This is a very important read for those out there trying to figure out if the "possible" benefits of an epidural outweigh the risks. It's important to do your homework now, before you head to the hospital or birth center as you won't receive full disclosure on the risks of the epidural when you're actually in labor. Yes, you will be given a quick rundown of some of the potential risks as they call them and given an informed consent form to sign. But what if the anesthesiologist were to explain each of the significant risks involved from start to finish just after you had asked for your epidural? Would you choose it? I guarantee that by the time they had gone though all the associated risks (short term and long), you'd already be through the most difficult part of labor, transition, and be halfway through pushing your baby out. (Transition - this is usually the part of labor when most women call for medication. It is also, in my experienced opinion, the most cruel time to offer medication simply because the mountain of active labor is peaking during this time, and pushing is literally just on the other side - where confidence, control, energy, and excitement are usually restored and where women can really do something about getting that baby out. Evidence shows that the pushing stage is most effective without medication - please read more about the detrimental effects of epidurals on pushing in the article - The Hidden Risk of Epidurals ).
Labor is hard and everyone has different levels of pain tolerance, but education is power. And if for a very brief moment in life, we are able to experience our full potential as women for the sake of not only knowing what we are capable of, but to give our precious little ones the best start possible, why not then, at the very least commit to a drug-free plan, prepare in the best ways possible, surround ourselves with positive affirmations, and hire birth professions, shown by evidence to successfully assist us along this path, help us reach our goals, and ensure positive birth experiences and outcomes?
We can't exactly commit to anything if we don't prepare properly - this is simply a fact. True, we'll never know exactly what childbirth will feel like until we get there, but if we have a comprehensive education, the right support, the ability to find calmness and breath (practice makes perfect or at least accessible here), and perseverance, our chances of having safe, drug-free, no/low-interventive/injury births are far greater than simply walking into the hospital with an "open-mind" as 'they' put so eloquently. Not that having an open-mind is necessarily a bad thing, but from the hospital's perspective, it actually can be. If you don't know what to expect and you don't know the risks and you haven't prepared and you haven't gathered the proper support, your "open-mind" isn't going to help you reach your goals - having an open-mind is not the same as making wise informed decisions.
Having an open-mind in labor to me means to try not to worry too much about how long you have been or will be in labor as long as the health of mom and baby are good; understanding that labor takes time and timing has a purpose and is an important exercise in having an open mind. Open-mindedness also means to be willing to move or try a different position that you haven't tried before and letting the pressure/pain you feel guide you through your labor and literally help you to open up. It means to accept that your body in labor is you in labor, and though you haven't been there before or maybe you have but had a different/negative past experience, your body inherently knows what to do, you must trust it and work with it. Having an open-mind in labor is helpful when you think of it in terms of an understanding of the body's natural normal physiological process, it is not helpful when it means letting others tell you what you need without having the evidence to back it up, or without allowing you to try other options before resorting to a typical protocol.
It's true that things may come up in labor where you need to detour from your original plan, but again, understanding and planning for these variations and interventions is key in making safe, informed decisions for you and your baby, and is also a determinate in your level of satisfaction of your birth experience and both you and your baby's overall health. It's your life - you expect to have a choice and control in every other area, why not in childbirth? It's your birthright, use it to fuel your choices and to create a plan that supports the safest journey with the most positive outcomes.
Conclusion from the Article:
Epidurals have possible benefits but also significant risks for the laboring mother and her baby. These risks are well documented in the medical literature but may not be disclosed to the laboring woman. Women who wish to avoid the use of epidurals are advised to choose caregivers and models of care that promote, support, and understand the principles and practice of natural and undisturbed birth.
Epidurals have possible benefits but also significant risks for the laboring mother and her baby. These risks are well documented in the medical literature but may not be disclosed to the laboring woman. Women who wish to avoid the use of epidurals are advised to choose caregivers and models of care that promote, support, and understand the principles and practice of natural and undisturbed birth.
Important Points from the Article: Including Epidural Effects on Newborns, Breastfeeding, and Overall Satisfaction of Birth Experience. (If you don't read the article above, please read these important notes below, thanks!)
Neurobehavioral Effects (from Epidural Exposure)
Ann Murray et al. compared 15 unmedicated with 40 epidural-exposed babies and found that the epidural babies still had a depressed NBAS score at five days, with particular difficulty controlling their state. Twenty babies whose mothers had received oxytocin as well as an epidural had even more depression of NBAS scores, which may be explained by their higher rates of jaundice. At one month, epidural mothers found their babies "less adaptable, more intense and more bothersome in their behavior." These differences could not be explained by the more difficult deliveries and subsequent maternal-infant separations associated with epidurals.90
Carol Sepkoski et al. compared 20 epidural babies with 20 unmedicated babies, and found less alertness and ability to orient for the first month of life. The epidural mothers spent less time with their babies in the hospital, in direct proportion to the total dose of bupivacaine administered.91 Deborah Rosenblatt et al. tested epidural babies with NBAS over six weeks and found maximal depression on the first day. Although there was some recovery, at three days epidural babies still cried more easily and more often; aspects of this problem ("control of state") persisted for the full six weeks.92
Breastfeeding
As with neurobehavior, effects on breastfeeding are poorly studied, and more recent randomized controlled trials comparing exposure to epidural and opiate drugs are especially misleading because opiates have a well-recognized negative effect on early breastfeeding behavior and success.103-107
As with neurobehavior, effects on breastfeeding are poorly studied, and more recent randomized controlled trials comparing exposure to epidural and opiate drugs are especially misleading because opiates have a well-recognized negative effect on early breastfeeding behavior and success.103-107
Epidurals may affect the experience and success of breastfeeding through several mechanisms. First, the epidural-exposed baby may have neurobehavioral abnormalities caused by drug exposure that are likely to be maximal in the hours following birth "the critical time" for the initiation of breastfeeding. Recent research has found (rather obviously) that the higher the newborn's neurobehavior score, the higher his or her score for breastfeeding behavior.108
In another study, the baby's breastfeeding abilities, as measured by the Infant Breastfeeding Assessment Tool (IBFAT), were highest among unmedicated babies, lower for babies exposed to epidurals or IV opiates, and lowest for babies exposed to both. Infants with lower scores were weaned earlier, although overall, similar numbers in all groups were breastfeeding at six weeks.109 In other research, babies exposed to epidurals and spinals were more likely to lose weight in the hospital, which may reflect poor feeding efficiency.110 Other research has suggested that newborn breastfeeding behavior and NACS scores may be normal when an ultra-low-dose epidural is used, although even in this study, babies with higher drug levels had lower neurobehavior (NACS) scores at "two hours."111
Second, epidurals may affect the new mother, making breastfeeding more difficult. This situation is likely if she has experienced a long labor, an instrumental delivery, or separation from her baby, all of which are more likely following an epidural. Hormonal disruptions may also contribute, as oxytocin is a major hormone of breastfeeding.
One study found that babies born after epidurals were less likely to be fully breastfed on hospital discharge; this was a special risk for epidural mothers whose babies did not feed in the first hour after birth.112 A Finnish survey records that 67 percent of women who had labored with an epidural reported partial or full formula feeding in the first 12 weeks compared to 29 percent of nonepidural mothers; epidural mothers were also more likely to report having "not enough milk."113
Two groups of Swedish researchers have looked at the subtle but complex breastfeeding and prebreastfeeding behavior of unmedicated newborns. One group has documented that when placed skin-to-skin on the mother's chest, a newborn can crawl up, find the nipple, and self-attach.114 Newborns affected by opiate drugs in labor or separated from their mothers briefly after birth lose much of this ability. The other Swedish group found that newborns exposed to labor analgesia (mostly opiates, but including some epidurals) were also disorganized in their prefeeding behavior "nipple massage, licking, and hand sucking" compared to unmedicated newborns.115
Satisfaction with Birth
Obstetric care providers have assumed that control of pain is the foremost concern of laboring women and that effective pain relief will ensure a positive birth experience. In fact, there is evidence that the opposite may be true. Several studies have shown that women who use no labor medication are the most satisfied with their birth experience at the time,116 at six weeks,117 and at one year after the birth.118 In a UK survey of 1,000 women, those who had used epidurals reported the highest levels of pain relief but the lowest levels of satisfaction with the birth, probably because of the higher rates of intervention.
Obstetric care providers have assumed that control of pain is the foremost concern of laboring women and that effective pain relief will ensure a positive birth experience. In fact, there is evidence that the opposite may be true. Several studies have shown that women who use no labor medication are the most satisfied with their birth experience at the time,116 at six weeks,117 and at one year after the birth.118 In a UK survey of 1,000 women, those who had used epidurals reported the highest levels of pain relief but the lowest levels of satisfaction with the birth, probably because of the higher rates of intervention.
Finally, it is noteworthy that caregiver preferences may to a large extent dictate the use of epidurals and other medical procedures for laboring women. One study found that women under the care of family physicians with a low mean use of epidurals were less likely to receive monitoring and Pitocin, to deliver by cesarean, and to have their babies admitted to newborn special care.119
