Childbirth drugs linked to heroin addiction

EXCLUSIVE "FORGOTTEN" research which shows that babies born to mothers who are given pethidine and diamorphine for pain relief during childbirth run a greater risk of becoming drug addicts in later life should be urgently investigated, says a maternity campaign group.

Scottish midwives and drug experts support the call, made by the Association for Improvement in Maternity Services (AIMS), for a review of a nine-year-old Swedish study, which it is claimed was dismissed by the medical establishment after it was published in the British Medical Journal.

Jean Robinson, honorary research officer of AIMS, said: "Scotland has a very high rate of use of these drugs, and a very high rate of drug addicts.

"The possibility that there is a connection now has to be properly explored."

Professor Bertil Jacobson, who is based in Stockholm, told the Sunday Herald that his research findings had been "unpopular" with doctors. "People were frightened and hurt, and nobody dared to repeat the study. There was a witch-hunt," he said. "It is extraordinary that it was never followed up, as it should have been. Personally, I am certain that there is a link."

Jacobson's research, which was conducted at Stockholm's renowned Karolinska Institute, compared the birth records of 200 adult drug addicts with those of their siblings. It found that the addicts were on average four times more likely to have been exposed to pain relieving drugs that were given to their mothers during labour.

The likelihood of the babies suffering drug problems in later life increased with the number of doses their mothers received.

The drugs - pethidine and diamorphine - cross the placenta entering the baby's blood supply, and it is Jacobson's hypothesis that and the experience of being sedated is "imprinted" on the baby's memory during the sensitive hours just before birth, leading to lifelong behavioural effects.

In his BMJ paper, published in November 1990, Jacobson wrote: "The remarkable stability of an imprinted memory might be one of the explanations for the well-known difficulties of treating addiction and the difficulty of avoiding relapses."

Scotland has an estimated 20,000 problem drug users, the vast majority of whom are addicted to opiates, a group of drugs which include heroin and methadone.

"When you consider that around half of all birthing mothers in Scotland are routinely given opiates to relieve pain, interesting questions arise," said Robinson. "It is our opinion that they should no longer be ignored."

There is no suggestion that exposure to the drugs before birth actually causes addiction, but the paper suggests that it could lead to a propensity towards drug misuse.

"It is a fascinating paper. It isn't off-the-wall," said John Davies, professor of psychology at Strathclyde University, and a leading drug addiction expert. "I am quite prepared to accept that this is one risk factor in addiction, and I think the author is right: it is worth researching further."

Dr David Goldberg of the Scottish Centre for Infection and Environmental Health said: "Any such study, if it is robust, does need repeating. This one seems to warrant further explanation."

Jacobson's findings challenge standard maternity hospital practice. Diamorphine, a drug which is derived from heroin, and pethidine are the most commonly-used pain relievers in Scotland. Last year, they were administered in 34% of all deliveries.

Unlike epidural analgesia, which is spinal and has to be given by an anaesthetist, the opiates can be injected by midwives, making them a cheaper, quicker alternative.

Last night Patricia Purton, head of the Royal College of Midwives in Scotland, supported the AIMS call for a review.

"We are being continually exhorted to work with research-based evidence, and this research needs to be tested," she said.

"My members are giving these drugs. If questions are raised about the consequences of that, they need to be explained."

The medical argument is that all treatments have risks as well as benefits, and that a needlessly painful labour can have physical and psychological consequences for mothers and babies.

"The business of possible imprinting is simply speculation, and I don't think there is any need to raise it routinely with mothers," said Arthur Davis, consultant anaesthetist at Kirkcaldy's Forth Park Maternity Hospital, who is an authority on pain relief during labour. "Opiods are still seen as useful, and they are widely used. We would of course answer any questions about them if they were raised."

However AIMS believes that if pregnant women were at least warned about the possible risks, they would be able to make a more informed choice about the form of pain relief they would prefer to use during childbirth.

"In my experience of talking to mothers, they want the information. No matter how difficult it is to hear, they would rather know about it beforehand," said Nadine Edwards, the organisation's Scottish officer.

AIMS promotes drug-free labour, and believes that if there were more appropriately-trained midwives on the maternity wards, the need for maternal pain relief would not be so prevalent.

"Women need good support antenatally and during their deliveries," said Edwards. "With resources so stretched, that's just not happening."

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