I've noted before some of the problems with epidural pain relief during childbirth, and my latest reading, Lise Eliot's What's Going on in There: How the Brain and Mind Develop in the First Five Years of Life confirms my worries. Here are a few of her concerns:

  • Every drug used for epidural anesthesia can diffuse out of the epidural space and enter the baby’s circulation. The good news…is that the total amount of drug reaching the baby is considerably lower than in systemic administration. Nonetheless, whatever dose does enter the mother’s bloodstream crosses quite efficiently to the baby’s circulation.

  • Although many studies report no effect…on Apgar scores or cursory neurological exams, few of them have used wholly unmedicated mothers as a control group. Using more sensitive indices of infant behavior, some studies have found that newborns…are less alert, less able to orient toward stimuli, and less mature in their motor abilities than babies of unmedicated mothers. Greater exposure…makes babies jumpy and more irritable. The effects are most pronounced on the first day after birth, but some have been found to persist up to six weeks of life.

  • The most common side effect of epidural administration is…a reduction in the mother’s blood pressure. Maternal hypotension is at least partially responsible for the fact that the baby’s heart rate often slows down for a while shortly after an epidural anesthetic is injected. If the mother’s blood pressure falls too low for too long, it can seriously compromise blood flow to the placenta, reducing the fetus’s supply of oxygen. These serious side effects are prevented by giving the woman fluids through an IV….If this countermeasure doesn’t work, another drug may be needed to prevent her blood pressure from falling too low and compromising the baby.

  • Many studies have now shown that women who receive epidurals have longer labors, on average, than women receiving systemic analgesia. This is especially the case during the pushing phase…. Women receiving epidurals are more frequently diagnosed with dystocia, the failure of labor to progress, four times likelier to require forceps, and two or three times likelier to end up having a C-section, than women receiving systemic analgesia or no pain relief.

  • Although most babies are not significantly affected, epidural anesthesia may compromise the health of the small subset of babies already at risk due to illness, prematurity, or a difficult delivery. Encouraging more women to have unmedicated deliveries would be better for babies, and for the women themselves, who would be exposed to fewer side effects, have shorter labors, and might be in better shape to begin breast-feeding and bonding with their babies right after delivery.

None of these concerns surprised me. What I did find astonishing was her report of the difficulty in getting reliable data on the adverse effects of epidural anesthesia relative to no anesthesia at all, instead of relative to other forms of pain relief: “There are simply too few ‘natural’ deliveries to enroll in a clinical study!” Upon reflection, I believe there are more mothers who chose unmedicated delivery than she implies, though I’m also certain the numbers are far lower than they would be if the public were better educated about the joys of natural childbirth and the dangers of anesthesia. Two additional reasons come to mind for the lower numbers available for study: Those who chose natural childbirth often do so for reasons that would also make them reluctant to have their newborns’ lives disrupted by clinical study. And, sadly, the hostile atmosphere frequently encountered by those seeking to avoid unnecessary medical interventions in the births of their babies often drives them underground, where they avoid observation for good as well as ill.

Posted by sursumcorda on Tuesday, August 16, 2005 at 12:15 pm | Edit
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This is interesting stuff. I agree with you that there are probably enough natural births that you could devise some sort of legitimate study, but I doubt you could get funding for it. From the point of view of the researcher I would imagine that tracking down the natural births would be finacially impossible. Most research is funded on a shoestring budget as it is, so being in one place to observe many births (ie, the hospital) is cost effective. If it costs $20 in travel--that's what, 1/4 tank of gas now?-- to observe one natural home delivery it quickly becomes too expensive when you multiply that by a few thousand...and whats more, the researcher would have to be "on-call" since random deliveries aren't being delivered every few minutes at the hospital! Sounds like great way to burn out a grad student. In the end, grants are given to research that has the biggest bang for the buck, which makes this kind of study so hard....I won't get on my soapbox about federal cutbacks on NSF grants if you don't provoke me ;-)

Posted by Andy on Thursday, August 18, 2005 at 4:10 pm
Believe it or not, there was a time when you didn't have to go into someone's home to observe an unmedicated birth. In the 70's and 80's it was fairly common with hospital births, at least in Rochester, at least among the people I knew. Our doctors didn't have a problem with non-medicated births at all, so it must not have been much of an issue. I'd like to think that it's not all that uncommon in hospitals even now, but I'm not the one trying to do the research, so you're probably right.

Posted by SursumCorda on Thursday, August 18, 2005 at 4:23 pm
The recent study of the safety of home births used the reportings of the attending midwives, plus surveys of the mothers before and after the births. Thus the problem of researchers' travel costs is reduced.

Posted by joyful on Friday, August 19, 2005 at 8:52 am
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Still More Epidural Dangers
Excerpt: I've already written (here and here), about some of the dangers of epidural anesthesia during childbirth.  Today's reports bring still more bad news to those who see epidurals as an important part of the birthing process: an apparent link between...
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