Public health authorities have
identified an enormous increase in the incidence of childhood autism. In
California, the number of kids receiving state services for autistic
disorders has nearly quadrupled since 1987. (1)
A recent news report on National Public Radio noted 775 news cases, a 33%
increase over the previous quarter in which only 550 new cases were
identified. This brain development disorder results in a lack of normal
language skills and inability to form human bonds of affection with parents
and other people. The majority of its victims are boys. Many also suffer
from epilepsy. The physical, mental, emotional and social disabilities
combined are so sever that most autistic children end up in institutions by
the age of 13. This is a tragedy for the child and its parents, a loss to
society and an economic burden of great proportion. Autism is now thought to
affect one person in 500, making it more common than Downs syndrome or
childhood cancer. According to Dr Marie Bristol Power from the National
Institute of Child Health and Human Development, it is a not a rare disorder
but a “pressing public-health problem”. (1)
Neither the cause of this
disorder nor the reason for its exponential increase is well understood by
researchers at this time. However
there is data associating autistic disorders with the use of an artificial
hormone (Pitocin) which is given to pregnant women to induce or speed up
labor (1, 2).
Pitocin is a synthetic exogenous source of the natural hormone oxytocin
which stimulates the gravid uterus to contract. It was developed as a drug
by the Parke-Davis pharmaceutical company in 1953 and put into general use
in 1955. It comes from the pituatary glands of cattle and includes acetic
acid for pH adjustment and .5 percent chloretone as a preservative. The lead
story in the July 31, 2000 issue Newsweek magazine was devoted to
exploring this growing health problem. The Newsweek reporter,
Geoffrey Cowley, interviewed Dr Eric Hollander of New York’s Mount Sinai
School of Medicine, a physician who specializes in treating autistic kids.
Dr Hollander reported that several years ago he noticed that 60% of the
autistic patients in his clinic had been exposed to this drug as a fetus.
Material published by the World Health Organization also notes an
association between the use of Pitocin and autistic disorders (2).
In spontaneous labors the
mother’s pituitary gland makes an endogenous (i.e. internal)
oxytocin that triggers the physiological onset and progress of labor. The
hormone oxytocin is also produced during breastfeeding (causing the let-down
of breast milk) and it accompanies sexual orgasm. For this reason it is
referred to as the “love hormone” by obstetrician Christian Northrop, MD
as each of these biological events are associated with experiences of great
emotional bonding and include meaningful social interaction between the
individuals involved. Since autistic disorders produce an inability to make
or maintain affectionate bonds or have normal social relationships, one
cannot help but wonder if perhaps there is an causal relationship between
these disorders and exogenous sources of an artificial form of oxytocin.
Perhaps flooding the immature body of the fetus (especially boy babies) with
this gender-specific synthetic hormone from animals somehow interferes with
the eventual function of these psychological systems. It is an intriguing
question.
However, Pitocin is not the only
drug received by women whose labors are being induced or augmented. The use
of Pitocin requires that the mother also be given IV fluids, have continuous
electric fetal monitoring in place and remain sedentary in her hospital bed
while connected to this equipment. Pitocin-induced uterine contrations and
enforced maternal immobility makes labor more painful, so much so that under
these circumstances most laboring women also receive narcotic pain relievers
and/or epidural anesthesia. The use of these drugs and anesthetics is also
associated with an increase in operative deliveries (vacuum extraction or
forceps). It is possible that the causative agent or trigger event for
autism is a particular combination of drugs or certain physical problems or
propensity for either the mother or baby, in combination with certain drugs,
rather than a simple direct effect of Pitocin per se.
The use of Pitocin to induce or
augment labors and concomitant use of epidural anesthesia has been steadily
climbing for the last 20 years – about the same period that the increase
in autism has been reported. Estimates of the use of Pitocin in laboring
women over the last 2 decades range from 12% to 60%. However, a 1992 survey
by a medical anthropologist at the University of Texas found that 81% of
women in US hospital receive Pitocin to either induce or augment labor.
Epidural use is as high as 95% in many urban hospitals. When one factors in
a Cesarean rate of 23% (acknowledging some overlap), the proportions of
these facts is staggering as virtually 100% of medically-managed births are
subjected to a high level of pharmaceutical interventions that have never
been approved for use in fetuses. It certainly seems prudent to research the
possible association with pharmaceutically-augmented labors in an attempt to
discover the cause of the rising tide of autistic disorders. It may be
necessary to amend our current obstetrical practices to prevent an epidemic
of this expensive and emotionally-crippling
disorder.
Existing
data on babies born at home
under the care of midwives
as a control group in Autism research
For research purposes it
seems only logical to utilized the subset of healthy childbearing women who
received physiological management of the intrapartum and experienced no medical treatments during the labor and birth (i.e. –
no Pitocin or other labor-inducing drugs, no narcotic pain medications, no
general or regional anesthetics and no operative deliveries, etc) as a
control to determine if intrapartum medical treatments are causative or
contributory to the development or acerbating of autism disorders.
In the early 1990s the Midwives Alliance of North America (MANA)
embarked on a retrospective statistical study of domiciliary birth outcomes.
More recently they have been conducting a prospective study by enrolling
nationally certified professional midwives as a requirement of their
re-certification. To date they have compiled statistics on about 15,000
births. This would provide the
demographic data for follow-up questionares to ascertain the rate of autism
within this substantial group of babies who were unmedicated during the
labor. Also a recent change in the California birth registration law
authorizes for the first time since 1915 the filing of birth certificates by
professional midwives providing community-based birth services (client home
and free-standing birth centers) so that the gathering of statistical data
in California on this subset of births is now possible.
An informal survey among the
dozen or so community midwives practicing in our geographical area and
spanning the last 20 years, failed to identify any babies born at home who
have since been diagnosed with autistic disorders. Every year I attend a
national midwifery conferences sponsored by MANA which includes an exchange
between midwives of practice problems and unusual trends. Among the 400 or
so community midwives (CNMs and direct-entry midwives), no cases of autism
have been reported. Admittedly this is not a rigorous scientific study but
it does raise questions as to whether strict adherence to physiological
management of intrapartum events, either alone or in combination with the
self-selection of healthy women choosing home-based midwifery care, may
confer some protective effect relative to autistic disorders.
We are very much interested
in facilitating this form of research and would be happy to follow your lead
in helping to bring about interest in it by scientists at US-Davis and
elsewhere who are involved in the study of autistic disorders.
(1)
Newsweek Magazine, July 31, 2000
(2)
Care in Normal Birth: A Practical Guide—W.H.O’s “Safe
Motherhood” series
(3) Mothering Magazine, Spring Issue, 2001
cc:
Ken
Johnson, PhD, MANA Statistical Project
Robbie-Davis Floyd, PhD, University of Texas