Research Roundup

ISSN 0256-5004 (Print)

By Gill Boden and Nadine Edwards

AIMS Journal 2014, Vol 26, No 2

Perinatal Pitocin as an early ADHD biomarker: neurodevelopmental risk?

AIMS Comments

Administering synthetic or artificial oxytocin during childbirth may be the most common labour inter vention in the world. If it is, then it is crucially important to know about any unintended harmful effects. A study published in 2011 by Kurth and Haussmann strongly suggests a link between increases in the use of pitocin (an artificial oxytocin, known as syntocinon in the UK) around the time of birth and subsequent childhood attention deficit hyperactivity disorder (ADHD). The authors looked at the birth records of 172 children aged between three and 25 and considered obstetric complications, family incidence of ADHD and gender. They found that perinatal pitocin exposure was a strong predictor of ADHD diagnosis which occurred in 67% of those children exposed to pitocin and in 35.6% of those who were not. This work was done as part of a PhD.

The sample is not representative and the proportion of ADHD in this sample is above what you might expect to come across in a general population, but the finding is so clear that further research is needed. There are already concerns about correlations between pitocin use and autism (see and-autism/), as well as an increase in postnatal bleeding, so in my view we must press for more research to clarify these relationships, but in the meantime far more caution should be exercised before using this powerful drug.


  • Perinatal Pitocin as an early ADHD biomarker: neurodevelopmental risk? Kurth L, Haussmann R. Journal of Attention Disorders 2011 Jul;15(5):423-31. doi: 10.1177/1087054710397800. Epub 2011 Apr 28.

Safe prevention of the primary cesarean delivery

In February 2014, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine issued a joint consensus statement, Obstetric Care Consensus Statement: Safe Prevention of the Primary Cesarean Delivery.

What the consensus says

By 2011 one in three women had caesarean sections in the US, but 'the rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused.' Evidence of potential short-term and long-term harms from the overuse of caesareans is cited, particularly for women and babies in subsequent pregnancies, due to increased placental problems.

As in the UK, wide variations in caesarean rates are documented - between states (23% to 40%) and between hospitals (7.1% to 69.9% overall, and 2.4% to 36.5% for women deemed 'low risk').

Main reasons for women having caesareans included: first baby, slow labour, concerns about fetal heart rate tracings, fetal malpresentation, twins or more and suspected large baby.

The statement looks at these and other issues, and makes recommendations for practice which could decrease the caesarean section rate. For example:

  • 'Slow but progressive labor in the first stage of labor should not be an indication for cesarean delivery', suggesting that more time should be given before deciding that interventions are needed. It is also recommended that the active phase of labour should not be diagnosed until the woman is 6cms dilated.
  • 'A specific absolute maximum length of time spent in the second stage of labor beyond which all women should undergo operative delivery has not been identified.' For healthy women and babies, the statement recommends at least two hours in second stage for women who have had a baby and three hours for women having their first babies, but that this could be longer if progress is being made,before considering interventions.
  • changing the mother's position, which might resolve concerns about the baby's wellbeing if decelerations in the baby's heart rate are thought to be due to cord compression.
  • advising induction of labour for medical reasons only before 41 weeks and 7 days of pregnancy. At and after this time induction is recommended in order to reduce the risk of caesarean delivery and perinatal mortality and morbidity.
  • offering cervical ripening methods for induction in women with an unfavourable cervix.
  • 'Suspected fetal macrosomia is not an indication for delivery and rarely is an indication for cesarean delivery.' Thus caesareans should only be offered to women with babies over 5000g (4500g for women who have diabetes), though 'estimates of fetal weight, particularly late in gestation, are imprecise' and ultrasound to estimate the baby's weight in the third trimester of pregnancy should be used sparingly.
  • 'Perinatal outcomes for twin gestations in which the first twin is in cephalic presentation are not improved by cesarean delivery.' It is recommended that women expecting twins, where one or both are head down, should be advised to plan vaginal births, but that skilled practitioners are needed.
  • 'Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula'

The statement concludes by acknowledging that changing obstetric culture and practice is remarkably difficult and numbers of suggestions are made for change, including controversial tort reform.

AIMS comment

This consensus statement has been described as a 'game changer' ( and would certainly be a departure from usual current practice in the US. It is important because it acknowledges both the short and long-term risks of caesarean sections for mothers and babies, and sets out the known evidence (and rates this evidence) with a view to reducing the numbers of first caesareans. Some of the main recommendations are to allow more time for labour and birth, to wait longer before diagnosing 'failed induction', to expand normality, and to retain or improve clinician training and skills (such as rotating the baby's head manually when it is posterior or to the side during the second stage of labour, offering operative vaginal deliveries as a safe alternative to caesarean section, and offering external cephalic versions to women with breech babies near or at term). It also accepts that continuous support is beneficial for women and reduces the need for interventions.

Of course, this statement remains within a medical framework, using medical language, and describes a largely medicalised philosophy and practices. A consensus for reducing the numbers of caesareans might look rather different if it were based on midwifery knowledge and informed by what we know about the physiology of birth and the benefits of continuous support from a trusted midwife. This could include, for example, taking a much more individualised approach to induction, generally avoiding arbitrary time limits (rather than just extending them), encouraging healthy women to birth in community settings, providing environments that least disturb the woman in labour and encouraging women to move as they want during labour and birth, thus reducing stress and the likelihood of fetal distress which could reduce the need for the recommended medical procedure of amnioinfusion for some instances of fetal heart rate decelerations.


  1. Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123:693-711 Series/Safe_Prevention_of_the_Primary_Cesarean_Delivery

The AIMS Journal spearheads discussions about change and development in the maternity services..

AIMS Journal articles on the website go back to 1960, offering an important historical record of maternity issues over the past 60 years. Please check the date of the article because the situation that it discusses may have changed since it was published. We are also very aware that the language used in many articles may not be the language that AIMS would use today.

To contact the editors, please email:

We make the AIMS Journal freely available so that as many people as possible can benefit from the articles. If you found this article interesting please consider supporting us by becoming an AIMS member or making a donation. We are a small charity that accepts no commercial sponsorship, in order to preserve our reputation for providing impartial, evidence-based information. You can make donations at Peoples Fundraising. To become an AIMS member or join our mailing list see Join AIMS

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all.

Latest Content


« »

Report of Parliamentary Debate on B…

AIMS Journal, 2024, Vol 36, No 1 By Elle Gundry The first parliamentary debate on birth trauma took place in the House of Commons on Thursday 19th October 2023. [1] Thank…

Read more

Doulas supporting clients to make a…

AIMS Journal, 2024, Vol 36, No 1 By Anne Glover I work with women from all walks of life, but one thing that is important to them all, is having a positive and satisfying…

Read more

My Complaint

AIMS Journal, 2024, Vol 36, No 1 Editor’s note: In this quite shocking account of disrespect and neglect, Grace describes the arrival of her first baby. With Grace’s perm…

Read more


« »

MaMA conference - 26/ 27 April 2024

MaMa Conference is the largest & longest running annual midwifery & maternity conference in the UK. Over the past 12 amazing years we have created an original and unique…

Read more

AIMS Workshop: The Foundation Stone…

Join us for an interactive online AIMS workshop: " The Foundation Stones for Supporting the Physiological Process in Pregnancy and Birth ". In this workshop discussion we…

Read more

Midlands 2024 Maternity and Midwife…

"The Maternity and Midwifery Festivals are back face to face and we’re looking forward to meeting you in 2024. Nine events across the UK and Ireland – all of them free of…

Read more

Latest Campaigns

« »

What are the priorities for midwife…

AIMS is proud to be supporting the RCM's Research Prioritisation project as a Project Partner and with one of our volunteers on the Steering Group…

Read more

Parliamentary Inquiry into Birth Tr…

Introduction to AIMS and why AIMS is making a submission Since 1960, AIMS has been the leading advocate for improvements in UK maternity care. We have national and intern…

Read more

BICS Conference poster: AIMS Campai…

AIMS Campaigns Team volunteers are presenting a poster about our campaign for Physiology-Informed Maternity Services at the 2023 conference of the British Intrapartum Car…

Read more