Epidurals

[SquishyMommyof2]

"I wonder if women are told this? Women will go through utter hell if they think it's going to be good for the baby. She may accept all of the risks to her. But tell her about the risks to the baby and you've got something else."
-Marsden Wagner, MD, former director or Women's and Children's Health for the World Health Organization

1. Because of the potential for epidural-increased fetal heart rate decelerations, it is necessary to use continuous electronic fetal monitoring. Studies have shown that electronic fetal monitoring increases the cesarean rate by 2-3 times (without improving the baby's outcome.) A drop in fetal heart rate adds worry and stress to labor, and sometimes is serious enough to warrant fetal scalp-blood sampling.

2. When an epidural is introduced, the mother's blood pressure drops, often causing serious fetal distress from decreased oxygen circulation. IV fluids must be administered rapidly to counteract this side effect of epidurals to the mother. While this relieves one problem, it creates others, including excessive swelling of the mother's feet, legs and breasts. When the breasts are engorged, the nipple is flattened. This makes it difficult, sometimes impossible, for the newborn to latch on.

3. Epidurals also numb the bladder, eliminating the sensations which signal the need to urinate. At the same time, huge amounts of fluids are flowing into the mother to counteract the anticipated drop in blood pressure. So to prevent bladder distention, a urinary catheter is needed until the epidural wears off. Catheterization brings an added risk of bladder infection, which would then require antibiotic treatment. Studies show that there is a 700% increase in urinary incontinence 3 months after an epidural. Even a year later, incontinence remains 200% higher than non epidural moms.

4. AS explained earlier, epidurals disturb the natural feedback system that stimulates and maintains good, strong active labor. If labor progress slows or stops all together, uterine contractions can be artificially stimulated with pitocin through an IV. Pitocin, even when carefully administered through an electronic "pump", causes unusually strong and prolonged contractions. Such contractions decrease the oxygen supply to the baby causing fetal distress.

This risk requires continuous electronic fetal and uterine monitoring. Unfortunately, continuous electronic fetal monitoring, regardless of why it is used, increases C-sections.

5. One study (Murray, et, al, 1981) found that the time it takes to push a baby out is longer for mothers either with an epidural (100.4 minutes) or with pitocin and an epidural (83.8 minutes) compared with an unmedicated mother (47.7 minutes)

As described elsewhere in this chapter, epidurals interfere with the urge to push, the effectiveness of pushing, the rotation of the baby's head into the most favorable position and the mother's capacity to choose her most effective birthing position. That's why with an epidural there is a five-times greater likelihood that forceps or vacuum extraction will be used to pull the baby out. Another study found forceps were used in 60% of mothers with epidurals, and 80% in mothers with pitocin AND epidurals, but there were NO FORCEPS DELIVERIES IN THE UNMEDICATED GROUP.

6. The incidence of deep vaginal tears that extend into the rectum is 3 times greater with an epidural because of the increased use of episiotomy and the use of forceps. Deep tears and painful and take longer to heal, and may later cause fecal incontinence and chronic pain during sex.

7. Studies have shown an increased c-section rate. Thorp et, al. found a C-section rate of 17% in its epidural group and only 2 percent in the non-epidural group, even though the mothers in the two groups were equivalent before the epidural was administered.

Thorp et. al. (1993) reported that the earlier an epidural is begun, the greater likelihood of a cesarean: They reported a 50% increase in cesarean birth rate when an epidural was started at 2 cm, 33% at 3 cm, and 26% at 4 cm.

The Cesarean rate can be attributed to the following epidural-related factors:
-Fetal distress brought on by the mother's drop in blood pressure, decreasing the placental blood flow
-weakening, slowing or stopping of uterine contractions
-abnormal position of the baby's head, resulting from a failure to rotate and descend normally during second stage because the epidural has relaxed and numbed the pelvic floor muscles (and interrupted the natural hormonal feedback loop)
-Decreased pelvic diameter when the mother is forced to lie on her back.

8. Epidural Fever The hard work of normal labor raises the mother's temperature slightly, which causes no problems. Epidural "fever", although medically benign, must be treated more seriously.

The incidence of epidural fever is disturbing. Among epidural-mothers, 1 in 4 will develop epidural fever after 4 hours and almost half after 8 hours.

Just two to three hours after an epidural is started, the mother's temperature begins to rise approximately 0.1 degree celcius per hour and 1.0 degree celcius (1.8F) every 7 hours.

Fusi, et. al. observed that, "The rise in temperature in most women with epidural did not result from an infective process, but from their inability to dissipate the heat generated in the process of labor." They went on to postulate that: "This inability stemmed from the paralysis of the lumbosacral autonomis nerves which not only produced changes in blood pressure, but also prevented sweating. Since in conditions of heat stress up to 80% of body heat production is removed by evaporation of sweat, loss of sweating over the lower half of the body will inevitably cause a positive heat balance with a resulting rise in core body temperature. ...Epidural block therefore seems... to create an imbalance between the heat producing and heat dissipating mechanisms, causing a fever even in absence of vaginal, uterine or urinary bacterial infections."

However, because infection can have serious consequences for both mother and baby, once a fever develops aggressive medical management must be undertaken.

A rise in mother's temperature (from whatever cause) may result in the rise of fetus' as well, causing dramatically increased heart rate and possible metabolic deterioration. Medical management of this condition includes IV antibiotic therapy, and speeding up labor with pitocin, forceps, vacuum extraction or Cesarean.

Infection in newborn babies is extremely serious and must be treated immediately. Neonatal ICU nurses I interviewed explained that "some babies born to mothers with fevers in labor, depending on the circumstances, get septic workups. But all babies born with an elevated temperature are put in the NICU for a septic workup."

What does a septic workup involve? Blood is drawn from the baby at least once (and as often as every few hours), and sometimes a spinal tap is performed. A spinal tap involves inserting a needle into the outer covering of the spinal cord in order to sample the fluid that bathes the spinal cord. The fluid is cultured in a lab to see whether an infection is present.

Infection in a newborn can be life-threatening. So, even before results have come back from blood work or spinal taps to show whether an infection is actually present, antibiotics and treatment must begin. At the very least this situation creates tremendous stress and worry, an emotionally painful separation from the baby, and interference with breastfeeding. Additional medical bills immediately soar into the thousands.

All this pain, anxiety and expense for what is usually found to be a benign epidural fever (which requires no treatment.) Yet, the workup must be done to a void missing the timely diagnosis and treatment of an actual infection.

9. It is a popular myth that epidural medication doesn't get to the baby. Epidural anesthetics DO cross the placental barrier. Anesthetic levels in the baby's blood have been found to be as high as one third of maternal blood levels. As a result, compared to the unmedicated babies, babies in the epidural or pitocin-epidural groups showed "drugged behavior" (eg trembling, irritability and immature motor activity) on the first day, with behavioral recovery by the FIFTH day. It takes 48 hours for a newborn to eliminate the epidural anesthetic from its system.

When pitocin is used with the epidural, there was an even greater depression of motor activity. Babies were more tense, hypertonic and displayed depressed reflexes.

Murray et. al. discovered that A MONTH AFTER BIRTH, unmedicated mothers reported their babies to be more sociable, rewarding, and easy to care for than did the epidural mothers. In addition, the unmedicated mothers were more responsive to their babies cries than mothers who had epidurals anesthesia in labor.

The early days of the mother-baby relationship may impact bonding and the future of that relationship. The bay's behavior makes a powerful first impression. When in the first month, babies appear "disorganized" (which means they are more irritable, withdrawn, look away and suckle less) mothers are more likely to perceive them as difficult babies. That impression can affect the mother, unconsciously, in ways that shape her behavior toward her newborn, which over time, will shape the baby's personality and consequently the mother-baby relationship.

SO, IF YOUR DOCTORS TELL YOU EPIDURALS ARE A WOMAN'S BEST FRIEND, DON'T BELIEVE IT!!

HOW PAIN HELPS YOU GET YOUR BABY OUT

Nature's blueprint for women in birth includes pain, and the pain is purposeful. Pain is experienced when stretch receptors in the dilating cervix send signals to your brain, calling for more oxytocin to be released - which in turn fuels labor and increases dilation. The sensations you're experiencing are part of an ingenious feedback mechanism which is essential to normal labor and birth.

The pain and sensations of labor tell you what position is best for you and how to move in labor to get your baby out. With an epidural, this feedback is wiped out. Of course, such information would no longer be useful anyways, because after an epidural you are immobilized and hooked up to machines and restricted to lying on your back.

Pain also increases endorphin levels in your body, while analgesic drugs and epidural anesthesia lower them. This is significant because endorphin levels correlate with the release of oxytocin. So, when pain is relieved the stimulus for endorphin production is eliminated, and its levels fall. This change is usually accompanied by a drop in oxytocin, thus slowing down labor and dilation.

[RNsteph]

Jan. 25, 2009 at 8:41 PM

This was an interesting journal.  I agree with much of what was written as I saw it first hand working in labor and delivery.  However, I have also seen women in so much pain and so exhausted that they could not physically continue labor.  I also saw many women who went into the labor process enthusiastic and well prepared to do it naturally, but reached a point where they could no longer manage the pain no matter what they tried.  I have physically assisted thousands of deliveries and I never saw an emergency c section caused by an epidural.  Yes...I saw fetal heart rates decel after initial epidural inserition.  I have seen blood pressure drops in the mothers...that's why you have a qualifed nurse and anesthesiologist ready to handle what might come up.  Vital signs are taken frequently throughout the first hour post epidural insertion.  The nurse is at mom's side the entire time.  She is there to insure mom's and baby's well being.  Yes, the fevers do occur. Sometimes.  Yes, it takes longer to push a baby out with an epidural that is very deep - on the other hand, an exhausted mother can get some much needed rest and the baby can "labor down"   A relaxed mother doesn't hold up labor progress.  A tense woman unable to relax can slow the labor process.

In short, I agree - the best labors are the ones that have a mother in control and able to manage through the contractions and pushing.  Many women try...but some just can't do it and I hate to see anyone feel guilty because they chose an epidural.  A successful labor and delivery is one where the mother and baby come out healthy. 

I personally delivered two children naturally, and one with an epidural.  I was absolutely terrified of labor after my second delivery.  There was absolutely no way I was delivering again unmedicated.  My son was fine, I pushed with no difficulty, and truth be told, he was my easiest baby.  So statistics can go both ways.