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Archive for May, 2011

One of the most common interventions requested by a laboring woman in the US is an epidural. Many cannot imagine going through labor without receiving one. However, not many women know what it is, why it started as a labor drug, and what the benefits and risks are in using an epidural. So, here we go! Let’s explore this intervention.

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What is an epidural and why is it used?

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The first epidural was administered in 1885, when a doctor in New York injected cocaine into the back of a suffering (not pregnant) patient. Much later, doctors decided to try it on laboring women, and since then the use has skyrocketed.

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The goal of an epidural is to provide pain relief for a laboring mother who feels that she cannot cope with the labor process. It is administered through a spinal block, meaning that the drugs are injected directly into the spinal column instead of orally or through the bloodstream. The woman sits on the bed and a large needle is placed into the small of her back. Some women say they feel pressure when the needle is inserted.

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The drugs in an epidural are local anesthetics, which are most often given in combination with analgesics. The anesthesia numbs the lower body. The analgesia reduces the perception of pain, similar to narcotics. They include drugs such as epinephrine and morphine.

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Does an epidural work?

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Well, it depends on who you ask. About 25% of epidurals are “perfect.” Meaning, they provide pain relief for as long as needed, there was no feeling on both sides of the body, and the needle was placed correctly without accidentally hitting a nerve or causing damage. The other 75% either wear off quickly so that more drugs need to be added, only numb one side of the body, or cause nerve damage.  10% of epidurals don’t work at all. However, so many women are terrified of birth thanks to the media, doctors, and horror stories from other mothers, that we continue to ask for epidurals because we think we cannot handle the excruciating pain we know it will be.

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How does it affect normal labor?

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Many studies have been performed on how an epidural affects normal labor for a healthy woman. One of the first noted is that the use of an epidural prolongs labor. This is most likely due to several factors that work together: a woman is limited in her movement, her uterine muscles are somewhat numbed by the drugs and are unable to contract properly, and the woman cannot feel when her body is ready to push, so has to rely on nurses to tell her when. All of these factors play into the lengthening of labor.

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Epidurals also increase the need for Pitocin to restart labor once it has stalled. Contractions caused by Pitocin are much harder and longer than normal contractions, so this also frequently leads to the need for more drugs via epidural.

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When a woman is in labor, her body releases endorphins that help her to transcend pain. They send her into an altered state that allows her to tune in to her body and her baby. The rest of the world fades away and she is in her own world throughout the labor. It is nature’s pain relief. An epidural reduces the release of these labor hormones and makes women more docile and silent during labor. Sarah J. Buckley, a leading Australian physician, mused that “perhaps the widespread use of epidurals reflects our difficulty with supporting women in this altered state, and our cultural preference for laboring women to be quiet and acquiescent.”

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In addition to these ways in which an epidural affects labor in general, there are several other ways in which epidurals negatively affect both the mother and baby. Now, I do not list these to frighten anyone unnecessarily, but I do believe that it is extremely important to fully know what you’re agreeing to before allowing someone to mess with your body.

Side effects

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Mother:

Close to a quarter of all women who receive an epidural experience complication. And they can be serious. A woman who has had an epidural is three times as likely to die as a woman who did not have one. One in five hundred women will experience short-term paralysis that can last days, and in half a million epidurals, one will be left permanently paralyzed.

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The most common side effect is a drop in blood pressure. Because it is so common, nurses generally administer fluids via IV before placing the epidural, although still roughly half of women experience low blood pressure. This leads from mild side effects such as feeling faint, to more serious problems such as maternal cardiac arrest and lowered blood supply for the unborn baby. Shivering, nausea, vomiting, and severe headaches are also common after an epidural. One major UK study found that a woman was twice as likely to hemorrhage after giving birth with an epidural than was one who did not have an epidural.

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Finally, epidurals increase the risk of other interventions, especially a cesarean, which is major abdominal surgery, presents it’s own set of risks to both mother and baby, and requires weeks of recovery.

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Baby:

Although I have heard both doctors and mothers say over and over again that epidural drugs do not reach or affect the baby, study after study shows otherwise.

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First, the placenta is not a barrier between the mother and baby. It is a conduit. What goes into the mother also reaches her unborn child. That is why, during pregnancy, women are cautioned to eat a healthy diet, and to avoid or limit over-the-counter-drugs, caffeine, alcohol, sugar, or exposure to chemicals and smoke. Why, then, do all of those rules go out the window during labor when there is no medical need to use any drugs except in women who truly do have medical complications?

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…regional anesthetic agents do not remain regional in their distribution. Measurable levels of these drugs appear in maternal blood from 1-7 minutes after instillation and measurable levels appear shortly thereafter in fetal blood regardless of the type of regional anesthesia or the agent employed.

~Dr. Howard Fox, University of Kansas Medical Center, Division of Neonatal Medicine

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If the drugs do enter the baby within 10-15 minutes after an epidural, what do they do?

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A lot, actually. Fetal distress is one of the most common side effects of epidurals in labor, and it is also the most common reason cited for emergency c-sections. Changes in the fetal heart rate are very common, which indicate that the baby does not have adequate oxygen or blood. Babies exposed to epidural drugs can also experience respiratory problems, and at birth have even higher drug levels in their systems than even their mothers do.

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I cannot tell you how many times I’ve heard and read women declare that they had to have an emergency c-section due to fetal distress, and that they were so thankful they were in a hospital so that the doctor could save their babies. What they don’t realize is that the drugs given to them by that doctor were the very things that caused the emergency in the first place.

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Is there any way to relieve pain without drugs?

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Absolutely! Pain relief in itself is not necessarily a bad thing. When drugs are not used, a woman, given freedom to labor how she chooses, will move into positions she finds most comfortable. Be that walking, sitting, resting in warm water, on hands and knees, or in one of the myriad other positions she will find a way to adjust herself that feels right. Her movement also helps her baby move down the birth canal into the correct position for birth. This is not possible with an epidural because women are confined to their backs on a bed, which by far the worst possible position for giving birth because it closes the pelvic opening, making it much more difficult for the baby to get through. Lying on her back also ensures that she is working against gravity, rather than with gravity.

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Many midwives and doulas use soothing herbal scents or tinctures to help soothe a laboring woman, as well as massage or acupressure. Laboring women also frequently find music and dim lighting to be calming as they work to bring new life into the world. Fear of labor and laboring in an unfamiliar place with unfamiliar people can increase both pain and length of labor. Seeing birth as a normal and natural part of your passage into motherhood helps tremendously.

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Additional side effects

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In order to be completely thorough, here are additional side effects for both mother and baby not mentioned above, in no particular order:

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Severe postpartum depression

Death of baby

Increased likelihood of: being induced, using forceps, and episiotomy

Feelings of emotional detachment

Decreased mother-infant bonding

Complications to baby

Chronic back pain

Fetal drowsiness

Chronic migraine headaches

Chronic “pins and needles”

Loss of consciousness

Convulsions

Septic or bacterial meningitis

Fecal and urinary incontinence

Seizures/Trauma

Inability to push out baby

Misplaced catheter

Accidental injection of anesthetic into bloodstream

Punctured dura

Allergic reaction

Fetal hyperthermia

Neonatal jaundice

Poor fetal muscle strength

Neurological complications

Permanent nerve damage

Loss of sensation and sexual function

Damage to spinal cord

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The decision whether or not to use an epidural is completely up to you. In some cases it is truly necessary, such as for a cesarean birth. Other times it is personal preference or because another intervention made contractions too much to handle. Just know the possible negative side effects so that your choice is fully informed. And also realize that introducing one intervention often leads to more interventions that you may not have planned on or wanted.

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References:

The American Pregnancy Association

Born in the USA by Marsden Wagner

“The Hidden Risks of Epidurals” by Sarah J. Buckley as reported in Mothering Magazine

“Effects of Maternal Analgesia on Neonatal Morbidity.” By Howard Fox, University of Kansas, Neonatal Division

The Bradley Method by Marjie Hathaway, et al.

Pregnancy in America, documentary 

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I apologize for the long time between posts. My husband currently works at a school around children, and brought home a nasty bug that has made the rounds in our household. I haven’t had time to do much. So, finally, here is a much overdue post.

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What is natural childbirth?

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Generally, women who choose to have a natural birth are those who view childbirth as a natural, normal process; one that doesn’t generally need outside intervention in order to have a healthy baby. They (or we) have confidence in the fact that our bodies are designed to birth new life, and we realize that women have been doing this for centuries without assistance, and in most places around the world they still do it that way.

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In the United States, this mindset is not normal by any means. We, as a country, have turned this normal process into a medical “condition” that requires a surgeon’s expertise (that is what an OB/GYN is, after all: a surgeon trained in the surgical repair or removal of female body parts). Women are taught to fear the prospect of labor, and are told to trust a surgeon to safely deliver their babies. Doctors frequently perform “emergency” cesareans and “save” the baby or mother from certain death. Of course, these “emergencies” mainly occur due to the doctor’s medical intervention in the first place, but more on that later.

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Natural childbirth does not rely primarily on surgeons, but on the woman’s own body. When I say “natural childbirth,” I mean a birth that is completely drug-free, during which the woman is allowed to labor and give birth in a position she chooses, rather than one that is forced upon her. In all situations, unless there is a real medical reason to have to perform a cesarean, a natural birth is many times safer for both the mother and baby than births that rely on drugs or other interventions (induction, forceps, suction). The reason for this is that drugs always have side effects, and many of them are not only unpleasant, but downright dangerous for mother or baby.

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The Purpose of this Blog

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In future posts I will be going over how to successfully have a natural birth, from nutrition during pregnancy to the best labor positions and relaxation techniques. I want to provide a myriad of resources to childbirth classes and reading material that may help you in your own birth journey. I will also cover each common intervention such as epidurals, induction via pitocin or cytotec, twilight drugs, forced removal of the baby vaginally, and cesareans. My goal is for women to go into labor knowing their options, knowing the risks and benefits associated with each drug, when that drug is likely to be used, and to have the ability to make decisions for themselves.

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What I desire for you

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I want you to know the truth, and then to make your own decision based on facts. Although I am, admittedly, an advocate for natural childbirth and firmly believe it is best and safest in the majority of cases, I don’t just want you to have a natural childbirth. Although I love homebirth, I don’t necessarily want you to have a homebirth. What I desire is that you have the information so that you are able to choose how to birth your baby with your eyes wide open, rather than out of fear or intimidation or ignorance. Whether that be with drugs or without, in a hospital, birth center, or at home, my goal is twofold: one, for you to know why you’re making the decisions you make and, two, not to fear childbirth but to welcome it as the miraculous event it truly is.

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