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The Epidural and Labor Medications
You may not have been told the truth about the epidural and labor medications.
You may have been told the medicine does not cross to your baby and that it won't affect the course of your labor.
The reality is medications through blocks, injections, and administered by IV line do cross to your baby and they can affect your labor and birth experience.
Epidural Pain Relief
Epidural analgesia (pain relieving medication) has become a "norm" in modern birth. Many women plan an epidural into their birth plan. They automatically assume that the pain of labor will be too much to bear and intend to have an epidural right from the start.
This is fine with some women, but other women would give it much more serious thought if they knew the risks of the epidural.
For pain relief, the epidural is very effective (though about 15% of women will get incomplete or no pain relief).
An "epidural" itself is not a medication - it is the process by which a long needle is inserted into your back then into the tough membrane protecting the spinal cord (this membrane is the dura). Varying types of medications and variable doses are injected into this space.
Epidurals transform natural labor
When you have an epidural your natural labor becomes a medical event. The baby must be monitored continuously. You must have an IV line and two thirds of mothers will need a catheter (to drain urine because you can no longer go to the bathroom).
Most women cannot move the bottom half of their body when they have an epidural. Even the so called "walking epidural" is really a "shuffling epidural" because movement is still hampered. And an IV line must still be run.
Women who have an epidural have a much higher risk of having an instrumental delivery (forceps or vacuum) or a cesarean section.
The epidural relaxes pelvic muscles and makes it more likely that a posterior baby will remain posterior throughout labor. This makes the birth harder for both you and baby and again increases the risk of assisted delivery - which also increases the risk that the baby will be injured at birth. Bruises, blood clots, and facial injury are all possibilities for the newborn.
Epidurals Rob the natural pain relief
Epidural analgesia significantly affects the hormones that run through your body during birth. The depression of these hormones means that you're robbed of some of the natural ways to cope with labor.
It's harder to work with your labor because the hormones that would encourage your getting into the birth rhythm have been stopped or reduced by the epidural.
Labor has been shown to take longer with an epidural. With an epidural you're also more likely to need labor augmentation (help) from synthetic oxytocin to keep your labor moving. This greatly increases the risk of distress for the baby and cesarean section for the mother.
The natural high and euphoria of birth may also be taken from you. Because the hormones of birth are slowed down or stopped you don't feel the final surge of "feel-good" hormones as you push your baby out.
These hormones prepare you to hold your baby - and they help you to be alert and ready to interact with him or her. Loosing them can cause bonding problems for some mothers and babies.
Distressing Problems
You may suffer from a drop in blood pressure when an epidural is given. This can cause heart problems for you and distress for your baby.
This problem is so common that most doctors try to prevent it by loading a woman up on IV fluid before the epidural is even administered.
If you're given opiate drugs through your epidural there is a possibility of breathing problems for you. Epidurals given incorrectly can bring lasting headaches for you. Backaches are also a persistent complaint of mothers who have received an epidural.
Passing to Baby
Epidurals do not pose problems only for you. Your baby gets the medication from epidurals flowing through his or her body quickly after you're given the injection. Do not let anyone tell you differently - medications do cross the placenta to your baby.
Your baby's heart rate may be affected by epidural. Some babies are not able to stabilize their heart rate after the medication is given and an emergency c-section is required.
Epidural babies are often born in poorer condition than babies born with no medications given during labor. They have lower APGAR scores and require more resuscitation. They are more likely to have brain damage and seizures in the neonatal period.
If you develop a fever after being given an epidural (quite a common occurrence) your baby will have to go through a full sepsis workup.
This means that your baby will be tested for infection. A sepsis workup requires separation of mother and baby and it's also physically painful for your newborn.
These babies show a higher rate of jaundice in the days after birth and tend to be crankier. Their mothers rate them as more difficult and the bond between mother and child is not as strong as that of mothers who had a natural birth.
Breastfeeding is less likely to go well if you had an epidural.
Narcotics
These medications are given through an injection into the muscle (or an injection into the IV line). Narcotics can also be given in epidurals. They provide quick and temporary pain relief. They come with side effects.
Narcotics can make mothers sleepy and feel "out of it," as if they cannot connect with their own body. They can also cause nausea. Sometimes contractions can decrease in strength. Artificial hormones (Pitocin) used to make the labor "pick up" again bring a host of increased risks, as discussed above.
The baby is affected by narcotic injection. Respiratory distress is a possible side effect. Many, many babies whose mothers have narcotic pain relief during labor suffer from breastfeeding problems in the early hours and days.
Other medications
There are other medications similar to epidurals. Some types of medications are injected directly into the tissues of the pelvic floor to relieve pain for an episiotomy. These are normally given at the very end of labor and may not affect the baby, but the side effects for mothers are similar to epidurals.
Injections past the epidural space and into the spinal fluid or spinal space (called intrathecal and spinal blocks) can give faster pain relief than an epidural. The relief tends to be for a more limited time. There is a chance of headache, backache, itching, etc. - all the side effects associated with epidurals.
Summary
Some women really want to choose medication or epidural for pain relief. It is each and every woman's own choice. But you also deserve to know all the facts about the possible (and probable) side effects of these medications.
Women who have medications often say that they have the lowest amount of pain during childbirth. Interestingly, they often rate that they are the least satisfied with their birth experiences.
Studies have shown that women remember their birth experiences with remarkable clarity decades after they have given birth. The women most happy with the births of their children are women who have given birth naturally, without potentially harmful medications clouding the early hours, days, and weeks with their babies.