Getting informed about epidurals

I’ve been working on an Epidural Fact Sheet to hand out to my clients. As I’ve said before, I believe that every expectant mother should learn about epidurals, whether or not they plan to get one. One of the best sources of info about epidurals is Henci Goer’s book, A Thinking Woman’s Guide to a Better Birth; this page is also helpful, and I got lots of the info below from two articles by Sarah J. Buckley in Mothering magazine.

So here’s a short version of the Fact Sheet I’m writing.

Epidurals have one major advantage: They provide effective pain relief for most women who receive them. This can be very helpful in allowing a tired mother to rest or sleep, or in making a mother more comfortable when she does not wish to feel the sensations of labor.

Epidurals also carry tradeoffs for ALL women who receive them:

–If you receive an epidural, you will almost certainly be hooked up to an IV, a continuous fetal monitor, a pulse monitor, and a blood pressure cuff. You’ll probably have a catheter inserted and be restricted from eating and drinking. You will be confined to bed and unable to move on your own.

–Epidural drugs cross the placenta and are taken up by the baby’s body, where they are processed more slowly than in the mother’s own system.

–Epidurals significantly change the balance of labor and birth hormones, which—in an undisturbed labor—keep the labor moving along, give the mother energy to push her baby out, help the mother get in the “zone” so she can move and labor instinctually, and contribute to the feeling of “high” or ecstatic love that washes over a woman when her baby is born. Each of these effects is altered by epidurals. I believe this may be the major reason that mothers receiving epidurals tend to be less satisfied with their birth experiences.

Finally, epidurals carry risks that affect SOME women who receive them:

–Very common side effects include itching, shivering, sedation, nausea.

–Epidurals slow labor and make the pushing stage longer on average.

–Epidurals make mothers more likely to be given Pitocin to augment labor.

–Epidurals can cause abnormalities in the fetal heart rate.

–Epidurals don’t always give the pain relief mothers expect. Ten to 15 percent report the pain persists on one or both sides of the body.

There are many other potential risks for the mother (fever, postpartum bleeding, headaches, and other more serious problems) and for the baby. One common scenario is that the mother develops a fever because of the epidural, and providers, wanting to make sure the fever doesn’t indicate an infection, evaluate the newborn baby for sepsis. This means the baby will be separated from the mother for a prolonged period of time, possibly subjected to invasive tests (including spinal taps), and given antibiotics.Other issues–including how epidurals affect the breastfeeding relationship–are poorly studied.Bottom line: This is a bigger deal than taking an Advil for a headache! Epidurals have their place, but all mothers owe it to themselves and their babies to consider the facts before making the decision.


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