Natural Childbirth V: Epidural Side Effects and Risks | Chris Kresser

Natural Childbirth V: Epidural Side Effects and Risks

by Chris Kresser

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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:

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:

  1. Buckley S. Gentle birth, gentle mothering: a doctor’s guide to natural childbirth and early parenting choices. Celestial Arts 2009. pp.117
  2. Hale TW. Medications and Mother’s Milk. 12. Amarillo, TX: Hale Publishing; 2006.

197 Comments

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  1. My children are 24 & 21 and have had great problems with ADD/ADHD that after reading and reading so much research I believe is directly attributable to “non-natural” childbirth. Both labors came on their own, but were augmented with Pitocin and epidurals. Both had fetal distress during the long labor process & birthed with meconium in their lungs which we were told can happen when the fetus is under stress during birthing. Both had to have NeoNatologists suck the meconium out of their lungs. I have always wondered how long they weren’t breathing while that procedure was done. Now it is known that the contractions are more intense/closer together and fetuses don’t have time to “recover” in between each which causes loss of oxygen. I now know from attending many NAMI classes and learning more about the brain that this undoubtedly cause a degree of damage to the frontal lobe, which controls executive function (judgement, impulse control, etc). It has been a lifetime of suffering for both the parents and of my now very dysfunctional young adults. Had I truly understood the risks, I would not have had epidurals or used pitocin. Chemicals in our food and in our bodies do have many negative side effects.

  2. Thank you Chris for writing this article.

    Everyone who wants unbiased information on this topic should study Dr Sara Buckley’s work. She is not only a doctor but also a mother of 4.
    I apprectiate her supportive and respectful approach.

    Her website is:
    http://sarahbuckley.com/

    I wish all of you love, peace and health with the path you choose.

  3. Epidurals can cause one of the top 10 most painful diseases!!
    Nobody warned me of this….
    I had my first child natural and my second with epidural because I was having my tubes tied anyways and would need a epidural for that.
    The disease I have is called ARACHNOIDITIS! I’m in bed 23 out of 24 hours per day.
    I have a very high tolerance to pain, but this disease would take down the strongest person in the world. Don’t be fooled by reading that this disease is rare because it isnt (keep reading and you will learn the truth)
    I was one of the lucky ones with adhesive arachnoiditis and was actually able to raise my children.
    So ladies come out of the hospital being unable to care for the baby they just had….and others have other children at home that are use to a mommy caring for them and come home unable too!!
    This disease is horrific! Please if you do anything before having a child; read about arachnoiditis!! It took 7 years after a mild car accident to realize I had arachnoiditis. Like I said, “I was one of the lucky ones who only had mild pain from this diesese. The car accident brought it out all the way. Some people don’t know they have it and have a slight fall and it brings it out. We are the lucky ones because most have pain after they have epidural in childbirth.
    I had many MRI’S and arachnoiditis didn’t show up. Hell, most Dr’s don’t know about arachnoiditis. The person doing a epidural does and won’t warn you of this disease. if you bring it up I’m sure you will be told it is rare. It isnt! It’s hard to diagnose so you will spend years and years in pain until it gets so bad and you can’t walk, can’t urinate without catheter, neurological issues and so on and so on. Oh, and you won’t be able to have intercourse and that will just help cause divorce. You won’t be able to care for a spouse or children, not have sex, barley shower by yourself, care for a home and will be in bed with life ending pain….if you don’t have a super husband that can deal with doing it all,it will lead to divorce!
    I had a wonderful job before I ended up with arachnoiditis, but now my family is down a paycheck and we had to drastically downsize. I have one of those super-husbands that does not care that we don’t have sex or that he has to do everything. I was lucky enough that my children were 13 and 18 so I did have time doing p t.a and taking them to baseball and dance, but we lost out on many years of being together and they deserved A LOT more than this diesese gave them. I’ve talked with A LOT of mothers that lost out on taking care of children, lost spouses, homes and so on. Why does this sound so dramatic when I’m not dramatic…..because adhesive arachnoiditis is dramatic!! It will ruin you’re whole family and life. I could have avoided all of this had I been told about this diesese but again….maybe I would have thought it won’t happen to me!
    PLEASE read about arachnoiditis before you ever let a Doctor put anything in you’re dura! Epidurals and steroid injections could ruin the life you have and you’re childrens!!

    • Alicia, I have Arachnoiditis too, caused by an Epidural.
      The pain is dreadful but the loss of mobility and energy, especially being able to care for and play with your child is worst of all.

      I echo your warning, Epidurals are DANGEROUS.

      Wishing you and all the Mothers who are suffering, love, hope and positivity. Xx

    • You probably have tried lots of supplements, but i would try serrapeptase. Its dissolves adhesions. Its is so powerful, it removes plaque from heart arteries, so bypass surgery is not needed. I know this, because i know someone personally who proved this to be true!

  4. In one study you mentioned, “Prospective study to assess risk factors for pelvic floor dysfunction after delivery,” urinary symptom reached 43.6% in those without epidural analgesia. While the incidence was 31% in those WITH epidural analgesia. (p=0.04) Saying that epidural analgesia may be a protective factor instead of a risk factor.

  5. I have given birth four times: two unmedicated hospital births, a home birth, and a medicated hospital birth. In considering options for giving birth to my fifth child, I came across this article, and want to share my experiences and what they’ve taught me, in case it’s helpful to anyone else who may be informing themselves to prepare for birth.

    Baby #1: I was focused on all-natural everything, took hypnobirthing classes, and believed in the moral superiority of unmedicated birth and that “one intervention leads to another until you end up at a c-section.” Labor started spontaneously at 41 weeks. The hypnonsis worked well until it didn’t (somewhere close to transition). Labor was slow, baby’s heart rate became hard to follow, I was exhausted, and my providers (midwife and amazing L&D nurse) convinced me to accept amniotomy and a scalp monitor. With these interventions in place, I was momentarily distraught by the deviation from my birth plan, but labor progressed with a terrifying intensity that literally took my breath away, and soon I was holding a healthy baby boy whose face was a bit bruised from his chin-up presentation. In retrospect, allowing a couple of small interventions actually kept us from a c-section.

    Baby #2: I decided to have at home with a midwife. I felt labor would go more smoothly for my baby and me in our own “nest,” and I would be able to rest afterward with my baby and husband and without all the many interruptions hospital protocol deemed necessary. Labor started close to 42 weeks and progressed well. After about twelve hours and some intense pushing (don’t know how long), my daughter was born, the sac rupturing on the next-to-last push. My experience of pain was definitely moderated by being at home and having an intact amniotic sac. As my baby was crowning, the midwife asked me to stop pushing and asked my mother to hold her head, because the cord was wrapped around her neck a few times. She was very calm about it and quickly unlooped the cord. Then I pushed her out. Of all my babies she was the pinkest—no oxygen deprivation there! My baby thrived from the beginning, and I recovered quickly.

    Baby #3: I had originally planned a home birth. But I became increasingly anxious about that choice, for no particular reason. When I came up GBS positive, I knew I wasn’t willing to risk exposing baby to a bacteria that the research has so strongly shown to be potentially devastating for a newborn, especially when antibiotic prophylactic has been shown to be an effective way to prevent those outcomes. So I decided to give birth in the hospital again, unmedicated (except for abx), with a doula for support. I went ten days past a precise due date and still felt too much anxiety to go into labor spontaneously. After prayerful soul-searching, I opted to have labor induced via amniotomy. Six hours later, a labor pattern that satisfied the doctors was established, and I spent most of my labor in the tub, thanks to my doula. This proved a very effective way to cope with pain. Sadly, I had to get OUT of the tub to birth, and the return of gravity was awful, but soon I had another healthy baby girl in my arms, calm and alert. I felt very much like she and I had worked as a team to bring her to light, which is exactly what that natural interplay of hormones is supposed to do.

    Baby #4: By the end of this pregnancy, I was severely depressed, overweight, anemic. I knew I was in no state, physically or mentally, to give birth without medical help. I also knew that I needed the pregnancy to be over as soon as it was safe for baby. So I went in for a scheduled induction on her due date. Pitocin contractions were much stronger, but I was able to endure until the anesthesiologist came. The epidural worked very well. I experienced no complications, not even a drop in blood pressure. I was alert and actually appreciated NOT being “on another planet”—it made it possible for me to think to ask for glucose in my IV when I became exhausted and ravenous, for example. I felt I was able to advocate for myself because I was more present. I was able to watch in the mirror as my third daughter emerged with her amniotic sac intact, “in the caul.” It was truly amazing to see her dark hair floating in the blue-gray balloon bulging out of the birth canal. I would have missed that without the epidural keeping me “on this planet.” Then the midwife broke the sac and placed my healthy, crying baby in my arms. It took her awhile to stop crying, she was so upset by the sudden change in her circumstances!

    The only bad part of the epidural was that as my body went through transition, and I could not feel it, I experienced my first ever panic attack. My support people talked me through it, and the relaxation techniques I had used in previous labors came in handy. Since that experience though, I have had repeat episodes of panic in claustrophobic circumstances . So I’d say that may be a lasting effect of how my body/mind responded to the epidural. On the up side, my depression improved significantly within a week of giving birth, and even though my fourth child’s birth was quite different, emotionally, from my other birth experiences, I was happy with the choices I made, and my daughter has been healthy and very bright from day one.

    Thoughts: There really isn’t one “right” way to give birth. Every woman is different, and every labor is different. The most important thing a mother can do is listen to her instincts. Inform yourself with the best research available, definitely. But be open and flexible: embrace whatever will ultimately give you and your baby the best outcome. Even if that’s a home birth. Even if that’s a pitocin-induced birth with an epidural.

    A mother should not feel judged or pressured when it comes to such personal, life-altering decisions. She should, however, have access to solid information to guide her choices, and she should be encouraged to trust herself, trust her body, and trust her intuition.

    • I had a difficult labor, spontaneous contractions that seemed to last a few weeks!! I had an epidural after my second night of full swing labor that i was still having spontaneous contractions with. All together it lasted three days and nights, I vomited a lot and needed a drip. The epidural made my labor a nicer memory, as I was able to rest a short while while my drips worked and calm down as I was highly dehydrated. I had no problem pushing my daughter out even though my contractions where still spontaneous and kept stoping. I also breastfed my daughter for ten months and did not leave her side. I highly disagree with these researching as the women that I know that had gas and air did not breastfeed. You can not say a birthing experience or a drug makes you bond more/ loss with your baby, or has an impact on breastfeeding. This is ridiculous.

  6. I have read through all these comments and article , and as much as points were made and facts were proven and opinions were given ….

    I have concluded that those supporting natural childbirth at home alone do so because they have had it successfully and feel like it’s worth bragging about to say you haven’t used medicine

    And those who did use medicine are maintaining its best because it’s better to be safe than sorry , which seem the wisest.

    But in all I know for a FACT that childbirth is different for every woman , my mom has six of us very differently , my 3 sisters and I had very different experiences , and I have a friend who can’t have a child naturally , only by cs ( and trust me most of you natural birthers can’t wrap your mind around her pain , my stomach crawls whenever she talks about it )

    So before you start posting judgemental comments , thinks twice about it , and count yourself lucky if you give birth ( regardless of what method ) successfully.

    Whether by medical attention or not if you and your child survives , it’s not going to call anyone MUMMY but you !!!!!!

    If that’s not enough connection , I don’t know what is , I hope less people have the need for medical attention

    • The fact that childbirth is different for everyone is something I have been trying to get into the heads of many midwives and pregnant women.

      Giving birth at home alone is similar to driving without a seatbelt. You can get away with it for years and probably will be able to brag about it. But when a serious collision does happen the significance of the seatbelt becomes clear very quickly, though often it is too late.

      Pain is pain, and its physiological and emotional consequences are the same. Doesn’t matter if the pain comes from an amputated finger or childbirth (they are more or less similar in intensity). You don’t fail your baby or the family if you get your labor pain treated. This is 21st Century, and yet the only place in a hospital where you can hear mind numbing screams of pain is labor ward.

      • Total bollocks, here the equivalent of a serious collusion would require a level of neonatal care that neither of the two closest hospitals can provide. Those at home and those at either of those two hospitals would both require a 45 minute transfer to that hospital. The vast majority of serious consequences are determined by midwives before birthing at home and if there is even a remote chance of one occurring a home birth would not be supported and the parents would be strongly advised against it.

        • As I said before, the assessment of risk is a personal matter. For me the statistics associated with the home birth makes this mode of delivery unacceptably dangerous. I someone looks at it differently it is their personal choice.

          In terms of the equivalency of a serious car accident and complications, I am not sure why look only at neonatal side of things. I don’t have the statistics, but have been personally involved in quite a few of “RIGHT F****NG NOW!!!” when a woman is rushed from the delivery suite to the theatre with the cord prolapse or severe foetal distress.

          In terms of determining the chances of a bad outcome – I don’t think midwives have the magic mirror to do that. Most dramatic and stressful complications in obstetrics often happen out of the blue, without the slightest warning. The incidence of cord prolapse is between 0.1 and 0.6%, while mortality associated with it is about 9%. Anyone interested can just read the RCOG guidelines and decide if home delivery is worth the risk: https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-50-umbilicalcordprolapse-2014.pdf

          • Just a quick comment about “pain is pain” from a man who I assume has never given birth. As a woman who has given birth twice, once vaginally and unmedicated, and once via necessary cesarean due to severe IUGR, I have to disagree with that statement. The “pain” of labor was very different and the hormones made me eager to give birth again in the future. The very real pain of recovering from major abdominal surgery was so much worse than contractions. There were no hormones to mitigate what I was experiencing and no purpose. I just felt like I’d been cut in half and was miserable. So please, when you’ve never experienced it before, don’t pretend to know what giving birth feels like.

            And cord prolapse is just as likely to occur while a mother is still at home and not yet arrived at the hospital, given release of membranes early in labor when it’s more likely a baby is not yet engaged, increases the chances of a prolapse.

            Given the % of complications that can come from being in the hospital (cranky doctor pulling on the umbilical cord, ripping it from the placenta and causing a hemorrhage comes to mind but there are so many more, such as “pit to distress”) I think it’s fair to say there are no guarantees anywhere.

        • And Steve – have you ever given birth?.. Then we can discuss the birthing pain. The article is okay, but honestly feel that it is very unfair when males toot that women should be doing natural birth since “it is such a natural pain”. 200 years ago people used to get surgeries without real anesthesia, it does not mean this is the best way to have them.

        • “The vast majority of serious consequences are determined by midwives before birthing at home and if there is even a remote chance of one occurring a home birth would not be supported and the parents would be strongly advised against it.”
          So not true. I was low-risk, monitored by midwives, started to give birth at free-standing birth center. I tried to tell midwives that my Mother had prolonged labor, but they didn’t listen, said everyone was different, and I needed to concentrate on positive thoughts. I trusted them completely, and my baby was the one who paid for this. Long story short, after 30 hrs of labor, midwives still were not sure if I need to go to the hospital or not. They never said that there was potential danger for the baby if I won’t go. I went because of crazy pain only, but it turned out that my baby suffered because prolonged labor. He passed meconium, aspirated, his lung didn’t expand… Luckily, in the hospital they gave me epidural, induced me with oxytocin and I progressed very fast. My baby spend 2 weeks in NICU, first on ventilator, than oscillator, on IV narcotics for pain, 2 meds to keep his blood pressure from dropping, urinary catheter, arterial line, central venous life. They didn’t know if he would survive for a week. 6 months later he still cried from pain. It could have been totally prevented if I gave birth in the hospital, with continuous monitoring, and my providers erred on the side of caution, rather than “naturalness”. Just remember that your child might pay for your choices.

          • I am so, so sorry to hear about your and your baby’s experience with his birth. It was clearly traumatic and I’m thankful that he made it. Hopefully I won’t seem unkind, but do want to point out for others reading this that 30 hours is not an overly long time to be in labor, nor is length of labor necessarily tied to fetal distress. Meconium is passed when the baby is distressed, and distress is caused by lack of oxygenation. All increased risks for causing meconium to be passed, excepting placental insufficiency which can’t be easily determined, would risk a mother out from home birth or birth center (preeclampsia, maternal hypertension, etc.) It occurs most often when there’s compression to the baby’s cord or vagal stimulation from head compression (which causes fetal heart rate to drop). It can be a one time thing that make the baby “pass out” and have a bowel movement, or longer, repeated restrictions of oxygen. Babies can pass meconium inutero during short or long labors. Just the presence of meconium staining does not indicate there will be a problem. The thicker and more particulate, the greater the concern that baby will inhale and aspirate at birth, potentially causing pneumonia. The neonatal resuscitation guidelines state that if a baby is born vigorous and crying then it goes to mom’s chest, regardless of meconium. If the baby hasn’t taken a breath yet then they are to suction and try to remove any possible meconium that could get into the lungs. Planned birth center or hospital birth, this very unfortunate but rare outcome would likely have been the same.

    • The best option for the baby is un-medicated birth in a hospital. Some women would rather not deal with the pain, but that fact remains…the drugs do carry risks and even 1% of an adverse effect on my baby is worth enduring the pain. Criticism of women who you say “brag” is just ridiculous. Why shame someone for doing what is safer when they should be encouraged?

      • Suri, the best option is what your provider recommends as being safe for both you and your baby. I needed induction with Pitocin + epidural for my labor to progress. Because this wasn’t done in time, my baby ended up in NICU between life and death. I also had strong opinions about what I wanted and didn’t want done, but my experience proved that strong opinions are dangerous. Listen to your doctors!

  7. Can anyone tell me what the standard procedure is on checking cervical dilation before giving an epidural. I understand the new procedures are doctors don’t want to check to frequently for risk of infection. But is it accepted to not check dilation at all from admission to the hospital to bring administered an epidural?

    I was against epidurals but after being told I’d be laboring for hrs longer I opted for an epidural. It was administered at 11:45. They finally checked me at 12:00 and I was already 10 cm. if I knew I was at 10 cm I would have never opted for one. They said the baby should prob be here with 2-3 hrs. 4 hrs later I was being prepped for a c section due to maternal fever, fetal heart distress and the baby not dropping or progressing into the birth canal. All things I’ve later could be potential risks or side effects of the epidural. I also had itchy skin for days, chills that literally shook my body and the epidural was so strong all I wanted to do was go to sleep.

    I feel like my epidural high jacked my pregnancy and robbed me of delivering my baby naturally. Not to mention the wks of healing and side effects of the c section. 10 wks later and I’m still devastated and regret my epidural everyday. I fully believe it caused my c section and robbed my of holding my baby after delivery. Immediately after the epidural was given my contractions slowed. At 10 cm I was progressing great and all of a sudden it all slowed down. He wasn’t progressing. Soon his heart rate would drop after every contaction and then my fever. Within 4 hrs of the elidursl I was I tears being prepped for a c section.

    My questions lie in why they refused to check my cervix prior to giving me the epidural, and is that standard or typical practice. She shouldn’t these, and all the potential side effects of the epidural been outlined to me and my partner before it was given?

    • Rebecca I truly feel for you. That sounds like an absolutely devastating blow. After reading this article and your story I am confident I will never accept an epidural unless it is absolutely critical, which I can’t see how it possibly could be. If you can find some light in this situation, know that you are helping other women to know the real truth. Sending love Aisha

      • That’s the point. She wasn’t checked so she didn’t know. It sounds as if they were unwilling to check her dilation before her epidural was administered and just assumed she hadn’t progressed much and would still be in labor for hours. That’s the thing with birth. Moms can go from 3-complete in two contractions. Birth doesn’t usually follow rules.

    • The main requirement when administering an epidural in labor is to make sure that labor is in fact established. Therefore, the presence of regular contractions and the opinion of the obstetrician is sufficient. The timing of epidural in labor has no bearings on the frequency of complications. In some situations epidural can be placed even before contractions start: induction of labor for example.

      • I agree. I was planning a homebirth (in Australia), however had prem rupture of membrane at 35 weeks and had to deliver in hospital, which at 35 weeks was happy to do so. I’d been in hospital for 2 days before my first noticeable contraction at 11pm. By 12pm the next day my contractions were still irregular but 5-7 min apart I was told I’d be in labour for at least another day or two as it was my first and I didn’t seem to be in too much discomfort from the contractions. By 4pm contractions were 2-5 min apart and I called my partner to come to the hospital because I felt I was getting close. Still I was told it could be another couple of days and that I was in pre labour, I was still on theward not in the birthing suite. At 5.44pm I was told I’d tested pos for strep b and that a doctor would be in to see me. At 6.10 I was told I would be induced as my “labour hadn’t started yet”. In the 3 or so min the doctor was there I had 3 very strong and obviously close contraction (but clearly wasn’t in labour…) at 6.30 I finally made it into a birthing suite where they put my on an antibiotic iv and checked how dilated I was for the first time since arriving at hospital, it was the 3rd day. I was 6cm and 15min later my son was born tiny but loud! My labour was fast, calm and mostly quiet. Had I not been tested for strep or if it had come back negative I don’t doubt my baby would have been delivered on the ward and notbin the birthing suite. I was told they don’t do unnecessary internal exams. Pft. Unnecessary…

  8. Just wanted to add a positive note, since there are so many negative comments trying to promote medical intervention and even “elective c-sections”. I had my first baby two years ago without epidural in a hospital setting. The birth was attended by midwife and it was a very supportive experience. Being free to walk around and change positions made the labor so much more bearable. I felt that I was truly able to listen to my body and work to help my baby to get into the optimum position for birth. I had a quick labor and only about 20 min of active pushing, which I credit to the positioning. My daughter was born healthy and very alert, no signs of distress at any point. I had no post-partum complications, such as incontinence, pain during sex, or a severe tear. There are many methods for natural pain management, including massage, hydrotherapy, and I found yoga to be especially helpful. The books Mindful Birthing and The Birth Partner are great resources for learning more. It’s true – our bodies are designed for birth, unfortunately we live in a fear-based culture where there are too many special interests telling us we aren’t capable. Obviously there are always situations that require medical intervention; however, the fact that only 22% of Britons get an epidural vs 75% of Americans is evidence that it doesn’t need to be routine.

  9. Darn, I was reading this because I wanted to find out how many times it was okay to get an epidural. I’ve had two healthy babies so far, both with epidurals and they are the BEST THING EVER. I want to have a pile of kids, but I’m unsure about getting a needle in my spine over and over.

  10. I like the comments since they help the reader see all the stories, opinions, and look into the facts and/or falsities on this subject so that they can make an informed decision. I, unfortunately, could not get through the pain. This could have been for many reasons, but mostly not having a great coach or massage therapist with me and/or not training and getting ready for the big day. But the pain was much too great and I chose the epidural. Each of my 4 pregnancies were very different but had 1 thing in common: at 4 cm the pain was horrific. I think petocin (which i was given with one of my deliveries) did cause the pain to soar so I would never do petocin without an epidural. The most important thing is to make it out alive and healthy. I think a lot of the traumatic stuff comes after delivery when they try and push all the extra stuff like vaccines, antibiotics, etc. on you and the baby. I always got out as soon as possible and i wish pediatricians had more experience (they should have the oldest pediatricians in these wards along with the newbies to learn from them) because they ruined 2 of my 4 delivery experiences.

  11. When mom gets an epidural fever, which can’t be distinguished from infection, causes the mom and baby to be exposed to antibiotic administration, sepsis workups, NICU admissions and longer hospital stays. The epidural itself causes an inflammatory response in the placenta, which is not a good thing for the fetus. The fever rate with epidural is shown to be 23%, vs 6% in laboring women without an epidural. See Sharma, S K, Rogers, B, Alexander, J M, et al. (2014). A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor. Anesthesia and analgesia, 118(3), 604-10.

    • Association of maternal fever with epidural has been known for a long time. Here is the discussion for those interested: http://www.allaboutepidural.com/epidural-side-effects-fever-and-neonatal-evaluation-for-sepsis
      The question is if epidural is the cause of the fever OR there is underlying pathology that makes labor more difficult and increases the likelihood of request for epidural. I believe it’s the latter.

      When you read articles you should pay attention to the details. In the article it never says that epidural causes inflammatory response in the placenta. It said: “Fever during labor epidural analgesia is associated with placental inflammation”.

      Also, if you have access to the full text, in the discussion you will find the paragraph mentioning previous studies that show that women with elevated interleukin-6 were are likely to develop fever with epidurals. That again suggests an underlying inflammatory process before epidural is administered.

      Lastly, if someone believes epidural causes inflammation of the placenta they have to propose a feasible mechanism that could suggest how and why epidurals would do that. So far there have been none.

      You are correct when you say that babies born from mothers with fever are more likely to be investigated for sepsis. In fact, babies get investigated more often if mother had epidural, even if there was no fever.

  12. Hello-
    I read this article and related comments after having a very traumatic experience with my oldest daughter and her delivery December 2014. My daughter and her partner are very much into “natural” living. She is a very small person and he is a very tall person. Their birth plan was to have my first grandchild at home with a midwife. My daughter is a very healthy and very active individual. Together she and her partner researched anything and everything about natural childbirth. They had a highly recommended midwife and they attended natural child-birthing classes and chose a naturalistic approach to the entire pregnancy.

    While this was not how I chose to have my three kids, I was open to the idea that this could be a good experience. My alarm as her mother, began when she ended up post term and clearly with a very large baby. I even asked her if anyone had spoken with her about what should occur and when post term. This was met with absolute anger and resentment by her partner. I am not going to lie, at 43 weeks I was very concerned. In an odd twist of fate, the midwife who they had paid the entire balance of the birth fee only covered 42 weeks. So, she was unable to deliver after the 42 week mark. They were directed to a renowned teaching hospital in Oregon for the birth.

    My daughter eventually went into labor at 43.5 weeks and she and her partner went to the hospital to deliver via natural childbirth. For two full days they shunned the family while they labored. They were declining cervical exams since in their research these are linked to infection and declining medical advice in general. The text came at 4:00 am on New Year’s Eve from the partner “you win, they have started the epidural and petocin, do you want to come be with her instead of me?” Being a mom and trying to keep peace I tried to calm him but immediately went to the hospital.

    What I found there scared me to death. My daughter had been in hard labor for several days and was absolutely exhausted. Meanwhile, doctors were coming in and advising that they believed a cesarean to be the prudent choice at this point. This was met with a very aggressive and highly agitated angered response from the partner who I assume my daughter agreed with. My daughter and her partner did not want to even hear about cesarean birth and advised the doctors to please refrain from bringing it up again unless “new Information” came available. They accused the doctors of bringing negative energy into the room.

    This continued for most of the day. Psychologists were sent in to inquire without judgment how far they were willing to take their “natural approach”. Was it okay for the baby to die? Was it okay for the mother to die? Both my daughter and her partner became a little more agreeable to putting parameters around it and both agreed that death wasn’t an acceptable outcome.

    They did allow a cervical exam. They also pushed for another 6 hours before doing an additional cervical exam. Ultimately, it was discovered that while she was dilated, pushing, and in full on labor the baby had not moved from its initial position. They were allowed to continue trying and later in the evening the doctors told them the baby was beginning to show signs of distress and that she was showing evidence of infection. They again reiterated the need for a cesarean.

    At this time they conceded to the cesarean, the entire while he was acting like a raging child, ticked off at the world and bringing so much negative energy that it was to me unbelievable. It was as though he believed that this was the hospital’s fault. I went into the operating room with her as did he. The baby was delivered fairly quickly and was very healthy. She on the other hand hemorrhaged losing almost half of her blood and was running an exorbitant fever racked with infection. She almost died. It was crazy to me that people would refuse medical care and yet she later told me that they were absolutely 100% convinced that there was never a real reason other than someone being a wimp for not having natural birth.

    Honestly, the struggle did not end there. She also needed blood and antibiotics which he really didn’t want her to have. I almost wondered if he wanted to kill my daughter. I think natural childbirth can be a great thing for some people. I also think that both sides, medical and natural tend to be very slanted to their beliefs and it is almost like you must make a choice. The choice almost killed my daughter and I have a bitter feeling towards all of these classes that did not address how to identify and accept when natural childbirth might not be a possibility. This is one grandmother’s story and one that I hope people will at least think about.

    • I commend you for realizing the severity of your daughters case.. I’m a labor and delivery nurse and have seen several very similar situations.. Parents are completely and utterly blind to the fact that there is a real risk here.. Sadly I have seen this EXACT behavior from very educated people.. And their baby died simply because they wanted a “natural birth”.. So unbelievable selfish and naive.. Perfectly healthy babies dying because of stupid choices..Your daughter was extremely lucky they have a healthy baby.. People think that hospitals and OBs are out for their own good.. All we want is a healthy mom and healthy baby.. Bad things happen every day in labor and delivery when you least expect it… Even if you had the most perfect healthy pregnancy .. We all want best for the mom/baby whether it ends up w a vaginal birth or cesarean ..

    • What you have described is a fairly extreme example of proponents of “natural” birth. As I said many times before, “natural” should refer to the outcome of childbirth, a happy mother and healthy baby, not to some idea of how the baby should be delivered. Sadly, it is also not uncommon for husbands or partners to force their opinions on women in regards to what they should and should not accept while giving birth.

      Home birth is a horrible idea, in my opinion, for many reasons. Dr Amy Tuteur has discussed it numerous times on her blog, http://www.skepticalob.com. I lost count how many times I anesthetized a woman for urgent cesarean where a few minutes of delay would mean certain death of the newborn.

      • Are you seriously recommending that skeptic blog? She is a fear monger. Even the ACOG website has a load of references in their section regarding why they do not recommend home birth, which are all filled with information on why home birth is just as safe, if not safer, for the low-risk mother. I checked 70% of them, and none or few contain the information they claim. Furthermore, you must know that home birth is safe. That is not refutable. It is not. not. not at all. not one bit. Obviously the woman above has a daughter with a controlling, zealot husband. That is the problem, not home birth.

        • In terms of the safety of home birth, to be honest I have not researched this topic in detail. However, I have participated in quite a few instances when a woman is rushed to theatre and her baby’s life is saved by cesarean section. Were these women at home their babies would be dead.

          When labor goes wrong things often go downhill very quickly, and low risk situation turns into a high risk in one breath. Sure, the chance of a terrible outcome is low. But when it does I advise you to be close to doctors, not midwives, doulas or aromatherapists.

          Let’s put it this way: I would never recommend my daughters to have a home birth. In fact, I would recommend them to have elective cesarean, but this is a different topic altogether.

          • Really, if she was 43 weeks and 5 days, almost a month after her due date… Then her due date was wrong. A doctor would tell you that.

            • Laya-
              You seem very angry at my story. Sadly it is a real story and while you may be skeptical about the due date I am not. A doctor would have likely have provided the same due date but they chose to not have doctors and only midwives. Chill out and realize that you may have a great experience with home birth but it may not be in the cards. You sound very much like my daughter, ie very angry at anything that does not meet your idea of how it should work.

              • Toni-

                I’m sorry… My intention wasn’t to sound angry at your story?

                One of my comments was meant for Epidural Guy in relation to his saying that he would wish for his daughters to have elective cesarean. My point was that cesarean isn’t necessarily a safer option. Obviously in needed circumstances it is.

                I don’t really see how you think my response was angry towards you? I think the story is real and it sucks. It just stinks the way things didn’t go the way they planned, but hey… Things usually don’t go as planned.

                All I meant for you was to say that if she was a month overdue, her due date was likely incorrect. No intentional animosity directed at you.

                • To be clear, I don’t think you are angry at me. I wrote that wrong. At the time I wrote on the blog I was severely pissed off at the “natural” community for failing to address the potential for intervention and what those red flags might be.

                  My daughter and her husband are highly educated individuals (1 phd, 1 masters) and they studied everything natural. They attended everything natural. They were clearly past their due date (even though it was just a midwife there was the use of a sonogram on multiple occasions). They still wanted to believe all the wonderful stories that people shared about being post term and natural methods of induction. As I said before, my grandson was born holding himself up on his arms and looking around so there is little doubt that he was older.

                  I am much less angry now because I realize that my daughter played as much of a role in the birthing decisions as did her husband. While he appeared controlling to me, he was trying to protect her desires and interests.

                  They were 100% convinced that induction was evil. They were 100% convinced that anything other than natural childbirth was a failure on their part.

                  They blame some things still on petocin and the cesarean. They are still very into natural.

                  My anger as grandma was their unwillingness to at least understand what plan b was. So, I would personally never recommend a cesarean for a person who can have a baby through the birth canal. I would also never fault a person who chooses an epidural. We are all different and every circumstance is different. I had 2 natural and 1 cesarean (emergency). Please for your health keep an open mind and look at plan b so it doesn’t have to be such a downer. In our case, the most joyful experience in the world turned into our worst nightmare and it did not have to be that way.

                  All the luck in the world to you!!!!!!! XXOO

              • Guess I accidentally replied to the wrong comment. That was my mistake. But seriously, not angry at you or your story at all. Only was a slight peeved with the suggestion of elective cesarean.

          • You would prefer your daughter to have major surgery than a vaginal delivery? WHO says only 10-15% of women actually require c-section. Cesarean does not mean safety. For example, Brazil’s c-section rate, according to a WHO health report using stats from 2008, is 45.9% (as of 2008), but Brazil’s maternal mortality rate is 2.8% (as of 2013). USA’s c-section rate is 30.3% (as of 2008), but their maternal mortality rate is 1.5% (as of 2013). Japan’s c-section rate is 17.4% (as of 2008), and their maternal mortality rate is 0.4% (as of 2013). You can see the correlation between the increase in the c-section rate and maternal mortality.

            And you would STILL have your daughter have a cesarean?

            Also, the home birth midwife that delivered me has delivered 1,000 babies. She has never lost a mother or baby. She has a transport rate of between 10% and 15% and of those 10-15%, a c-section rate of 3%. 1,000 babies is statistically significant. She’s never lost one.

            AND emergency situations are not as “snap-your-finger, OMG in the next millisecond you WILL DIE” emergent as you make them sound. There are always warning signs to call for action. Licensed midwives are educated enough to know what to do in the meantime IF the situation is so emergent that an ambulance should be called.

            • Correlating an outcome with a single variable is a typical mistake made by amateurs. To start with, several years ago WHO backed away from the “optimal” cesarean rate of 15%. Second, maternal and neonatal mortality ratios are determined by more than one factor, socio-economic status being one of the most important. There are a quite a few other differences between Japan and Brazil, besides the caesarean rate.

              As far as obstetric emergencies are concerned – sure, lots of times you get warning signs in advance. In rare cases though when things start to move downhill very quickly you want to be as close to the operating theatre as possible.

              The midwife you had seems very sensible, and her outcomes is the testimony to this fact. Keep in mind though, that mortality is measured per 10,000 of births, and though one thousand deliveries is not something to shrug off as insignificant in terms of personal experience, this number is not large enough to draw generalised statistics. In clinical medicine the word “never” has limited value.

          • My mother/baby nurse friend would totally disagree with you about recommending your daughters to have c-sections, since we’re not basing our opinions on research but on experiences. Hers involved being talked into a cesarean by her O.B. because she was obese and was going to have a huge baby, estimated at 11 lbs. She had her elective cesarean because she didn’t want a “dead baby” (that’s a nasty card for doctors to play if there isn’t a very really and urgent risk at hand). She almost bled to death in the O.R. as her nurse friends and husband stood by. She couldn’t care for her 7lb 3oz baby, 23 inches long I believe, for days and I think she got an infection (which occurs in up to 1/3 of cesarean births). Cesareans do not save the pelvic floor, they are not risk free. I know women who have had bladder nicks and on-going complications, wounds with tunneling that will not heal despite working with wound care specialists, removal of part of the bowel due to adhesions caused by the surgery, placenta accreta requiring a team of five specialists to attend her birth and planned hysterectomy. Cesarean has it’s place, I’ve had one and I’m thankful that it saved my son’s life (severe IUGR at 29 weeks). But when one third of births are via cesarean and the risks and complications aren’t being taken into account, it needs to be talked about more truthfully.

        • My daughter was very much obsessed with a home birth scenario. Perhaps if they had considered having induction once it was obvious that my grandson was overdue then the complications would not have occurred. I wrote my comments because my daughter was o NOT INTO LISTENING TO ANYTHING that did not fit into the “natural” bucket that she risked her life and almost lost. The good news is that my grandson is very healthy. I would never recommend cesarean for all. On the other hand, when things go wrong it does seem to happen very quickly. At least keep an open mind that home birth may not be a reality for every person but may work perfectly for others.

          By the way, any doctor may have told them differently, however they chose to go a natural route with NO doctor. Also, all evidence points to the actual due date as being spot on. My grandson has acted older from the day he was born.. ie could hold his head up and look around from day one.

          Just keep an open mind and be prepared for things not going the way you desire. That is my message.

        • Apparently he’s serious, but that’s what industry apologists do. Corporate science, regardless of methodology or conflict of interests, is the norm.

    • Thank you very much for sharing your story! I am sorry to hear you almost lost your daughter, that must have been very traumatic. I agree with you that childbirth shouldn’t be an all or nothing dispute. I would like to decline an epidural if possible, however, will definitely take medical intervention when necessary and there are significant risks to myself and the baby. Thanks again for sharing your story, I think it’s very helpful for people who are not going into it with an open mind.

    • SHE WILL HAVE A VBAC successful next time maybe if she’s lucky! Find a good midwife!

      2 months before baby I started having severe HBP and was in and out of the hospital. They never figured out why until after baby came when it stopped. She was laying on an artery.

      In the meantime, here’s what I recommend. Pineapple juice like crazy the last 2 weeks of pregnancy. LOTS. I was drinking half a gallon a day and also taking evening primrose even though my midwife told me not to. I’m rebellious. My cervix was soft, but I wasn’t dilating. I was told to come in at 39 weeks early in the AM to be induced. I wasn’t induced. I told them that they wouldn’t have to induce me. I told them a pharmaceutical for softening the cervix would put me in full blown labor. Sure enough, it did. I got the contractions down to 2 1/2 minutes and 3 cm dialated. THAT WAS ALL. After something like 9 or 10 hours running up and down the halls and squatting and rolling around on the ball and that was all, I could have screamed. Anyway, made the midwife break my water. 52 minutes later my daughter was born.

      I ate whenever I wanted. I drank whenever I wanted. I didn’t do an epidural. I was recommended antibiotics which I did do, but only the kind that keep me down for 30 minutes and allow me to move around. I told them after a while to kiss my ass I wasn’t going to monitor the baby anymore b/c the baby kept changing positions with the monitor on. PEEING IS KEY. I don’t care if the woman has to pee so bad she’s going to pee everywhere but a toilet. JUST PEE. I recommend getting on a toilet. I also recommend a bathtub.

      • I will never have an antibiotic during labor again though. My daughter got staph infection in the hospital and was sick 2 months. It spread from a diaper rash caused by honest diapers. She then got a secondary strep infection too. It was a very scary time. antiobiotics during labor also cause milk protein allergies in babies.

  13. I wish people would stop using the word “brave” for women who use nautral birth. One isn’t lesser or more because they did not use meds or used meds. How are you brave if you die during nautral? Just like epi has a slim chance of risks nautral has a slim chance you could die or your baby could. That’s not brave, that’s sad. So let’s not assume every natural birth is bravery. I rather do what’s best. I dont think any women wants to take a less brave way out they just want what’s best for them and their baby.
    If you think just because having meds you didn’t endure pain , you’re not brave well there are many natural births that are easy and quick, then that’s not brave either. Just lucky.

    Every woman is brave for giving birth, period!

    • Definitely! I don’t like that either. All moms are brave, and some women can’t have natural labors and even if they can but choose not to do things completely natural that’s their right and they should be able to do what they need to to make their labor as enjoyable as possible. No woman should be made to feel bad about it. All women are different and so are all labors!

    • I dont understand this mentality of women bashing, birth bashing, labor bashing, pretty much any kind of bashing one woman can dish out to another in terms of how they are choosing to live their pre-natal days, post natal and of course, the labor and delivery. My mom said that when she was pregnant with us, no one would ever have said anything or questioned/bashed her for her decisions. Granted it was a different time, I know the c-section rate, epidural rate and everything else was much less. However, unless one is planning on abusing or neglecting their newborn immediately after birth, no one should have a say or make a judgmental comment about that woman’s plans. Elective c-section or natural birth, every woman should have to right to freely and openly choose whats best for them at that time. And no one should feel the need to be confrontational about their decision. Lay off one another ladies.

  14. The “inhibit catecholamine (CA) production”, “increase in labor times from 4.7 to 7.8 hours” and “more than 2 times as likely to have stopped breastfeeding” links cannot be opened

    =(

  15. I want to know if epidural cause autism or not. The recent study of University of MI was talking about the relation btw recent trend of painless scheduled delivery and the recent increase of autism in US. I am scared to have a verginal natural birth, but also I am afraid of side effect of the painless delivery.

    • I have never looked at any correlational studies linking epidurals with autism, but if it hasn’t been explored it definitely should. Do you have a reference/citation?

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