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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.

Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA
Course Tutor, Step2 Education

 

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

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