The word for today is Epidural. Sometimes they call it “epi” for short, but it doesn’t have a ring to it like “pit”. Epidural anesthesia, a form of regional anesthesia. Drugs are injected through a catheter that is placed into the epidural space. This causes both a loss of sensation (anaesthesia) and a loss of pain (analgesia), by blocking the transmission of signals through nerves in or near the spinal cord. If done correctly you should have a numbing sensation in this area:
Most everyone knows what an epidural is, and most laboring women (in hospitals) ask for it by name. There are hospitals in the USA with a 98% epidural rate for laboring women. Our government statistics are hard to find, but according to polls - hospital epidural rates run between 70-98% (with many in the business saying their hospital has an 85% or higher rate).When I had my first child 15 years ago, I was terrified. Our hospital was small and didn’t even offer epidurals back then. I asked for a cesarean just so I could avoid the pain of childbirth all together. . Thankfully, I had a doctor who didn’t just *do* cesareans out of patient request. I won’t go into my birth story, but in my case the fear was much worse than the contractions. My point is, that had my hospital offered epidurals -I would have had one placed weeks in advance. As it turns out, even if I could have had an epidural, I had no time to get one anyway. I went from 5cm to 10cm in 20 minutes. I can honestly understand the fear that many women feel, and I can relate to them wanting an epidural. I believe that our society has made birth such a scary event, and women are convincing themselves that they cannot endure a birth without pain relief. This is a sad thing.
If epidurals were risk free, the rising epidural rate would not scare me. I’d still cringe that women had lost the ability to trust their bodies, and strengths, but I could still live with it. I’ve actually heard stories of nurses telling mom’s that epidurals are RISK FREE! Hello! If they were risk free, you wouldn’t have to sign a waiver before the Anesthesiologist did the deed! Let us go over the pros and cons of epidural anesthesia:
Pros:
1. Almost always a complete relief in pain
2. Sometimes labor can progress more rapidly
Cons :
*Not always effective - 10-30% of women will not have adequate relief
A) Sometimes added boluses are needed and anesthesiologist needs to be called in
B) Sometimes anesthesiologist cannot make it in time so you labor without it anyway
* Stopping the progress of labor, increased need for Pitocin by about 90%
* hypotension (a drop in blood pressure) 12 - 23% -sometimes medication is needed to bring it back up.
* maternal fever - (then unnecessary antibiotic therapy - then the yeast infection - then.....)
An astounding 96% of all women who get a fever in labor have had an epidural. 86% of newborns are put on full-spectrum antibiotics, and have full septic workups while in the NICU have been born to mothers who had epidurals in labor. (This is just precautionary).
*itching
* inadvertent spinal (causing excruciating headaches, which a blood patch does not always a cure)
* nausea and vomiting.
* backache - this has become very common -and may last weeks and even months afterwards.
* fluid overload- because IV’s are needed and they run a risk of fluid overload that may lead to pulmonary edema.
* infection from epidural site
* respiratory arrest
* anaphylaxis
* nerve damage
*Decrease in the ability to push effectively. The build up of anesthetic simply weakens muscles to the point of ineffectiveness. Mother may not be able to push enough to effectively help the baby to rotate and descend.
*Cesarean: Eight primary studies revealed that the rate of cesarean section was 10 percentage points higher in the women who had received epidural anesthesia. One study actually found that the cesarean rate increased to 50 percent when the epidural was given at 2 cm dilation, 33 percent at 3 cm, and 26 percent at 4 cm. (The primary reason for section is fetal positioning is compromised).
*Mother feels detached from the process and becomes an observer; others may reduce emotional support. The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams. Sometimes mom may describe the birth as more cold - this can be due to mother not being in her left brain - where the birth memory is a little more ‘warm and fuzzy’.
Indirect increase in:
* operative delivery (forceps, vacuum, C/S) which all have their own risks
* episiotomy/tears (due to either the forceps, vacuum, or mom simply not being able to control the pushing stage effectively or move into a position that helps reduce tearing).
* oxytocin augmentation
* fetal scalp electrodes and intrauterine pressure catheters (IUPC)
* intrauterine infection - related to the increase in vaginal exams, IUPCs, etc.
*breastfeeding and infant behaviour - depending on amount of narcotic and anesthetic the baby has been exposed to. (Yes, they often use a narcotic for the local part of the epidural).
Very Rare Cases:
convulsions
respiratory arrest
cardiac arrest
allergic shock
nerve injury (1 in 10,000) usually causing numbness in one leg that will subside in weeks or months afterwards - seldom is it a permanent side effect.
Epidural abcess
maternal death
Risks to baby:
* fetal distress- bradycardia - one study reported 11% occurrence within 5 - 20 minutes of administration. Can cause fetal heart to drop or become irregular (leading to emergency c-section)
* Medication crosses placenta -especially the narcotic
* Septic workup and NICU care if maternal fever develops (may include Lumbar Puncture)
* Complications due to forceps, vacuum or cesarean section delivery
* Respiratory depression
* Increased likelihood of fetal distress due to mother's low blood pressure
* Short-term neurobehavioral changes, including irritability and inconsolability
*Drowsiness at birth
*Poor sucking reflex
*Poor muscle tone and strength for the first few hours after birth
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I know what you must be thinking right now. First of all, you may not believe all of the above. If you do, than you are most likely saying that these side effects are RARE. After all, if 95% of women in the hospitals today are living to talk about it, and say how wonderful they are- these risks must be REALLY, really low. Well, I am finding that many of these risks are not really that uncommon. Some more than others, obviously. I did an informal poll across the internet. I asked a series of questions from women who have had epidurals, and asked for their honest response. I had about 80 people respond, though I do not have all of their results complied quite yet. I’ll give you what I do have already. (I'll try to get everything added up and added soon!)
Did it (the Epidural) work effectively the whole time?
38 yes- 17 no
Some comments from those surveyed:
“I had "windows" in 2 places up until my c-section”
“it started wearing off”
“ No way! I had a window of pain from the beginning and then it completely stopped working after an hour.”
“No. It didn't take on the right side of my body ever. For 8 hours or so I could only feel excruciating pitocin contrax on my right side and I couldn't move to help me get through them.”
Sort of’s - 4
I had to have two boluses before it worked well”
“Yes, epidural worked effectively - did wear off after about 9 hours and CRNA never rebolused when I asked for one.”
“ It failed when they took me to the OR for a c-section.”
If not, how long did you have to wait for the Anesthesiologist to come back and fix it?
5 people said “30minutes”
1 person-unsure - the anesthesiologist had to fix it a total of 3 times, but was quick to come each back each time
1person said:- 45 minutes
2 people waited- one hour
1 person waited- 1.5 hours
1-person commented: “several hours”
2 people said it was never fixed
(One comment): “No, it was never fixed- it didn't go into the right spot and I had a non-med labor”
**NOTE - some of the above women marked YES to the first question on “did it work effectively the whole time?” !!
Did you or the client have itching?
19 Yes 35 no
comments from the Yes people:
“God-awful”
“ it about drove me nuts.”
“Yes, horrible itching!”
“Very much so, for at least 12 hours.”
“Yes, so severe I almost took off my skin with a washcloth”
Was there a drop in blood pressure?
Yes -22 no 35
Some comments for some of the 'yes' answers':
YES!! I was not regestering at all had to give me three shots and stop my labor for a while
Yes . I dropped to 40/20..i could not even see for a sec...but they pushed some meds
Yes, quite severe involving several injections of epinephrine to fix it.yes drop in blood pressure drastically actually, my breathing became erratic, I got dizzy, starting blacking out.
Any trouble breathing?
Yes - 5 No -49
““Eventually she had difficulty breathing as her diaphragm had been relaxed to the point she could not adequately respirate. After a brief loss of consuciousness, the amount of epidural was scaled back. The anesthesiologist did not return until the second time she stopped breathing and a code was called”
A drop in fetal heart rate?
yes-23 no - 29
“The baby lost variability about 2 hours after the placement of the drip and was delivered by crash c-section. “
“yes there was a drop in fetal heart rate and because of it I had to be rushed for an emergency c-section”
A fever?
Yes- 8 no- 47
Was Pitocin needed?
Yes - 20 No - 34
*several of those no’s were because they were being induced with pitocin anyway
Was internal fetal monitoring used?
Yes -17 no -39 (some did not answer this question, or didn't know the answer, so I left some out)
Did the baby need help with forceps or vacuum?
yes - 12 no-33
Did you have an episiotomy?
yes -19 No- 30
Did you end up having a cesarean?
yes 15 no 41
Did you develop a spinal headache during or afterwards?
Yes -5 no-49
“YES! Then I did two blood patches to try to fix the problem”
(from a doula): “One client; it lasted for 5 days postpartum and she received 3 blood patches which didn't work. She reported it worse than labor.”
Did you have any long or short term effects from the epidural?
Yes - 21 no- 31
Some specifics for those who answered ‘yes’ to side effects of epidurals:
"my bladder "froze" I could not go to the bathroom til the next morning. (almost 24 hours)"
" urinary incontinence still"
"unable to control bladder (no feeling) and use of legs for 1 week afterward"
"I had some back pain for awhile"
"Intermittant soreness at the epi site for about 6months"
"I had a persistent backache at the spot it was inserted for about a year or so"
"The only thing I remember is having back pain for 6 - 12 months after. I didn't think at the time is was due to the epidural, but looking back seems like that would make sense as it was pain in the middle back where it was put it."
" I have pain at the epi-dural site during my period."
"I have achy back in the spot where the epidural was, but not serious."
"..it numbed me from the neck down. I could not move for over two hours"
"Yes - permanent nerve damage down left leg. Unable to walk for 3 weeks."
"was left paralyzed for about 6 weeks and disabled for several more months. I still have
issues with the injury every few months. I will pay for the rest of my life
for my epidural."
"I had an allergic reaction that made it difficult to walk for the first 5 days postpartum. I felt very weak. "
"numb patches on leg for a few days afterward"
"Just my one leg being over numb"
"The only effects I noticed a little numbness in my left leg. After I got home was when I would bend over to pick up something or change my daughter's diaper or something like that.. I would get a terrible pain in my lower back. That lasted for about a year... But it was worth it!! "
"I have severe back pain at all times, and get very frequent migraines."
"my back hurts whenever I bend over, doesn't matter how long I bend over for, it always hurts pretty bad."
"After 11 months I have horrible back pain, sometimes I can’’t even pick up my daughter or get up off the floor it hurts so bad."
"yes I have lasting effects from the epidural that didn’t even work."
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Twenty-one women said they had long or short term effects -and several said that the epidural was still worth it! So how many women *are* out there living with some little ache or pain due to their epidural, but still feel “it was worth it”? For those who have not experience a birth any other way, how can they truly be sure it was worth it? I’m not talking about the woman who gave it her all, and truly tried to get through birth without one.
There *are* benefits of a drug free birth. The pros for a drug free birth are much longer, and the cons are much shorter. In our society, women are convincing themselves that childbirth is like a dental procedure. You may have heard the comment “well you wouldn’t have a tooth filled or pulled without novacaine”! Birth is no where near this type of procedure. I could give several rebuttals for this comment, but right now I’ll leave it alone. Our bodies were made to do this, and do it very well. There are so many things that we can do to help ease the intensity of contractions - and many women not only find it bearable, some find it virtually painless. Not everyone, but humans have been giving birth quite well without drugs for thousands of years. We were made to do this, and in most every case, it is very do-able. It takes a lot of things to make it do-able - and we need the support of our care-providers and hospitals to make it more manageable. For example, no Pitocin unless truly necessary. Keep women out of bed, and let them choose the positions they labor and birth in. Tubs and showers for everyone to labor and even birth in. I could go on, but this is already a really long blog today.
I think I’ll try to add a blog tomorrow on the benefits of birthing drug-free. This way you can understand why I feel epidurals should be used less frequently.
Thanks for reading
~The Birth Teacher
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