The Evidence Says: Epidurals Do Impact Newborns

"There are many controversies in maternity care. The spectrum of debates run to both ends of the spectrum: from those who feel all women should have interventionized maternity care to the home birth advocates. However, one of the most controversial topics in care is epidural anesthesia.

"Fueling the flame of the epidural controversy are the diametrically opposite positions published in anesthesia journals vs. those in other medical journals such as nursing, midwifery and family practice.

"In most hospitals, laboring women who have received epidural anesthesia are confined to bed as they no longer can rely on their legs for stability. This may severely limit movement and positioning. Additionally, hospitals may have a policy that all laboring women receiving medication, specifically epidural anesthesia, have an internal fetal heart monitor in place. This requires breaking of the amniotic sac or membranes in a procedure known as amniotomy. Occasionally, it may be necessary to augment or stimulate a labor with Pitocin after an epidural has been given, as epidurals have been shown to slow some women's labors – making the labor longer and harder on the woman’s body (Mayberry, L.J., Clemmens, D., De, A. Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review. American Journal of Obstetrics & Gynecology. 2002 May;186(5 Suppl Nature):S81-93.

"Researchers have linked epidural anesthesia to assisted delivery, or the use of forceps or vacuum extraction during the pushing portion of labor (Torvaldsen, S., Roberts, C.L., Bell, J.C., Raynes-Greenow, C.H. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. Cochrane Database Systematic Review. 2004 Oct 18;(4):CD004457.). Researchers also find that 88% of women who requested an epidural for pain in one study reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity. Pre-labor survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings.( Kannan, S., Jamison, R.N., Datta, S. Maternal satisfaction and pain control in women electing natural childbirth. Regional Anesthesia and Pain Medicine. 2001 Sep-Oct;26(5):468-72.

"Epidural anesthesia also causes a drop in maternal blood pressure, thus the need for 1000 ml of IV fluids administered prior/during the administration of the anesthesia.

"For the newborn, the effects of epidural anesthesia are more hazardous. Women who have epidurals are less likely to fully breastfeed in the first few days and are more likely to stop breastfeeding in the first 24 weeks due to the difficulty newborns have in coordinating sucking and latching. (Torvaldsen, et al. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. International Breastfeeding Journal 2006 Dec 11; 1:24. Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. When used in combination during the labor process, which happens frequently, epidural anesthesia and pitocin influenced endogenous oxytocin levels negatively ~ thus negatively impacting both milk ejection and milk production. Jonas et al. Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin in response to suckling during the second day postpartum. Breastfeeding Medicine 2009 June; 4(2): 71-82.

"Countless other studies including the Journal of the American Board of Family Medicine and Dr. Sarah Buckley all focus on the hazardous impact of epidurals on breastfeeding and the newborn.

"This evidence may be an inconvenient truth."

I found this article at: The Evidence Says: Epidurals Do Impact Newborns

In a personal note: Each time I had an epidural, it seemed to delay my breast milk production. I had an epidural with the birth of each of my first two babies, and the only impact I noticed is that my milk took an extra day to come in. With both of them there was a very hard day when the baby was screaming in hunger and all I had was colostrum to feed them and they weren't satisfied until my milk came in the next day. With my 3 un-medicated births my milk came in exactly when the baby's appetite increased enough to need it.

Epidural: Procedure, Benefits, and Potential Risks

The most common form of pain medication used in childbirth in the United States is the epidural block. Despite its widespread use, I strongly feel that the majority of pregnant women in the United States are not properly educated about the use of an epidural block. Here is some information that every woman should consider when deciding whether or not she will choose an epidural in labor.

How an epidural is done:

• The drugs used in an epidural are usually a combination of an anesthetic (like bupivacaine) and a narcotic or opioid (like fentanyl). Dosage depends on the anesthesiologist performing the epidural.
  
• The mother must have an IV line to ensure adequate fluids.
• Constant monitoring of the mother's blood pressure and baby's heart rate is needed.
  
• The mother is placed on her side or sits up and leans forward to receive the epidural.
• The anesthesiologist cleans the lower back area.
• A local anesthetic is given and then a hollow epidural needle is inserted between two vertebrae into the epidural space, just before the membrane that covers the spinal cord.
• The mother usually feels pressure.
• A test dose of the medication is usually given to ensure proper placement and effectiveness of the epidural.
  
• A thin, plastic tube called an epidural catheter is threaded through the hollow needle into the epidural space and the needle is removed.
• The catheter is taped to the mother's back.
• Generally each contraction will get easier, and the mother will begin to feel pain relief in about 10 to 20 minutes. Her legs may feel warm or tingly and may feel heavy.
• The lighter the epidural dose, the more control the woman will have to move her legs and the easier it will be to change positions.

Advantages to using an epidural:

• Allows the mother to stay alert throughout labor and delivery.
• The baby is less medicated compared to if an IV narcotic is used.
• The mother can rest during a long labor.
• Can provide pain relief, particularly when labor is induced with pitocin.

Potential side-effects of an epidural:

• The woman's ability to move around or change positions may be limited. She is generally restricted to the bed.
  
• The medication may cause an erratic fetal heart rate. Local anesthetics cross through the placenta.
• Drugs can cause various degrees of maternal, fetal, and neonatal toxicity.
• May slow down labor (particularly if given before 4-5 cm dilation).
• May increase the possibility for use of pitocin.
• May make it hard for the mother to push the baby down. Some women don't feel the urge to push at all when they have an epidural. This is generally related to how strong the epidural is.
• May increase the likelihood of the use of forceps or vacuum extraction.
• May cause a fever in the mother when used for long hours.
• May make it more likely the newborn will be screened and treated for infection.
• Some mothers experience nausea, vomiting or itching when epidural narcotics are used.
• May cause short-term urinary incontinence, and a bladder catheter may be inserted into the mother. A full bladder will generally slow the progress of labor.
  
• Delayed fetal rotation and descent.
  
• Spinal headache if the epidural needle goes in too far (if it punctures the spinal space). This is usually a severe, debilitating headache that can last for a couple of weeks. A blood patch can be done to help repair the damage and alleviate the headache.
• Postpartum backache.
• Possible long-term paralysis. This is more rare than other side effects, but it can happen. I have a friend who experienced a numb spot in her leg for several months after having the epidural.
  

Click here to see photos of the epidural procedure by Patti Ramos

This information was paraphrased and compiled from An Epidural for Pain Relief: Making an Informed Choice by Nicette Jukelevics, MA, ICCE and Pregnancy, Childbirth and the Newborn by Penny Simkin, PT, CD(DONA). For more in-depth information about the risks and benefits of epidurals, please also see The Thinking Woman's Guide to a Better Birth by Henci Goer.