Epidurals: Pros, Cons & Alternatives
According to The Journal of Obstetrics and Gynecology, approximately 80% of vaginal deliveries involve epidural anesthesia. This high percentage has made epidural anesthesia the most popular method of pain relief during labor today. Epidurals are very effective at eliminating the pain of labor and can help many women get through an exhausting or extremely long labor by allowing the mother to rest.
The epidural procedure is one that can take an hour from start to finish, and longer if the anesthesiologist is not readily available. The procedure starts with an IV to prevent a decrease in blood pressure in the mother. This is followed by electronic fetal monitoring of the baby’s heart rate and a blood pressure cuff to monitor mother’s blood pressure. At this point the mother will be placed on her side and asked to curl into the fetal position to open the vertebrae in the low back. The anesthesiologist will numb the skin with a local anesthetic and then push a large needle between two vertebrae just above the waist. During this 5-10 minute period the mother will need to hold completely still, even during contractions, to prevent spinal cord injury. When the needle is in the epidural space, the anesthesiologist will perform a series of tests to make sure he is in the right place and did not hit any blood vessels on the way in. He will then thread a tiny flexible plastic catheter through the needle and withdraw the needle. The catheter will be used to inject the anesthetic. Finally, the anesthesiologist will test the area with a pinprick or ice to determine if there was enough anesthetic delivered and if it was delivered to the right area.
As common as epidurals are today, they come with a multitude of side effects for both mother and baby. These include, but are not limited to:
* Slowing and prolonging labor
* Nausea and vomiting
* Leads to the use of Pitocin
* Causes ineffective pushing
* Leads to vacuum, forceps, and excessive pulling by the birth provider
* Causes significant drop in blood pressure
* Links to an increase in cesarean rates
* Requires electronic fetal monitoring for fetal distress
* Causes profound, prolonged drops in fetal heart rate
* Requires IV fluids for mother – requiring labor to occur with the mother on her back
* Increases the stresses on the baby’s spine
Rare complications can be urinary incontinence, chronic headaches, long-term backaches, nerve damage, toxic drug reactions, breathing difficulties, and maternal death. The need for a urinary catheter is common and can lead to urinary tract infections. Infections usually require separation of mother and baby right after birth. During this separation it is likely that baby will be subjected to blood tests, a spinal tap, and other diagnostic procedures to rule out the possibility of an infection in the infant.
Chiropractic implications of an epidural can be profound on the delicate spine of the newborn. The numbed bottom half of the mother stops the feedback mechanism to the brain for effective pushing at the right moments, instead relying on a machine to tell the mother when to attempt to push. The epidural also requires the mother to stay on her back, eliminating the use of gravity and moving the pelvis into an ideal position to push. Not only does this process places significant stress on the newborn’s spine, but many times Pitocin is added to strengthen contractions artificially. This eliminates the rhythmical natural contractions and places significant strain on the cervical spine of the newborn as it is forced unnaturally through the birth canal. Many times this artificial contraction does not allow the baby to move his/her head through natural flexion and extension needed for resituating. Many studies have shown that the use of an epidural increases the use of forceps, vacuum, and excessive pulling of the baby’s head due to the mother’s inability to push. When the baby is born their spines are very delicate and nothing is fused together. As the vacuum, forceps or manual pulling is done on the head, there is significant traction placed in the infant’s neck, injuring the cervical spine and spinal cord. If a cesarean is preformed, it places significant strain on the infant’s spine and is a host to many maternal and newborn injuries, such as nerve damage.
Research done by Dr. Chung Ha Suh, Ph.D., professor of mechanical engineering at CU, found that the pressure of a subluxation equal to the weight of a quarter decreases nerve transmission by 60%. This pressure can occur without any pain or other signs or symptoms. Although newborns can have signs of vertebral subluxation, such as colic or inability to turn their head, many times these often occur without any immediate signs or symptoms. Combine this with the women’s inability to experience sensations at birth, many mothers assume no spinal trauma occurred in their newborns. This makes it critical to have the newborn checked by a chiropractor as soon after birth as possible.
Natural childbirth contains self-limiting, rhythmical pain and stress that has many positive effects for both mother and baby. For the mother, the nerves in the cervix, vagina, and pelvic floor transmit stretching sensations and pain to the stretch receptors in the pituitary gland. The pituitary gland is located in the brain and upon receiving this transmission will secrete oxytocin. By secreting more oxytocin the labor intensifies causing further dilation. When the head of the infant presses on the pelvic floor it creates the urge to push. This mechanism is blocked by the epidural. The pain guides the mother to find new positions that relieve the pain, this usually helps reposition the baby down the birth canal as labor continues. In response to the pain, the mother’s body secretes adrenaline and endorphins. This gives her stamina, relieves the pain, and elevates her mood. During an uncomplicated birth, endorphins are found to be 30 times higher than non-laboring women and 50 times higher in women who are experiencing prolonged or difficult births. This can not occur with artificial oxytocin (Pitocin) because it can’t cross the blood brain barrier. The benefits for the baby start with the stress hormones the mother’s body is producing. These hormones trigger the final preparation for the baby’s lungs to breathe air, mobilize glucose for energy, and shunt blood away from the limbs into the heart and brain to protect against a lack of oxygen during labor. Also, because there is less intervention during the birth, the newborn gets to immediately be with the mother and start bonding.
There are many methods to reducing or coping with the pain of labor. These include but are not limited to:
* Warm baths
* Heating pads or ice
* Structured breathing
* And Many Others!
Having a birth plan written out in advance will help families deal with many of these decisions. Each woman is different and the birth process should be one of joy and excitement. Knowing all of the options, both pro and con, will help each mother make educated decisions with which they can be happy. Be flexible – know that plans can change in the middle of the labor process and make sure the mother is supported by those who are closest to her. One thing to remember is that women’s bodies still work and intervention is not always necessary.
- Engelhardt K. Epidurals Facts, Implications and Alternatives. Pathways Magazine Issue 31: page 18-20.
- Goer H. The Thinking Women’s Guide to a Better Birth. 1999: page 125-148.