About the Epidural

Hi! Sorry for the long delay between my articles lately. I'll try to get them closer together in the future.

An epidural is a type of anesthesia offered to laboring women. A anesthesiant drug, often mixed with a type of morphine is injected in the membrane surrounding the spinal cord. One the product is injected, the lower part of the body is numb and doesn't feel pain (or anything) anymore. This intervention is now used proficiently in labor and delivery rooms all across the western (and then) world. But this intervention is not without risks. Reflexion on a intervention taken much too lightly.

 NOTE: In certain rare cases, an epidural is done for medical reasons, either because of the mother's health state, or because of certain complications. In other cases, an epidural can become necessary if a laboring woman is in a state of great stress and/or she is experimenting an excruciatingly painful labor, and that all the alternatives can't help her. This article concerns ''confort'', or ''routine'' ''epidurals'', that are called for by the mothers, or strongly pushed on them by the medical team for no medical reason and without thinking of, or trying alternatives.

First of all, I can't talk about epidurals without talking abour pain. This ''terrible'' pain of childbirth that the medias keep scaring us with. It is important to mention that ''pain'' is an important part of the physiological process of childbirth. It contributes, among many other things, to the production of endorphins, a natural analgesic hormone with a similar effect as morphine, but coming directly from the mother's body. These help her to relax her body and to navigate through labor, help the baby's lungs to be ready for breathing, help to prepare lactation, and are important for the mother and child bonding experience. Why not try to accept and plunge into the intense sensations of childbirth instead of trying to suppress them?  There is much to say about pain, and I have to go back to my initial subject. But keep in mind that pain is a very important part of labor, there are ways to navigate through it peacefully, and that it is not necessarily excruciating like what you can see in movies and TV shows. I highly recommend you to read some more about pain and it's important role during childbirth, like in Ina May Gaskin's books, for example. Watch some real birth videos, and films like ''Orgasmic Birth'' and ''Birth as We Know It'' to see some real, empowering (and sometimes even pleasurable) births.

Even if pain is part of the process, it doesn't mean the laboring woman has to take it as a fatality and stay on her back waiting for it to pass, as if there was no other way to deal with it. There are many ways to prepare for it before labor actually starts, with meditation, prenatal singing, reading empowering birth stories, acupuncture, and much more. Once the labor has started, there are many alternatives to try before going for an epidural. Here are a few examples: Having a doula at your side, walking, massages, stretching, suspensions, using the birth ball, relaxation, taking a nice hot bath, etc.

And now back to the main subject. Nowadays, many talk about epidurals as if it was a miracle drug, THE thing that gives you the perfect painless birth, etc.  But that is not exactly the case...

To start with, there are some medical risks. For the mother there are risks due to the toxicity of the product, and possible side effects like nausea, throwing up, itching, and urine retention. In more serious cases there could be troubles of arterial hypotension (with effects on the baby's heart rate), and even some troubles of consciousness that can, in rare cases, go all the way to coma, convulsions, and cardiac/circulatory troubles. These are very rare, of course, but the risk is still there. There are also some technical risks, due to a bad insertion of the needle all the way into the spinal cord (1% to 2% of cases) which can cause various problems with the nervous system. In 5% of cases, complications like fevers and high maternal temperature can be observed. These augmentations of temperature can be dangerous for the baby, because they augment the risks of neonatal infection or can cause problems with the baby's nervous system. The risk of postpartum hemorrhage is also higher.

As for the foetus, it has to be taken into account that any foreign product injected into the mother's circulatory system is at risk of passing the placental barrier. The placenta can choose what is good and what is not for the baby when it comes to natural elements and hormones, like vitamins, minerals or oxygen, but cannot recognize foreign products like drugs, alcohol or artificial hormones. The various substances that are injected in the mother's body can then be found in the baby's system and can cause, among others, modifications to the heartbeat and breathing problems at birth.

Having an epidural also messes up with the hormonal system of birth. During a natural labor and birth, a woman will produce a hormone called oxytocin. This hormone causes contractions, serves as a pain suppresser for the baby, and is the hormone that makes the mother fall in love with her baby when she sees him/her for the first time. There are also endorphins, to help with the pain, and many others. When an epidural is administered, the anesthesia slows down the natural labor, and the woman will be put under a synthetic oxytocin drip to speed up the labor. When this happens, the natural hormones stop being produced. Synthetic oxytocin causes contractions that are much stronger, and more violent than natural ones, and it does not work as a pain suppresser for the baby like the natural oxytocin. So, when an epidural is on, along with with the drip, the mother is numb and doesn't feel her contractions, but the baby feels them, as violent as they may be, and is not getting the natural pain suppresser intended for him. Instead he is getting a cocktail of chemical hormones and analgesic drugs...

Then, the belief that epidurals speed up labor and helps the baby is only true in some rare cases. Some very stressed and tense women have had easier labors because once all their tensions and stress were gone, their were able to let their cervix relax and open. But in most cases, the epidural is more likely to slow down labor. This is why no one is supposed to get one before the cervix is 4 cm open, as it could cause the labor to stall or even stop. This is also why the epidural is almost always combined with a pitocin drip, to make the contractions go on. Then, in cases where a classic epidural is administered (there is also a kind called a walking epidural, which allows a little more mobility and the mother should be able to walk with assistance) the laboring mother has to stay in bed on her back or on her side, her whole lower body paralysed, and she cannot really move around to help the baby's descent. 

During a natural birth, when the mother's rythm is respected, there is this thing called the ''urge to push'' that usually comes when the mother is completely dilated . The mother feels a new set of very effective contractions to push the baby out and feels the need to bear down. When the mother has an epidural, the medical team has to tell her when she has to push, and the pushing is not as efficient. This means that she often has to push harder, longer, and there is a bigger chance there will be the need for a forceps of vacuum assisted delivery. 

When the baby is born, it isn't necessarily the end. All the drugs and artifcial hormones given during labor can have an impact on the baby's state at birth. He can be sleepy or somnolent, and not completely awake and alert as he normally should be. This can affect the first contact with the mother and can cause breastfeeding problems. Some babies aren't even able to take the breast and suckle correctly. 

During a natural birth, the mother will experience a high peak of oxytocin, the hormone of love, at the moment of the birth of her baby, which makes her fall in love with her baby and greatly contributes to the mother-child bonding. This important moment doesn't happen the same way when the mother had artificial hormones given to her during labor. 

There is much to say about the various risks and effects of epidurals. I am also very conscious that there are some births where for medical reasons, and sometimes even to save a life, an epidural and various drugs may become necessary measures. My point here is to inform you about the possible and non-negligible effects of this intervention. There are so many births that could have happened without any problem had they been natural births, but because an epidural was administered in the first place, became cascades of interventions and lead to episiotomies, forceps, or cesarean sections. 

I do not wish to judge women who have made that choice, or who are considering it. My text isn't an anti-epidural manifest. I simply want to demystify this intervention and spread the information, so that women who do chose to have one in the end, do it knowing what it is all about and not in ignorance of it's possible adverse effects. 

The following is an article about epidurals taken from the magazint Midwifery Today. It is very anti-epidural, but the stats are interesting and the arguments are well thought. I warn you though, it is pretty intense. http://www.midwiferytoday.com/articles/epiduraltrip.asp

Here are a few more article and studies about epidurals, and their pros and cons I highly encourage you to check them out if you want to know more:

See you soon!