anesthetic will remain the same no matter how much you wring your hands about it."

What a pointless comment. I have nothing to say about the chemical structure of pethidine. I'm only interested in how well it works, and why women are still encouraged to see it as both effective and harmless, when there is good evidence that it's often neither.

Fruitybread - sorry, the only reference I could find to the Nyberg study online was here:

here in another midwifery textbook (this links you to a chapter of it)

"Neonatal side effects include respiratory depression (which may require injection of the antagonist naloxone), subdued behaviour patterns, including a lack of
responsiveness to sights and sounds, drowsiness and impaired early breastfeeding
(Elbourne & Wiseman, 2004; NICE, 2007). Babies of mothers receiving opiates in
labour appear more likely to become addicted to opiates/amphetamines in later life
(Jacobsen et al., 1988, 1990; Nyberg et al., 2000)"

Re: neonatal exposure to opiods and adult drug addiction -

According to this - www.aims.org.uk/effectDrugsOnBabies.htm, the Jacobson study from 1988, about ampetamine addiction, talks about GAS - nitrous oxide, not pethidine - and finds that "the hospitals which had used more nitrous oxide produced more addicts."

Then the 1990 study into opiate addiction looks at morphine, pethidine, barbiturates and gas. "25% of mothers giving birth to babies who subsequently became opiate addicts had been given opiates (morphine or pethidine) barbiturates, or both, in labour compared with only 16% amongst the control group. And they had been given nitrous oxide for longer; exposure now seemed to be a risk factor for opiate as well as amphetamine addiction."

So actually.... he's more down on gas than he is on pethidine. And the mums he looked at might have had both morphine AND barbiturates (and gas) during birth.

I think I'd like to read the full text of the studies before commenting more.

The point I was trying to make is that concerns have been raised about the long term impact on babies of opioid use in labour which haven't been fully resolved.

Once again you make a statement so far off the mark I don't even know where to start drawing a map to set you straight.

I'll just leave you with your own conclusions; I hate breastfeeding. In fact, I trawl hospital corridors looking for breastfeeding support group posters so I can tear them down! Then I stamp on them and shout, 'That's what I think of breastfeeding!'

Ugh.

I can't read your mind Michelle, and neither can anyone else here.

If you repeatedly post praising the effectiveness of a drug which is well documented to damage breastfeeding, without once acknowledging this fact as being worthy of concern then people are going to arrive at their own conclusions.

You've banged on about the chemistry of opioids without responding to any of the points I made about research showing that pethidine is not particularly effective for relieving labour pain. You've ignored the many comments from women who've used this drug that I linked to who attest to this, and to unpleasant side effects associated with it.

You've insisted it's not a sedative, you've insisted it doesn't really effect the baby if it's given early enough in labour, and you've insisted that it provides good pain relief. That it's one of the marvels of modern medicine. You are wrong on all counts.

Anyway, I've neglected my children long enough - arguing with you. You've offered no good quality evidence about the use of opioids in labour in support of your view so it's futile continuing this discussion. I always engage in these debates hoping to learn something new. So far you've not taught me anything.

I have agreed that it can be ineffective for some people. I don't agree that it is a good enough reason to not provide it to those who do find it effective.

Pethidine is not the death knell for breastfeeding at all. You can't possibly be of the view that every single woman given pethidine then goes on to formula feed?

What I find the most offensive is your view that women should be denied pain relief which can and is used safely and effectively in order that they are of better use as a milking machine immediately after labour. I am not a milk dispenser or an incubator.

Pethidine is not perfect and I have not tried to suggest it is. I am merely saying that calling it tantamount to injecting heroin into a newborn is needlessly dramatic and linking to hokey research in an attempt to imply that it dooms children to a life of drug addiction is just plain wrong.

Finally, although unlike you I accept that my experiences are not the ultimate proof of anything, I found pethidine effective pain relief. It improved my birth experience and it did not affect breastfeeding in any way. I will take it again and I would strongly object to it not being available to those who want it. Of course there are risks but there are also risks with epidurals. Even simple paracetamol is an extremely dangerous drug. We don't leave women suicidal with pain in the aim of chasing some childbirth Eutopia.

tearing down breastfeeding posters. WTF?!

I don't tear down breastfeeding posters. I was being facetious towards the implication that I've got nothing better to do with my time than sabotage other people's attempts to breastfeed.

michelle i have learnt a lot from some of your posts but your sarcastic ones do you no favours. And i object to your use of the term "milking machine"

I don't think women should be seen as a supply of milk moonface. Especially not at their own expense. I use that term to express my own disgust at the idea of women being forced to endure incredible pain so as to not potentially compromise the possibility of breastfeeding. I'm a human being not a pint of milk.

Besides, I don't think sarcasm is too bad of a reaction to being incorrectly told that I've dosed my son up on heroin and that he's likely to become a drug addict now. I could easily be extremely angry about that.

wanting to bf doesn't reduce a woman to a supply of milk. No one has suggested denying women pain relief for any reason. Other pain reliefs are available.

You are entitled to react to what you want how you want. I'm just saying it doesn't serve your argument well.