First author is Karly Denkhaus
There is currently a plethora of television shows and movies, both fictional and non-fictional, which characterize themselves as portraying the realities of childbirth. More often than not, these shows depict women either screaming in pain from almost the very beginning of labor, cursing their significant others (no Gleek will soon forget Quinn yelling, :You suck! You suck! You suck!” at Puck for the duration of her labor), and begging for an epidural, or, alternatively, simply scheduling the birth of their child as if it were an average lunch meeting.
The childbirth process is increasingly becoming more proceduralized and medicalized is the United States. Currently over well over 60% of women giving birth every year opt for the use of an epidural, and in some maternity wards the percentage may be as high as 80-90%, and it is estimated that only 6% of women in large hospitals, and 12% of women in small hospitals, opt for a completely drug free birth1. Not only are these drugs unnecessary for a safe, comfortable, and positive birth experience, but they can hinder it.
Based on these statistics, one would assume that the various drugs used during labor and delivery would have been extensively tested on both the mother and the child, and would have been found to be safe. That is simply not the case. In fact, many of the drugs used during labor are used “off label” meaning the FDA has not approved them for use during childbirth. Even those drugs that have been approved have not necessarily been proven safe, the FDA has simply decided that their potential benefit outweighs their potential risks, and the FDA does not require that drugs are tested for delayed impacts on the neurologic development of the child.
Physical Effects on the Baby
Of the drugs used that are approved for use during labor and delivery, there have only been limited studies on the risks they pose to both the mother and her child in either the short or long term. Drugs easily cross the so-called placental barrier, and that the baby may have greater sensitivity to the drug because of the immaturity of the blood-brain barrier and the fact that the drug can bypass the liver at this time 2. This can affect the maturation, specialization, placement, and efficiency of the infant’s brain cells. Babies exposed to labor drugs in utero are also more likely to have low Apgar scores3.
Epidural anesthesia presents its own set of problems. Infants exposed to bupivacaine, the drug commonly used in epidurals, are less likely to be responsive immediately after birth. Additionally, visual skills, alertness, motor organization, and ability to control consciousness and stress responses were all significantly impaired4. Babies born to mothers who have had an epidural are more likely to be admitted for neonatal care and remain there longer than babies of mothers who did not have an epidural5.
Emotional and Social Effects on the Baby
Beyond immediate physical effects on the child, the use of drugs can have serious emotional and social effects as well. Because it takes time for drugs to be excreted from the baby’s system, they can severely hinder early breastfeeding 6. And remember the vital importantce of breastfeeding for short and longterm health (series here). Babies whose mothers had drugs during labor or delivery take longer to attempt to breastfeed7 and are more likely to cry when handled for up to seven weeks post-birth 8. Additionally, some drugs, such as the commonly prescribed Demerol, can be transferred through breastfeeding. This only serves to exacerbate the problem by giving babies a double dose of the drug. As far as more long term effects, children exposed to pain relieving drugs in labor have an increased risk for drug addiction later in life 9.
Effects on Mom
Aside from the direct impact on the infant, women who have received epidurals suffer their own social and emotional consequences. Women are often told that birth will be one of the greatest experiences of their life; however, women who receive an epidural report being less satisfied with their birth experience 10.
Additional alternatives to epidurals are found in websites that discuss natural childbirth. Here are some sources that might be useful:
1. Alexander, K. J. (2007, February 19). Insufferable. Retrieved from http://www.babble.com/pregnancy/giving-birth/managing-birth-pain
2. Burt, R. (1971). The fetal and maternal pharmacology of some of the drugs used for pain relief in labour. British Journal of Anaesthesia, 43: 824-836.
3. Chamberlain, G. ed. et al. (1993). Pain and its relief in childbirth: the results of a national survey conducted by the National Birthday Trust. Edinburgh: Churchill Livingstone.
4. Rosenblatt, D. B. et al. (1981).The influence of maternal analgesia on neonatal behaviour: 11 Epidural bupivacaine. British Journal of Obstetrics and Gynaecology, 88: 407-413.
5. Fisler R et al., 2003). Neonatal outcome after trial of labor compared with elective repeat caesarean section, Birth, vol 30, pp83-88.
6. Rajan, L. (1994). The impact of obstetric procedure and analgesia during labour and delivery on breast feeding. Midwifery, 10(2): 87-103.
7. Ransjo-Arvidson et al., (2001). Maternal analgesia, during labor disturbs newborn behaviour: effects on breastfeeding, temperature, and crying, Birth, 28, pp5-12.
8. Belsey, M.E. et al. (1981, April). The influence of maternal analgesia on neonatal behaviour: 1. Pethidine, British Journal of Obstetrics and Gynaecology, 88: 398-406.
9. Jacobson, B. et al. (1990). Opiate addiction in adult offspring through possible imprinting after obstetric treatment. British Medical Journal, 301:1067-1070.
10. Bennett, A. (1983). Factors affecting the physical and psychological experience of normal childbirth : A report of low-risk, primiparous women in Sydney.