Have we identified those techniques that put children at risk of disability?
This is a call for education and training for hospitals, doctors, nurses, and other attendants of birth to lead the call for prevention to observe and protect the unborn; to review and educate all attendants of birth, to advise parents for healthy prenatal care, to measure quality of care outcomes and to identify and prohibit known obstetric techniques that put children at risk of disability. This is also a call to continue educating medical staff the importance to record the data on the revised standard certificate of live birth for research in the prevention of Developmental Disability.
Are ASD or CP possibly caused by injury, medications used, obstetric procedures or complications from preterm birth or very low weight in childbirth? With the large increase in elective obstetric procedures and the use of stimulant, analgesics and anesthetics at birth through the 1990’s, could there be a connection?
“Adequate research on the benefits and risks of medical practices used during childbirth evaluate the quality of medical care provided during childbirth and the timing of scheduled cesarean sections.“ (1)
As early as 1927, “The preeminence of trauma among the causes of intracranial hemorrhage in infants is now almost universally accepted. Obviously any condition which increases the stress which the fetal head sustains in its passage through the birth canal will increase the chances of injury. Contracted or malformed pelvis, rigid soft parts, precipitate or prolonged labor, abnormal presentation, high forceps deliveries, breech extraction, or over-large fetal heads are all common factors which predispose to birth injury.” (2)
The nervous system has many factors of safety and compensation, but the means of actual repair is individual. Although adults have a chance at cure of neurological injuries, children whose brains are developing, not fully formed brains, have little chance of using these compensation factors. (2)
In the last decades there has also been a large increase in elective obstetric procedures which also use stimulants, analgesics and anesthetics. Is there a connection? What are the long term effects of these procedures and medications?
“Since 1979, the American College of Obstetricians and Gynecologists has recommended against deliveries or induced labor before 39 weeks unless there is a medical indication, such as the mother’s high blood pressure or diabetes or signs that the fetus may be in distress.” “Babies born before 39 weeks are more likely to have feeding and breathing problems and infections that may result in admissions to neonatal intensive-care units …..the elective deliveries may cause developmental problems.” (3)
Although there have been developments in neonatal clinical practice to limit neurological damage in the case of premature birth such as in cooling the brain to reduce damage and better ways to ventilate the baby to ensure oxygen is getting to the brain, in this research study of people born between 1973 and 1985, they found there are more incidences of psychiatric disorders in those who are born prematurely than full term birth, attributed to “disrupted development” of the brain. (4)
Shorter pregnancies from 1980 to 2011 had been blamed on the use of induction of labor and cesarean delivery prior to full term. This demonstrated greater risks to infants compared with those delivered later in pregnancy. Induction of labor had increased nearly every year since 1990, but had declined in 2011 and 2012.
“Doctors have been warned for decades about the dangers of delivering babies early without medical reasons, but the practice remained stubbornly persistent. Now, with pressure on doctors and hospitals from the federal government, private and public insurers and patient advocacy groups, the rate of elective deliveries before 39 weeks is dropping significantly 17% in 2010, 14% in 2011, and 11.2% in 2012, according the latest hospital survey from The Leapfrog Group, a coalition of some of the nation’s largest corporations that buy health benefits for their employees. This represents however, only about one third of all American health facilities.” (5)
The U.S. DHHS Agency for Healthcare Research and Quality, in their June 2014 Future Research Needs: Evidence-based Reports Comparative Effectiveness Reviews, systematic reviews of existing research on the effectiveness, comparative effectiveness, and comparative harms of different health care interventions, intended to provide relevant evidence to inform real-world health care decisions for patients, providers, and policymakers. An important part of these reviews is to not only synthesize the evidence, but also to identify the gaps in evidence that limited the ability to answer the systematic review questions. The following is a research study that they are intending for 2014: No. 22: Future Research Needs for Strategies To Reduce Cesarean Birth in Low-Risk Women. (6)
Federally funded research has not concentrated on the long-term effects on the fetus of drugs given to the mother during labor and delivery.
The GAO recognizes that long term follow up studies are also important. Perinatal interventions may dramatically alter later growth and development. (In the newborn) There is also an increased recognition of the potential disconnect between perinatal outcomes and long-term effects. The administration of oxygen and postnatal steroids are prime examples of interventions that may have positive effects, but negative long term effects.
Parts of the brain are fairly well developed at the time of birth but other parts are not, particularly the cerebellum. Introduction of medicines during this period of rapid development even for one administration can kill or cause aberrations in cells. Cells in the cerebellum will need to move to their final position, linking up with other cells. “Both the rate of cell death and the patterns of migration of cells in the cerebellum have been shown to be very sensitive to the introduction of toxic substances. (7)
“Medications can potentially permanently disrupt the normal link up of the baby’s brain cells; this alters the biochemical markers that guide the cells into their proper places. The cells connect, but not correctly.
Not only is this a problem for the baby, but damage can be transmitted from generation to generation. This is all the more reason to be careful with using medications in pregnancy and labour (labor).” (7)
Does the FDA have the opportunity to observe long-term effects of obstetric drugs on infants until drugs are marketed and used extensively, and can they ensure that FDA knows about all adverse reactions to marketed drugs? (8)
Have we done everything we can to educate all attendants at birth of the safest obstetric practices, identified those techniques that put children at risk, or educated the public on the risks and benefits of these procedures and medications offered in pregnancy and delivery?
Although medical advances have worked to assist the preterm and very low weight baby, much could be done to avoid these risk factors. This is a call for more quality care assurance measures in the use of birth intervention, more education in obstetric techniques to avoid injuries, and a TEAM approach.
What other road blocks in collecting data for research do we face to find the causes of Developmental Disabilities so we might prevent disability?
If you have information about the prevention of disability, please comment or send us an e-mail.
New Horizons Un-Limited invites you to visit our Report on the Prevention of Disabilities which focuses on the prevention of Developmental Disabilities.
(1) Senate, Efforts to Reduce Infant Mortality and Improve Pregnancy Outcome, Gregory J Ahart, USGAO (Washington, D.C., 1980), pp. 1-39.
(2) Frank R Ford, Branson Crothers and Marian C. Putnam, Medicine Monographs: Volume XI, Birth Injuries of the Central Nervous System, (Baltimore, The Williams & Wilkins Company 1927) p. 12.
(3) “Early baby deliveries much less frequent Pressure from feds, insurance firms a factor, survey finds,” Kaiser Health News, by Phil Galewitz, (22 February 2013).
(4) James Gallagher, “Premature birth linked to worse mental health,” BBC News: Health, 01 June 2012, (03 June 2012).
(5) “Early baby deliveries much less frequent Pressure from feds, insurance firms a factor, survey finds,” Kaiser Health News, by Phil Galewitz, (22 February 2013).
(6) U.S. DHHS, Future Research Needs: Evidence-based Reports. June 2014. Agency for Healthcare Research and Quality, Rockville, MD. <http://www.ahrq.gov/research/findings/evidence-based-reports/technical/future/index.html> (09 December 2014).
(7) Beverley Lawrence Beech, “Drugs in Labour: What Effects Do They Have 20 Years Hence?” 1999 Midwifery Today, Inc., All Rights Reserved. <http://www.midwiferytoday.com/articles/drugsinlabour.asp> (01 January 30) (Brackbrill, 1979).
(8) Senate, Efforts to Reduce Infant Mortality and Improve Pregnancy Outcome, Gregory J Ahart, USGAO (Washington, D.C., 1980), pp. 1-39.