On My Mind This Week: Fevers and Labour Stalls

Every time I move through a period of dis-ease and healing I come out the other side having learned something new or having been reminded of an old truth.

Like the time I had the flu when Lena was about six or seven years old. She was sitting with me in our kitchen come living room watching some programs and I decided to get up to make one of my herbal tea concoctions for getting rid of chest and nasal congestion.

That day I was reminded that pouring boiling water into a glass jar results in a mess if your heat conductor gets immersed. Yes, I had thought to place a table spoon into my seventies glass jar to conduct the heat just like I had many times before. Only this time I decided to fill the entire jar, make a little extra tea. Hesitating only briefly before dismissing the warning in my head, 'It's gonna crack!' I poured past the top of the spoon. 

In the second or two it had taken to pour the water to level with the top of the spoon my fevered brain produced the thought that the spoon was most likely not even needed anyhow. It was a gimmick, a habit, a little ceremony that had become a family tradition. Granny did it, mum did it so I did it. Sure, how much heat could a tablespoon really absorb and conduct? Probably just a little drama we all liked to enact. 

'Just fill the jug!'

The truth revealed itself instantly: 

The spoon hadn't been just our silly little family ritual but it had thus far secured the integrity of my lovely glass jar with the orange and yellow flowers on it!

To this day this remains a story that Lena and I get belly laughs over; In hindsight this is one of the funniest situations ever.

On the day the sound of the crack that occurred in a perfect line around the bottom of the jar sounded ominous of loss.

My beautiful jar was done for!

The prospect of having to clean up a flood of about two litres of hot tea rather than sitting back down to tend to my sore body and head cuppa in hand only added to my pain. 

There was a brief flicker of hope. Perhaps the bottom would stick on for long enough to let me lift the jar over to the sink?

It didn't!

The jar lifted clean off the base.

Lena watched me from the sofa and started to laugh immediately and I don’t blame her, the scene was hilarious. Me in my PJs - dishevelled hair, red face, redder nose, the jar, the spoon, the crack, the top of the orange flower jar now in my hand, bottom still sitting on the countertop - crying out:

‘Scheiße!!!!!!’

Once all the water had poured out of the bottomless jar in a big gush and made its splash on the kitchen tiles the spoon fell down in the middle of it with a tinkling metallic sound.
Then there was only the sound of Lena’s laughter.

Me, I wanted to cry (but didn’t).

Lena came to help with the flood, the jar had to go in the bin and that was that.

Fevered delirium, I have found, can lead to far more useful thoughts than it did that day! Wallowing in it can be akin to meditation, just more sticky. I am only back from a week of dealing with symptoms of flu. At my stage in life I have the great luxury of being able to fully surrender to my body's messages most of the time. 

'Lay down and rest' it said and so I took it to bed. 

I committed to using the opportunity as a time of self-study. My headache, fever, congested respiratory trackt and aching body became objects of meditation. Instead of focusing all my attention on a candle flame, the image of a flower, the tip of my nose or my breath as is often the practice in a yoga meditation, I examined and observed these symptoms with loving curiosity. I explored the layers and layers of sensations in my body. I could transmute the pain in my hips by staying focused there but then I had to put up with the headache and visa versa. I haven't figured out how to silence pain in more than one area of my body (yet). In between those meditations I drifted into fitful sleeps. I crawled onto my yoga mat to release the tension in my muscles, went back to bed, drank heaps of tea and water, peed lots, watched too much Netflix, listened to podcasts, wrote a bit and read in some of my favourite books.   

I continuously affirmed that every single symptom my body presents to me is a sign that my body is doing its work. Recently the idea that the body always works perfectly even in dis-ease (and of course in labour) has been very present with me, not least due to having consumed a lot of reading and listening materials published by Yolande Norris Clark. Yolande rejects the allopathic approach generally and she makes a great argument. Not all of it resonates with me but I love how positively my change of perspective on any of my own physical symptoms has impacted my body, mind and spirit in the last seven days. 

I finally understood.

Believing that none of my symptoms were a pathology in themselves but rather my body’s carefully orchestrated response to environmental challenges really shifted how I felt about ‘being sick’. There was little of the drama that we can create around our sicknesses, only loving awareness. I didn't resent it either and I didn't feel sorry for myself. Replacing the idea of ‘being sick’ with the idea of going through a cycle of healing is incredibly powerful as is knowing that once this healing response is initiated your body will move through. Given the right conditions healing is almost inevitable even if you 'do nothing' (perhaps particularly if you 'do nothing').

Your body seeks homeostasis always.

This time I surrendered to resting for six solid days. No pharmaceuticals and very little aromatic 'medicine' either. Just some cajeput, german Chamomile and eucalyptus for comfort and my herbal teas for hydration. 

The exercise has made me wonder about the effect of introducing paracetamol when your body is moving through any kind of innate process. My body was very specifically giving me cravings for clean foods. I wanted oranges, lots of them, and I wanted raw garlic. I most definitely did not want coffee and would not have dreamt of having a 'wee beer' or 'glass of wine'.

My body did not want to have to deal with toxins and paracetamol is well known for its toxicity on the liver (and less well known for possible neurotoxicity).

I’ve written before about the fact that until I became a midwife and was socialised into the medical paradigm of birth (and life) I had been very reserved about reaching for any kind of pharmaceutical form of pain relief. It wasn’t something that my mother or gran ever encouraged unless I was beside myself with pain. As a family we had a measured approach to taking any kind of painkillers and we didn’t often try to reduce a temperature either. I remember very clearly having it explained to me that the temperature was important, that I needed it to get better. 

Midwifery made me a lot more complacent about paracetamol (until about two years ago). 

In medical midwifery paracetamol is frequently used to lower temperatures in pregnant mums and in labouring women, too. An elevated temperature effects the heart rate, it rises. Elevated heart rates and continuously rising heart rates are potentially dangerous in themselves and when observed in a baby in labour, a rising heart rate can imply that the baby is developing an infection. I have been asking myself the question if lowering the mother's temperature routinely significantly changes any future events for the baby. Does the temperature per se harm the mother or the baby or is it the effect of the infection that triggers the temperature in the first place that causes the potential issues?

I don't see how this could ever be studied in a pregnant population particularly when we know that there is a limit to the rise in temperature our central nervous systems can endure. It is prudent to act on fevers in labour because the baby's temperature will be impacted by the mother's and the baby is living right in the mother's core, where her own temperature is highest (So, in pregnancy always consult with a medical professional if you are concerned about a rising temperature).

In non-pregnant adults, however, there is no evidence to suggest that a fever lowering treatment reduces the risk of dying or severe illness in patients with febrile conditions (1).

This is an interesting point of discussion because a study published in 2019 by researchers of the Johns Hopkins Bloomberg School of Public Health suggested a potential link between acetaminophen (paracetamol) concentration in a newborn’s cord blood and their chances of developing ADHD and autism (2).

I just want to acknowledge that this can make for difficult reading particularly if you had paracetamol in pregnancy or labour and you have a child with neurodiversity. Please know that this study does not suggest that paracetamol causes ADHD or autism and the authors themselves declare that there are limitations to the study. The study suggests a possible correlation and a scope for further study. We can only act in accordance with what we believe is right at any moment in time.

The reason I am sharing this is that as a society we have come to see a ‘simple analgesic’ like paracetamol as next to benign and yet we actually know very little about its effects on the body.

I see parents issue paracetamol to their children without giving it a second thought. I’ve seen it recommended to be given before you bring a child for vaccination, for teething and routinely if the child’s body is dealing with infection. Most of the time it is used to treat even minor temperatures. Personally I used to only lower Lena's temperature when her fevers were significant and I got concerned that it could cause her febrile convulsions. Even then my first go to were leg wraps (3). Paracetamol was reserved as a last resort measure. I feel that most people kept it that way back in the day and I reckon that occasional prudent use of paracetamol most likely does not do any permanent damage.

I would question what regular use can do though. There was a time in my life when I took it every month for menstrual discomfort and every time I suffered the aftermath of a particularly drunken night out. That is definitely not something I would do now. I think there is an accumulative effect of repeat exposure to toxins that would be harmless on their own but they leave traces in our bodies and cause damage over time. Obviously pharmaceuticals are not the only culprit here but I am trying to clean up my act.

I found a small study that used MRI scans in healthy adults (4) before and after ingesting paracetamol. It is obvious that a pain relief substance acts on the central nervous system given that that is where our perception of pain plays out but we are only starting to understand its effects on the brain. This small study suggests that there are observable effects on the brain and possible more centralised effects on the nervous system, too. The authors suggest further study. 

Historically the pain relief effect was discovered by chance. Acetaminophen is a derivative of aniline. Analine in turn is made in part from benzene and benzene is a common additive for petrol and (just in case you collect trivia) it is where the German word for petrol (Benzin) comes from. So, ultimately a bunch of guys in a lab (so called 'chemists') played around with some organic compounds in the 1850s. Eventually they isolated what they decided to call paracetamol, 'tried it on humans' and discovered that it seems to relieve pain and lower temperatures. A quick read through the wikipedia for paracetamol reveals that it was abandoned for a little over 70 years because of some safety concerns. It was finally revived in the late 1940s and the discovery and marketing of drugs that could relieve pain was the making of pharmaceutical giants such as Bayer in Germany.

Today it is an over the counter tablet that you can pick up for buttons at your local supermarket. You can even buy suspensions for babies in the supermarket. We consider it to be harmless and in small doses given when appropriate it may be. 

That doesn't mean that the potential advantages always outweigh the possible disadvantages in everyone's assessment and yet I reckon that the administration of paracetamol is not preceded by any major conversations around informed consent in the clinical setting (I personally never made any attempts outside of 'Would you like some paracetamol for your pain?').

My reflections last week as I watched my body respond so perfectly to whatever environmental pathogen caused the upper respiratory tract infection that I experienced have deepened my understanding of my body as being in constant movement. The processes on a cellular level happen when I am completely knocked flat by the flu just as much as they do when I am dancing to my favourite song. My various blood cells, the extracellular fluids, my hormones, endorphins and whatever compounds it takes orchestrated their magical healing symphony for me and I truly believe that this would have been hindered by introducing paracetamol.

Given that my mind is never far from pregnancy and birth I naturally expanded to thinking about how paracetamol probably hinders the wonderful orchestration that our bodies can conduct in labour when the right conditions for body mind and spirit are present.

Paracetamol is given frequently to women in early labour and I think it is mainly to be seen to ‘do something’ for a woman who is sore. And it has to be said that a large proportion of women who come through the doors of the maternity hospital expect to be 'given something' to help with the pain. As much as maternity services are creating certain narratives, they are also responding to the expectations from the general public. 

That's culture. 

The beauty is that culture can be shifted and currently there's a monumental shift happening. People are coming back to the old ways and they are increasingly sceptical of authority.

In my book I discuss the potential for repeated doses of paracetamol causing labour to stall. I particularly point to the prostaglandin inhibiting effects of paracetamol and the fact that prostaglandin is one of the ingredients in the recipe for labour. Now I wonder if there's more to this. What if labour is a process that requires the body to be as free from toxins as possible in order to unfold? What if asking your liver to just quickly metabolise up to four grams of acetaminophen in twenty-four hours (along with whatever else we throw at you) is just a little too much for some people? I've heard it said that labour can never stall as such. Just like any other physical process, the body seeks to complete it and in order to do this the conditions need to be just right. The temperature of the room, the lighting, the people in the room, the mood of everyone in the room, the food, the hydration, the sound; none of it must interfere at all or at least not for any prolonged amount of time. Any perceived labour 'stall' is not a pathology (as midwives are taught to interpret it) but rather a symptom that reveals that the external conditions that the mother is finding herself in are being interpreted by the body as threatening. Maybe subjecting the body to repeated demands to 'clean up' small amounts of potentially harmful substances is such a factor.

There are so many ways in which you can work with your body in early labour that do not involve paracetamol. An aromatic bath, a walk, a cuddle, some massage, dance, rest, deep breathing, nice food; they can all help you through the hours of early labour. 

I am planning an aromatherapy for late pregnancy and early parenting workshop in May and I can't wait to share with you my new and old pearls of wisdom. Shoot me an email to [email protected] to register your interest.

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1. https://www.bmj.com/content/378/bmj-2021-069620
2. https://hub.jhu.edu/2019/11/05/acetaminophen-pregnancy-autism-adhd/
   
3. https://www.practicalmommy.com/calf-wrap-for-fever-application-and-mode-of-action/ 
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026835/