Sunday, November 22, 2009

Do Epidurals Affect the Baby?

In class last week, I had a couple express surprise when I said that all drugs get to the baby, including epidurals. They have friends that are doctors that have said otherwise. I have spent the week looking up several articles and resources, and, my friends, epidurals indeed adversely affect the baby. I do not want to make this an overwhelming post, so I will touch on the highlights of how the babies are affected.

First, it is important to note that the "older" studies with very significant data were largely done by pediatricians. The newer studies, found to not be nearly as complex, have been done by anesthesiologists. Obviously, there is a conflict of interest there!

There are a couple of problems that researchers have run into with these studies. The first is that so many women that have epidurals also have other "pain relieving" drugs in their bodies that also influence and affect the babies. This makes it difficult to assess the effects of just the epidural. In addition, epidurals have different drugs in them. Different anesthesiologists and/or hospitals will often use different drugs in their epidurals.

So many of the effects on the baby have to do with the effects on the mother from the epidural. I am not focusing on the effects for the mother in this post, however, but some of these effects on the mother is what creates a problem for the baby from the epidural. For example, maternal fever is very common and can cause complications for the babies. So is a drop in maternal blood pressure. This is why a woman will receive IV fluids before the epidural is administered -- it is a preventative measure.

Effects of the Epidural on the Baby

Epidurals can change the Fetal Heart Rate (FHR), indicating that the baby is lacking blood and oxygen. This will often occur in the first 30 minutes after an epidural is placed. Opiate drugs, common in spinals and epidurals, are the likely culprit. These changes in FHR will often resolve themselves if the mom is allowed to move a bit or change position. If the baby's heart rate does not bounce back, the woman may have a cesarean section.

The supine position (lying on your back), also contributes to changes in fetal heart rate. A woman with an epidural is mostly in this position, which can deprive the baby of oxygen, affecting the baby's brain. In my case, this is why I nearly had a c-section. I had the epidural, pitocin, etc., etc., and my baby's heart rate would not come up after contractions. Moving from side to side after each contraction is what helped his heart rate. Had I remained on my back, his heart rate would not have come back up, and I would have had surgery. Had my sister-in-law, a doula, not been there, I would have had a c-section. The nurses or doctors certainly weren't telling me what to do. They would have been happy to perform surgery, I have no doubt.

Babies that are born to mothers who developed a fever from the epidural in labor are more likely to have a low Apgar score -- poor muscle tone, require resuscitation (11.5% versus 3%), or have seizures in the newborn period. One of the most common problems from the maternal fever is that the doctors do not know if the fever was from an infection involving the uterus or from the epidural. They will typically do a sepsis, or evaluation, of the baby. This involves prolonged separation from the mother, invasive tests, and almost always, antibiotics until the test results are available. In a study of first-time mothers, 34% of epidural babies were given a sepsis evaluation, but only 9.8% of nonepidural babies underwent the evaluation.

It is important to note that a newborn's ability to process and get rid of drugs is much less than an adult's. It must also be considered that the drugs are often stored in the newborn's tissues such as the brain and liver where they are more slowly released. Epidural babies are more likely to have jaundice. The reasons are not entirely clear on this, but it is suspected that it is related to an increase in assisted delivery (forceps or vacuum extraction) or to the increase use of pitocin with epidurals.

Neurobehavioral Effects
Epidural babies have been found to have a depressed NBAS (Neonatal Behavioral Assessment Score, devised by pediatricians) Score at five days old, with difficulty "controlling their state." Babies that received pitocin as well as the epidural had even more depressed NBAS scores, as well as higher rates of jaundice. At one month of age, epidural mothers found their babies "less adaptable, more intense, and more bothersome in their behavior."

Other differences between epidural babies and unmedicated babies include: less alertness and ability to orient themselves. The epidural mothers typically spent less time with their babies while in the hospital, finding the more drugs they received, the less time they were with their baby.

In another study, researchers found that at three days old, epidural babies cried more easily and more often and aspects of this continued for the entire six weeks of the study. In the conclusion of this particular study, researchers expressed concern about "the importance of first encounters with a disorganized baby in shaping maternal expectations and interactive styles."

Finally, the effects of an epidural on breastfeeding must be addressed. The first hour is a critical time to establish breastfeeding and if a baby has poor muscle tone or sucking reflex, or mom is hemorrhaging (more likely with an epidural), breastfeeding may be put off until well past that hour. As I write this, I have mixed feelings. It is crucial that mothers understand the effects of their actions in choosing an epidural, but if something happens and for whatever reason you cannot breastfeed immediately, do not give up since you missed out on that first hour. Babies and moms can figure this out! With that being said, I will continue on the effects of the epidural on breastfeeding.

Oxytocin is a breastfeeding hormone. If a mom has been induced with pitocin, administered an epidural, had an instrumental delivery, etc., this hormone was not allowed to be present in its natural form. There were just too many disruptions. This can adversely affect how well breastfeeding gets started. If mom is tired, baby is still feeling the effects of the drugs and not sucking well, the nurses, and even the pediatrician, may be pushing formula on this baby. And then starts the vicious cycle of nipple confusion. The baby doesn't have to work to get milk from the bottle, and when he is put to the breast, gets frustrated. Mom gets frustrated and resorts to those stupid formula samples she's been receiving on her doorstep for months!

Epidural mothers are less likely to breastfeed exclusively compared to nonepidural mothers. Epidural mothers are more likely to report having "not enough milk."

It is unfortunate that doctors are leading people to believe that the epidural is safe for moms and babies and there are no risks. There are risks, not just to our health, but to how we parent our babies. The more attached you are, the better you will appreciate your baby. You will trust your body to breastfeed and your baby will be eager to nurse.

I'd like to end with a quote by musician, Ani DiFranco, talking about her unmedicated birth: "I'm really happy in the end that I felt every last bit of the pain, and was as present as I could be. Whenever you go through something terrifying and come out the other side, you grow and have more self-respect in terms of your own strengths. I wanted that more than I wanted whatever sort of numbing the hospital would have offered."

What's good for mom is good for baby. Just say NO to the epidural! You are strong and powerful. You can do this, just like millions of women before you have done this. Giving birth is giving life. You and your baby deserve the very best start down this new road. Surround yourself with positive people who believe in you and your abilities.


Seeker said...

Don't forget about the fact that when a mother receives an epidural, she has far fewer endorphins released. Those endorphins not only help the mother deal with labor, but they help baby deal with it as well. Mom may be feeling no pain but there is evidence that this lack of endorphins may make labor much harder on baby.

Regina said...

This is exactly what I needed to read right now! Thank you! It is easy to find loads of risks when it comes to pitocin and inductions, but not as easy to find about epidurals. Like you said, everyone, including doctors, basically says there is no risk or side affect.

Anonymous said...

It's strange that someone would believe that drugs given to you while pregnant (even during labor) wouldn't get to the baby. Sad, really, how few people know about the way their bodies, and their baby's body, work.

prashant said...

Those endorphins not only help the mother deal with labo

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BeanyMama said...

Beautiful post as usual, Donna!!

The Mama said...

Great post, Donna! Loved the Ani quote, such a hippie girl! :) LOL

So true about the endorphins... forgot to add that happy feeling post birth to the birth story I just emailed you.

Anonymous said...

Great post. Can you cite your references please?

Donna Ryan said...

Yes, I actually took most of my statistics, etc. from an article in Mothering from a couple of years ago about the risks of epidurals. There were more than 100 references. Is there something specific you were curious about? It's probably easier for me to find the source for you if I know what I'm looking for.

Crying Baby Help said...

First time parents may seem to get weary especially if they have a colic baby but there are some ways to learn in order get adjusted with crying babies. Such as proper way of feeding the baby, the right position of the pillow, kind of mattress used and others.

Coppelia said...

I'm glad I found your blog. I hope more women can find out about this and we can bring America back to a healthy and safer way of birthing babies!

For pregnant mommies, please make sure to find supportive medical staff or midwives who know what you desire for your birth.

Ask a lot of questions and other moms for their experiences.

It's one thing what is said in an office, and another what will happen in the hospital.

Ask!!! And pray and surround yourself with supportive people (husband, doula, etc.) who will help you and baby have a beautiful BIRTH-day.

Samantha said...

I can't tell you how refreshing it is to read that there are many other people out there as passionate about natural birth and breastfeeding as I am! I had a medicated delivery with my first and was *very* dissatisfied and felt like I had been pressured into getting the epidural. My husband and I really prepared and were very 'set' in our birth plan the second time around with our midwife, and we had a beautiful, unmedicated husband coached delivery. I really DID notice a difference between my babies after birth and I wish I could go back and change things for the first one. I will *never* go back to medication...EVER...and I promote natural childbirth to all of my friends. I also am glad someone else out there hates those stupid formula samples...itreally makes me mad that babies receive sub-par nutrition because some rich CEO advertised to moms that they don'/can't feed their babies!

Jacksmama said...

This is a great article...SO many doctors and nurses tell women that their baby will not be adversely affected at all, and it seems that answer just satisfies most women. I birthed our son naturally and am due in May with our second baby...I am excited to deliver naturally again, and I am so grateful that our bodies were made to bring children into the world! It is doable, and it is SO worth it to be alert, awake and have full mobility while giving birth. Shortly after I nursed our son for the first time and got poked and prodded a bit by nurses, I was on my feet feeling great, ready to introduce our baby boy to our friends and family. I would not have it any other way, and I LOVE helping to educate women about the perks of natural childbirth, and letting them know that THEY CAN DO IT if they set their mind to it. Thanks for being another advocate for natural childbirth!

Betty999 said...

Yes. Please post some references. I am all for a drug-free birth. I had 2 myself. I am not the one who needs to be convinced. By my own informal research, I noticed that approximately 8 out of 10 women who I know got the epidural, had to get a c-section. Like you wrote, it may have had to do with the other drugs made necessary by the epidural, but the epidural was the hand that pushed the dominoes down. Too many c-sections. Nobody can say that they were all necessary. There is no way we would all be here if that were the case. :-)

Unknown said...

As a doula, I assisted a friend's daughter today giving birth to her daughter. It never fails to amaze me...this everyday miracle!!

But I was interested in reading more about epidurals and their affect on the baby since the doctor (that I absolutely adored) mentioned to the mother-to-be that the baby is NOT affected by the epidural and it would be ok is she opted for that. Good news is that this doctor DID promote the natural approach and cheered when my 'gal' made her decision to forge on without meds. But I was interested in learning more because one does hear comments like that from the obstetricians.

It just makes sense that everything passes through to the baby. I have seen over and over when a 'mom' opts for an epidural, a downward spiral ensues.

I commend, wholeheartedly, those few daring gals that try the natural route. It certainly is against the grain. At the hospital today, the nurse and doctor were telling me that the C-section rate in our county was over 50% and that epidurals were administered more than 90% of the time.

It's a tough trip but so worth it. When I had my last of 3 natural births many years ago, I remember feeling a bit sad knowing that it would be the last time I would experience that unforgettable, unbelievable, so in touch with life feeling again.

I challenge all you women out there to at least consider the many, many advantages for you and your baby. We ARE strong!! Resolve to just do it!