The Epidural

My practice is largely pediatric and the vast majority of moms tell me that they had "natural childbirth" with their children but they also had an anesthetic! Mothers have been led to believe that as long as babies are delivered vagi-nally and their eyes are open, it is a "natural delivery." Nothing could be further from the truth!

An epidural is an anesthetic injected into the lower part of the spine. This drug lessens pain, it's true, but it also crosses the placenta and directly affects the fetus.

Often, the Apgar scores of babies whose mothers have had an epidural are lower. The Apgar score (activity, pulse, grimace, respiration, appearance) is a numerical figure out of 10 that measures the stress of delivery on the fetus and the relative health of the baby. Anything less than 10 indicates possible birth trauma.

A mother given an epidural is no longer in charge of the birth. She is not in full control of her contractions, which then necessitates the use of a number of medical interventions. Labor becomes difficult and often the baby becomes trapped in the birth canal. This of course, causes the use of vacuum extraction, forceps, and/or a Caesarean section (C-section) to rescue the baby. These procedures create their own complications and can be detrimental not only to the baby but also to the mother. Parents should know about these increased risks.

The Physicians Desk Reference cautions that "local anesthesia rapidly crosses the placenta...and when used for epidural blocks, anesthesia can cause varying degrees of maternal, fetal and neonatal toxicity. This toxi-city can result in the following side effects: hypotension, urinary retention, fecal and urinary incontinence, paralysis of lower extremities, loss of feeling in the limbs, headache, backache, septic meningitis, slowing of labor, cranial nerve palsies, allergic reactions, respiratory depression, nausea, vomiting and seizures." Many of these side effects can result in a number of complications. For example, an epidural can lower a woman's blood pressure (hypotension) which can lead to decreased heart rate in the fetus. This can cause fetal distress and result in a C-section.

Epidurals can:

1. Cause longer and slower progress of labor.
2. Can cause fevers in moms during childbirth.
3. Increase the use of the labor-inducing drug, pitocin, by as much as three and a half times, which causes slow and irregular contractions.
4. Increase the use of antibiotics in your baby by as much as four times.
5. Increase the use of forceps by as much as four and a half to 20 times.
6. Cause neonatal jaundice due to altered red blood cells.
7. Increase the incidence of birth trauma from the use of mechanically assisted deliveries.
8. Cause adverse behavioral effects in the baby.

There are a number of steps moms can take to minimize the risk of epidural anesthesia. Giving birth in a birthing chair or on an incline will help greatly. Also, birth is a major physical experience. This means work. It is therefore important to be in good shape; your family chiropractor may recommend a regular exercise regimen which will be of great benefit. Third, proper nutrition fuels the body for the process of birth. Your health care advisor and/or your health food store will be of great help here.

I also strongly recommend the services, and advice of a midwife; I find that they are extremely knowledgeable and well trained to help with delivery. Reputable birthing classes are also of assistance in minimizing anxiety.