Birth Mythbuster 3: Use of epidurals has no effects on the baby
Before I get into the topic of epidurals, I want to make clear that as a doula I do not try to sway my clients one way or another while in the birthing space, and that I only provide information about epidurals when asked. There have most definitely been times when I have witnessed that the use of an epidural is what has helped a laboring woman relax enough to get the rest she needs, and has allowed her body to labor down and open up, particularly during a LONG labor or when she is so tense from the pain of the contractions that she is preventing her body from opening. I myself am one of those women. I used an epidural on the third day of a labor induction, and I feel that is what allowed me to have the energy to deliver my baby vaginally. I encourage my clients to learn the facts about the use of drugs during labor, and then to make decisions based on the pros and cons of the facts. What bothers me is when healthcare providers and non-expert advocates of the use of epidurals (think your neighbor who wants to give you unsolicited advice to "get the drugs!!!!") say there are no real or lasting effects of getting an epidural, because there can be. So, what does the informed birthing person need to know?
1. Anything that goes into the mother's system does enter the baby's system through the complex workings of the placenta. This topic has been studied extensively, and still various studies come to various conclusions. The existence of the "placental barrier" used to be widely believed in due to the fact that alert babies were born to completely sedated mothers when that was the most common way to deliver babies in a hospital setting. Now however, it is understood by all that these drugs did pass into the placenta, but what was being observed was the longer lag time needed for the drug to go into the placenta and from there into the baby's system. While I was reading up on this issue, I realized that this topic is VERY complex, because the molecular make-up of any particular substance is what determines how much of the substance actually gets into the blood stream of the baby. So there are differing opinions on how much effect various substances have. Has your healthcare provider urged you to not drink alcohol during pregnancy? Why? Because it crosses into the placenta and since it is unclear how much alcohol has an effect on the fetus, the conservative approach is to avoid it all together. Many of these same practitioners, however, cite there is no effect on the fetus when a mother receives what is most likely an opiate injected into her blood stream during labor. The science tells us that these drugs do cross over to baby, it's just not clear yet how much of an effect this has.
2. Epidurals block the release of maternal hormones, which can directly effect the efficacy of labor. Labor and delivery is all a direct result of the release of hormones by the laboring woman. This slowing down of the release of hormones can impact the baby directly by making the labor longer and more tiring for the baby as it is also working to come into the world. Some researchers think the wide use of epidurals in turn contributes to the wide use of synthetic oxytocin in the form of the drug Pitocin (which was also administered in my first labor...I know there is definitely a time and a place). Another hormone which can be blocked by the use of epidurals are the beta-endorphins which naturally reduce pain, and allow the laboring woman to go into a naturally altered state. There are also stress hormones which surge at the end of a labor, causing the fetal ejection reflex by giving the laboring woman that final surge of energy to push her baby out. When these are blocked, women are often all out of energy by the end of their labors and are working against their own bodies to get the baby out. Babies and moms need all of the hormones created by the body to help deliver the baby most effectively, so the fact that the production of these hormones could be blocked with the use of an epidural should be one of the factors considered when women are talking to their care providers about their pain management plan.
3. The use of epidurals may have an impact on the breastfeeding relationship. Remember the disruption in the release of oxytocin I mentioned? This is one of the hormones largely responsible for the production of breastmilk, and the surge of this hormone during labor also triggers the initial production of milk. Some research suggestions that the production of milk is delayed or inhibited when an epidural is used during labor and delivery. The use of epidurals has also sometimes been shown to effect a baby's ability to do what is commonly known as the "breast crawl" and latch on their own initially. When placed skin-to-skin on his mother, a baby can inch his way toward the breast, find the nipple, and raise his head back just enough to open wide and latch on. Some research suggests that babies whose mothers used epidurals had more trouble doing this, and therefore needed more help learning to breastfeed, which can have lasting effects on milk transfer and weight gain. There is still much to learn about this topic, but it is definitely something to consider when writing your birth plan.
So, what's a modern laboring woman to do? I for one am so happy to live during a time when I have choices. I am disappointed when I hear care providers telling women there is "no need to be brave" when they forgo epidurals or choose to delay their use. Women report the most satisfaction with their birthing experiences when they feel empowered to make decisions that they understand and feel good about. I suggest that you READ, READ, READ and TALK, TALK, TALK to your provider. (For an interesting read on the use of epidurals, here's an easy to understand article.) Read sources that you trust and figure out their opinions about pain medication, specifically about epidurals. During your prenatal care, ask your healthcare provider about her opinion on the pros and cons of the use of epidurals to manage pain, and politely question her if she says there aren't any cons. Decide when the best time will be to get the pain relief and try to stick to that plan in order to minimize the effects. And when choosing your doula and any other support person ask about how they will respond to your choice to use medication or not. All people in the room, paid or unpaid should be supporting YOUR decision. No one should be trying to convince you to do something different (whether it's to use drugs for pain management or not.) Even when epidurals are used, the pain is not completely eliminated, and labor and deliver still require a lot of effort, concentration and intentional relaxation. So make sure to choose a doula who will support you no matter what you choose! This is YOUR birth experience.