Wednesday, May 5, 2010

Controversial question of the week.

Why is it that the same mamas who criticize me for drinking coffee (amongst other things) while pregnant are the first to ask for the epidural? Has the epi become so common that people forget that there are risks involved? (Edited to add: As pregnant women, we all make decisions concerning our actions based on a perceived risk/benefit ratio. My beef is not with other mamas' decisions so much as what I've recently discovered- apparently it's socially acceptable to comment on a mama's choices while pregnant regarding nutrition, exercise, caffeine, etc., but heaven forbid someone mention the risks involved with an epidural. It's a hot-button issue, and I personally feel that many women who themselves have epidurals either haven't been sufficiently informed of the risk, or it is downplayed by their physicians.)


Update: This info is from Marsden Wagner, MD. (If you don't know, he is a perinatologist and perinatal epidemiologist, and served as the director of Women and Children's Health at the World Health Organization). The article was originally published in Midwifery Today, and the whole piece can be found here.

"Twenty-three percent, or nearly one in four women, given an epidural block will develop a complication. One undesirable complication is death—epidural block for relief of normal labor pain results in a three times higher mortality rate for the woman than labor without epidural block. One out of every 500 epidural blocks results in temporary neurological problems, such as paralysis in the woman; and in one out of every half-million epidural blocks, this neurological damage to the woman is permanent.

These extremely serious risks of epidural block are not so common, but several less serious, but still significant, risks are much more common. Fifteen percent to 20 percent of all women given epidural block develop fever that results in the undesirable necessity of administering diagnostic tests and antibiotic treatment to the baby. Fifteen percent to thirty-five percent of all women given epidural block cannot urinate and must have a tube inserted into their bladder. Thirty percent to 40 percent of all women given epidural block have severe backache for hours or days after birth, and 20 percent still have severe backache one year later. So they have traded pain relief during a few hours of labor for severe back pain for a year or more! Because labor pain is an essential component of the normal mechanisms of the body for the progress of labor and since the epidural block eliminates this necessary pain, epidurals also eliminate the normal mechanisms for the progress of labor. So it is to be expected that considerable research documents a longer labor if the woman is given epidural block. As normal labor is no longer possible with epidural block, there is four times greater use of forceps or vacuum extraction and at least twice as much cesarean section after epidural block. These surgical interventions, of course, carry their own risks both for woman and baby. So the woman choosing epidural block trades less labor pain for a longer labor and, if a cesarean section is done, more pain for several days after the birth, as well as increased risks for both herself and her baby.

Thus, epidural block presents many serious risks for the woman. Are there risks for her baby? Since it is unlikely any woman would choose a form of pain relief that puts her baby at risk, women are not told that in 8 percent to 12 percent of labors in which the woman is given epidural block, severe fetal hypoxia (lack of oxygen to the unborn baby) is shown on the electronic fetal monitor. The American College of Obstetricians and Gynecologists, after acknowledging the frequency at which birthing babies suffer hypoxia after the woman is given an epidural block, recommends that all women given epidural block have continuous electronic fetal monitoring so that fetal hypoxia can be identified."


Beth said...

I don't criticize people for their choices, but I chose not to have caffeine because studies show it can lead to miscarriage. I know there can be risks with an epidural, but I don't think they include the death of the baby. I admit I'm not well researched though.

To answer your question on my blog, Eleanor doesn't cry - either not at all, or not for more than a minute - when we put her down early. She has her lovey and her rain forest thing, and they soothe her enough. We did do CIO a while back though, and it took one week. Ever since then, she just smiles, rolls over, and sucks her thumb when I put her down at night. She's great at putting herself to sleep.

Jenny said...

My doctor sat there and basically told me there were no risks of an epi worth worrying about. He said he didn't understand why a woman would want to go through a painful birth if she didn't have to. Many women are a combo of lazy, trusting and head-in-the-sand so they don't do any research outside of Babycenter or whatever silly website will feed them the same familiar info. And those websites tell them to avoid coffee and a bunch of other stuff that may or may not be harmful at all. (I'm not being judgmental; this was ME when I was pregnant with Suzi. I've been on both sides!) I've noticed lately that people will go with the flow until it almost drowns them and then they'll start making their own researched decisions.

Emily said...

Actually, beth, epidurals absolutely increase both infant and maternal mortality rates. With epis, pit is almost always required, and pit results in contractions that are longer and stronger than natural ones, putting stress on baby. When things like irratic heartrate and stress are noted, csections are much more likely. Then everyone celebrates how the section "saved" mama and baby , when really it was a bunch of unnecessary intervention that caused the issues in the first place. I'll get the research links when I get home, but I highly recommend "the business of being born." the movie does a great job of explaining everything. Also, infants do commonly show signs of being letharic when mama had an epi, and women die every year from allergic reactions as well.

Kacie said...

I recently read about a case in Ohio where the anesthesiologist passed on meningitis to several patients who received epidurals. The doc wasn't wearing a mask when it was administered, and that's how they think they caught it.

One mother died because of it, and the other was extremely sick.

Rare, isolated, and possibly preventable if a mask was worn (or epi avoided).

But it brings me to a more wider point, that maybe you won't get menegitis, but certainly it puts you at risk for an infection in general.

I think moms who are "Bring on the epidural as soon as I show up to the hospital" probably don't fully understand (or want to understand) the process of birth, and why labor and feeling labor is important.

Epidurals can sometimes sound like the perfect way to labor -- no pain. But they aren't always able to make a labor painless.

Being stuck in a bed, hooked up to IVs and unable to really move or feel my body just sounds awful. Epis can cause the mom's BP to crash, distress for the baby, allergic reactions...there's all sorts of things that go wrong.

But popular media perpetuates that birth is insanely painful and horrible and epidurals are the solution. Until birth can be widely understood as a process (not a medical event!) and that there's a purpose to the pain, I think we'll continue to see high epi rates.

My hospital has a 98% epidural rate. The moms who go without on purpose are very few. I will invite any medical staff who is interested in observing an unmedicated birth into my room simply because I think they need exposure to it.

Emily said...

Kacie- amen, sister! I totally agree with you. How are women supposed to believe that unmedicated, natural birth can be beautiful when they are inundated with examples of women screaming, cursing, etc. through labor and delivery? Education and example are key. When I had Lucy, my nurse was AWESOME, and she volunteered to care for me BECAUSE she had NEVER seen a natural birth, and was curious.

Jenny- you are so right. I was bored at work and hit up I was appalled at what I saw. You don't want to get me started on babycenter.

Jenny said...

Wanted to add--I am one of those women who couldn't pee after the epi. I eventually did and never needed a catheter, but it was scary. I should've been focused on my baby and instead I was sitting in the bathroom with the water running wondering if I'd ever pee again. I also feel I only had the episiotomy because of the epidural, which was a definite trade-off, as you mentioned. It was pretty tough trotting Suzi back and forth to the pediatrician in that first week with those stitches. Ouch. The thing is, for women who don't get the epidural right away, it can be hard to think about what the trade-off is. I just needed relief and I didn't see how I was going to get the baby out without it. I am still kicking myself for not hiring a doula.