Wednesday, September 1, 2010

The Down-side of Epidurals

"Epidural analgesia is one of the most striking examples of the medicalization of normal birth, transforming a physiological event into a medical procedure."
World Health Organization

*Please note that I have gathered my information from numerous sites/sources and have them all listed/linked at the end of this blog.  If you have any questions, please let me know.  Thank you.*

Epidurals became more widely used by laboring women in the 1970s. 

Nowadays, the number of women who request epidurals for their labors are compounding yearly.  In 1975, 20% of laboring women were using Epidurals.  Today, almost 80% of women rely on Epidurals for pain relief.

Let's take a look at the side effects, to the mom, from the Epidurals:
  • Hinders the body's ability to release Oxytocin.  This natural occurring hormone in the body helps the uterus contract.  Most women who get an epidural will also need the synthetic form of Oxytocin, called Pitocin.
  • Along with the hindering Oxytocin comes the risk of "preventing" the mom to bond with baby after birth.  Oxytocin is called the "Love Hormone" and in natural birth, the body is flooded with this hormone, helping the mom bond with her baby. With epidural use, this is hindered.
  • Hinders/prevents the body from releasing other hormones called catecholamines.  These hormones are normally released during times of stress (and not just in laboring women).  These hormones are what give you that "final rush" or renewed strength to push at the end of labor.  With the epidural hindering the body's release of these catecholamines, laboring women often need assistance to birth their babies (from vacuum/forceps extraction to C-Sections).
  • Postpartum Urinary/Bowel Dysfunction is when the mom loses the ability to control her bladder/bowel movements.  This can last anywhere from a few hours to a few months.
  • Uncontrolled shivering is a very common side effect (and reported to be very uncomfortable).
  • Loss of perineal sensation and sexual function.
  • Postpartum Backache which can last for months or even years.
There are other, more serious side effects (though rare) that should still be taken into consideration:
  • Epidural abscess is when a pus pocket is formed between the outer membrane of the spinal cord and the bones of the spine. 
  • Meningitis or MRSA
  • Blood clots are rare, but can pose a big problem if the clot travels (heart/lungs/brain).
  • Drop in blood pressure.  This happens with the administration of epidurals in almost half of the women who receive it.  Having the blood pressure drop can cause fetal distress due to an inadequate oxygen supply (via blood/placenta) but also can cause respiratory issues for mom and baby and sometimes even cardiac arrest.
  • Urinary Retention is an issue during labor for several reasons: having a bladder that becomes too full will hinder the dilation of the cervix and the rotation of the baby's head (in natural birth, the mom has frequent urges to empty her bladder for this reason).  A full bladder also increases the risks of mom having a bladder and/or urinary tract infection after birth.  In order to prevent the risks of an over-filled bladder, a catheter will be inserted when the epidural is administered.
  • Increase the chances that your upper body will feel itchy.  Women who have this side effect are given the option of taking another drug to combat the itchiness.
  • Nausea/Vomiting is extremely common with epidurals.  It does not, however, usually last long.  You may be given a drug to combat the nausea, but the side effect of most anti-nausea drugs is drowsiness.
  • Fever is not as common (only affects about 15% of all women who get epidurals) but the risks increase the longer the epidural is being utilized.  Epidurals hinder the body's ability to sweat (which is very common in naturally laboring moms) and sweat is the body's way of releasing excess body heat.  The danger to the excess heat is that it adds more stress to the baby.  This may cause the baby's heart rate to fluctuate and become erratic, increasing the odds that a C-Section is needed.  Most moms who get an epidural induced fever are also given antibiotics to prevent infection.  Fevers during labor may also prompt the medical team to give the baby antibiotics (and possibly a stay in the NICU).
  • Inability to effectively move around.  This is true in 100% of epidural cases and this can hinder the natural processes of labor, increasing the odds of needing birth assistance (vacuum/forceps) and/or an emergency C-Section.
  • Spinal headache is reported in about 10% of epidural uses.  Some spinal headaches can be mild and some spinal headaches can be debilitating (where you must stay laying down and prevent yourself from any sudden movements).  These spinal headaches can last a few hours, weeks, and in some rare cases, months.
  • Some studies have shown that there is an increased risk with postpartum hemorrhaging with the use of an epidural.  A British study found that epidural use almost doubled the chance of having postpartum hemorrhaging.
There are other very rare, but very serious side effects that can happen, including:
  • Allergic shock due to sensitivity to epidural medications.
  • Cardiac Arrest due to a sudden drop in blood pressure (which will also affect the baby).
  • Convulsions
  • Respiratory paralysis
  • Death
A big concern of mine was the possible side effects on a newborn baby.  While I have not been able to find many studies on the effects of an epidural on a newborn, "it has been noted that possible problems to the newborn are rapid breathing during the first few hours of life and vulnerability to low blood sugar." (Wikipedia).

Despite women being constantly reassured of the "safety" of epidurals, very few woman are given the possible side effects of epidurals.  If you read over the list and decide that the epidural is still your choice to help with birth pain, at least you are making an informed decision.  I do wonder, though, of all the women who are made aware of the possible side effects, how many would have still chosen an epidural.

There are other ways of managing labor pains.  The vast majority of labor pains can be managed through movement (walking, squatting, rocking, etc) and through guided visualizations/meditations.  When you learn to listen to your body and desired positioning, the "pain" factor diminishes immensely.  It has been proven that practiced visualizations and meditations also help to calm/quiet the mind enough to allow the laboring mom to go through the contractions without "fighting" the contraction.  The more relaxed the rest of the muscles of the body are, the more easily the uterus can contract effectively and less painfully.

There are other, drug-free, alternatives to pain management in child birth.  Did you know that dehydration and hunger increase the pain of childbirth?  This is why it is so important that laboring mothers are drinking plenty of fluids and eating when she desires.

Epidurals can be a very useful tool for emergency procedures, but there are very real risks to using an epidural.  The more you know about the possible side effects of epidurals; the more you know about alternative pain management during labor, the more informed your choice can be when it comes time to make the choice. 

Please note that I may not have included all possible risks and encourage you to do more research into the risks of an epidural.

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