Before we dive into a discussion of epidural analgesia I’d like to clarify my intention in writing this series in light of some of the comments on previous articles.
The purpose of this series on natural childbirth is to demonstrate that homebirth is as safe – if not safer – than hospital birth for low risk pregnancies, and that medical interventions commonly used in hospital births such as epidurals, induction with synthetic oxytocin and cesarean sections have risks and complications that are often not communicated to pregnant women.
Currently fewer than 1% of births happen at home in the U.S., and I believe this is largely due to misconceptions about its safety. My intention here is to correct those misconceptions.
The purpose of this series is not to condemn the use of these interventions in all circumstances. All of them have their place, and can be very helpful and even life-saving (for mothers and babies) when used appropriately. In fact, I said the following in bold text at the end of the first article in this series:
I want to be clear: no matter where birth takes place, complications may arise that require medical intervention and I am 100% in support of it in these cases.
There is still much we don’t understand about birth, and even more we don’t have direct control over. In some cases, despite a woman’s best efforts to have a natural, undisturbed birth, complications arise that require medical attention (and transfer to a hospital if she started laboring at home). In these circumstances, I absolutely endorse taking advantage of whatever interventions may protect the health and safety of both the mother and baby. At the end of the day, that is far, far more important than the method by which the baby was born.
I also want to be clear that I am not judging women who choose to have hospital births, receive epidurals, induce with Pitocin or end up having a cesarean section. I respect the right of women to choose a method of childbirth that feels safe and comfortable for them.
My purpose, instead, is to tell the side of the story that women are often not told, and to raise awareness of the risks associated with these procedures so that when it comes time to make their own decision, women are adequately educated and informed to do so.
What is an epidural and how common are they?
Dr. Leonard J. Corning, a neurologist in New York, was the first physician to use an epidural. In 1885 he injected cocaine into the back of a patient suffering from spinal weakness and seminal incontinence.
Today, epidurals are by far the most popular method of pain relief during labor in U.S. hospitals. According to the Listening to Mothers II survey (2006), more than 75 percent of women reported that they received an epidural, including 71 percent of women who had a vaginal birth. In Canada in 2005-2006, 54 percent of women who gave birth vaginally used an epidural, and during those same years in England, 22 percent of women overall had an epidural before or during delivery.
In an epidural, a local anesthetic – still derived from cocaine – is injected into the epidural space (the space around the tough coverings that protect the spinal cord). Epidurals block nerve signals from both the sensory and motor nerves, which provides effective pain relief but immobilizes the lower part of the recipient’s body.
In the last decade, a new type of epidural has been developed (called “walking epidurals”) that reduce the motor block and allow some mobility.
Spinal analgesia (a.k.a. “spinals”) are also used for pain relief during labor, but unlike conventional epidurals, they allow women to move during labor. In a spinal, the analgesic drug is injected directly into the spinal space through the dura, producing fast-acting, short-term pain relief.
Epidurals have significant impacts on all hormones of labor
In the last article, Natural Childbirth IV: The Hormones of Birth, we discussed the exquisite orchestration of hormones during birth and the risks of interfering with the body’s natural hormone regulation.
Unfortunately, epidurals interfere with all of the hormones we discussed.
They inhibit beta-endorphin production, which in turn shuts down the shift in consciousness (“going to another planet”) that characterizes undisturbed birth.
Epidurals reduce oxytocin production or keep it from rising during labor. They also blunt the oxytocin peak that would otherwise occur at the time of birth because the stretching receptors of a woman’s lower vagina (which trigger the peak) are numbed.
As Dr. Sarah Buckley explains 1:
A woman laboring with an epidural therefore misses out on the final powerful contractions of labor and must use her own effort, often against gravity, to compensate for this loss. This explains the increased length of the second stage of labor and the increased need for forceps when an epidural is used.
Epidurals have also been shown to inhibit catecholamine (CA) production. Remember that CA can slow or stop labor in the early stages, but it promotes the fetus ejection reflex in the second stage of labor. Thus inhibiting CA production may make delivery more difficult.
Epidurals limit release of prostaglandin F2 alpha, a lipid compound that stimulates uterine contractions and is thought to be involved with the initiation of labor. Prostaglandin F2 alpha levels should naturally rise during an undisturbed labor. However, in one study women with epidurals experienced a decrease in PGF2 alpha and a consequent increase in labor times from 4.7 to 7.8 hours.
Epidurals interfere with labor and have side effects for mothers
Epidurals have been shown to have the following effects on labor and laboring mothers:
- They lengthen labor.
- They triple the risk of severe perineal tear.
- They may increase the risk of cesarean section by 2.5 times.
- They triple the occurrence of induction with synthetic oxytocin (Pitocin).
- They quadruple the chances a baby will be persistently posterior (POP, face up) in the final stages of labor, which in turn decreases the chances of spontaneous vaginal birth (see below).
- They decrease the chances of spontaneous vaginal delivery. In 6 of 9 studies reviewed in one analysis, less than half of women who received an epidural had a spontaneous vaginal delivery.
- They increase the chances of complications from instrumental delivery. When women with an epidural had a forceps delivery, the amount of force used by the clinician was almost double that used when an epidural was not in place. This is significant because instrumental deliveries can increase the short-term risks of bruising, facial injuries, displacement of skull bones and blood clots in the scalp for babies, and of episiotomy and tears to the vagina and perineum in mothers.
- They increase the risk of pelvic floor problems (urinary, anal and sexual disorders) in mothers after birth, which rarely resolve spontaneously.
One important thing to note about these studies: in most of them, the women in the “control” groups were given opiate painkillers, which are also known to disrupt the natural hormonal processes of birth. We can assume, then, that a comparison of women using no drugs during labor would have revealed even more substantial differences.
Epidural also have side effects for babies
It’s important to understand that drugs administered by epidural enter the baby’s bloodstream at equal and sometimes even higher levels than those present in the mother’s bloodstream.
However, because babies’ immune systems are immature, it takes longer for them to eliminate epidural drugs. For example, the half-life of bupivacaine, a commonly used epidural analgesic, is 2.7 hours in an adult but close to 8 hours in a newborn. 2
Studies have found detectable amounts of bupivacain metabolites in the urine of exposed newborns for 36 hours following spinal anesthesia for cesarians.
Some studies have found deficits in newborn abilities that are consistent with the known toxicity of drugs used in epidurals.
Other studies have found that local anesthetics used in epidurals may adversely effect the newborn immune system, possibly by activating the stress response.
There is evidence that epidurals can compromise fetal blood and oxygen supply, probably via the decrease in maternal blood pressure that epidurals are known to cause.
Epidurals have been shown to cause fetal bradycardia, a decrease in the fetal heart rate (FHR). This is probably secondary to the decrease in maternal CA caused by epidurals which in turn leads to low blood pressure and uterine hyper-stimulation.
Epidurals can cause maternal fever, which in turn may affect the baby. In a large study of first-time moms, babies born to mothers with fever (97% of whom had epidurals) were more likely to be in poor condition (low APGAR scores) at birth, to have poor tone, to require resuscitation and to have seizures in the newborn period, compared to babies born to mothers without fever.
Older studies using the more exacting Brazelton Neonatal Behavioral Assessment Scale (NBAS, devised by pediatricians) rather than the newer, highly criticized Neurologic and Adaptive Capacity Score (NACS, devised by anesthesiologists – can you say “conflict of interest”?) found significant neurobehavioral effects in babies exposed to epidurals.
In one such study, researchers found less alertness and ability to orient, and less mature motor abilities, for the first month of life. These findings were in proportion to the dose of bupivacaine administered, suggesting a dose-related response.
Epidurals may interfere with mother-baby bonding and breastfeeding
Some studies suggest that epidurals may interfere with the normal bonding that occurs between mothers and babies just after birth.
In one study, mothers given epidurals spent less time with their babies in the hospital. The higher doses of drugs they received, the less time they spent.
In another study, mothers who had epidurals described their babies as more difficult to care for one month later than mothers who hadn’t had an epidural.
It’s important to note that neither of these studies prove that epidurals were the cause of the behavioral changes observed. However, if epidurals were at fault, the effects are most likely caused by their interference with the natural orchestration of hormones we discussed in the previous post, and may also be influenced by drug toxicity and the complications associated with epidural births: long labors, forceps and cesareans.
There is also evidence that epidurals may decrease breastfeeding efficiency.
In one study, researchers used the Infant Breastfeeding Assessment Tool (IBFAT) and found scores highest amongst unmedicated babies, lower for babies exposed to epidurals and IV opiates, and lowest for babies exposed to both.
A large prospective study found that women who had used epidurals were more than 2 times as likely to have stopped breastfeeding by 24 weeks compared with women who used non-pharmacological pain relief.
Conclusion
Epidural analgesia is a highly effective form of pain relief and a useful intervention in certain circumstances.
However, epidurals and spinals also cause unintended side effects in both the mother and baby, and interfere with the natural birth process and bonding between mother & baby.
In some cases epidurals may be beneficial, but the evidence suggests that they should not be used as routinely as they currently are in the U.S. and other industrialized countries.
Articles in this series:
- Natural childbirth I: is homebirth more dangerous than hospital birth?
- Natural childbirth IIa: is ultrasound necessary and effective during pregnancy?
- Natural childbirth IIb: ultrasound not as safe as commonly thought
- Natural childbirth III: why undisturbed birth?
- Natural childbirth IV: the hormones of birth
- Natural childbirth V: epidural side effects and risks
- Natural childbirth VI: Pitocin side effects and risks
- Natural childbirth VII: Cesarean risks and complications
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{ 53 comments… read them below or add one }
Thanks for writing about such an important issue. Regarding epidurals, when I went to give birth to my first child in 1998, the hospital personnel were astonished an thrilled when I said I definitely don’t want an epidural. 71 % in US seems to be far beyond 90 % where I live (in Finland). Most who don’t have an epidural just lack the time to have it, I was told.
I would never have an epidural, because I’m not afraid of nature’s own pain. I don’t understand how majority of women are more afraid of nature’s own pain than a medical intervention with risks (and a huuuge syringe!
. I’ve given birth three times, all without anestesthetics, and I loved the experiences. For me, the beta endorfins definitely did their job.
Great post! Really sums up the risks associated with epidurals. I really wish parents were educated in advance about the choices they have available to them during pregnancy and birth so they can make informed decisions about their care. I love providing that education! I teach a program called Hypnobabies and we teach women how to use ‘eyes open childbirth hypnosis’ and medical grade hypno-anesthesia which is really powerful! I’m really looking forward to using it for my 1st birth!
You keep writing. I completely agree that the mother’s of the babies I see, severely handicapped babies, are even ill-informed about normal birth processes. They have no faith in the natural birth process or their ability to deal with the pain.
With the estimates of babies with autism at about 1 in 60 right now, I would say your articles are timely and well researched. Keep on writing.
I agree Stephanie,
You hit the nail on the head, that most women fear natural birth and feel that no one in their right mind would want to face labor without pain medication. Part of it, is lack of education on natural methods to cope with the pain.
This is (terrifyingly) true. When my mother was in the hospital with a broken back, that because of several complications they could not operate on, the ‘pain’ nurse that administers the morphine asked her to describe the pain hourly on a scale from one to ten – with ten being ‘childbirth’. This woman, and the medical school that trained her, genuinely belived that childbirth was the worst possible pain a human being could feel. She was nothing short of shocked when my mother (rather curtly) informed her that childbirth was far from the worst pain ever.
I’m sorry to hear there’s such a backlash about your pregnancy/baby posts & program. But, when you’re pissing people off, you know you’re in the right place. We’ve got a massive issue with the cultural acceptance of all things medical as simply something that is “standard operating procedure”, when for centuries, there was no such THING as any of the Western medical approaches. Sure, in life-critical moments, I’ll get myself to a hospital, but in managing what is essentially just “part of nature”, why invite in medical intervention if its not necessary? Keep working hard Chris. I hope many will continue to see how right you are about this stuff!! (and all the other stuff you’ve written…which is all awesome!)
This is very interesting. What can you say about about eating the placenta as all mammals instinctively do?
I’m in favor of it. Placenta has been used as a restorative and healing medicinal during the post-partum period in Chinese medicine for thousands of years. In the modern Western world, a practice that is becoming more common is to have the placenta powdered and encapsulated so mothers can take it in capsule form for a period of time after the birth.
My niece delivered her own baby at home with her husband and nobody else as planned. They kept the pacenta intact connected to the cord and to the baby until it dropped off on its own accord a week later. I had never heard of this practice, but apparently it is so the baby gets all the nutrients from the placenta?
Yes, it’s an interesting practice called lotus birth, if you’re interested in googling it. It’s very safe for babies-and good to atleast delay the clamping of the cord until it has stopped pulsating if one is going to choose to cut the cord. One doctor I know of who writes about lotus birth is fantastic and her name is Sarah J Buckley- same one quoted in part of the above article. I’m still reading through her book, I borrowed from a friend, called “Gentle Birth, Gentle Mothering”.
And btw, Pearl’s cord fell of just 2 days after birth, and Samuel’s came off on day 4, so the length of time is pretty short but varies from baby to baby. Nice surprise to see you here, A. Becky!
My wife did this, and it blunted her post partum depression very well! She is now becoming a certified placenta encapsulator and she can’t wait to oper her own business.
I wish I had been better informed about the birth process, had a birth plan, and a doula. I was completely unprepared for the sleep deprivation I experienced with #1. And, for #2, I was completely unprepared for a late in the game discovery of a breech baby with a MD who would not do a vaginal delivery.
Epidural with number one. Epidural plus c-section for number two.
IDK, I think I was naive and thought I could have natural births with almost no preparation beforehand! We went to the obligatory hospital class and thought we were set!
It wasn’t until I hooked up with La Leche League that I learned about different births, doulas, education, choices, etc.
Astonishing to think about in hindsight!
The hospital class teaches you how to be a good patient! That’s why we need to spread the word! Putting a link to your site on my blog tomorrow, Chris!
Chris,
Interesting article. I looked at the references and they don’t support your claims. Firstis correlation is not the same as cause. The studies say that women who have epidurals alos have longer labors and pelvic floor problems. They don’t say one causes the other. It can certainly be that in longer labors, more women request epidurals.
You say there is a higher c-section rate, lower vaginal delivery rate and higher perineal tear rate. The studies you cite say in the abstract, the c-section rate is no different and don’t say anything about perineal tears. Again instrumentation complication rates are not mentioned in the abstract. Maybe the full study mentions these?
Just trying to figure out where you got your conclusions.
Thanks
What you suggest is possible, but unlikely. The increased risk of pelvic floor problems is much more likely to be associated with other interventions that typically occur alongside of epidurals, such as induction with Pitocin, instrumental delivery and episiotomy, longer second stage (pushing) of labor and “coached” pushing.
See:
http://www.ncbi.nlm.nih.gov/pubmed/15902173
http://www.ncbi.nlm.nih.gov/pubmed/6147604
http://www.ncbi.nlm.nih.gov/pubmed/15902179
This study shows a tripled risk of perineal tear, and this one shows slightly less than double the risk.
The abstract of the study I mentioned does indeed mention an increased rate of instrumental delivery with epidurals:
The impact of epidurals on cesareans is somewhat controversial, with studies showing mixed results. But after reviewing the research, I believe it’s fairly clear that epidurals combined with low-dose oxytocin regimes (most commonly used in North America) are likely to increase cesarean risk by 50%, whereas epidurals with high-dose oxytocin (less common in North America) may actually decrease the risk. This study suggests first-time mothers accepting an epidural who also use low-dose Pitocin may be up to 2.5 times more likely to have a cesarean.
This has actually been argued extensively in the medical literature for years. The biggest and best review is from the Cochrane Reviews http://www2.cochrane.org/reviews/en/ab000331.html , which showed no difference in c-section rates. The 2 studies you cite show no difference. You can’t have the same c-section rate and also a lower vaginal delivery rate in comparing with and withoutr epidural. The rough consensus in medicine is that that the longer, harder laboring moms tend to use epidurals more than the quicker deliveries. the harder labors have more c-sections and more epidurals, but the epidurals don’t cause more c-sections.
Anyway, it certainly is better to have a faster. easier labor and not need an epidural.
Again, with your other claims, just because 2 things are correlated, does not mean one causes the other. All of these studies are correlation only, one should use that to investigate more, not assume causality.
People in general, including ACOG, are not able to adequately discuss reasearch findings in a scholarly manner. Instead they often make leaps of causality instead of correlation. This only adds to the inflammatory and misguided assumptions. Is it that women who request epidural have inherently abnormal, difficult, or medically managed birth that then cuases complications? Rather than blaming epidurals which the research does not prove, we woukd be better discsussing the complexities involved in providing women wirh what they need to safely birth without intervention.
Obviously, this article is written by a man who will never undergo the major pains of labor. I have read all of the information, and support any woman who wants an epidural in order to endure labor pains.
Thank you for this series. At last a website to which I can point all my pregnant friends. It is a shame that women are usually offered – and usually gratefully accept – a suite of interventions, not being informed about associated risks. Having read a lot on the subject, I was always amazed by how little women know and how blindly they can trust the system.
Thank you for the wonderful information. Your reasons for writing, along with an unmedicated birth center birth, are why I am studying to become a birth instructor. Women need to know.
Believe it or not, natural childbirth with assistance is illegal in Alabama and other states as well. I didnt have natural birth but if I ever have another child I will definitely try it.
Thank you so much for writing this article. I have been in a constant battle defending my position, and ultimately had to find a new birth coach, because I am not wanting an epidural unless medically necessary.
very important to me that i read ur article which i found it interesting and convinced me to give birth after 20 weeks without epidural
So glad I came across your article. I gave birth at 22 years old, naturally. Almost unheard of now in days…My friends thought I was crazy for “planning” a natural birth. I went in well prepared, I read, watched videos, ate well, stayed active, and got myself mentally ready for what I was going to experience. Most importantly, I knew that my body was designed to give birth. I decided to have a midwife who’s beliefs on child birth were much like my own because of that I knew that my nurses wouldn’t try forcing an epidural down my throat or should I say spine. I just wanted to give my baby the best chances in life even if that meant feeling some labor pains. I must say it was the most rewarding and selfless thing I could do for her. 24 hours later both my daughter and I were able to go home. Our bond is like no other…I highly recommend natural births!!!
When I failed to progress with my son in 2010, I was given pitocin to get my labor going. Because the contractions started getting so intense, I had an epidural. Within 30 minutes of receiving the epidural, my blood pressure dropped to where the monitors couldn’t read it anymore. I passed out, threw up, was given oxygen, and had to have 3 rounds of medication to counteract the epidural’s side effects. My SpO2 levels were compromised, as were my son’s, and his fetal heart rate dropped during all of this. I was rushed into the OR and had a c-section. If I had it to do all over again, I wouldn’t have allowed them to start pitocin, and I definitely wouldn’t have received an epidural.
Typical…..a man telling a woman how to give birth.
And you can eat the placenta too.
I have 5 healthy children. Three with pain meds, two without. I’ll take the pain meds, thanks.
Mary,
I don’t recall anyone telling others “how to give birth.” This research and dissemination, whether conducted by a male or female is common knowledge. Take a chill pill.
Susan,
I dont thnk Mary is out of line or “not chill” at all. She actually had the experience of both. She had healthy babies with both procedures, no problems that might have had her inclined to blame the epidural. Your first child I heard takes the longest anyhow…..so why would someone who took the epidural not be informed that it might have NOT been the epidural. When you dont have an open mind …to me…you are an extremist. I also agree that Men should really not have any say in the child birth process. Thanks Mary for having an open mind set and giving our best oponion, after having tried both sides.
I am 36 weeks preganant…heard stories of all kinds…and going into the birthing experience with the intent of natural but not being affraid of other options either.
Danielle, the article isn’t about closing your mind off to the possibility of an epidural. It’s not telling women not to get them. It is written by a researcher (yes, a male researcher) who is listing potential side effects in order to inform.
Pregnant women are frequently coddled, treated like they cannot read research, and prescribed interventions without being fully informed or even before they give permission. It’s insulting. I’d rather hear as much information as I can before making a choice.
A friend of mine was given an amnio because she was over 35. The (small, but real) risks of miscarriage were never discussed with her. It was just–’get this test, because you’re in the high-risk age bracket.’ She wouldn’t have wanted the test if she’d known it carried a risk to the fetus. She trusted her doctor to inform her.
Women shouldn’t feel shamed into any kind of birth. It’s just that, a fully informed woman might make different choices. Most women will find the epidural risks acceptable. There really are a lot of healthy babies/mothers after an epidural. A few might not, and it’s best that they be informed.
Thank you for this info. It should be included in all pregnancy test kits JUST so all women will be exposed to it! I was bullied into getting an epidural with my first child after being mocked for not wanting a medicated birth (I had carefully chosen my OB who fully supported me, but, of course, had no control over the L&D nurse I received). I was then flat out lied to by the nurses and doctors who told me point blank that NONE of the drug crossed into the baby. Poor baby had some major issues the first few days including not breastfeeding well for quite some time – later a lactation consultant told me it was most likely the epidural and then labor augmentation drugs as she sees it all the time with medicated births.
My story, sadly, is not unique. It does point to a reason why women are leaving hospitals to deliver at home, where they are supported in their plans for unmedicated births and surrounded by individuals they know and trust. After welcoming my second child into the world in the safety of my home, I would never go into another pregnancy planning a hospital birth.
I to feel like I’m bullied into having an epidural, my aunt told me that I must take the medicine I don’t know why? She never gave birth!!! And whatever my hospital could squeeze out of my insurance they’d do it. My goal is to wait until its the second or final stage of labour and then go to the hospital. I DON’T WANT TO BE INDUSED, I DON’T WANT CC, AND DEFINATELY I DONT WANT EPIDURAL !!!!!
Side effects of walking down the street – you may get hit by a bus.
Had an epi and spinal another time…both gave me a very sore back. Spinal tap area ached way more than the darn uterine/abdominal wound.
My last hospital experience was miserable and I resolved then that number 3 would be at home…God willing and the creek don’t rise.
I am a guy that is dedicated to his wife and future child. I have been reading, watching TLC, and researching everything. I am outnumbered by my wife and her mother and they won’t listen to my concerns with the risks of pytocin and epiderals. I feel like I have more I interest than my wife about pregnancy and all I get is I wish you were the one that was pregnant. What’s a guy to do?
See if you can get her to read anything by Dr. Odent or Marsden Wagner about how you shouldn’t interfere with pregnancy. Ina May Gaskin’s “Birth Matters” might change her outlook. Can you get her to watch The Business of Being Born – I think it does a great job of showing how traumatic pitocin is for the baby. Henci Goer has a book called “The Thinking Woman’s Guide to a Better Birth” that lists the risks and benefits of all interventions. A word of “warning” is that many of these sources will lead you to understanding that a hospital birth is a fight and home birth tends to be more evidence based, but they also do talk about the risks of the interventions you are concerned about. Oh, and please stop watching TLC!!! A Baby Story and those other shows, unless they’ve gotten better, put the moms into risk and then “rescue” them to look heroic – pretty dangerous. Can you guys get a doula? That might also help out. Big hugs to you. It must be hard when you are more concerned than she is. It does sound like though that she just needs the resources to find the inner strength to realize that she doesn’t NEED an epidural to cope with the pain – there is dangerous pain that is causing damage and then normal labor discomfort (pain) that has a purpose. A lot of labor is a mind game – face your fear and decide to give in and relax and go within yourself then it’s very easy to cope with. The pain of labor is made worse by fear, which is sounds like she needs, and made even worse with pitocin b/c pitocin stops your body from releasing natural pain fighters. Oooh, while I don’t know much about it, maybe look into hypnobirthing with her – a lot of women using that technique to help them out and report great success. My first OB even suggested it to me when I told him I didn’t want an epidural. Anything that can help her relax and build her confidence. Women in our culture LOVE a dramatic birth story for some reason. The “best” births are often really quite boring
go into labor, relax through the contractions/rushes, give into the process, body pushes out baby on its own, all is good – a nice “boring” birth to you and your new family!!!!!!
Wow thanks for all the great resources!!! I also just can’t believe the possible connection pitocin has with autism and the way the hospitals are gonna just keep pumping into mothers!! People just don’t want to ask questions and demand answers anymore…
Keep up trying to educate your woman. She’s very lucky to have such a supportive and well educated guy! Hopefully you’ll get into her head so she can avoid interventions/interferences and have that oxytocin high that every woman and baby deserve and quite frankly need after birth. I’m happy the link has been made between pitocin and autism. I just hope people start to listen. Regardless, the empowerment a new mother can feel when she gives birth (SHE gives birth) instead of the medical establishment forcing birth to occur is amazing. Best of luck. Natural birth is amazing and such a boost for moms, especially first time moms. To know that your body is NOT broken and that YOU are the one to bring forth a life is really enlightening and strengthening. Women have been robbed by a lot over the generations. It’s nice to see men such as yourself and Chris Kresser helping support women in this rite of passage.
Mr Kressler,
I’ve worked with mothers and babies for 15 years….Your data is seriously out of date. There is no risk for increased cesarean section in women who receive epidurals- Zhang, 2001. Not only that, in randomized prospective trials (Wang, 2009) epidurals can be given in the latent phase without increased risk of c-section. Yours and other websites only serve to frighten women and when they “give in” to pain relief, they feel they let themselves down. This is just a start…you are twisted in many of your other statements, and by using big words like PGF2- alpha you supposedly lend credence to your misguided article. And, amazingly, you forget to mention one known negative of the epidural which is increased body temperature and unnecessary neonatal workups for sepsis. I can only imagine your agenda but please don’t enlighten me further on those details. Lastly, Don’t forget to remind women that choose natural childbirth at home- when all goes well, wonderful, when it doesn’t, the experience and outcome may ruin your lives.
Just let the process proceed as natural as possible. Epidurals definitely influence a babies CNS. Only within the last hundred years or so have women had babies in hospitals, with forceps, and epidurals. Women have given birth naturally for centuries. There is no need to abuse the medical advantages we have today, but rather utilize them in emergency situations.
Joan,
Thank you so much for this!
Love what you do. Love this article. I’m all about educating women and their options.
I wish more people would trust their own bodies and realize that the female body is MADE to give birth. Without artificial interventions (i.e. Pitocin, epidurals, etc.), there are wonderful positive feedback loops that help push the woman closer and closer to delivery. There are just so many things that most women do not understand how labor works.
Epidural does not increase the risk of caesarean section, this has been settled in 1998 (and confirmed many times since then). Epidural does not interfere with breastfeeding: studies show some statistically insignificant effect in the first 24 hours only. It is also important to understand the difference between the associations and cause-and-effect relationship. Epidural is associated with tears, that is correct. But it does not cause them. The reality is that women with prolonged or obstructed labour are more likely to get an epidural. Incidentally, these women are at higher risk of tears. Epidural also has beneficial effects on the baby, compared with both opioid analgesia and no analgesia. It may also prevent long-term pain after vaginal birth.
I was induce a week early. I went in on October 4 7:00 in the morning the doctor checked my cervix said she was still a little high but started the Iv meds anyway at 12:00 they broke my water at 1 they gave me my first epidural. Didn’t help at all they put 3 valves in it still no relief. So at 2 they redid it that time it work but I felt really druged and even my skin was a yellowish color then my little Madison was born at 6:10 pm. She barly cryied after birth. They cleaned her up and gave her to me she didn’t want to eat all she wanted to do was sleep. The next day they notice that her glucose was going down and she had poor oxygen. They transfer her to St.V children hospital they notice at that time that she had Lactic Acic in her blood. Mean While I was also admitted for high blood pressure and my feet and legs were swollen worse then they ever had been, Also my face was really swollen my lips and could barly open my eyes. I was in the hospital for a day and a half before I was able to go see my baby. Time I got to see her they got her Lactic Acid level back down from a 16 to 2 and it was floating between 2 and 5. When she was 6 days old they decided to feed her started her out on breast milk 10 ml every 3 hours the next day her Lactic Acid jumped back up to 12 to 16 she had to be put back on the ventilator they stopped feeding her but they couldn’t get it to go back down. At 9 days old they transfer her to Riley Hosiptal. They was going to do more test but on the 15th at 12 midnight the last check on her levels her Lactic Acid was a 20 then she just gave out. They tested her for all of the matabolic disorders at St.V’s a month later all of her test came back and they could not find an underlined condition just that what ever they could feed her would of poisoned her. I don’t understand how an almost 9 pounds baby could have these kind of problems and the Matabolic Doctor said he never seen a case like hers. I really think it was the Epidural that causes all of these problems I think they over medicated me. Iv’e been trying to find similar story’s on the Internet but haven’t yet. I never knew that the epidural crossed over to the baby I feel so guilty. The only thing I was ever told it could cause damaged to my back, never told it could build up in my baby. I am so mad I have 3 other children all healthy and yes I was induce with all 3 and had an epidural with them but never so much. And nobody in my family or my husband has any type of Matabolic disorder in our family. I think Major Hosipal messed up and poisoned my daughter. So please anybody if you have a similar story or knows somebody who has a similar story please contact me at cynthiaasher30@gmail.com Because I would really like to know if an epidural can poison a baby if to much is givin to the mother. I don’t care if its 2 yrs later I need some answers,
This infomation is useful.
But it would be a lot more useful if it included at least *something* about the frequency of various physical effects mentioned — on either the mother or on the baby.
For example, the various potential negative effects on the baby of the mother’s receiving an epidural are useful to know. But it would be *immensely* more useful if at least *some* information were provided about how often they occur. (With the full understanding that any generalization cannot take into account the differences in dosages, mothers, and babies.)
In fact, it is not clear from what I read above whether *any* of the aftereffects on the baby of the mother’s epidural might typically be long-term effects, or whether all of them are short-term effects.
It is also completely ignored that expectant mothers may be filled with anxiety by worrying about the possibly agonizing pain that labor and giving birth may cause them. This anxiety undoubtedly affects the baby, and its effects have to be weighed against the effects of an epidural. (If the mother knows she can have an epidural with only the faintest risk of long-term effects on the baby, she might be a great deal less anxious.)
Is its valuable to get this side of the story, but it is *****much***** less valuable when the likelihood of the ill effects, and their duration, are completely omitted. As well as the positive side of epidurals being completely omitted as well.
I have had migraines and the tendency to have headaches easily since I was a teen. When I had my first child, I was talked into getting induced early, I tried to go natural, but after laboring all night with no progress I was exhausted and was “encouraged” to get pitocin and and epidural. I said yes. I now have chronic daily headaches. The headaches started the day I got the epidural. They subsided somewhat when I was pregnant with my second. But I ended up with an epidural again, and the headaches got really bad again. With my third, the headaches got a little better again and I was determined to do a natural delivery. I had a midwife and I did. The headaches thankfully did not get worse. However, I still have them. I feel like I have seen every Doc and talked to every anesthesia person I know, I basically get a shrug and a I have no clue answer. No one can tell my a) why I have headaches and b) how I can get rid of them. I take supplement recommended by my neurologist, changed my eating, literally eat no processed food, no soda, no sugar–and I still can’t get rid of them. I would give almost anything to go back and redo my first birth. I get so frustrated with the lack of answers.
It is interesting that you connect your headaches with the day you got epidural, though on the same day you also got pitocin and you delivered the baby. And you still think epidural caused your headaches even though you had a tendency to have it easily since your teens.
One way epidural can cause a headache is a dural tap. However it doesn’t seem to be the issue in your case. In general, it is quite common not to be able to find a cause of a headache. It would be a good idea to start a diary to record all possible things that may cause your headache: duration of sleep, detailed record of foods eaten, stress, travel, alcohol, medication etc. Maybe eating some sugar or processed food will ease the headaches? I get severe headaches from oversleeping, so I try to avoid doing it or take strong painkillers early.
Epidural analgesia in labor is still considered somewhat exotic by many people, and that’s why it is blamed for lots of ills it does not cause. I find it unfortunate.
I think the fact that I have always been susceptible to headaches is the reason I ended up with chronic daily headaches after the epidural with my first baby. And yes, I definitely think that the epidural is the cause of the escalation. The epidural is the only thing in common from my first two births (besides the actual baby), as I did not get pitocin with the second and the fact that the headaches did not get worse after my third which was a natural birth as it did with the second, seems to point in that direction. I do have a general idea of what will make it much worse: not enough sleep, an abundance of caffeine, sugar, processed food, alcohol. So while eating better decreases the intensity, they are by no means gone. I do realize that there are a lot of women that can have epidurals with seemingly no problems, but I feel like my issues are from the epidural and maybe it was the pitocin combined with the epidural that screwed up my brain physiology. I have no clue. All I know is I am the one that has to deal with this day in and day out, which is what I find unfortunate and frustrating.
CZS, I hope you get better and wish you to get rid of your headaches. I respect your opinion, however there is no data in the medical literature that supports your view that your chronic headache was caused by epidural. First childbirth is an intense and physiologically traumatic event, which by itself sufficient to cause headache in someone who is predisposed to them. Who is treating your headaches? Your GP or a pain specialist? Once again, I wish you full recovery.
I see a neurologist at the headache clinic at my local major hospital. I am thinking about getting my medical records from my deliveries and seeing if there is something else that happened in the first two that didn’t in the last one. It’s been nearly 7 years now….I’ve had a headache basically since then, with no break. Thanks for you well wishes. They are appreciated.
I have had 2 healthy labour and deliveries WITH walking epidurals and I am pregnant with #3 and am planning on an epidural. Kudos to those that do it without anything. I have enjoyed my painless, restful labours (I actually got to sleep a little bit) I was just wondering how does the drug get into your blood stream when it is directly put into the spinal fluid (which is part of the blood brain barrier is it not). My kids did not come out drugged – 9/10 apgar with #1 and 10/10 apgar with #2. I had no issues after birth with headaches or excess pain. Minimal tearing in #1 (pushed for 30 minutes) and no tearing in #2 (pushed in 1 contraction/5 minutes and he was out). I realize these studies are done, however there are SO many factors other than epidurals and pain meds that have to be taken into consideration — family history, skeletal and muscular structure and strength, awareness of one’s own body, weight, how the mother carried, uterus position, baby position, the list could keep going. My kids are healthy and happy, so to those mothers now worried about epidurals, just be aware that YES there are risks, but there are also risks with natural birth depending on your individual health and circumstances. Therefore choose what you think is best for you and you little one.
An educated comment. First of all, the amount of drugs that gets absorbed from the epidural space is very small. Normally epidural is done with 0.2% ropivacaine and 4ug/ml of fentanyl. The former does not have any unfavorable effects on the fetus. The latter, an opioid, potentially can cause side effects and complications. However, given that epidural infusion is done at about 10 ml/hour, the amount of fentanyl given to the mother is 40 um/h. This amount is quickly metabolized and removed from the bloodstream. Compare this to 100 mg shot of meperidine that many midwives consider a better alternative to epidural – and you shouldget no surprise that epidural babies have significantly better Apgar scores than those born from mothers who received IM opioids.
And yes, the factors that determoine the outcome of labor are numerous, and epidural is only one of them. The last sentence summarizes it best: “Therefore choose what you think is best for you and you little one.” Do that after learning everything you can about all things labor.
Natural childbirth is good to consider but if the health of the mother is at risk, the experts should decide which method should be the best. We can’t deny that certain medicine has side effects, this is why it’s ideal to consult medical experts first before coming up with a medication.