Read more from Livingston at Childbirth Today
There are many controversies in maternity care. The spectrum of debates run to both ends of the spectrum: from those who feel all women should have interventionized maternity care to the home birth advocates. However, one of the most controversial topics in care is epidural anesthesia.
Fueling the flame of the epidural controversy are the diametrically opposite positions published in anesthesia journals vs. those in other medical journals such as nursing, midwifery and family practice.
In most hospitals, laboring women who have received epidural anesthesia are confined to bed as they no longer can rely on their legs for stability. This may severely limit movement and positioning. Additionally, hospitals may have a policy that all laboring women receiving medication, specifically epidural anesthesia, have an internal fetal heart monitor in place. This requires breaking of the amniotic sac or membranes in a procedure known as amniotomy. Occasionally, it may be necessary to augment or stimulate a labor with Pitocin after an epidural has been given, as epidurals have been shown to slow some women's labors – making the labor longer and harder on the woman’s body (Mayberry, L.J., Clemmens, D., De, A. Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review. American Journal of Obstetrics & Gynecology. 2002 May;186(5 Suppl Nature):S81-93.)
Researchers have linked epidural anesthesia to assisted delivery, or the use of forceps or vacuum extraction during the pushing portion of labor (Torvaldsen, S., Roberts, C.L., Bell, J.C., Raynes-Greenow, C.H. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. Cochrane Database Systematic Review. 2004 Oct 18;(4):CD004457.). Researchers also find that 88% of women who requested an epidural for pain in one study reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity. Pre-labor survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings.(Kannan, S., Jamison, R.N., Datta, S. Maternal satisfaction and pain control in women electing natural childbirth. Regional Anesthesia and Pain Medicine. 2001 Sep-Oct;26(5):468-72.)
Epidural anesthesia also causes a drop in maternal blood pressure, thus the need for 1000 ml of IV fluids administered prior/during the administration of the anesthesia.
For the newborn, the effects of epidural anesthesia are more hazardous. Women who have epidurals are less likely to fully breastfeed in the first few days and are more likely to stop breastfeeding in the first 24 weeks due to the difficulty newborns have in coordinating sucking and latching. (Torvaldsen, et al. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. International Breastfeeding Journal 2006 Dec 11; 1:24. Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. When used in combination during the labor process, which happens frequently, epidural anesthesia and pitocin influenced endogenous oxytocin levels negatively ~ thus negatively impacting both milk ejection and milk production. Jonas et al. Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin in response to suckling during the second day postpartum. Breastfeeding Medicine 2009 June; 4(2): 71-82.
Countless other studies including the Journal of the American Board of Family Medicine and Dr. Sarah Buckley all focus on the hazardous impact of epidurals on breastfeeding and the newborn.
This evidence may be an inconvenient truth.
excellent post! I will incorporate some of the more technical findings in my childbirth education classes... scary that folks are told that the epidurals never even reach the baby.
ReplyDeleteA massage therapist once told me that she ccould tell without asking, 6 weeks after the birth, if a baby's mother had an epidural, just from his muscle tone. Of course the medication from the epidural reaches the baby. The babies act stupified at the breast, often coming the the breast, latching on, and then waiting for something to happen, a something called suckling which they apparently can't remember to start doing. I think of it like having a few drinks too many, and trying to put the key in your front door to unlock it; it's just awkward, and often unsucessful, and frustrating, and you may need help.
ReplyDeleteBeing a first-time mom and never giving birth before, I knew that I wanted a completely natural birth but was told by my peers that I would give in as soon as the labor pains started. I was pretty determined to not have any interventions but I still decided to give birth in a hospital (luckily I had a more 'holistic' doctor). I managed labor better than I ever expected and without any type of intervention. When the doctor placed my daughter on my chest, she had this calm, peacefulness about her that was telling me, "Thank you mommy for birthing me without the drugs". She layed with me, we nursed and enjoyed each other. As a woman, we are designed to give birth. We can handle the pain, the end result is a miracle and the pain is a faded memory.
ReplyDeleteI cannot scientifically prove this but after seeing many epidural born babies and many more non-epidural born babies, and understanding both hormonal and birth mechanics. I would have to hypothesis that epidurals may make the pain go away for the mothers but I believe it also makes the birth more painful for the babies... The natural endorphins that the mothers body produces in the feedback loop of labor stop being produced with epidurals. Theses babies then are not being bathed with those natural hormones, thus they are not receiving natural painkillers. The epidural anesthesia does not effect babies in the same way it effects the mothers....
ReplyDeleteI agree with Anonymous. I have written about this here: Carol Gray's Blog
ReplyDeleteThe irony is that most women that go without IV or epidural medication are accused of doing so for their own personal experience. Those people have no interest in "going natural," because they don't need a sense of empowerment. What they fail to realize is that it isn't the pain that causes that sense of empowerment; it is the realization that you, as a mom, made a choice to experience pain to ensure that your baby was not exposed to drugs.
ReplyDeleteI, too, believe that babies of epidural moms experience more pain. It isn't just because of the absence of maternal endorphins, either. Birth is a dance. Mom experiences pain in response to the baby meeting an obstacle. Mom's response is to move in such a way to alleviate the pain or get it over with more quickly, which, in turn, helps the baby to maneuver around obstacles. Take away mom's sense of pain and you are basically letting your child do it all on his/her own in there. Thinking about it that way makes me very sad.
I came across this article, and just in case others do, I want to add my experience. I intended to go natural. I did everything I learned in my Bradley classes, and my husband coached me through all the relaxation techniques we had practiced. But after many, many hours of labor with double-peaking contractions and only 30 seconds in between and THEN being told I was only a 5 (having dilated 1 cm in 5 hours), I opted for the epidural. I had been told they were terrible, that my baby would come out drugged, etc. But you know what? It was the best decision for me. Because of the epidural, I stopped throwing up constantly, and I was able to rest. I also think that the stress of childbirth was causing me to dilate more slowly, as much as I tried to relax. I was in labor for another 7 hours, including 3 hours of pushing. No pitocin. My midwife gave me my daughter immediately for skin-to-skin, and within 20 minutes, she was nursing. My milk came in on day 3, and we've had no problems with latching or with milk supply. My daughter was not drugged up. Her muscle tone was fine.
ReplyDeleteWith my next baby, I will try again for a natural birth. It's not because I think the epidural was poison. But she got stuck on my pelvic bone during delivery, and I would have liked to try more positions to move her around. Not sure if it would have worked since she was a 9 lb baby (which I delivered with NO tearing). But I always think more options are better. Still, if I end up choosing another epidural, I think that will be fine, too. I honestly think the pitocin is the big problem, not the epidural. And I think working with a midwife, even in the hospital, made all the difference for me and for my daughter.