21. THE POISONED APPLE

First published in Midwifery Matters 179

By Antonella Gambotto-Burke

My baby was born blue and motionless. She didn’t even look real.

‘Is it dead?’ I asked, blurred by morphine.

This was my first response to my only child. Beyond the apathy, nothing. In that moment, it may even have been all right if the blue unmoving thing were, in fact, dead. I was naked, listing like a sloop and on all fours. I didn’t feel like a mother. I didn’t even feel human. I’m not sure I knew who I was anymore, not really, or what I was supposed to feel. Thick felted tongue, that yolk-slow rolling of my eyes: a routinely dissociated drug-comedown. I’d lost a cup and a half of blood internally through tearing. The IV had come loose, and splashed my face with blood. I was a zombie: drugged and swaying, staring through my dying baby at nothing.

‘Oxygen!’ one of the midwives, somewhere behind me, said.

Bethesda’s Apgar score was 4 out of 10: ‘moderately abnormal’, and on the cusp of grave difficulties.¹ As I said, she was cyanotic and not breathing. The umbilical cord was not involved. Hospital notes state that at one minute after birth, she was unresponsive and her muscle tone was poor. Intermittent Positive Pressure Respiration (IPPR) was required. Had it been any worse, she would have needed endotracheal intubation – commonplace in severe cases of Covid-19 – in addition to the IPPR bag and mask. ‘Emergency 33 called to assist neonatal resuscitation,’ the midwife wrote. Bethesda’s breathing was established within two seconds. At five minutes, her Apgar score had climbed to nine.

My child belonged to me, then, not to history.

At no point during my antenatal classes or during the delivery itself was I informed that neonatal respiratory distress is a long-known byproduct of obstetric anaesthesia,² and nor was I warned that as a result of obstetric anaesthesia, my baby could have died at birth.

I was told nothing. Because I was in a major teaching hospital, I assumed that I was safe.

During an examination after my waters broke, I was found to have Streptococcus B (Group B Strep, or GBS) – harmless bacteria, present in two to four women in 10. In rare cases, it can be dangerous to a newborn.³ Because of this, I was administered ampicillin, an antibiotic, as a preventative measure during labour for my full-term, uninduced baby.

I wasn’t told that in the UK, only 0.2 per 1,000 of all full-term babies contract GBS, and that premature babies comprise 83 percent of the deaths.⁴ I also wasn’t told that antibiotics delay the development of protective intestinal bacteria, and that disturbances in early microbial gut colonisation are associated with chronic diseases in adulthood (inflammatory bowel disease, obesity, colon cancer, and so on).⁵

Culture-proven infections account for only 5 percent of global antibiotic use.⁶ Hospital-based over-use is, in part, responsible for the increasing bacterial resistance to antibiotics,⁷ which kills over 23,000 Americans each year.⁸ In the US, half of all low-risk, full-term babies are exposed to antibiotics.⁹ Dutch researchers noted that of ‘all disrupting factors, early antibiotic exposure is considered to have the greatest impact on the gut microbiome in infants, leading to a disturbed microbiome still months and sometimes years after antibiotic treatment.’ In turn, the loss of important bacteria and reduced bacterial diversity can lead to pathogen growth, changes in metabolic processes, and an impaired immune system. And, even if the gut regains its diversity, the bacterial composition may be permanently altered.¹⁰

My hospital records show that I had a ‘long discussion’ with a midwife about GBS after the contractions kicked in, but do not mention that she did not tell me about the potential long-term impact of antibiotics on my baby. The midwife emphasised the rare, potential dangers of GBS rather than the routine dangers of the prophylactic drug.

Having planned a natural birth in the hospital birth centre, I capitulated, frightened by the amalgam of her smile and those fleeting mentions of infant death.

Synthetic oxytocin, the drug ‘most commonly linked to preventable adverse effects in childbirth’, is recommended only in the event of risk to a mother’s or baby’s life,¹¹ but I was given the drug because I wanted a shorter labour.

A sense of control over my femininity was, for me, critical. I refused to be a beast in the thrall of its instincts or a primitive, squatting. At three or so in the morning, my waters had broken, but I had no interest in further vulnerability. It was time to resume authority over my body. A girlfriend, one of the senior partners at a law firm, had, with a knowing look and before I went to hospital, advised me to ‘take all the drugs you can get’.

I wasn’t told that synthetic oxytocin causes jaundice in newborns,^{12 13} reduces oxygen supply to the foetal brain,¹⁴ and is associated with low Apgar scores.¹⁵ The first is no small matter; if the level of bilirubin, which measures bile in blood, climbs too high, neurological damage – cerebral palsy, convulsions, deafness, mental retardation, and other issues – can occur.¹⁶ In addition, far from triggering the profound mother/baby attachment associated with natural oxytocin, synthetic oxytocin administered to a mother during the peripartum period (before, during and immediately after birth) is associated with a higher risk of her being diagnosed with postpartum depression or anxiety disorders – 36 percent higher in women with a history of depression or anxiety, and 32 percent in women with no such history.¹⁷

Oddly, the website for the British National Institute for Health and Care Excellence (known by its attractively anodyne acronym, NICE), an organisation that ‘improves health and social care through evidence-based guidance’ for British government bodies and general practitioners, fails to mention the well-established connection between jaundice and synthetic oxytocin. Instead, NICE associates jaundice with breastfeeding¹⁸ without mentioning that breastfeeding, in fact, clears bilirubin from the intestines more efficiently, which is why frequent breastfeeding is recommended for jaundiced babies.¹⁹

NICE then states that a newborn is more likely to develop ‘significant’ jaundice if the mother intends to ‘breastfeed exclusively’,²⁰ although how maternal feeding intent impacts on neonatal bilirubin levels is not explained.

Bethesda was born jaundiced; I never knew why. Because her bilirubin levels were so high, we were kept in hospital, meaning that she and her father were denied the most critical of bonding opportunities. There was, of course, no provision for partners in the maternity ward.

I wasn’t told that the administration of synthetic oxytocin is also linked to uterine hyperstimulation, a serious complication that can impair blood flow to the placenta, resulting in foetal brain damage, eye problems, heart damage, heart rate abnormalities, and respiratory distress, among other serious and potentially life-threatening complications.^{21 22}

What I was told at hospital antenatal classes was this: that synthetic oxytocin accelerates both the birth process and the intensity and timing of contractions. Amused, I thought, I’m not afraid of a little pain. Big deal. The midwives, however, failed to clarify the degree of the pain’s acceleration; at one point, it felt as if a jackhammer were being driven, at full force, into my pelvis. As New Zealand researcher Sarah J. Buckley wrote, ‘Women who are administered synthetic oxytocin also commonly receive epidurals to counter the increased pain, and women with an epidural often require synthetic oxytocin, because epidurals reduce the natural release of oxytocin.’²³

The unnatural length and power of these jackhammer contractions reduced Bethesda’s supply of blood and oxygen, increasing the risk for hypoxia (low oxygen), which, in terms of neurodevelopment, is a potential catastrophe.²⁴ I will never forget my own agonised breathlessness as Bethesda, with a tiny foot, used one of my ribs as leverage to escape the pressure of a uterus unnaturally contracted by synthetic oxytocin.²⁵

When, in response, I grunted, ‘Fuck!’, the young Australian midwife scowled: ‘Language!’ Unable to access sufficient oxygen and hallucinating, Bethesda was terrified, fighting to leave what had, for nine months, been her untroubled garden.

Through my choices – through my false consent – I had doubled my baby’s chances of suffering respiratory distress at birth.

I wasn’t told that the administration of synthetic oxytocin to the mother is associated with psychomotor issues in the child. Variables had no impact in the studies: the resulting delays on fine and gross motor development were clear.^{26 27} In 2014,²⁸ ‘a higher propensity in anaesthetic-exposed children to develop motor deficits’ was discovered, although there were no significant effects on cognitive or linguistic capacity.²⁹

Bethesda’s unusual recall and use of complex words by the age of two – she spoke her first word at five or so months – caused me to have her tested by a developmental psychologist, who found that in terms of emotional and intellectual ability, she was in the 99th percentile; in terms of motor development, however, she was in the 16th percentile: borderline low average, almost a year behind her peers. Her coordination was so poor – she also had issues with perspective – that her ballet teacher asked me to remove her from the class as her inability to follow complex physical instruction was too distracting.

I did not know that natural oxytocin floods the undrugged brain’s fluid during labour, combating anxiety and stress and lowering the awareness of pain. Unlike natural oxytocin, synthetic oxytocin fails to penetrate the mother’s blood-brain barrier.³⁰ This means that there is no ‘cushioning’ of pain awareness, amplifying the mother’s stress. Stress, of course, slows and stops effective labouring. During labour, mental stress experienced by mothers has been found to dominate the physical,³¹ meaning that, in terms of ensuring a safe delivery with the best results for mother and baby, the mother’s feelings – her desires, her fears – need to be addressed not only in the lead-up to birth, but throughout her pregnancy.
At no point did it occur to me that women are designed to cope with the pain of childbirth.³² Oxytocin is naturally released in peak quantities during labour to buoy mothers through delivery. Its release can be triggered by the partner’s tender stimulation of the clitoris and nipples,³³ or by massage-like stroking in the lead-up to, and during, birth.³⁴ The repeated massaging of a pregnant woman over a fortnight before birth increases her pain threshold through the intricate interplay between her oxytocin system and opioid neurons.³⁵ Beta-endorphins, triggered by her comfort, also play a pivotal role in reducing pain awareness.

A 2020 12-country study concluded that documented variations in synthetic oxytocin dosages are ‘inexplicable’. It’s ‘crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used.’³⁶ Despite this and other similarly grave findings, a study from Denmark, where 31 percent of labouring women are given synthetic oxytocin, concluded that no revision of the guidelines is warranted.³⁷
I also wasn’t told that obstetric drugs significantly hamper the production of analgesic and bonding hormones, in the process dulling – or eradicating – the delirium of postpartum ecstasy,³⁸ and with that, mother/child attachment. None of this information was given to me, or any other woman I knew who gave birth in a hospital. We were processed like livestock. Our babies were all born with dulled eyes – some jaundiced, others fatigued or feeding poorly, listless, stoned. Some screamed, further distancing their distanced mothers.

When the young midwife told me that I was only one centimetre dilated after 10 or so hours of gruelling labour – nowhere close to giving birth – I gasped that I could not go on. The effort it took to stem the swell of panic at her words was significant. Terror coursed, liquid fire, through my veins. This pain transcended my understanding of what it was to hurt: it had become sinister. Like those waves known to surfers as ‘bombs’, it would, I feared, bury me.

I sensed, and feared, the impending transformation.

This time, there was no going back.

Recognising that my strength was failing, I rose: I had no option but to fight what I understood as mutiny, as gendered oppression. I remember the conviction that I had to fight without identifying an opponent – blind fear, pitted against pain, landing punches. There would be no surrender. Birth, to me, was a battle against biology, not a process of expansion or an unfolding.

Beneath the pain created by my demand for expedience, the vulnerability I’d warred all my life to disguise.

I thought, Fuck that.

Nine months of gestation, in the balance. Nine months of love. Not one person told me the odds. I gambled my baby’s life for gender status.

I demanded an epidural.

What I did not know was that the degree of labour pain is now á la carte. Universally, the decision to be administered obstetric drugs is now understood as ‘women’s choice’. ³⁹ It is never mentioned is that this ‘choice’ is based on fear, misinformation, patriarchal conditioning, and veiled medical coercion. The ‘choice’ to be injected with drugs associated with permanent emotional and physiological repercussions for babies and with fractured mother/baby attachment is as false as the choice to be murdered.

Throughout the developed world, birth is now perceived as an ordeal without meaning, a species of nightmare necessitating stupefaction or unconsciousness to endure: a bad trip.

My own bad trip is contained in a section of my hospital records entitled ANAESTHETIC PROCEDURES (OBSTETRICS). The anaesthetist’s handwriting is almost illegible – an electrocardiogram reading. This lack of attention reveals his indifference, as he was in no hurry at the time: I remember him, as if in an absurdist drama, flirting with the student midwife as I lowed in pain. Bored, he asked me to sit up and lean forward so he could inject me. The drugs he administered only worked for a brief period of time. I required multiple top-ups and even then, experienced every shard of pain; the only part of my body he succeeded in anaesthetising was my diaphragm, meaning that when I was ordered to push, I no longer understood how.

By 6.25pm, ‘distressed and uncooperative’, I refused another top-up. Who knows what the impact would have been on my daughter. The midwives had no idea how to calm me; all they knew how to do, in terms of managing the distress that changed my baby’s brain, was offer me more drugs. I was, one of them wrote, ‘not cooperating, demanding ‘it over’’.

Not cooperating, demanding it over.

This was their perception of a first-time mother who had been labouring for over 12 hours, whose pain had been freakishly amplified by synthetic oxytocin, and who had been inexpertly anaesthetised.

Birth intervention is not an isolated action but an avalanche: once it begins, it doesn’t stop.

The use of Panadeine, an opioid (500mg paracetamol, 8mg codeine phosphate hydrate), is not recommended for children who, like my daughter, had breathing problems at birth. Nor is it recommended for breastfeeding mothers as the drug is transferred through breastmilk and – I quote from the manufacturer’s leaflet – ‘may harm your baby.’⁴⁰

The US FDA has gone so far as to issue a ‘strengthened warning to mothers (among other warnings) that breastfeeding is not recommended during treatment with codeine… due to the risk of serious adverse reactions in breastfed babies such as excess sleepiness, difficulty breastfeeding, and serious breathing problems that may result in death.’⁴¹ Despite this, I was liberally administered Panadeine as a result of the pain caused by the post-birth catheter necessitated by the epidural.

The other poisons and dosages that were given me and, indirectly, to my baby, were:

11.50am 0.50% Ropivacaine and 150mcg fentanyl – 20ml
12.55pm 0.25% Bupivacaine – 5mls
13.50pm 0.50% Ropivacaine – 5mls
13.58pm 0.25% Ropivacaine – 5mls
14.30pm 0.20% Ropivacaine and 50mcg fentanyl – 10mls
16.35pm 0.25% Bupivacaine – 5mls

Earlier in Apple: Sex, Drugs, Motherhood and the Recovery of the Feminine, I write about some of the known effects of fentanyl administered at birth.

Ropivacaine (also known as Naropin) was first released for use in 1996.⁴² Its manufacturer’s leaflet acknowledges that newborns are ‘more susceptible’ to the drug, and that it’s ‘not known’ whether it has any effect on pregnancy or is passed on through breastmilk.⁴³ Despite the fact that even the manufacturer acknowledges that no, they have no idea what Ropivacaine might do to my foetus on a temporary or permanent basis, 25ml or more of the diluted drug was administered to me – and, indirectly, to my foetus – by an obstetric professional.

One to 10 in every 10,000 women to whom Ropivacaine is administered suffer ‘sudden life-threatening allergic reactions’ such as anaphylactic shock; others go into cardiac arrest, or suffer arrthymias (uneven heartbeat) or nerve damage. One to 10 in every 1,000 women to whom Ropivacaine is administered suffer anxiety, fainting, or experience difficulty breathing.⁴⁴

Again, I was told none of these things.

No mother I have ever met could name the drugs she was administered at birth.

Bupivacaine (also known as Vivacaine; with epinephrine, Marcaine and Sensorcaine; and with lidocaine, Duocaine) was synthesised in 1957 and released in 1965, the year of my birth.⁴⁵ Of all the anaesthetics, it’s the most cardiotoxic – that is, a drug that has a poisonous or deleterious impact on the heart.⁴⁶ It’s also neurotoxic.
The effects of bupivacaine on newborns have been called ‘significant and consistent.’ In a 1981 study – available to anaesthetists for almost a quarter of a century prior to Bethesda’s birth – it was shown that immediately after delivery, babies ‘with greater exposure to bupivacaine in utero were more likely to be cyanotic and unresponsive to their surroundings.’⁴⁷

Just as my daughter was, in matter of fact.

After bupivacaine, alertness and visual acuity in the infant is impaired throughout the first day of life and the following six weeks⁴⁸ – again, just like my daughter. I remember wondering why her eyes lacked the brightness and expressiveness of the newborns in the natural birth books I had studied, and noting that she always looked glazed.

A cold drink or even the briefest swim in cold water still turns Bethesda’s lips dark blue. I still experience peripheral panic every time it happens, unable to bear the thought that I have, through my own susceptibility to an ancient ideology, permanently hurt my child. It’s difficult to even consider it: my baby, my baby. Cyanosis is caused by low blood oxygen (poor circulation). The potential ramifications of this debility, caused by my own choices, fill me with anguish, guilt, shame, rage and an impotence that I am still at a loss to metabolise, because it is, of course, the byproduct of a damaged heart.

Out of fear, I elected to have my spine injected with 10ml of a diluted known cardiotoxin that, like ‘almost all’ anaesthetic drugs, ‘easily’ crosses the placenta.⁴⁹

Out of fear, I elected to risk my newborn being born blue, and unbreathing.

Out of fear, I permanently damaged my daughter’s heart.

This, as Bethesda’s records state, is what is now understood as a ‘normal’ vaginal delivery. In short, it’s now ‘normal’ for a mother to choose to permanently injure her baby.

In the First World, obstetric drugs are now widely – and seemingly exclusively – addressed within the context of the mother’s choice, rather than as Ground Zero for neurodevelopmental and other dysfunction. I was the witch in Snow White and this was the apple I gave my daughter.

This is the apple most mothers have offered their babies for almost two centuries.

About the Author

Antonella is the author of Apple: Sex, Drugs, Motherhood, and the Recovery of the Feminine and of Mama: Love, Motherhood and Revolution, among others. She contributes to a raft of major newspapers, including The Weekend Australian and The Sunday Times, and, with two-times Producer of the Year Gavin Monaghan, is Mama ft. Antonella. Follow Antonella on instagram.com/gambottoburke and mamaftantonella.com.

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