Epidurals don't affect the baby? - Page 3

[mollyeilis]

Something I've noticed about birth is that many people generalize.

When I was practicing chiropractic and asked questions about the patient's own birth and any births the patient had had (hard to write that out), they would invariably say "oh that's just how they were doing things then".

I could have 3 50 year old women on one day tell me vastly different birth stories about their children, all born in the same year, but they would all say "that's just how it was done then".

I've noticed it in health care professionals as well. For instance, my stepmom-the-neonatal-nurse works for what seems to be a highly progressive, good hospital (although from her description they do tend to berate the "failed" homebirthers who come in; guess who doesn't know I'm homebirthing?), and she simply refuses to believe that things are different in other hospitals.

I'm not sure what the block is, but I was trying to tell her things that have happened to friends or online acquaintances, and she just couldn't hear me.

Not sure if this is relevant here, but I thought I'd mention it.

[crazy_eights]

Originally posted by Greaseball
It's true, some epidural babies come out "just fine" even when mom has been warned of the risks. Some formula-fed babies even turn out fine, or at least they appear to be fine. Sometimes the mother uses illegal drugs, and the baby also appears to be fine. So if such a mother hears all the stories and her baby is allright, she will probably discredit us, but I don't think it hurts to warn her.

Instead what we are doing is telling these women that there are almost no risks (consent forms do not always explain risks) and then blaming the baby's condition on the mother or baby instead of the drugs.

You seem to be missing the point. I am all for warning about the risks of epidurals. What I am NOT for is telling FALSEHOODS about what will happen if you have an epidural. Telling a mom she has an increased risk of having a malpositioned baby - that is a real risk with real information. Telling her she might have a blue, floppy, depressed baby as a result of an epidural is simply NOT TRUE.

[Greaseball]

How do you know it isn't true? Because you've never seen one? A lot of other practitioners have. What should they tell their clients?

[kama'aina mama]

What chava says makes a lot of sense. If you are really married to talking about blue floppy babies you should probably be clear that it is pretty rare. (I would also be interested in knowing if it is provably linked to epidural...) Telling people horror stories that are likely to be discounted before their very eyes is not helpful in terms of making your case.

[eilonwy]

Originally posted by Greaseball
How do you know it isn't true? Because you've never seen one? A lot of other practitioners have. What should they tell their clients?

Um, how do you know it is true? Because you've seen one video with a blue floppy baby in it and an epidural? How do you know it wasn't just the color scheme of the tv acting up, to say nothing of some other factor in the birth?

[Greaseball]

I've also read a lot of birth activist materials, and even books written by non-activists, including doctors. Why would they lie? For fun? They make more money with an epidural birth; why would they say things to discourage them if htey weren't true?

People who work at different hospitals have different experiences. I worked at one where every patient given a certain type of drug developed harmful symptoms. Other people at other hospitals report that almost none of their patients developed harmful symptoms. I don't think that means "it's not true." I think it means we observed different things.

Although I have not observed births, I don't see any reason why those who do would write a book full of lies.

[Lucky Charm]

I'm with mom2six.

I have seen so many births, most of the moms had epidurals, and the instances of a blue floppy baby was incredibly rare!

[eilonwy]

Originally posted by Greaseball
Although I have not observed births, I don't see any reason why those who do would write a book full of lies.

In other words, you're willing to question data but only when it's not what you want to hear. You're very quick to believe what people tell you as long as it is what you want to hear. Have I got that straight?

[Greaseball]

Yes. Aren't we all? Don't you tend to believe things that mesh more with your own beliefs as well?

That may be why no one is willing to admit that a lot of health professionals and mothers have noticed harmful side effects from epidurals, which include weakness in the baby. The literature is not hard to find, but who wants to read it when they already have their own belief? Aren't we questioning data when we say that what is written by Dr. Mendelsohn, Ina May Gaskin and other supporters of natural birth is not true?

I know people are afraid to list all the bad side effects because women don't want to hear "horror stories" (Ina May's book was criticized because it listed maternal death as a side effect of the epidural), but I think keeping people in the dark about horror stories is what allows the horror to continue. No one wants to admit that formula feeding increases the risks of infant death (yes, even in America) - it's just too horrible. Well, it's the first thing I tell people.

[eilonwy]

Originally posted by Greaseball
Yes. Aren't we all? Don't you tend to believe things that mesh more with your own beliefs as well?

No, not really. Just because something is what I want to hear doesn't make it true, that's why I do the research. I prefer facts to idle speculation. I don't just stop when I find something which supports my initial hypothesis; that's not logical. I feel a strong need to look at both sides of an issue (or all three, or however many there are) before I make a decision, and I couldn't call it an educated decision if I made it any other way.

I too have told people that artificial feeding methods are more likely to result in death than natural ones, and have explained the reasons for it. I also explain that it's extremely unlikely in either case. Breastfeeding is very important to me, but when you tell someone "A baby is more likely to die of SIDS if you give them formula" you're not likely to make a convert. They're going to think "I've encountered dozens/hundreds/thousands of formula fed babies, and not one of them died of SIDS. Where the heck does this freak get off telling me that formula will kill my baby?" It doesn't help, and it does take your opinions about everything down a notch or two in value, when people can immediately discount that one.

[crazy_eights]

Originally posted by Greaseball
How do you know it isn't true? Because you've never seen one? A lot of other practitioners have. What should they tell their clients?

Can you quote a source for this? That the current technique for epidurals causes an increase in blue floppy babies? (the technique has evolved a lot over the years)

BTW - My experience is not limited to one hospital or even one country.

[Greaseball]

It was stated in the childbirth section of the most recent "Our Bodies, Ourselves." It specifically mentions floppy babies, although it did not say they were blue.

Their source for that information was "The Thinking Woman's Guide to a Better Birth."

Ina May's new book mentions that the baby's heart rate can drop, and the baby may have breathing difficulties and trouble breastfeeding.

Cohen's "Open Season" reports an increase in fetal distress, drowsiness, poor sucking reflex, long-lasting hyperactivity, poor muscle tone (floppy?) and lower apgars. She says, "One hospital pamphlet boasts about their epidural refresher classes. If I taught epidural classes, very few people would have one, guaranteed."

How new is the new technique, and what is different about it?

[Lilg127]

This is one of my biggest pet peeves. I've had so many people tell me epidurals don't reach the baby. Than they get pissed at me when I tell them the facts otherwise. I hate it!!! I hate the mentality, I hate the misinformation out there...

[Greaseball]

And the thing is, a lot of OBs even know the facts but they can't bring themselves to tell their patients.

Our ped congratulated me on choosing homebirth and she said "But I can't tell anyone else here that I feel that way." Why not? Why can't she tell people the truth - that for most women, homebirth is safer?

Dr. Mendelsohn used to refuse to see patients who would not breastfeed. I wonder if there are any OBs who refuse to attend the births of women who are going to ask for drugs.

[crazy_eights]

Originally posted by Greaseball
It was stated in the childbirth section of the most recent "Our Bodies, Ourselves." It specifically mentions floppy babies, although it did not say they were blue.

Their source for that information was "The Thinking Woman's Guide to a Better Birth."

I happen to have a copy of "Thinking Woman's Guide" right here. Henci Goer sums everything up in a "pro/con" section. Here is her pro/con section on epidurals:

"Pro: Epidurals almsot always completely eliminate pain while leaving you awake and alert. This allows you to rest or sleep. In a difficult labor, epidurals coan transform what otherwise would be a harrowing experience into a positive one. In some cases, epidurals seem to promote progress in labors that have gotten "stuck".

Cons: Epidurals slow labor, which results in increased use of IV oxytocin (Pitocin) to stimulate stronger contractions, and usually leads to higher epidiotomy rates, forcepts or vacuum-extraction rates, and cesarean rates, especially in first-time mothers. Epidurals require electornic fetal monitoring and a precautionary IB. You are also more likely to need bladder catheterization. Body temperature rises over time, so you are more likely to develop a fever."

She goes on to describe secondary problems (bladder infection from catheter, fetal distress *from overly strong contractions from the pitocin augmentation*, 3rd and 4th degree tears from forceps) which can occur. No mention of depressed (as in "limp, blue and floppy") babies and the only breathing problems mention are ones in the mother in the rare instance of a "high spinal" - when the level of anesthesia goes too high.

Ina May's new book mentions that the baby's heart rate can drop, and the baby may have breathing difficulties and trouble breastfeeding.

I also have Ina May's book here, but not at hand. Yup, if the mom's BP drops, the baby's heart rate will drop. That is why you have to have an IV and get at least a liter of IV fluids before they will give you an epidural. If that doesn't work (by increasing blood volume) they give ephedrine. That is a common problem, but a highly treatable one. Again, not sure where the "breathing difficulty" part is coming from. The studies are mixed on whether they cause breastfeeding problems.

How new is the new technique, and what is different about it?

The technique is combining narcotic with the bupivicaine (marcaine) so that less "numbing" medication has to be used. Not sure exactly how recent that this technique is, but within the past 10 years. Definately since "Open Season" (published in 1991 - have that one too). Bottom line, the more "numbing" medication, the more labor disfunction and higher chance of some of the rare complications.

OH - and to whomever said that doctors get paid more for births where epidurals, not exactly. First of all, the OB doesn't get paid more. The anesthesia staff gets paid, not the OB. The incentive for an OB *might* be that it is easier to control a delivery allowing him/her to make it to a delivery without having to be in hospital for hours (medication can be upped to control an urge to push, for example). Another problem is that with decreased reimbursement from insurance companies and increase in malpractice premiums, many OB's have upped the number of pts. they will take on, decreasing the amount of time they are available for each pt. Hence the incentive to "micromanage" labors to occur when they are available and not have to "labor sit" in the hospital. When a woman labors with no anesthesia, an OB can be sitting around for hours lest he miss the delivery, while if she has an epidural it is not uncommon for the OB to not even be called in until the baby is visable on the perineum.

Add to this that many hospitals want to have 24 hour anesthesia coverage so that they can handle all emergencies quickly. And if you have to staff, you have to pay them. So you see that there is a tremendous incentive on the part of many OB's and hospitals to have woman laboring with epidural anesthesia.

[Greaseball]

The incentive for an OB *might* be that it is easier to control a delivery allowing him/her to make it to a delivery without having to be in hospital for hours (medication can be upped to control an urge to push, for example).

It also keeps the woman quiet and in one place. She probably has to be on her back too, which is an easier position for the doctor. And if she can't participate as much and needs to be coached, the doctor has the advantage of getting to control the situation more.

In Birth as an American Rite of Passage the author notices that when pain is caused by the woman's own body and birth process, the hospital staff will do anything they can to make it go away. But if the pain is caused by obstetrical procedures, they urge the woman to "bear it for the baby's sake."

The doctor doesn't get paid more (unless he has to use more intervention because of the epidural, such as forceps), but the hospital still makes money. Even nonprofit hospitals like to get all they can, to make up for the charity patients.

[pamamidwife]

Epidurals do not necessarily cause "floppy babies" (I'm assuming we're talking about babies with some level of moderate to severe distress where they have experienced hypoxia - or lack of oxygen - right before birth?).

Epidurals can create a situation where the mother's blood pressure drops dramatically. When this happens, it is not uncommon to have the baby's heart rate drop as well. It's why epinephrine is usually on hand and given after the administration of an epidural.

Epidurals also put women in a position of pushing more on their back, and needing to do some very forced pushing because of the lack of sensation about when and for how long to push. This - not necessarily the epidural - can put a borderline baby into fetal distress, where the baby does not recover well after the contractions. This can lead to a baby that emerges with little tone or color.

Then again, I was just at a birth for a first-time mom where the baby had BEAUTIFUL heart tones as mom pushed her out in a squat. The baby had great scalp color as she crowned for quite awhile as the mother eased her out. When her body was born, her color was pretty gray and mottled and her tone was really bad. Her eyes also kept rolling back, like she wasn't going to come around. But, she did within the first minute or so after birth. (Her heart rate, by the way, was GREAT during this transition)

If someone had seen just that birth, they could have made assumptions that squatting or long crowning could cause a floppy baby. This is not the case. Some babies have lower tolerances to lower levels of oxygen (which can occur during pushing) and if there are position issues or forced pushing issues, this exaggerates the lower tolerance.

Hope this makes sense.

[captain optimism]

I had both pitocin and finally, after many hours, an epidural. I didn't intend to use either drug but my water broke and I went 44 hours without going into active labor. I tried a lot of natural methods to get labor going, including herbs and shiatsu, but no dice.

I had pitocin for 24 hours, then added the epidural and more pitocin, and then pushed--another 44 hours of pharmacological "fun" at the hospital in total.

My son was born very alert and looking fine. This fit in with all the monitoring the hospital staff did--his heart rate stayed strong and he experienced no infections during the long labor. But, he didn't latch on at birth and when I finally got a lactation consultant into my room, I learned that he was sucking his tongue. Getting him to nurse was a big project. (But I am persistent and he is still nursing!)

I can't know whether the epidural was the factor that made him suck his tongue. It could have been the long labor, but as we have read upthread, epidurals increase the risk of long labors. I spoke with several lactation consultants and a local LLL leader. At least two of these bf experts thought the epidural was the deciding factor. I did not dilate until I was given the epidural, but I also found that pushing out the baby while numb from the waist down was, uh, ridiculous. I couldn't feel anything, it was undignified, inefficient, uncomfortable. Finally the epidural pump broke and I gave birth with the pitocin and no epi and that was better.

I can see from my own experience that in the midst of a crazily long, complicated and painful labor, having a method of giving anaesthetic drugs that will help a mom give birth is a good thing. But if I were planning a birth, I wouldn't plan to use it. The possible risks elucidated here are compelling, but so is my personal experience. It just makes it a lot harder to have a normal birth.

[Greaseball]

OK, I got all my sources together so now everyone can see where I get my wacky ideas.

Birth as an American Rite of Passage, Davis-Floyd, 1992. "There are several other potential disadvantages of epidural anesthesia...dangers to the baby include oxygen deprivation, slowing of the heart rate, an increase in the acidity of its blood, and poor muscle tone..." (pg 114)

Unassisted Childbirth, Shanley, 1994. "...breathing and sucking difficulties for the baby...impaired muscular, visual and neural development of the baby; permanent brain damage and mental retardation of the baby; infant death." (pg 20)

(Shanley did not specify the epidural; she says "drugs" or "anesthesia." Her sources include Dr. Doris Haire, who writes "Recent research makes it evident that obstetrical medication must play a role in our staggering incidence of neurological impairment.")

Mal(e) Practice, Mendelsohn, 1982. "The obstetrician's benign assurance that he is going to make the mother comfortable is the prelude to the obstetrical version of chemical warfare...[The mother] should protest, because every drug she is given threatens to injure or even kill her or her child... (pg 166) "Even a full-term, healthy newborn baby is not fully developed at the time of its birth...the newborn infant is incapable of dealing effectively with the drugs that have crossed the placenta and entered its bloodstream..." (pg 168)

Open Season, Cohen, 1991. "And what effects do epidurals have on babies? Epidurals cross the [placenta] and affect the baby in both short- and long-term ways (drowsiness, poor sucking reflex, suspected hyperactivity up to seven years of age). One group of reserachers found effects on the muscle strength and tone of newborns...Compared with babies in an unmedicated group, epidural babies performed poorly on the motor, state control, and physiological response clusters, as well as their total score..." (pg 98)

Ina May's Guide to Childbirth, Gaskin, 2003. "Babies whose mothers have had epidurals soemtimes have breathing difficulties and a difficult time establishing breastfeeding." (pg 236)

Our Bodies, Ourselves For the New Century, Boston Women's Health Book Collective, 1998. "Observed behavioral changes include decreased rooting activity and increased muscular floppiness." (pg 492)

OK, so now everyone can see where I get all this stuff. Even if you don't agree with it, and can present other stuff that contradicts it, can't you see I'm not just making it up?

[MamaTT]

Hey Greaseball, I have also read about the respiratory suppression associated with epidural births, so I don't think you're loony there. However I do think that the "blue floppy babies" term is a loaded cliche, and I wouldn't use it w/ a mom on the fence. (That said, I am sure I've used it when ranting to my dh, :LOL)

Just from recent personal experience, I have a church friend who just gave birth to her first a couple weeks ago, and oops! They gave her just a bit too stong of a dose in the epi and they almost lost the baby. No Sh*t. Even with the meds they have to reverse the effects, it was pretty scary. And the medical team acknowledged the causal relationship of the OD to the near-death of the baby.

FWIW.