Autism, ADHD, and Medicated Births

Published: 05/28/2009

Introduction

Over the past decade, concerns over traditional childhood diseases such as measles and whooping cough have been supplanted by developmental disorders such as autism and attention-deficit disorder and attention-deficit/hyperactivity disorder (ADD/ADHD). Autism now affects 1 in 150 eight-year-olds in the United States,^[1] while more than 4 million children nationwide qualify for a diagnosis of ADD/ADHD.^[2,3] As these changes have taken place, no one has satisfactorily answered the question of the etiology of these problems, and why their incidences have increased so dramatically over the past decade.

Theories abound regarding the causes of these 2 conditions: low birth weight and premature delivery, viral infections, vaccines, sugar, psychological trauma, too much TV, older parents, genetic mutation. Another area that might be explored is medicated birth and “actively managed” labor, which has increased since the early 1980s.^[4,5]

Prevalence of Medicated Birth

Medicated birth is now quite common in the United States. The Centers for Disease Control and Prevention (CDC) reported a 65% use of spinal or epidural labor analgesia in 2005.^[5] That report captured a 21% rate of “augmented” births — births speeded up, usually through the use of Pitocin® (synthetic oxytocin). This figure may be an underestimate. In a 2002 study in American Family Physician, 44% of laboring women who received epidural analgesia required synthetic oxytocin augmentation.^[6]

Pituitary oxytocin orchestrates contractions as well as the release of pain-blocking endorphins in mother and baby. Nicknamed the “hormone of love,” it facilitates nursing and mother-child bonding and enhances relationships among family members, friends, and intimate partners.

The primary action of synthetic oxytocin is to cause all uterine fibers to contract at once, instead of in fundally dominant peristaltic waves from top to bottom. Synthetic oxytocin-augmented contractions are associated with uterine hyperstimulation, fetal distress, and hypoxia.^[7]

Relationship to Autism and Attention-Deficit/Hyperactivity Disorder?

A report in the January 2009 issue of the American Journal of Obstetrics and Gynecology stated that “[Synthetic] oxytocin is the drug most commonly associated with preventable adverse perinatal outcomes.” Adverse outcomes with synthetic oxytocin administration include lowered fetal oxygen saturation.^[8] It “was recently added by the Institute for Safe Medication Practices to a small list of medications ‘bearing a heightened risk for harm,’ which may ‘require special safeguards to reduce the risk for error.’”

So is there a connection between synthetic oxytocin and autism, ADHD/ADD, or both? A 2007 review of studies on the etiology of autism cited neonatal hypoxia among the risk factors for the condition.^[9] Fetal distress, cesarean delivery, and low Apgar scores, as well as maternal hypotension and bleeding during pregnancy, were regarded as “obstetric surrogates” for hypoxia: “Taken together, the studies suggest that hypoxia-related obstetric complications and fetal hypoxia may possibly increase the risk for autism.” The reviewers noted the limitations of the studies: few in number, variable diagnostic criteria, and the fact that “several other neurodevelopmental diseases, as noted, may likewise be associated with the identified risk factors.” In other words, intranatal hypoxia was associated with neurologic problems other than autism. The authors called for future studies to investigate “obstetric conditions such as newborn hypoxia and LBW (low birth weight)” — and by inference, the obstetric causes of these problems.^[9]

An April 2001 study in Pediatrics supported older findings suggesting that autism diagnoses are associated with unfavorable perinatal events, including induction of labor, prolonged or precipitous labor, and oxygen requirements.^[10] However, no single complication or cluster of complications was clearly responsible for the disorder; and the findings may indirectly support the hypothesis that autism is a genetic disorder that may itself create complications in pregnancy and birth. That study called for more investigation of pre-, peri-, and postnatal associations that could generate a risk profile for autism spectrum disorders. Parental age and genetic susceptibility have been recently associated with autism spectrum disorders. However, if autism is a form of iatrogenic brain damage, parental age could very well be an indicator, because high-risk pregnancies, many of which include women over age 35, are often aggressively managed at delivery.

Moreover, recent discovery of genetic variations linked with autism may indicate a genetic susceptibility to the environmental event.

Eric Hollander, director of the Seaver and New York Autism Center of Excellence at Mount Sinai School of Medicine, has been studying potential benefits of oxytocin in the treatment of autism. However, in a 2007 interview he said, “In some individuals whose oxytocin system could be genetically vulnerable, a strong environmental early hit while the brain is still developing could downregulate the oxytocin system, leading to developmental problems. But this is only a hypothesis that has been observed by association.”^[11] Evidence at the molecular level helps support Hollander’s hypothesis.^[11] Nevertheless, a study published in 2003 that examined the rates of labor induction using synthetic oxytocin in children with autism and matched controls reported no differences in synthetic oxytocin-induced rates as a function of either autism or IQ level vs control. The study was small and more research is warranted.^[12]

Two questions remain unanswered:

• Are pediatric developmental disorders, such as autism spectrum and ADD/ADHD, actually forms of perinatal brain injury?
• Is there a relationship between the increase in the active management of labor and the increased incidence of these brain disorders in children?

One 2009 review recommended a precautionary approach to active management, emphasizing more physiologic protocols and advocating lower synthetic oxytocin doses and allowing more labor time — rather than adding more oxytocin.^[13] The authors said, “There is no place in modern obstetrics … continuing to blindly increase the Pitocin® dose until the 1-minute Apgar score is recorded.” That seems a welcome approach until questions about the role of labor drugs in childhood developmental disorders are answered.

Pregnant in America 6-5

Tomorrow from 9 a.m. to 4:30 p.m. at the Central Union Church behind Kapi`olani Hospital, $20 presale $25 at the door (space limited)

1660 South Beretania Street, Honolulu

There will also be a wonderful discussion afterwards where midwives, doulas, nurses and physicians will be discussing the future of birth in Hawai`i and how we can improve and work together.

Contact Kari Wheeling:  951-5805; kariwheeling@yahoo.com

DONA International Birth Doula Workshop

Maui, Hawaii

DONA Birth Doula workshop in beautiful Maui, Hawaii

A three day retreat where you will learn to support the amazing and transformative process of childbirth

The Beautiful MALAMALAMA FARM AND CENTER www.malamalama.org

^{April 20th, 21st, & 22nd, 2009}

A three day workshop will consist of two steps towards becoming a DONA certified Birth Doula; both the DONA approved workshop, and the childbirth preparation for birth doulas will be included.

Participants will learn the doula’s role in providing emotional and physical comfort measures for the birthing family. You will also gain knowledge of:

·         Proven hands-on techniques for support, from relaxation to back labor

·         Emotional aspects of pregnancy and childbirth as well as support techniques

·         Working with special circumstances

·         Communication strategies

·         Doula’s code of ethics and standards of practice

·         The process of becoming a DONA certified Birth Doula

Materials: Included in the workshop are the DONA International manual for birth doulas, as well as the DONA International Position Paper (step one in your required reading) and various resource materials.

Food and accommodations are part of the package; April 19^th through the 23rd.  Additional nights stay can be arranged through check out on April 25^th.

Jessica Atkins: Certified Birth Doula (DONA), Birth Doula Trainer (DONA), Certified Childbirth Educator (ICEA), Teen Educator (CAPPA) Breastfeeding Specialist, with 19 years of experience educating and supporting families

Registration is Required: Please contact Jessica during central time hours between 9:00am to 8:00pm at 512-842-1280 or Jessica@FamilyBearing.com  or for more information and to register electronically see the website www.FamilyBearing.com 

To learn more about the process of becoming a DONA certified doula see the website: www.dona.org

SAVE THE DATE: February 27, 2009

Training: Gentle Birth Skills & Drills

Date: Friday, February 27, 2009

Time: 9am to 5pm

Place: Central Union Church

Cost: $75 without CEUs or $125 w/ CEUs

Who should attend: nurses, doulas, childbirth educators, midwives, expecting parents

HMHB invites you to attend an upcoming training titled “Gentle Birth Skills & Drills” presented by Barbara Harper from Waterbirth International. Barbara Harper is a nurse, doula, midwife and childbirth educator who has been providing education and training programs for parents and practitioners over the past two decades. See attached training brochure and registration form for more information.

Knowing how to assist women to let go and use simple techniques for comfort, security and safety creates a gentler birth process for both mother and baby. At the end of this workshop the participant will be able to:

1) Identify the major hormones and their interplay between mother and baby in labor and birth

2) List the Gentle Birth Principles and Practices

3) Outline three alternative steps to resolve shoulder dystocia

4) Discuss the impact of birthing practices on bonding and breastfeeding

5) List three indications for the use of water as an intervention in labor

Please call or email me with questions. Please forward to your network.

Mahalo!

Kari Wheeling

Healthy Mothers Healthy Babies

951-5805

Lately there have been news articles talking about the state of maternity care in the U.S. and what the alternatives and choices are to making well informed decisions about your care.

I’m just really glad that this is being talked about more in the recognizable papers such as The New York Times….now hopefully positive changes will come from all of this=)

Monday December 8th and Tuesday December 9th at the New Hope Diamond Head Resource Center in Kahala Mall.

Dr. Sears is a nationally recognized pediatrician and best selling author of over 40 childcare books.  A medical and parenting consultant for Parenting.com and Baby Talk and Parenting magazines, Dr. Sears hosts one of the leading healthcare parenting websites www.askdrsears.com and has appeared on more than a 100 television programs.

Buy tickets at:  Tickets may be purchase at Baby aWEARness (Manoa Marketplace) or Vim n Vigor (Pearl City) or either online stores with an extra $1.50 handling charge (http://www.babyawearness.com or http://www.vimnvigor.com)

Research   
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Research published [in 2007] concluded that hospitals’ articulated reasons for closing or placing limits on their related midwifery services are not necessarily what is motivating such moves.

Looking at two cases in which hospital-affiliated midwifery services had good outcomes, the researcher in this report conducted 52 detailed interviews with midwives, nurses, administrators, childbirth educators, policymakers and physicians and reviewed archived data such as e-mail, policy statements and memos.

In one of the cases, the hospital had claimed that too many of the women served were high-risk, so midwifery was not safe. In the other case, an increase in malpractice insurance was given as the reason for closure. No documentation backed up either of these claims; and the interviews and data analysis showed that the midwifery practice in fact represented competition for the hospital, doctors or both. In other words, the hospitals and doctors got less business if women had access to midwives, yet the public messages related to safety and liability.

The author of the study also pointed out that the US medical education system pays subsidies for medical residents, creating a disincentive to using midwives. Finally, she noted that since most state laws require that midwives be overseen by doctors, they are dependent on their competition, putting them at a disadvantage.

This small study reflects the reality that health care, as we know it in the US, is not necessarily about providing the best care for citizens, but about protecting the interests of the system. The logic of cost-saving and efficiency is also lost in this system.

~ Social Science & Medicine 65(3): 610-21

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
 Midwifery and the Right to Privacy   
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The argument that restricting midwifery violates a mother’s right to privacy is futile. A woman has a fundamental right to make personal decisions about procreation, marriage, contraception, child rearing and education; but she does not have a fundamental right to decide how, where or under whose assistance she gives birth because, after the second trimester of pregnancy, the state acquires an interest in protecting the unborn, “viable” child. A woman’s freedom to choose must yield to this interest. Thus, the right to use a midwife is not a fundamental right. Challenges to statutes restricting that right on grounds the statute violates a mother’s right to privacy must survive only rational basis review, and therefore, will likely fail. The case law shows us why.

In 1976, California required midwives to be certified. Three uncertified midwives challenged the statute on grounds that requiring certification violated a mother’s right to privacy. The California Supreme Court held that, because a mother’s privacy interest came second to the state’s interest in protecting the mother and unborn child after viability, the right to use a midwife was not a fundamental right and the statute must survive only rational basis analysis. Establishing qualifications on which consumers could rely made the certification requirement rationally related to protecting mothers and newborns.

In 1987, a New Jersey appellate court upheld a statute requiring that a nurse have a license beyond the traditional nursing license to practice midwifery. Furthermore, nurses could practice only in licensed facilities with health care teams. A nurse challenged the act on grounds that it violated the right to privacy by precluding parents from using a birthing style and qualified attendant of their choice. The court held that, because the statute did not require women to give birth in a hospital or to obtain medical treatment, but merely regulated nurse-midwifery, no fundamental issue was raised and rational basis analysis applied. The statute survived rational basis review because the license and health team requirement was a reasonable approach to establishing the safest conditions for births attended by nurses.

In 1991, two Colorado direct entry midwives challenged a statute requiring one to have a nursing or medical license to practice midwifery. The midwives argued that the statute violated mothers’ right to privacy by precluding them from choosing their method of childbirth. Citing Roe v. Wade, the Colorado Supreme Court held that the right to make personal choices about procreation did not extend to choosing whether to use a direct entry midwife to assist in childbirth. Thus, requiring midwives to have licenses did not violate the right to privacy.

~ Erik L. Smith
  Excerpted from “Midwifery and the Constitution,” Midwifery Today, Issue 65

~~~~
Read more of this article excerpt in the full online version of E-News at: http://www.midwiferytoday.com/enews/enews1022.asp

Since our `ohana has grown to 6 keiki…my time has been trickled down a bit…of course there are new and interesting developments and I will get them on here ASAP.

For now just wanted to mention that the ‘Orgasmic Birth’ is another awesome film that every expectant couple should see.  Hopefully once I get my ‘Business of Being Born’ DVD back I can start hosting more screenings again. then Orgasmic Birth as well later.

Cindy Urbanc’s midwifery class started and I’m soooo bummed I wasn’t able to make it…it sounds absolutely awesome.  Will def be signed up for the next session!  For those that haven’t visited yet, her new store locale is awesome as well and offers some wonderful food items too!  It’s in the Manoa Marketplace where the old Wedding Cafe used to be, def check it out!

The baby expo is coming up next weekend…not sure if I’m fully ready for it yet but I know it’ll be a blast as always!  Please come by and visit our booth #442

Hope you all are doing well=)

                                                           IT’S UP TO YOU

It’s up to you whether you choose to complain and bemoan the state of OB healthcare today or choose to do something about it.  I’m told that women are reluctant to speak up about what they want for their labor and birth, anxious about changing providers, hesitant about asking questions-they don’t want to “rock the boat”, appear “aggressive”, hurt anyone’s feelings.  I say hogwash.  Hogwash.

You really have 2 choices for most dilemmas:

DO SOMETHING or

DO NOTHING.

By doing NOTHING, you can continue to whine and complain about all the things you don’t like about the system, that person (doctor, nurse, lab tech, etc.), this or that policy, etc. and remain the VICTIM.  You become slogged down in a quagmire of woe.  You ignore that feeling in your gut, those red flags, that undercurrent of dread or worry each time you visit your provider, even though you verbalize those feelings.  Who taught you to disassociate from your true feelings?  Who told you to second guess yourself?

We, as women, are famous for this!  We continue to date or marry men even though we realize there were so many signs that it wasn’t the right match, we hope to change them, we hope they’ll “come around”.  When we don’t get our way, we pout or don’t talk, but we continue to piss and moan to girlfriends, to spout off courageously anonymous on discussion forums, but we rarely go to the source, we choose to do NOTHING.

This holds us down, this makes us weak, this forces us to suffer the consequences of our silence.  This contributes to causing the system to remain painfully the same.

Now, when you do SOMETHING, it lights a fire in your belly.  It forces you out of your comfort zone.  It makes your heart beat faster, your blood run quicker, you feel alive and eventually liberated.

“The other side of every fear is freedom.”

“The truth will first make you mad, then, set you free.”

The philosopher Schopenhauer said “All truth goes through 3 stages: First, it is ridiculed, then, it is violently opposed, finally, it is accepted as self-evident.”

Quote from the ’05 Coach Carter movie:

Coach Carter:  “What is your deepest fear?”
One of the basketball players:  “Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won’t feel insecure around you. We are all meant to shine as children do. It’s not just in some of us; it is in everyone. And as we let our own lights shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”

And each time you do this, it gets easier and more familiar and it can evoke change.  You are the consumers, you drive things to happen, you have all the power!  But more importantly, you are the life-giving Mothers.  This is YOUR body, YOUR birth and YOUR baby.  And once they’re out, you will have to have the courage and tenacity to speak on their behalf, so it’s got to start now.

These are my wishes for all women of childbearing age:

Plan your pregnancy (meaning take your prenatal vitamins or at least folic acid prior to conceiving, give up bad habits and renew good                 ones)

Eat whole foods and get a lot of exercise to keep your immune system and placenta strong

Choose your provider carefully-interview several and ask labor/birth-specific questions early

Consider a midwife if you want to: avoid routine intervention and have options, have someone who supports the normalcy of                 pregnancy, labor and birth and have someone who addresses your emotional and physical well-being.

Choose your place of birth carefully-don’t just take a standard tour-make an appt with the L & D charge nurse or childbirth educator                 to ask specific questions, call the hospital to ask about their policies (Cesarean, Epidural rates, baby rooming-in protocol,                        etc.)  Call some doulas and ask their opinions.

Interview several Pediatricians or Family Practitioners, asking specific questions

Do your research regarding pregnancy tests, birthing options, newborn procedures and vaccinations to help                 make informed choices.

Let many other people’s stories roll off your back like water-you’ll get used to unsolicited advice; you get even more once the                 baby’s here.

Write letters to hospital administrators regarding your care-tell them what  and who you liked and why and what areas need   improvement.  They take this input very seriously.

Surround yourself with those who think like you and use affirmation.  .

Connect with your partner because your relationship will change dramatically.

Mahalo Pat and so true