Epidurals don't affect the baby? - Mothering Forums

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#1 of 68 Old 04-04-2004, 09:33 AM - Thread Starter
 
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That is what my SIL's doctor/hospital told her. They said that the drugs have no effect on the baby because they don't enter the bloodstream.

I was like, "Of course the epidural affects the baby, that's why so many have problems nursing."

But I need to know for sure. What's the word, ladies?
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#2 of 68 Old 04-04-2004, 09:44 AM
 
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Yes, yes, yes! The epidural reaches the baby. Easy thing to do at almost any library or pharmacy. Look up Lidocaine. It is an analgesic sometimes used for epidurals. (Keep in mind of course, epidural is the name of a procedure that delivers drugs... there are a variety of drugs administered this way.) Under Lidocaine look up the precautions and warnings. Somewhere in there it specifically says 'When used as an epidural watch out for fetal overdose.' Why would you have to worry about the fetus at all if the drug doesn't reach them?

There was actually a study conducted in the late 60's (I believe) that I will find for you in the morning... using fetal scalp blood samples they found the drug administered to the mother by epidural in the babies bloodstream less than five minutes after the drug was given.

I am continually shocked that doctors lie in such a bold faced fashion to their patients.
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#3 of 68 Old 04-04-2004, 09:52 AM - Thread Starter
 
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thanks chica! I just found 2 articles on Mothering that show how quickly the drugs get to the baby and how long they stay in their immature systems.

What a dumba$$ doctor eh?

I understand my SIL being scared and deciding she wants drugs, but she HAS to know that the baby is going to feel them, too. No one should make a decision with blatantly false information.
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#4 of 68 Old 04-04-2004, 10:11 AM
 
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Oh... another thing or two: Are you familiar with the blood/brain barrier? It is a special filter that makes it very hard for drugs to get into your brain. When they want to use chemotherapy for brain tumors they have to go through all kinds of wild procedures to even get the drugs into the brain. You aren't born with this barrier. So a drug dosage that won't reach your brain and won't harm you at all may very well enter your fetus/newborns brain and cause damage. Also, when the baby is still inside and on the umbilical s/he is using your waste systems... your liver is filtering their blood, your kidneys are processing their urine, etc. After the baby is born they are left with an adult size dosage of drugs in their system and only their wee tiny still learning the ropes organs to filter them out.
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#5 of 68 Old 04-04-2004, 11:11 AM
 
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effects of epidural block as per "Medications used during Labor and Birth"

baby: "Low maternal blood pressure and fever can lead to fetal heart rate changes and lack or ozygen; subtle changes in reflexes, including suckling and breathing; fussiness;... observation in nursery if mother had fever in labor; septic workup, antibiotics, and 48 hours in special care nursery for observation for signs of infection if mother had fever (a common side effect in mothers who recieve epidural) in labor."

That's not to mention the side effects of pitocin, c-section, forceps, and vaccum extraction that also tend to be more common during epidurals.

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#6 of 68 Old 04-04-2004, 01:00 PM
 
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She could ask her doctor for the patient info sheet on any drugs they want to give during labor. Even the drug manufacturers admit to risks affecting both mother and baby.
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#7 of 68 Old 04-04-2004, 01:33 PM
 
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On A Baby Story (TLC) I saw a doctor tell a woman that the epidural is "completely safe".
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#8 of 68 Old 04-04-2004, 02:02 PM
 
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Quote:
Originally posted by kama'aina mama
I am continually shocked that doctors lie in such a bold faced fashion to their patients.
I don't think that most OB's are bold faced liars. I think most of them believe it. Truely.

The drug used in epidurals is bupivicaine (trade name, marcain). A more recent technique that most women get for epidurals uses this drug in combination with a small does of narcotic (usually fentanyl or sufenta). This combination allows them to use a much smaller dose of the bupivicaine while still getting good pain relief. If you have seen women on "A Baby Story" that could move their legs, get up on hands and knees, could feel to push with an epidural - they had this technique. Now compared to, say an injection of demerol, the drugs "hardly affect the baby". And doctors argue about if they affect them at all. For instance, many anesthesiologist disagree with the study that shows nursing problems/groggy babies after epidurals - and have other studies that back them up. Most also will show you research that shows that they don't affect c/sec rates either.

I personally think there are many other problems with epidurals- malpositioned babies, causing temps in labor, do increase c/sec esp. in first time moms. I'm not arguing for their routine use, just trying to show how the medical folks think.
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#9 of 68 Old 04-04-2004, 02:34 PM
 
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FOund this info on the two drugs used in epidurals. I'm showing it to show how little of the medication is used or even available to cross the placenta: "The two most common medications used are Bupivicaine (Marcaine) . 0625% - .5% and Fentanyl. Bupivicaine (an amide local anesthetic) is used because of it’s rapid onset and longer duration of anesthesia. It is also highly protein bound (95%), making only 5% available for placental transfer. Fentanyl is a short-acting narcotic (analog of morphine), that is 80 to 100 times more potent than morphine. It is used as a supplement to the Bupivicaine in labor epidurals.
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#10 of 68 Old 04-04-2004, 02:51 PM
 
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This is such a sore spot for me.

I was at a birth once where the doc (who, I swear, was called in from a golf game and came in wearing his full on tacky golf outfit) told the mom that there were "absolutely no risks whatsoever". Interesting that he said that to her bc I watched him draw up a syringe of Epi just before he gave it to her "just in case" (I wonder, just in case of what?) IMMEDIATELY after the epidural was placed and she laid down the baby's heart rate dropped to 50 and she started feeling dizzy. I think that they did end up giving her the shot and then bc she quickly dilated they did a vaccuum extractor on her. NO side effects my @$*#&!!

What I tell people all the time when we talked about epidurals is that I've been to quite a few births in the hospital but not a ton and I've seen A LOT of side effects, what does that tell you about the incidence of them? I've seen extreme itching, the epidurals not work at all or have really spotty coverage(on several women), major decels in the baby's heart rates, increased need for vaccuum extractions, lots of tearing that I always wonder if it would have been there had it not been for the epidural, increased use of antibiotics, and almost always augmented with Pitocin.

I think there's a mix of lying and truly believing what they say. Truly, their insurance companies don't ALLOW them to be honest and give full informed choice and I seriously don't think that most of them are smart enough to realize that the side effects that they're seeing are connected to the interventions that they use. They continue to believe that they're things that just normally "pop up" during labor which intensifies the fear, which leads to more interventions, which leads to more side effects, which leads to more fear..........
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#11 of 68 Old 04-04-2004, 04:15 PM
 
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When I was in labor with my first ds at 24 wks, the OB told me I couldn't have an epi because it would kill my baby. Yes, my baby was fragile. But, doesn't that imply that the epi DOES reach the baby?
I didn't want one anyway, but how can he tell me that when they claim the epi doesn't affect fullterm babies.
They need to get their facts straight. Do they really think that mothers don't share information?

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#12 of 68 Old 04-04-2004, 04:39 PM
 
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I think we are so used to seeing limp, floppy babies that cry miserably at birth that we don't think it could be abnormal.

I was born awake, looking around, and not crying. My brother was born asleep. I'm sure if we had been born in hospitals the doctor would have thought there was something wrong with us and given us low apgar scores, maybe even upended and slapped us.
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#13 of 68 Old 04-04-2004, 05:54 PM
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This is such an interesting thread - thank you all!

Elphaba, I'm betting this won't be the last lie you learn of through your SIL's birth. It sure can't go up from here. I'll keep my fingers crossed though.

Can't think about the babies receiving the drugs like this - hurts my heart too much.
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#14 of 68 Old 04-04-2004, 06:10 PM - Thread Starter
 
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I just want her to have all the information she deserves. She has pretty much no choices in her care, as they live in a rural area and she is not a homebirth candidate -- not for health reasons but for emotional/mental reasons. She's very comfortable with a medical model of care, whereas I am not, so I really try to not push my views on her but rather prod her into questioning and researching for herself. She just doesn't have a lot of time to do that since she is also a full-time grad student and has an internship, and those activities all take place about 4-5 hours from their home.

I had an epidural, but I knew it wasn't the best thing for the baby. I had planned a Bradley birth, but it didn't work out. I certainly didn't go into it thinking that drugs would have no effect on the baby, and I want her to have the same chance to make informed consent, or to at least stay home a LONG time! :LOL
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#15 of 68 Old 04-04-2004, 06:13 PM
 
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Some people don't even consider the epidural to be "drugs." I ask them if they're going to have drugs during labor and they say "No, just the epidural.":
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#16 of 68 Old 04-04-2004, 06:27 PM
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Wow, Greaseball, that would be funny if it weren't so tragic.

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#17 of 68 Old 04-04-2004, 10:17 PM
 
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Quote:
Originally posted by Greaseball
I think we are so used to seeing limp, floppy babies that cry miserably at birth that we don't think it could be abnormal.

I was born awake, looking around, and not crying. My brother was born asleep. I'm sure if we had been born in hospitals the doctor would have thought there was something wrong with us and given us low apgar scores, maybe even upended and slapped us.
I'm an L&D nurse. I've worked at hospital as an RN and been doula at birth center and homebirths. Limp, floppy babies are rare everywhere. Even with routine use of epidurals. Seriously.

See my post above. I think there is plenty wrong with routine use of epidurals. But let's not resort to scare tactics and misinformation in our quest to promote natural childbirth. In the end it will come back to bite "the movement" (the natural childbirth one) in the butt.
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#18 of 68 Old 04-05-2004, 01:40 PM
 
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Mom2six - What do you see as the most common problem babies have as a result of epidurals?
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#19 of 68 Old 04-05-2004, 02:01 PM
 
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Quote:
Originally posted by Greaseball
Some people don't even consider the epidural to be "drugs." I ask them if they're going to have drugs during labor and they say "No, just the epidural.":
I heard that recently, too. I asked a new mother if she had any drugs during labor and she said no, then went on to talk about how wonderful the epidural was. She actually had NO IDEA that there were drugs in the epidural. She thought that the procedure itself provided the pain relief, like acupuncture or something, and that the fluid going in was just saline or something. I know ya'll are probably thinking that she was just an idiot, but she really isn't. This girl was young, but no younger than I was when I had my first. She had no Internet access during her pregnancy, no friends who had babies, and no support from her family who stopped talking to her when she found out she was pregnant. She, like most young women, knew NOTHING about pregnancy and childbirth. It broke my heart to see the look on her face when she realized that she had not, in fact, experienced a drug-free birth.
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#20 of 68 Old 04-05-2004, 02:08 PM
 
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Quote:
Originally posted by Greaseball
Mom2six - What do you see as the most common problem babies have as a result of epidurals?
Poor positioning resulting in c/sec, maternal temp, which can result in a septic work-up for baby - though we no longer do LP's (spinal taps) for them - and baby might have to stay in the special care nursery, if the baby is on the large side, esp. if it's the mother's first baby - c/sec for "CPD" which is usually caused by the fact that we can't get strong enough contractions even with the almost routine added pitocin augmentation to counter the epidural weakening the contractions. Then again, epidurals slow down labor too, so it might just be "failure to wait" with a large baby not "failure to progress". Vacuums and forceps. I know there are some studies that show that epidurals effect nursing, but that would be a hard call for me to make. Most babies latch on with a short period after birth. My guess would be that it depends on how long the mom had an epidural and I think the effects are fairly subtle.
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#21 of 68 Old 04-05-2004, 05:51 PM
 
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I just saw an episode of a baby story where the mom was having a natural birth center birth wiht her second baby because with her first she had an epidural and could not walk for six weeks That doesn't sound like "no side effects" to me! There is always a risk with meds, the epi is no exception.
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#22 of 68 Old 04-05-2004, 06:19 PM
 
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I really don't know why it's seen as such a godsend. Some women I've talked to say that it actually made the pain worse, and others say it barely helped them at all.

I like to keep foot-long needles away from me! It sounds like they would hurt.

One midwife I knew said she's had a lot of homebirth clients transfer to a hospital only for pain relief. I don't get it...didn't they know it would hurt?
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#23 of 68 Old 04-05-2004, 06:24 PM
 
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I know I'm going to get flamed here, I just know it, but I had one epidural birth go horribly wrong and I had one that was wonderful. I don't regret getting the epidural. Both my babies had APGARs of 8-9 and nursed wonderfully within minutes of birth. My only side effect was itchiness, and it really wasn't that bad. This baby I am going to do a UC so I will tell you how it goes without any drugs :LOL
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#24 of 68 Old 04-05-2004, 06:31 PM
 
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Quote:
Originally posted by Greaseball
I really don't know why it's seen as such a godsend. Some women I've talked to say that it actually made the pain worse, and others say it barely helped them at all.

I like to keep foot-long needles away from me! It sounds like they would hurt.

One midwife I knew said she's had a lot of homebirth clients transfer to a hospital only for pain relief. I don't get it...didn't they know it would hurt?
Giving birth HURTS, at least for me. I got an epidural with my first, way too early, and there were undesired side effects. Came very, very close to a c-section. I would change a lot about that birth experience, but I can't say that I wouldn't end up with an epidural again. I had my last two with no pain relief at all, but they were fairly quick, relatively easy births. I don't know if I would endure twenty hours of back labor without any meds. I know women that have, but I don't know that I would.

I think that we start off with the epidural as the norm and go from there. I really think it should be the other way around. I think that epidurals, like most medications, have a place and I'm glad they are available to the women that need them. I just wish that women weren't told that we ALL need them, because I don't think we do.
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#25 of 68 Old 04-06-2004, 12:52 AM
 
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Quote:
Originally posted by Mothra
I think that we start off with the epidural as the norm and go from there. I really think it should be the other way around. I think that epidurals, like most medications, have a place and I'm glad they are available to the women that need them. I just wish that women weren't told that we ALL need them, because I don't think we do.
I think this is right on. In my town, the epidural rate is about 95%. I think it's safe to say that the average ob in my town attends about 5 or fewer unmedicated births per year. The average L&D nurse probably attends fewer than one per month.

Hospitals here really push epidural anesthesia. By and large, they are very concerned with their patients perception of pain. On another floor, where pain relief for gallbladder surgery doesn't affect the outcome, I think that makes perfect sense. On the L&D floor, where pain is fleeting and the use of medications [i]do[i] affect the outcome, of course it would be prudent to explore non-pharmacological methods of pain relief.

I'd like to think that healthcare professionals look at the evidence when giving information to their clients, but from what I have seen, clinical trials mean nothing and personal experience means everything. Given that most ob's in my town have very little experience with unmedicated birth, I take their words with the proverbial grain of salt.

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#26 of 68 Old 04-06-2004, 11:57 AM
 
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I loved my epidural, and I'm looking forward to it this time. My baby was not born limp or floppy, though we were both sick. Pain medication is a funny thing: if you get too much of it, it can affect all kinds of things adversely. If you dont' get enough, it doesn't do any good.

My plan was to deliver all naturally, no drugs or interventions. Yes, I knew that giving birth would hurt, and probably hurt a lot. I was well aware going in that it would be painful. What I wasn't aware of was that I would spend the better part of a week in active labor, unable to rest or relax, barely able to move. Hell yes I think epidurals are a Godsend! I'm eternally greatful for mine. It was the only part of my labor & delivery that was bearable.

Yes, I think that women should have accurate information about medications during labor. (I'm a big believer in accurate information about everything.) What they don't need is to be placated by doctors (and I'm still trying to figure out where these people are practicing, because I haven't met them) or to be terrified by natural birth zealots. I would encourage your friend (SIL?) to do some research of her own on the subject, and to come to her own conclusions. There's plenty of information available, and even though some of it is confusing, once you wade through the jargon and the scare tactics there's a lot of good, useful information out there. Heck, I'll even help. I'm up for a good research project!

About the nursing problems: From what I can tell, nursing problems seem to be more closely associated with how close to/far from term the baby was born than with medications or lack thereof during labor. Eli did have some problems, but not until my milk came in. I became engorged and my breasts were so big that he just couldn't latch on anymore without major help. His little mouth just couldn't open wide enough to get enough of my nipple. It had nothing to do with the drugs at all.

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#27 of 68 Old 04-06-2004, 12:11 PM
 
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I tell my clients that an epidural can be a good thing but make sure you are educated in the pros and cons. I also tell my clients that an epidural surpresses endorphines and actually causes a little harder recovery. When you go natural you get such a natural high after giving birth. I personally would rather have a natural birth with a better recovery than a drugged birth and longer recovery.

When I put it like that, my clients agree, natural birth would be much better.

One of my last clients is a post pardom nurse and she called me asking if I could help her achieve a natural birth because she wanted a recoevery like a natural patient. She's says the difference is night and day.

I think the recovery is the worst part of giving birth and if going natural will make that better...its so worth the pain.
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#28 of 68 Old 04-06-2004, 02:36 PM
 
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Thought that this was some good info. These are off of La Leche League's website

http://www.lalecheleague.org/NB/NBSepOct99p167.html

Quote:
Most of the research didn't study problems with breastfeeding associated with epidurals, so Riordan developed a study to focus on epidural anesthesia 's effect on the baby's suckling and the duration of breastfeeding. She explained the methodology of her study and its results. It clearly showed that medication during birth did negatively affect babies' suckling during the first 12 hours, and that combining medications increased the effect. Demerol was especially harmful to the baby's suckling ability. The duration of breastfeeding was not shown to be affected.
http://www.lalecheleague.org/ba/Nov99.html

Quote:
Fortunately, it is now possible to measure feedings at the breast using a valid breastfeeding assessment tool. In a recent study on epidural analgesia and breastfeeding, (25) the investigators used the Infant Breastfeeding Assessment Tool (20, 24) to assess breastfeeding scores in 127 babies. The 92 infants whose mothers had analgesia were compared with 37 babies whose mothers had an unmedicated labor and delivery. Lactation consultants in three hospitals with at least two years experience with breastfeeding dyads scored the feedings on their daily rounds on an as-they-come basis. Scores ranged from 0 to 12. Mothers were also asked to score the feeding at the same time as the lactation consultant. Not surprisingly these women evaluated the breastfeedings about the same as the LC.

Infants whose mothers had no labor analgesia scored higher (x=11.1) on the breastfeeding scale than mothers who had epidurals (x=8.5) or intravenous narcotics (x=8.5). Despite higher breastfeeding scores in neonates of unmedicated women, no difference in the duration of breastfeeding at six weeks was found between the medicated and the unmedicated mothers. The lack of a positive relationship between epidural labor analgesia and weaning before six weeks postpartum was surprising but reassuring in that the use of epidurals did not seem to be associated with early weaning.

Three other studies, all conducted before 1982, examined labor epidurals and general neonatal behavior with differing results. All used a control group of unmedicated mothers but did not measure breastfeeding as an outcome. Murray et al. (19) studied the effects of epidural analgesia on neonates whose mothers had 1) epidurals with continuous infusion of 0.25% bupivacaine (n=20); 2) epidurals in combination with oxytocin to stimulate labor (n=20); and 3) little or no medication during childbirth (n=15). Over half of the 15 mothers in the little-or-no-medication group briefly inhaled nitrous oxide and 11 received lidocaine for perineal infiltration. Infants in both epidural groups performed less well on the motor, state control, and physiologic response clusters of the Brazelton Neonatal Behavior Assessment Scale than the little-or-no-medication group. On the fifth day the babies in the epidural groups continued to show poor state organization.

Abboud et al. (1) compared fetal, maternal, and neonatal responses following epidurals that infused regional anesthetics (lidocaine, bupivacaine, or chloroprocaine). No narcotic was used. Fifty infants were in each epidural group, and 20 were in an unmedicated control group. The Early Neonatal Neurobehavior Scale was used at 2 and 24 hours of life to evaluate the babies' behaviors. Compared with the epidural groups, more infants in the unmedicated group scored lower in suckling and rooting at both 2 and 24 hours postpartum. Abboud later repeated the study (2), this time using a larger dose of lidocaine. Again, the average suckling and rooting scores were higher for the neonates in the lidocaine group at 2 hours postpartum, but the findings reversed at 24 hours postpartum and unmedicated neonates had higher suckling scores. United Kingdom babies whose mothers had no labor analgesia of any kind actually scored lower in rooting and suckling ability than infants whose mothers had epidurals, (8) but the differences were not statistically significant. Although these earlier studies are instructive, it is difficult to compare studies that were done over a decade ago with current investigations because of changes in epidural techniques and medication dosages.
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I wonder if the blue floppy babies result more from the pitocin than from the epidural?
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#30 of 68 Old 04-06-2004, 07:26 PM
 
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I had pit too. :LOL

Greasball, earlier you mentioned that you were born awake, looking around, but not crying. What makes you think you would have received a low apgar score if you'd been born in a hospital? As long as you weren't retracting or hyperventilating, you would have received a 3 in the breathing column. Niether of my nieces cried, and they both scored 10's.

Rynna, Mama to Bean (8), Boobah (6), Bella (4) and Bear (2)
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