By Connie Livingston
Read more from Livingston at Childbirth Today
There are many controversies in maternity care. The spectrum of debates run to both ends of the spectrum: from those who feel all women should have interventionized maternity care to the home birth advocates. However, one of the most controversial topics in care is epidural anesthesia.
Fueling the flame of the epidural controversy are the diametrically opposite positions published in anesthesia journals vs. those in other medical journals such as nursing, midwifery and family practice.
In most hospitals, laboring women who have received epidural anesthesia are confined to bed as they no longer can rely on their legs for stability. This may severely limit movement and positioning. Additionally, hospitals may have a policy that all laboring women receiving medication, specifically epidural anesthesia, have an internal fetal heart monitor in place. This requires breaking of the amniotic sac or membranes in a procedure known as amniotomy. Occasionally, it may be necessary to augment or stimulate a labor with Pitocin after an epidural has been given, as epidurals have been shown to slow some women's labors – making the labor longer and harder on the woman’s body (Mayberry, L.J., Clemmens, D., De, A. Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review. American Journal of Obstetrics & Gynecology. 2002 May;186(5 Suppl Nature):S81-93.)
Researchers have linked epidural anesthesia to assisted delivery, or the use of forceps or vacuum extraction during the pushing portion of labor (Torvaldsen, S., Roberts, C.L., Bell, J.C., Raynes-Greenow, C.H. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. Cochrane Database Systematic Review. 2004 Oct 18;(4):CD004457.). Researchers also find that 88% of women who requested an epidural for pain in one study reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity. Pre-labor survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings.(Kannan, S., Jamison, R.N., Datta, S. Maternal satisfaction and pain control in women electing natural childbirth. Regional Anesthesia and Pain Medicine. 2001 Sep-Oct;26(5):468-72.)
Epidural anesthesia also causes a drop in maternal blood pressure, thus the need for 1000 ml of IV fluids administered prior/during the administration of the anesthesia.
For the newborn, the effects of epidural anesthesia are more hazardous. Women who have epidurals are less likely to fully breastfeed in the first few days and are more likely to stop breastfeeding in the first 24 weeks due to the difficulty newborns have in coordinating sucking and latching. (Torvaldsen, et al. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. International Breastfeeding Journal 2006 Dec 11; 1:24. Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. When used in combination during the labor process, which happens frequently, epidural anesthesia and pitocin influenced endogenous oxytocin levels negatively ~ thus negatively impacting both milk ejection and milk production. Jonas et al. Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin in response to suckling during the second day postpartum. Breastfeeding Medicine 2009 June; 4(2): 71-82.
Countless other studies including the Journal of the American Board of Family Medicine and Dr. Sarah Buckley all focus on the hazardous impact of epidurals on breastfeeding and the newborn.
This evidence may be an inconvenient truth.