4.13.2010

Epidurals: The Risks to Mama and Baby

There are some situations where an epidural helps a women during labor, but for the most part epidurals interfere with the normal progress of labor and may negatively affect the baby and/or the mama. Before you choose to have an epidural during labor it's important to know all of the risks associated with this drug so you can weigh the risks and benefits and choose wisely.

Maternal risks
Hypotension (drop in blood pressure) - This is the most common side effect of an epidural. When your blood pressure drops it reduces blood supply to the placenta and your baby becomes distressed. The best way to reduce the risk of hypotension is to stay off of your back, but when you have an epidural it's hard to stay off your back.
Urinary retention/postpartum bladder dysfunction - This is a direct result of having a urinary catheter in place, which you can't really avoid if you have an epidural because you most likely will not be able to move much or at all. This increases your risk for a UTI and your bladder control may be lost for days, weeks, or months because of strain on the numbed pelvic floor muscles.
Uncontrollable shivering -  This is a very frequent side effect of an epidural. Most mamas I know that have had an epidural have had this side effect. It's uncomfortable for the mama, I mean, who wants to be shivering uncontrollably while laboring!? Use blankets, warm rice socks, and massage to help ease shivering if you do choose an epidural.
Itching of the face, neck and throat - I've been prescribed narcotics in my life that have made me itchy. Not fun! Especially not fun if you are laboring and about to give birth. This side effect is more of a nuisance than anything but do you really want to feel itchy? Some doctors will give a drug to combat this side effect which will have it's own list of risks.
Nausea and vomiting - Feeling nauseous and vomiting is uncomfortable. Some women get this even without the epidural, but the chances of it happening are of course higher if you do have an epidural. Nausea and vomiting can waste resources and deplete the mama of much needed energy for all that hard work she has to do. Medicine is usually give to help this effect but the side effects of that are intense sleepiness. Labor is tiring in itself, I can't imagine being even more tired. 
Maternal fever - Epidurals affect your ability to sweat, if you can't sweat you can't get rid of excess body heat, and let's face it, labor and birth is a pretty sweaty ordeal. Not only is the side effect extremely uncomfortable for mama but it also can cause the baby's heart rate to become distressed from the fever increasing the odds of a c-section. Babies are often separated from their mothers immediately after birth to check for infection.
Spinal headache - Generally cause by postdural puncture and leaking cererbrospinal fluid. Can range from mild to completely debilitating and last from days to weeks.
Uneven, incomplete, or non-existent pain relief - Uneven or incomplete pain relief is almost worse than having no pain relief at all. Personally, I would rather be in pain. Labor and birth hurt, yes, but it ends!
Feelings of emotional detachment - Some mamas feel detached from the birth experience due to the full effects of the epidural. This may affect the mother and baby bonding experience.
Postpartum feelings of regret - This depends on the mama. Some mamas plan for a natural birth or don't want an epidural, but hospitals are really good at talking mamas into getting one. The best thing that you can do is tell your providers your wishes beforehand and hope that they will respect that.
Inability to move about freely - Not being able to move inhibits labor progress and increases the likelihood of a cascade of interventions. The supine position is the worst position for giving birth, yet that's what position you will have to be in if you have an epidural. The supine position focuses your body weight on your tailbone which in turn narrows the pelvic outlet, increasing the length of labor and making delivery more difficult. This position also compresses blood vessels which interferes with circulation and decreases blood pressure which in turn lowers oxygen supply to the fetus and causes distress.
Loss of perineal sensation and sexual function - Generally from an episiotomy or use of forceps but can be cause by nerve damage as a result of the epidural

Extremely serious side effects:
Convulsions
Resp. paralysis
Cardiac arrest
Allergic shock
Epidural abscess
Maternal death

Baby Risks
Direct drug toxicity - All drugs that a mama receives in labor pass through the placenta to the baby. Babies are more vulnerable to the toxic effects of these drugs. A study from Sweden shows that epidurals are significantly associated with a low Apgar score at birth 2. One of the major problems babies experience from epidural usage is trouble breathing.
Fetal distress (abnormal fetal heart rate) - Fetal distress can lead to more interventions including increases risk of a c-section. C-sections are also risky to the baby and mama.
Drowsiness at birth, poor sucking reflex - This can affect the mama and baby bond after birth. The poor sucking reflex can be frustrating to the mama while her and baby are learning how to breastfeed and can result in the unecessary use of formula to "get something in the baby." The use of formula will negatively affect breastfeeding and the chain reaction of negative events continues.
Poor muscle strength  and tone in the first hours - There is a greater chance your baby will be taken for observation and oxygen after birth. Not only will the mama and baby be separated immediately which can affect both of them, but also means that your baby could receive test and interventions that are unnecessary.


Labor risks
Prolonged first stage of labor -
A prolonged first stage of labor can be really exhausting for mama. This can lead to use of pitocin, which leads to other interventions, fetal distress, and sometimes will result in a c-section. The cascade of interventions starts here. A waterfall!
Malpresentation of baby's head - Relaxation of the pelvic diaphragm predisposes malpresentations as does lack of mobility and switching positions.
Increases need for pitocin - Pitocin is very harsh on both the mother and baby. Some baby's can't handle the intensity of pitocin induced contractions which leads to fetal distress, more interventions, and sometimes a c-section.
Prolonged second stage of labor - Unfortunately a lot of care providers, especially in hospitals, put time limits on your labor. If the second stage goes beyond their time limit (usually 2 or 3 hours) then they will essentially force a c-section on you.
Decrease in ability to effectively push - If you can't effectively push then your chance of c-section increases.
Increased likelihood of use of forceps or vacuum extraction - The chance of these interventions if five time greater when an epidural is used. Five times greater! Forceps and vacuum extraction cause undue stress on the baby.
Increases chance of c-section - A c-section is major abdominal surgery and holds much more risk to mother and baby than a vaginal delivery. The c-section rate in the United States is astronomical.



When a mamas labor is progressing normally then the risks usually outweigh the benefits of an epidural. However, if she's exhausted, labor is not progressing normally or if she requires painful interventions then the benefits may outweigh the risks. I have a friend who was in hard labor for over 48 hours. I'm talking hard. She was dilated to 9 for about 4 hours and labor was not progressing at all. She started at the same birth center I went to but was eventually transferred to the hospital after that 2 days of intense labor. She lasted a long time naturally but she was very exhausted and obviously no progressing no matter what she did. This is a case where the epidural was beneficial. She needed to rest.
Research the risks and benefits before you make a decision. I can't stand when I see women touting the "I want an epidural in the parking lot" phrase.


 Sources
http://www.gentlebirth.org/archives/epdrlrsk.html
http://www.healing-arts.org/mehl-madrona/mmepidural.htm
1. K. Thorngren-Jerneck and A. Herbst, “Low 5-Minute Apgar Score: A Population-Based Register Study of 1 Million Term Births,” Obstet Gynecol 98, no. 1 (2001): 65–70.


Jessica

2 comments:

Lauren said...

Yeah! I like posts like these much better than the constant reviews! It's scary how many women routinely get epidurals without considering the huge risks!

Amber, The Unlikely Mama said...

I just love it when I hear women say that it's completely safe...because that's what they're doctor told them :-/

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