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Blog Archive
- ► 2023 (8)
- ► 2022 (88)
- ► 2021 (54)
To Numb or Not-to-Numb: The Great Epidural Debate
May 2015
DID YOU KNOW? Epidurals are the most common obstetric intervention in the US today, with both pros and cons for this procedure. Learn about some of the serious risks you may want to educate your patients about.
Each year, more than 4 million women in the US give birth, about 2/3 of them receive epidural anesthesia, and the number is increasing. In fact, epidurals are the most common obstetric intervention in the US today. Do the mothers you work with in the birthing process make a truly informed decision about using epidurals for their births? For most of us, that answer is probably "no."
Why does it matter? According to a research-based article by Alyssa Benedict, MPH, there are some benefits; however, there are very real risks to both mother and baby.
First, let's look at the natural progression of the laboring patient. Research shows that the maternal brains releases endorphins, with an effect 200 times greater than morphine. They also produce a tranquil, amnesiac state for the mother. Epidurals, though, interrupt this process, and interfere with labor hormones as well, causing labor to slow or stop. Benedict says, "Evidence clearly indicates that epidurals are associated with various [maternal] risks...a significant increase in instrumental deliveries (forceps, vacuum)...[which] have their own host of risks to mother and baby" (2014).
Other maternal risks include:
- hypotension (reducing blood supply to the placenta, respiratory distress for mother and infant)
- pruritus (leading to anti-itch medications which carry their own risks)
- prolonged labor length (increasing the likelihood of oxytocin augmentation, also with side effects)
- urinary retention (inhibiting cervical dilation and infant head rotation, increasing urinary tract infections, causing loss of bladder control for days to months due to strain on numbed pelvic floor muscles)
- maternal fever (decreasing mother's ability to sweat and increasing her inability to dissipate excess body heat, resulting in maternal treatment for chorioamnionitis, increasing infant heart rate, mother-infant separation for infection work-up, infant antibiotic treatment and longer hospitalization)
- inadequate analgesia (potential for incomplete, spotty, or no pain relief)
- unintended high levels of anesthesia (increasing maternal respiratory depression and related infant impact)
- inability to move freely (inhibiting labor progress, increasing birth interventions)
- nausea/vomiting (wasting needed maternal energy resources, increasing maternal discomfort, anti-nausea medications and resulting maternal sleepiness and medication side effects)
- post-dural puncture headache (caused by leaking cerebrospinal fluid, lasting from days to weeks, mild to debilitating)
- post-anesthesia back pain (lasting days to years, due to "stressed" labor positions exacerbated by muscular relaxation and absence of feedback pain to create movement from the damaging position, rarely, nerve damage)
- increased uterine infection
- misplacement of anesthesia catheter
- decreased maternal oxytocin (leading to use of Pitocin and medication risks)
- psychological risks (detachment, stress, regret, depression, disappointment, loss, lack of control)
What about the risks for the infant? The fetal and infant brains experience profound development during the prenatal period and for the first two years after birth, creating a vulnerability to drug exposure during birth. Narcotics and epidural medications rapidly cross the placental barrier, affecting the infant with greater impact due to the small brain size and underdeveloped liver. Here are further negative affects:
- reduced muscle tone
- increased incidence of jaundice
- damage to the central nervous system
- impaired sensory and motor responses
- reduced ability to process and respond to incoming stimuli
- interference with sucking and rooting responses, and with breastfeeding
- lower scores on infant developmental tests
- increased irritability
- sleep dysfunction
- reflux
- narcotic withdrawal symptoms lasting up to two weeks (irritable crying, tremors)
- psychological risks (maternal emotional changes seen in infant, stress, traumatic imprinting, decreased feelings of comfort and safety in their own bodies)
Frequent and prolonged crying is not a normal part of infancy, and this behavior is now being classified as birth trauma. One researcher found a correlation between adolescent drug abuse and the amount and timing of drugs given to the mother during labor (Harper, 2005). McCarty and Glenn (2008) state the "rise in epidural use and high-tech birth in general is not producing better birth outcomes, and, of growing concern, coexists with...'a crisis in infant and child development'...marked by alarming rates of autism, ADHD, childhood aggression and depression, asthma, overweight and obese children, attachment disorders and learning disabilities."
We know the benefits of epidurals are primarily maternal, with pain relief and relaxation. But I'll ask again, do the mothers you work with make a TRULY informed decision? You decide.
References:
Benedict, A. (2014). Epidural anesthesia: Important facts that will help you take charge of your birth. Pathways to Family Wellness; Issue 39.
Harper, B. (2005). Gentle Birth Choices. Vermont: Healing Arts Press.
McCarty, W. and Glenn, M. (2008). Investing in human potential from the beginning of Life. http://www.naturalfamilylivingsb.org/pdf/PositionPaper_1-09_press.pdf
Step 2 Education International Inc.
Montreal, Quebec, Canada
H4A 1G2
Courriel
This Privacy Policy describes how your personal information is collected, used, and shared when you visit or make a purchase from https://step2education.com (the "Site").
PERSONAL INFORMATION WE COLLECT
When you visit the Site, we automatically collect certain information about your device, including information about your web browser, IP address, time zone, and some of the cookies that are installed on your device. Additionally, as you browse the Site, we collect information about the individual web pages or products that you view, what websites or search terms referred you to the Site, and information about how you interact with the Site. We refer to this automatically-collected information as Device Information."
We collect Device Information using the following technologies:
- "Cookies" are data files that are placed on your device or computer and often include an anonymous unique identifier. For more information about cookies, and how to disable cookies, visit http://www.allaboutcookies.org.
- "Log files" track actions occurring on the Site, and collect data including your IP address, browser type, Internet service provider, referring/exit pages, and date/time stamps.
- "Web beacons," "tags," and "pixels" are electronic files used to record information about how you browse the Site.
Additionally when you make a purchase or attempt to make a purchase through the Site, we collect certain information from you, including your name, billing address, shipping address, payment information (including credit card numbers), email address, and phone number. We refer to this information as "Order Information."
- Users who are undertaking a course as part of a group or organization have certain data tracked as part of the service we provide to Clients and Facilitators. This includes information showing if you have logged in and when, dates of completion and what and when particular study topics, resources and assessments were viewed and completed. We refer to this information as "Student Access Information"
When we talk about "Personal Information" in this Privacy Policy, we are talking about Device Information, Order Information and Student Access Information.
HOW DO WE USE YOUR PERSONAL INFORMATION?
We use the Order Information that we collect generally to fulfill any orders placed through the Site (including processing your payment information, arranging for shipping, and providing you with invoices and/or order confirmations). Additionally, we use this Order Information to:
- Communicate with you;
- Screen our orders for potential risk or fraud; and
- When in line with the preferences you have shared with us, provide you with information or advertising relating to our products or services.
We use Student Access Information to provide accurate tracking to Users and Clients on completion and use of the courses, as well as for analysis on how to improve our services.
We use the Device Information that we collect to help us screen for potential risk and fraud (in particular, your IP address), and more generally to improve and optimize our Site (for example, by generating analytics about how our customers browse and interact with the Site, and to assess the success of our marketing and advertising campaigns).
SHARING YOUR PERSONAL INFORMATION
We share your Personal Information with third parties to help us use your Personal Information, as described above. For example, with your employer who needs to verify your completion or progress of your studies. We also use Google Analytics to help us understand how our customers use the Site--you can read more about how Google uses your Personal Information here: https://www.google.com/intl/en/policies/privacy/. You can also opt-out of Google Analytics here: https://tools.google.com/dlpage/gaoptout.
Finally, we may also share your Personal Information to comply with applicable laws and regulations, to respond to a subpoena, search warrant or other lawful request for information we receive, or to otherwise protect our rights.
BEHAVIOURAL ADVERTISING
As described above, we use your Personal Information to provide you with targeted advertisements or marketing communications we believe may be of interest to you. For more information about how targeted advertising works, you can visit the Network Advertising Initiative's ("NAI") educational page at https://www.networkadvertising.org/understanding-online-advertising/how-does-it-work.
You can opt out of targeted advertising by:
- Facebook: https://www.facebook.com/settings/?tab=ads
- Google: https://www.google.com/settings/ads/anonymous
Additionally, you can opt out of some of these services by visiting the Digital Advertising Alliance's opt-out portal at: http://optout.aboutads.info.
DO NOT TRACK
Please note that we do not alter our Site's data collection and use practices when we see a Do Not Track signal from your browser.
YOUR RIGHTS
If you are a European resident, you have the right to access personal information we hold about you and to ask that your personal information be corrected, updated, or deleted. If you would like to exercise this right, please contact us through the contact information below.
Additionally, if you are a European resident we note that we are processing your information in order to fulfill contracts we might have with you (for example if you make an order through the Site), or otherwise to pursue our legitimate business interests listed above. Additionally, please note that your information will be transferred outside of Europe, including to Canada and the United States.
DATA RETENTION
When you place an order through the Site, we will maintain your Order Information and Student Access Information for our records unless and until you ask us to delete this information. We are required to keep course completion records for at least 5 years in order to comply with certain accreditation requirements.
CHANGES
We may update this privacy policy from time to time in order to reflect, for example, changes to our practices or for other operational, legal or regulatory reasons.
CONTACT US
For more information about our privacy practices, if you have questions, or if you would like to make a complaint, please contact us by e-mail at [email protected] or by mail using the details provided below:
5890 Monkland Avenue, #16, Montreal, QC, H4A 1G2, Canada
Last Updated: September 2018