Friday, August 14, 2009

I'm the Mom, its my job to make informed decisions

Posted by Kim

Below is a very interesting article about epidural anesthesia and its effect on the baby. When pregnant for the first time I had heard that epidural wasn't great for the baby and I was very concerned about taking any pain relief at all. I had it set in my mind that I wasn't going to do it. However, I did not know any of the information about extended labor, increased use of Pitocin, or higher occurrence of assisted delivery.

When I was told that my first son had to be induced at 35 weeks due to low fetal movement all of my worries about epidural went out the window and I became totally focused on the survival of my baby. It seemed like the experience I was hoping to have was thrust into an emergency medical situation and I did whatever the doctors and nurses said to do. While no one in our hospital ever suggested to me that I should get an epidural, I chose it anyway. I still habor great remorse about this and am somewhat ashamed that I conceded to the pressure and got it.

However now as a doula I try to help myself remember that I did not have any of the gradual contractions that help a mom move into labor starting by helping her efface and dilate. I was at zero everything when my labor with Connor was induced so maybe that had something to do with extrememly pain that I was literally thrust into. I went into the hospital on Sunday night and Monday morning at 7am I was in a full blown labor when the second application of gel was put on my cervix. I literally felt no pain at all and my contractions were immediately 5 minutes apart. This is not the way I recommend labor to start. But then again, the doctors said that my baby had to be born or could be in danger.

Knowing now what I didn't know then about a baby's need for 40 weeks I know I would have thought long and hard about inducing my labor this early, but that is another post. All in all despite Connor's difficult start and the time he spent in the NICU, he is a healthy happy 6 year old and that is what I focus on now. But I often think, how can I learn from my birth experience and apply it to our medical care now? I no longer do everything my doctor says to do, although I respect her opinion. I make my own decisions, realizing now that doctors are only humans. I question everything and also seek alternative remedies before pursuing conventional medical intervention. Deciding what is right for my children is my job as a mom.

The Evidence Says: Epidurals Do Impact Newborns
Written by Connie Livingston

There are many controversies in maternity care. The spectrum of debates run to both ends of the spectrum: from those who feel all women should have interventionized maternity care to the home birth advocates. However, one of the most controversial topics in care is epidural anesthesia.

Fueling the flame of the epidural controversy are the diametrically opposite positions published in anesthesia journals vs. those in other medical journals such as nursing, midwifery and family practice.

In most hospitals, laboring women who have received epidural anesthesia are confined to bed as they no longer can rely on their legs for stability. This may severely limit movement and positioning. Additionally, hospitals may have a policy that all laboring women receiving medication, specifically epidural anesthesia, have an internal fetal heart monitor in place. This requires breaking of the amniotic sac or membranes in a procedure known as amniotomy. Occasionally, it may be necessary to augment or stimulate a labor with Pitocin after an epidural has been given, as epidurals have been shown to slow some women's labors – making the labor longer and harder on the woman’s body (Mayberry, L.J., Clemmens, D., De, A. Epidural analgesia side effects, co-interventions, and care of women during childbirth: a systematic review. American Journal of Obstetrics & Gynecology. 2002 May;186(5 Suppl Nature):S81-93.

Researchers have linked epidural anesthesia to assisted delivery, or the use of forceps or vacuum extraction during the pushing portion of labor (Torvaldsen, S., Roberts, C.L., Bell, J.C., Raynes-Greenow, C.H. Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia. Cochrane Database Systematic Review. 2004 Oct 18;(4):CD004457.). Researchers also find that 88% of women who requested an epidural for pain in one study reported being less satisfied with their childbirth experience than those who did not, despite lower pain intensity. Pre-labor survey results suggest that concerns about epidurals and their effect on the baby, greater than anticipated labor pain, perceived failure of requesting an epidural, and longer duration of labor may have accounted for these findings.( Kannan, S., Jamison, R.N., Datta, S. Maternal satisfaction and pain control in women electing natural childbirth. Regional Anesthesia and Pain Medicine. 2001 Sep-Oct;26(5):468-72.

Epidural anesthesia also causes a drop in maternal blood pressure, thus the need for 1000 ml of IV fluids administered prior/during the administration of the anesthesia.

For the newborn, the effects of epidural anesthesia are more hazardous. Women who have epidurals are less likely to fully breastfeed in the first few days and are more likely to stop breastfeeding in the first 24 weeks due to the difficulty newborns have in coordinating sucking and latching. (Torvaldsen, et al. Intrapartum epidural analgesia and breastfeeding: a prospective cohort study. International Breastfeeding Journal 2006 Dec 11; 1:24. Oxytocin and prolactin stimulate milk ejection and milk production during breastfeeding. When used in combination during the labor process, which happens frequently, epidural anesthesia and pitocin influenced endogenous oxytocin levels negatively ~ thus negatively impacting both milk ejection and milk production. Jonas et al. Effects of intrapartum oxytocin administration and epidural analgesia on the concentration of plasma oxytocin and prolactin in response to suckling during the second day postpartum. Breastfeeding Medicine 2009 June; 4(2): 71-82.

Countless other studies including the Journal of the American Board of Family Medicine and Dr. Sarah Buckley all focus on the hazardous impact of epidurals on breastfeeding and the newborn.

This evidence may be an inconvenient truth.

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