Epidurals have become just another part of childbirth. In the U.S., rates are around 60% in large hospitals [Anesthesiology, August 2006]. Yet even well-executed epidurals can have serious repercussions to both mother and baby, including drops in blood pressure, fetal distress, fever, and physical and behavioral effects in the newborn.
While a woman who is in unbearable pain may feel the risks are worthwhile, without proper information, women who are coping well may decide to get an epidural simply because it has been offered and they believe it is safe. It is a good idea for expectant mothers to educate themselves fully about this common but serious medical intervention so that an educated decison can be made.
Epidurals May or May Not Give Total Pain Relief
In most cases, epidurals completely eliminate the pain of labor while allowing the mother to remain awake and alert. For a woman who has had a long, difficult labor, the epidural can afford her some much-needed sleep as she prepares for the pushing stage. In some cases, an epidural can get a “stalled” labor moving again, perhaps by allowing a very tense mother to relax.
The epidural does not always, however, remove the intense pressure and sensation of pushing, which can be quite uncomfortable and overwhelming. The epidural may also give only “spotty” coverage, where one side of the body receives anesthetic while the other half does not or where coverage is otherwise incomplete.
Epidurals Often Lead to Additional Interventions
In her book The Thinking Woman’s Guide to a Better Birth [The Berkeley Publishing Group 1999], Henci Goer goes into detail about the very real consequences of this common pain management intervention.
- Epidurals can increase risk of Caesarian section. Epidurals slow labor, which leads to increased Pitocin (intravenous oxytocin) and higher rates of episiotomy, forceps delivery, vacuum extraction and Caesarian section. Increased Pitocin can strengthen contractions to the point where they cause fetal distress. Episiotomies can affect sexual satisfaction and continence for life.
- Epidurals require continual electronic fetal monitoring. This also has been shown to increase the odds of Caesarian section.
- Epidurals can cause a drop in blood pressure. This can cause fetal distress, resulting in the need for an emergency C-section. The copious amounts of IV fluids given in the hopes of preventing this can cause swelling and more serious complications as well.
- Post partum, epidurals can give mothers an excruciating “spinal headache.” This requires further treatment and interferes with breastfeeding and bonding with the newborn.
- Epidurals confine a laboring woman to bed. Lying prone not only slows labor but can have psychological repercussions on her as well. What was at one point a natural event in which she was participating has now become a medical event over which she has little or no control.
The above complications are only the ones that can happen if the epidural goes well. An allergic reaction or an error in the placement of the needle can cause catastrophic results including respiratory paralysis and cardiac arrest, according to Goer in as many as 1 in 3,000 cases.
Epidural Effects on the Newborn
Because the medication does cross the placenta, studies have been done on the epidural’s effect on the newborn. According to a 1997 study by M. Walker in the Journal of Human Lactation, the lingering effects of epidural anesthesia on the newborn can cause difficulty suckling and sleepiness, both of which interfere with early breastfeeding.
Over time, epidurals can also cause maternal fever, which stresses the baby and may result in him being subjected to painful procedures such as blood tests and a spinal tap after birth to rule out infection.
While epidurals have their place and can help a mother who is struggling with a long, drawn-out, or extremely painful labor, the decision to have an epidural should be treated as seriously as any decision to begin a medication that has numerous and potentially serious consequences.
Epidurals can be quite effective at relieving labor pain, but they are a major medical intervention that leads to additional interventions, and women should have a complete understanding of what they entail before making a choice to have one. If a woman decides to labor without an epidural, she can prepare herself with more natural pain relief and comfort measures. A midwife or childbirth educator can assist her with her plans for an epidural-free labor and birth.
Christy Swift - Christy Swift is a stay-at-home mom of two girls and a freelance writer. She has volunteered as a doula for young and underprivileged ...
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