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.
No comments: