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For decades, millions of mothers have been subjected to new obstetric procedures, but with little knowledge of the long term effects from such interventions. Such procedures might, however, be of importance for the infant's behavior as an adult. Jacobson and Bygdeman found that a traumatic birth was associated with an increased risk of the infant subsequently committing suicide by violent means, whereas giving opiates to the mother during labor seemed to reduce the risk. cases were matched with biological siblings to avoid confounding from genetic, socioeconomic, and environmental factors.


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Bertil Jacobson, M.D. and Marc Bygdeman, M.D.*

* Bertil Jacobson, professor emeritus, Department of Medical Engineering, F60 Novum, Huddinge University Hospital, SE-141 86 Huddinge, Sweden, and Marc Bygdeman, professor, Department of Obstetrics and Gynaecology, Karolinska Hospital, SE-171 76 Stockholm, Sweden. Email: bertil.jacobson@labtek.ki.se.

Editor's Introduction: In republishing this latest paper we honor Swedish researcher Bertil Jacobson for a decade of unique studies documenting the long-term consequences of trauma at birth. Working with records of large groups of people using sophisticated statistical methods, Jacobson and colleagues at the Karolinska Institute have repeatedly documented the unpredicted connection between routine obstetrical practices and the higher risk of addiction and suicide later in life. These findings, although published in medical journals, have been largely ignored in obstetrics and its warnings have not been heeded.

Jacobson alerted us to his findings in an invited address to our 3rd International Congress in 1987 subsequently published in our Journal, volume 2 (3) Summer 1988. An analysis of births and deaths in hospitals of Stockholm revealed an elevated risk of addiction and suicide in relation to prophylactic administration of drugs at birth. They found a highly uneven distribution of births of addicts which incriminated hospitals that had given mothers far more nitrous oxide. Researchers pointed to possible imprinting mechanism at birth to explain a tendency to repeat early traumatic events later in life-a tendency also discovered by an American team led by psychologist Lee Salk investigating adolescent suicides (1985).

By 1988, the Jacobson group proved a risk relationship between obstetric anesthetics and amphetamine addiction in the offspring. In 1990 they showed a similar risk relationship between anesthetics and opiate addiction. Further refined studies eliminated socio-economic status and residential neighborhood as significant risk factors (1992 and 1993). In the study below (1998) obstetric care was again related to proneness of offspring to suicide as adults. A key factor was the estimated amount of pain and discomfort (Trauma Score) suffered by the babies-especially boys-in labor and delivery. Ironically, the administration of more anesthetics lowered the risk of later suicide, posing a dilemma between risking addiction and risking suicide! Since pain at birth is ubiquitous in routine obstetrical birth, the real solution seems to lie not hi more anesthetics but in earnest application of all non-phannacologic measures that reduce or eliminate pain for mother and baby-a point not made in the paper.

Reprinted with permission, British Medical Journal, Volume 317, 1346-1349 (Nov. 14, 1998)