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.