7 December 2019
Why You Shouldn't Have An Epidural During Childbirth
Thousands of women give birth around the world every single day. It is estimated that about 61% of these women receive epidurals or some form of pain reliever. However, not many women know that this is merely a choice due to the imposed pressure provided by healthcare professionals. This choice is important to be aware of due to the unintended risks epidurals can have on a mother's body. If these women were given the full informed consent they are entitled to when having an epidural administered and are aware of the effects an epidural has, the likelihood of them receiving the epidural would lessen. Unmedicated birth is the most beneficial option for a mother and her baby because it eliminates any unintended side effects that can arise from an epidural for the mother, as well as her baby. Although receiving an epidural is a common occurrence for many women, it is usually done without them ever knowing the implications it can have. Usually, the pain and intensity of the situation are so high that it clouds good judgment and decisions are made in haste. As a result, mothers are left open and vulnerable with the risk of experiencing various consequences of the epidural. It is important for women to know its effects in order to prevent any repercussions. This leads to the question: What are the effects of an epidural on the body during labor and after birth?
Epidural analgesia, or more commonly known as an epidural, is a form of pain reliever that numbs you from the waist down. The epidural is injected through the lower back into the epidural space between lumbar vertebrae two and five (Simkin). This is a very dangerous procedure on its own because the insertion of the needle is in the space before the dura mater of the spine or the epidural space. The dura mater is the third outermost layer of membranes that surround the spinal cord. After the needle is inserted, the anesthesiologist will insert a catheter and remove the needle. Thus, if the procedure is administered incorrectly, there could be implications in the patients' ability to walk afterward. Especially, since the dynamic of the hospital room has high amounts of pressure and is fast-paced, making it easy for mistakes to occur. The administration of the epidural while in labor is a heavily debated topic between women who are pregnant or trying to have children and their families. The contentions revolve around the idea of birth as such a painful experience and that no one wants to experience pain, yet an epidural has many negative side effects, not only to the mother but to the baby as well.
Epidurals are commonly known to slow down the progression of labor. Having slowed labor is harmful for many reasons, but mainly because it causes an increased chance of the mother and baby's heart rate to drop and then needing a cesarean section. Furthermore, when slow labor occurs in the second stage it increases the rate of an instrumental vaginal delivery by 20-75% (Simkin). Instrumental vaginal delivery involves the insertion of a medical device to pull the baby out. These devices can include the use of a vacuum or forceps. A study was also done to show that "... there is sufficient evidence to conclude that epidural is associated with a lower rate of spontaneous vaginal delivery, a higher rate of instrumental vaginal delivery and longer labors..." (Lieberman, Ellice, and O'donoghue). The lower rate of spontaneous vaginal birth means that women are depending on these drugs that are given to them instead of letting their bodies naturally do what they are meant to do. What is also not so commonly known is that when the progression of labor is slowed, it causes a need for "...Pitocin; and has been found to increase the chances of a cesarean delivery in primigravidas by two or three times." (Simkin). When you have slowed labor it is an indicator that the mother is insufficiently producing the oxytocin hormone. Oxytocin is the hormone that allows for the contractions so begin and increasing so the birth can happen. Pitocin is a synthetic drug that imitates the hormone oxytocin, "the love hormone." However, Pitocin is an entirely different drug that has its own unintended effects. The unintended side effects that come with it are increased frequency and intensity of contractions. If we continue along with this domino reaction, we see a cesarean section is the next result. A cesarean section is something that most people do not desire because it is a major abdominal surgery that greatly increases the number of risk factors.
In active labor, having an epidural can increase the risk of many complications. These complications can range from a minor disruption, such as frequent shivering, to something major and life-threatening, such as paralysis. These implications can cause a rise in temperature that leads to an infection, a drop in blood pressure, short or long-term backache, spinal block resulting in a spinal headache, shivering, itchiness of the skin, retention of urine, as well as mistakes due to human error (Simkin). Although these effects may seem very small and manageable, they can all lead to something potentially more dangerous. Infection can lead to fevers and more sickness. A spinal headache is a very intense headache caused by the leaking of the cerebrospinal fluid from the membranes that surround the spinal cord. This leak has to be treated by a blood patch to prevent any more expulsions of the cerebrospinal fluid. Additionally, if the retention of urine is not caught and a catheter is for some reason not placed the bladder could rupture.
There are many unintended effects that an epidural has that illustrate just how potentially dangerous epidurals can be to the female body. After a woman has given birth, the effects of the epidural can continue to affect the bodies in many ways. First, it could affect a mother after birth, although that is very rare. It is caused by "...residual numbness or weakness from needle injury to nerves (almost 1 in 10,000), delayed respiratory depression with epidural narcotics (up to 12 hours later), and brain damage and death (extremely rare)" (Simkin). Although this particular unintended implication is very rare, it is still a possibility that can happen and everyone should be aware of. Another unintended implication that could arise if a mother decides to receive an epidural is the effect it has on breastfeeding. Epidurals decrease the chance of the successfulness of breastfeeding. Breastfeeding plays a huge role in the development of a child. It provides nutrients for the baby as well as antibodies that help fight off infection. In a study done with 189 women, the outcome concluded that "Intrapartum maternal opioid administration, especially meperidine (pethidine, Demerol) administration, decreases breastfeeding success" (Akbas, Mert, Akcan 24). If there is a decrease in success in breastfeeding, women are more likely to turn to the usage of formula. While formula can sustain an infant, it does not supply the baby with all the natural antibodies and nutrients. If a newborn does not have the necessary antibodies to fight off sickness and diseases, there is an increase in the chances of the baby becoming ill more frequently.
When an epidural is used during active labor, it causes many unintended side effects on the baby's body. Since the baby is still inside the womb and receiving everything from the mother through the umbilical cord it is bound to receive a small amount of the epidural. This causes an abnormal or high heart rate to the baby's body and a higher chance of the baby being septic (Lieberman, Ellice, and O'donoghue). An increased heart rate can cause a lack of oxygen to the baby. If the lack of oxygen persists, it can cause further damage to vital organs. Additionally, there is an increased likelihood of a newborn septic workup being performed just because the epidural was administered (Simkin). The risk of the baby being septic is a very serious issue because it is life-threatening.
After birth, the baby can still experience unintended aftereffects of the epidural. These effects can hinder the baby's ability to root and suck during breastfeeding and can cause neuro deficits. In studies, "Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies." (Simkin). As mentioned prior, this correlates to the effects of epidural on a mother because it affects her ability to produce milk or lactate. Moreover, healthcare professionals even witness these effects and make the connections among this harmful practice. In other findings, the aftereffects of epidurals can be "Short-term (six weeks or less) subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light..." (Simkin). Although these effects are not long-term there is still a possibility that complications can arise from them. Prolonged and decreasing responsiveness can turn into a long-term consequence and should be taken seriously.
The main reason everyone has about getting an epidural is pain. Unmedicated births provide an alternative to receiving an epidural. Unmedicated births can happen in one's home or even at the hospital, there are homeopathic remedies that can help in labor and also different techniques that do not cause any harm to the mother or the baby. Hypnobirthing is a birthing technique where you use positive thoughts, and positive affirmations for yourself to relax the body. With this method, a woman has the ability to have complete control over her mind and body. Allowing oneself to go down this unmedicated path, rids themselves of all the chemicals and synthetic hormones that are injected into their body when they receive an epidural. Research shows that "women in the hypnosis intervention experienced less pain, decreased time in active labor, and fewer days in the hospital..." (Varner). This reveals that hypnobirthing is an excellent way to effectively give birth in an unmedicated way that is natural and beneficial to both the mother and her baby. Most of the outcomes and effects of hypnobirthing are the complete opposite of receiving an epidural. The decreased time in labor eliminates all of the negative implications of having a slowed and lengthy labor. In turn, the need for a cesarean section or Pitocin is decreased.
Another alternative to having an epidural is using techniques such as the double hip squeeze. Double hip squeezes effectively alleviate some of the pain during labor by taking relief off of the hips. While this method is only a temporary method of pain relief it does not have any negative implications, unlike epidurals. When the baby begins descending the birth canal, it causes the pelvis to stretch, in turn putting intense pressure on the sacrum (McCulloch). This pressure on the sacrum can cause serious back pain during labor. By utilizing this method during labor, the pelvis allowed to open up. This technique provides relief for the mother and allows the baby a little extra wriggle room to move down (McCulloch). Thus, the double hip squeeze can also expedite the process of birth.
Holistic methods such as the use of homeopathic medicines, also provide us with a positive and natural alternative to having an epidural. There are various types of homeopathic medicines that have different effects on the body. These methods also prove to be an effective way of handling medical crises that can naturally arise during labor. For example, Arnica is a type of homeopathic medicine. Arnica is responsible for effectively reducing the bleeding or hemorrhaging caused by giving birth. In a double-blind study, Oberbaum drew a conclusion that "Treatment with homeopathic Arnica montana and Bellis perennis may reduce postpartum blood loss, as compared with placebo." (Oberbaum). It has been stated that "homeopathic medicine has been shown to shorten labor time and help prevent or minimize the possibility of a difficult birth if taken at the beginning of the ninth month daily." (Feder). Another homeopathic medicine is Caulophyllum. This medicine helps women with weak or incompetent uteruses who have previously had a slowed labor. Knowing how different homeopathic medicines can help during labor and delivery can put one's mind at ease when thinking about a home or natural birth. Although homeopathic medicines cannot reduce the pain brought on by childbirth, they can act as a substitute for the medications that are needed during labor and delivery.
All in all, there are a lot of negative unintended side effects that can arise from an epidural. Every woman is different and the effects they encounter will vary. Some women may be lucky enough to not have any effects while some could have the majority of them. There is also the chance of a human error occurring by the anesthesiologist during the procedure. This error can happen while inserting the needle into the patient and accidentally going too far causing it to hit the spinal cord. The result of this error can be complete paralysis of both legs. An epidural can cause the labor to be slowed which creates a negative domino effect of what the patient will need in order to deliver. These things can include the administration of more drugs, like Pitocin, which plays a role in picking the pace of labor back up, but if it continues to be slowed it can result in the baby and mother's heart rate to drop which causes for an emergency c-section. Overall, the unintended effects can potentially cause harm to the mother as well as her baby. However, there are other options that can provide a seamless and successful birth. Unmedicated births prove to be more beneficial because they do not require medications that have harmful side effects on the body. For example, hypnobirthing is a technique used to ensure a calm, peaceful and controlled birth. It does not completely relieve the pain, but it does lessen it. Another technique that can be used is double hip squeezes. These are done to alleviate the pressure put on the pelvis. Holistic approaches to birth can be very beneficial as well. The homeopathic medicines have various positive effects on the body for every stage of the pregnancy and in labor and delivery.
Akbas, Mert, and A Baris Akcan. "Epidural Analgesia and Lactation." The Eurasian Journal of Medicine, Atatürk University School of Medicine
Feder, Lauren. "Homeopathic Medicine for Easier Childbirth."
"Health Topics A-Z." PeaceHealth
Lieberman, Ellice, and Carol O'donoghue. "Unintended Effects of Epidural Analgesia during Labor: a Systematic Review." American Journal of Obstetrics and Gynecology, U.S. National Library of Medicine
McCulloch, Sam. "Double Hip Squeeze - What Is It And How Is It Used?" BellyBelly
Oberbaum, Menachem, et al. "The Effect of the Homeopathic Remedies Arnica Montana and Bellis Perennis on Mild Postpartum Bleeding--a Randomized, Double-Blind, Placebo-Controlled Study--Preliminary Results." Complementary Therapies in Medicine, U.S. National Library of Medicine
Simkin, Penny. "Weighing the Pros and Cons of the Epidural." Childbirth Solutions
Varner, Corry A. "Comparison of the Bradley Method and HypnoBirthing Childbirth Education Classes." The Journal of Perinatal Education, Springer Publishing Company