Thursday, January 20, 2011

pros and cons of epidurals

Epidurals have some major pros, which most of us all know well.  The first is obviously pain relief.  That alone is why most women get them.  They also can give you a break and let you rest if you labor is extremely long and strenuous, or are not physically or emotionally prepared to handle the labor.  They are especially handy if you need an emergency C-section; if you are already numb they can get your baby out much quicker.

I don't think the risks are as well known, and as there are risks taken in everything we do, sometimes we brush them off, anticipating a relaxed, pain-free labor -- which many women do have.  But many do not.  "Birthing From Within" has a very comprehensive list that I will copy down and shrink a bit for you:

"Epidural anesthesia does not guarantee complete pain relief.  Most women experience decreased pain with an epidural, but not complete relief.  In fact, one study reported that 15% of the women receiving an epidural got no pain relief.  According to another study (Wuitchik, Bakal, and Lipshitz,) the average reduction in pain relief following an epidural went from the maximum score of a 10 to a 5 ....

Epidurals hinder rotation of a posterior (face-up) fetus to the more favorable anterior (face-down) position. Thorp et al.'s randomized controlled study (1989) found that 19 percent of women with epidurals had a posterior baby persisiting into second stage compared with four percent of the non-epidural group.  Failure to rotate into the more advantageous "facing down" position is responsible for increases in Cesarean births and forceps/vacuum extraction deliveries.  This is true even when pitocin is given to strengthen contractions.

Epidurals increase the use of other medical interventions and their related risks for mothers and babies. 
  1. Because of the potential for epidural-induced fetal heart rate decelerations, it is necessary to use conitnuous electronic fetal monitoring.  Studies have shown that using continuous electronic fetal monitoring increases the Cesarean rate by 2-3 times (without improving the baby's outcome). ...
  2. When epidural anesthesia is introduced, the mother's blood pressure often drops, causing serious fetal distress from decreased oxygen circulation.  Intravenous fluids must be administered rapidly to counteract this side effect of epidurals in the mother.  While this relieves one problem, it creates others, including excessive swelling in the mother's feet, legs, and breasts.  When the breasts are engorged, the nipple is flattened.  This makes it difficult, and sometimes impossible, for the newborn to latch on.
  3. Epidural anestehsia also numbs the bladder, eliminating the sensations which signal the need to urinate.  At the same time, huge amounts of IV fluids are flowing into the mother to counteract the anticipated drop in blood pressure.  So to prevent bladder distention, a urinary catheter is needed until the epidural wears off.  Catheterization brings an added risk of bladder infection, which would then require antibiotic treatment.  Studies also show there is a 700% increase in urinary incontinence three months after an epidural.  Even a year later, incontinence remains 200% higher than in non-epidural moms.
  4. As explained earlier, epidurals disturb the natural feedback system that stimulates and maintains good, strong labor.  If labor progress slows down or stops altogether, uterine contractions can be artificially stimulated with pitocin through the IV.  Pitocin, even when carefully administered trhough an electronic "pump", can cause unnaturally strong and prolonged contractions.  Such contractions decrease the oxygen supply to the baby causing fetal distress.  This risk requires continuous electronic fetal and uterine monitoring.  Unfortunately, CEFM (regardless of why it is being used) increases cesarean births.
  5. One study (Murray, et al, 1981) found that the time it takes to push a baby out is longer for mothers either with an epidural (100.4 minutes) or with pitocin and an epidural (83.8 minutes) compared with unmedicated mothers (47.7 minutes).  As described elsewhere in this chapter, epidurals interfere with the urge to push, the effectiveness of pushing, the rotation of the baby's head into the most favorable position and the mother's physical capacity to choose her most effective birthing position.  That's why with an epidural there is a five-times greater likelihood that forceps or vacuum extraction will be used to pull the baby out.  Another study found forceps were used in 60 percent of mothers with epidurals, and 80 percent in mothers with pitocin and epidurals, but there were no forcep deliveries in the unmedicated group.
  6. The incidence of deep vaginal tears that extend into the rectum is three times greater with an epidural (because of the related increase of episiotomy and the use of forceps).  Deep tears are painful and take longer to heal, and may later cause fecal incontinence, and chronic pain during sex.
  7. Studies have shown an increase in Cesarean birth rate.  Thorp et. al. found a Cesarean rate of 17 percent in its epidural group and only 2 percent in the non-epidural group, even though the mothers in the two groups were essentially equivalent before the epidural was administered.  Thorp, et. al. (1993) reported that the earlier an epidural is begun, the greater likelihood of Cesarean:  They reported a 50% increase in Cesarean birth rate when an epidural was started at 2 cm; 33% at 3 cm; and 26% at 4 cm.  The increased Cesarean rate can be attributed to the following epidural-induced factors:
      1. Fetal distress brought on by a drop in the mother's blood pressure, decreasing placental blood flow.
      2. Weakening, slowing or stopping of uterine contractions.
      3. Abnormal position of the baby's head, resulting from a failure to rotate and descend normally during second stage because the epidural has numbed and relaxed pelvic floor muscles (and interrupted the feedback loop).
      4. Decreased pelvic diameter when the mother is forced to lie on her back.
  8. Epidural fever.  The hard work of normal labor raises the mother's temperature slightly, which causes no problems.  Epidural "fever", although medically benign, must be treated more seriously.  The incidence of epidural fever is disturbing.  Among epidural-mothers, one in four will develop an epidural fever after four hours, and almost half after eight hours.  Fusi, et. al (1989) observed that, "The rise in temperature in most women with epidural did not result from an infective process, but from their inability to dissipate the heat generated in the process of labor." .... However, because infection can have serious consequences for both mother and baby, once a fever develops agreesive medical management must be undertaken.  A rise in the mother's temperature (from whatever cause) may result in a rise in the fetus' as well, causing dramatically increased heart rate and possible metabolic deterioration.  Medical management of this condition includes intravenous antibiotic therapy, and speeding up labor with pitocin, forceps, vacuum extraction or Cesarean.  Infection in a newborn is extremely serious and must be treated immediately. .... So, even before results have come back from blood work or spinal taps to show whether an infection is actually present, antibiotics and treatment must begin. At the very least this situation creates tremendous stress and worry, an emotionally painful separation from the baby, and interference with breastfeeding.  Additional medical bills immediately soar into the thousands.  All this pain, anxiety, and expense for what is usually found to be a benign epidural fever (which requires no treatment).  Yet, the workup must be done to avoid missing the timely diagnosis and treatment of an actual infection.
  9. It is a popular myth that epidural medication doesn't get to the baby.  Epidural anesthetics do cross the placental barrier.  Anesthetic levels in the baby's blood have been found to be as high as one-third of maternal blood levels.  As a result, compared to the unmedicated babies, babies in the epidural or pitocin-epidural groups showed "drugged behavior" (e.g., trembling, irritability, and immature motor activity) on the first day, with behavioral recovery by the fifth day.  It takes 48 hours for a newborn to eliminate the epidural anesthetic from its system.  When pitocin was used with the epidural, there was an even greater depression of motor activity.  Babies were more tense, hypertonic, and displayed depressed reflexes.  Murray et. al. discovered that a month after birth, unmedicated mothers reported their babies to be more sociable, rewarding, and easy to care for than did the epidural mothers.  In addition, the unmedicated mothers were more responsive to their babies' cries than mothers who had epidural anesthesia in labor.  The early days of the mother-baby relationship may impact bonding and the future of that relationship.  The baby's behavior makes a powerful first impression.  When in the first month, babies appear "disorganized" (which means they are more irritable, withdrawn, look away and suckle less) mothers are more likely to perceive them as difficult babies.  That impression can affect the mother, unconsciously, in ways that shape her behavior toward her newborn, which over time, will shape the baby's personality and consequently the mother-baby relationship."
It's a lot of information, I know.  But it is important to weigh everything you can to make the best decision for your family.  Also, knowing these risks can help you to overcome them if you do get an epidural and can consciously decide to work a little harder to make sure they do not affect you as much.  You are in control of your own health, and for now, the health of your little one.

No comments:

Post a Comment