Epidural Anesthesia

Is Epidural Anesthesia for you?  Learn about the risks to you and your baby as well as learn about epidural side effects -like epidural headache.  

Many women in western cultures are terrified about the thought of natural childbirth.  Many women approach labor with the attitude that they want an epidural as soon as they reach the hospital parking lot.

There is a widespread belief by most women (and many Obstetricians even) that regional anesthesia does not reach the baby.  

The common understanding is that since regional anesthesia is inserted into the epidural space in the mothers back, it stays in that space and does not get out or circulate in the mother’s blood.  In addition people believe that, the placenta is a unique barrier that prevents anything bad from getting thru from the mothers blood to the baby. 

Unfortunately, nothing could be farther from the truth.  

The purpose of this article is to make mothers aware that this is a myth.  

We aren’t saying that you should choose not to have epidural anesthesia.  We feel strongly that all mothers should have the right to make informed decisions with full knowledge of all of the pros and cons.  

Perpetuating the myth that epidural anesthesia does not reach the baby is not serving newborn babies nor their mothers since it causes real complications that may have been prevented had the mother been fully informed and armed with natural childbirth techniques and options.

Facts about Epidural Anesthesia

Epidural anesthesia DOES get thru to the baby and the longer the mother has an epidural, the more the medication effects the baby.

Yes, we know, that is a frightening and often disheartening notion. But here is the deal...

Epidural anesthesia passes out of the epidural space into the blood and is eliminated thru the liver, kidneys, urine and colon.  Think about it... If this didn’t happen, the medication would have a permanent effect on the mother.

As with all medication taken orally or injected into the mother, epidural anesthesia has to be processed and eliminated thru the mother’s blood, liver, kidneys, lymphatic system, and expelled in either urine or out the colon.

Everything in the mother’s blood passes thru the placenta and circulates in the baby’s blood.  This happens to different degrees and has differing effects on the baby since the baby is much smaller than the mother.

For example: medication is prescribed based on the mother’s weight.  In many instances, the baby receives far greater exposure to the medicine because baby is much smaller, and receives a much higher concentration of medication for its weight.  If medication was prescribed based on baby’s size and weight, then the medication would likely not even be felt by the much larger mother whose immune system and circulation system is far more mature and experienced with dealing with foreign chemicals.

Epidural side effects on unborn and newly born babies include:

• Decreased heart rate during labor and birth
• Decreased oxygen to brain during labor and birth
• Increased stress to the baby
• Longer for the baby to do common newborn things like bond with mom and start breathing on its own.
• Decreased ability to latch

Keep reading for more information about epidural side effects and to see the studies that demonstrate them.  We know this is tough to read for many women, but it is important information for you to consider so that you can make truely informed choices during childbirth.

Are there other reasons that I should avoid epidural anesthesia?

Yes!  Other reasons to consider avoiding epidural anesthesia include:

• Epidural use often slows down labor and causes other interventions to be necessary
• Epidural use often causes stress to the baby (slowed heart rate, decreased oxygen, etc.)
• The length of time the baby is exposed to the anesthesia increases the number of side effects to the baby.
• Epidural use prevents the mother from walking and moving in ways that will help her dilate and help her baby to get in position for birth
• Epidural prevents mother from feeling discomfort that would motivate her to change positions as required for effective dilation, for her pelvis to open efficiently, and for her baby to pass thru the birth canal in the most effective manner
• Epidural use diminishes or eliminates communication between mother and baby during the birth process.
• Mother can’t help her baby if she can’t feel what is going on

Here is the bottom line.  The longer the mother avoids an epidural, the less exposure her baby has to the medication and the less likely other interventions will be necessary.  So there is a benefit to delay getting an epidural if you feel like you absolutely can't give birth without one.

What the scientific studies demonstrate

Way back in 1966 at UCLA Dr. Robert O. Bauer applied the gas chromatograph to the question of the possible transfer of drugs from regional anesthesia. (1)

Note: spinal, epidural, pudendal and para-cervical blocks are all examples of regional anesthesia.

In 1970 the Los Angeles Times reported: “A UCLA research team has found that nerve blocking anesthetics ... get into the unborn baby’s system and could harm some infants.  If the baby is a high risk baby and the mother is hyperventilating and undergoing other stresses, the effect of even small amounts of anesthetic on the fetus may be enough to produce some degree of brain damage” (1)

Meaning: epidural anesthesia may harm your baby.  In particular, if you aren’t breathing effectively, your baby may not receive enough oxygen and this could cause brain damage to your baby. 

Dr. Howard Fox, of the University of Kansas Medical Center, Division of Neonatal Medicine wrote: “...regional anesthetic agents do not remain regional in their distribution. Measurable levels of these drugs appear in maternal blood from 1-7 minutes after instillation and measurable levels appear shortly thereafter in fetal blood regardless of the type of regional anesthesia or the agent employed.” (2)

Meaning: If you get an epidural, the medication will enter your blood within 1-7 minutes and will be measurable in your baby’s blood shortly thereafter.

The British Journal of Obstetrics and Gynecology reported three key findings in 1980:

• “Bupivacaine is widely used as the local analgesic agent of choice for epidural analgesia in labor ... it is known to enter the maternal blood stream rapidly from the epidural space, and from there cross the placenta so that a measurable concentration is present in the fetal circulation within ten minutes of epidural injection.” (3)
• Significant and consistent effects of bupivacaine throughout the assessment period can be demonstrated. Immediately after delivery, infants ... were more likely to be cyanotic and unresponsive to their surroundings. Visual skills and alertness decreased significantly ... on the first day of life but also throughout the next six weeks” (3)
•  These results show that the neonate differs from the adult in respect of both the nature of effects of the drug and sensitivity to it.” (3)

Meaning: If you get an epidural, the medication will be measurable in your baby's blood within 10 minutes.  Babies born to mothers who have had an epidural consistently are less responsive to their surroundings and are less alert for the first 6 weeks of life. Epidural medication effects adults differently than babies.

As early as 1968 the journal Anesthesia reported “...anesthetic was absorbed from the sites of injection into the maternal arterial circulation within three to five minutes, and was transmitted across the placenta to the fetus.” (5)

Meaning: if you get an epidural, the anesthesia will reach your blood in 3-5 minutes and will affect your baby shortly thereafter.

A study published in Obstetrics and Gynecology in 1996 concluded: “Epidural analgesia may increase substantially the risk of cesarean delivery. ...” (7)

Meaning: If you get an epidural, your chances of having a cesarean go up substantially.

A study published in American Journal of Obstetrics and Gynecology in 1993 concluded: “In a randomized controlled, prospective trial epidural analgesia resulted in a significant prolongation in the first and second stages of labor and a significant increase in the frequency of cesarean delivery....”(8)

Meaning: If you get an epidural, your labor will slow down and you are much more likely to have a cesarean.

A study published in the American Journal of Obstetrics and Gynecology in 2000 concluded: “The management of epidural analgesia during labor was associated with the potential for increased risk of cesarean delivery.”(9)

Meaning: getting an epidural makes it much more likely that you will need to have a cesarean section.

A study published in Obstetrics and Gynecology in 1995 concluded: “After epidural analgesia ....the ability of the uterus to dilate the cervix is reduced significantly.” (10)

Meaning: dilation slows down due to epidural anesthesia.

Another study published in American Journal of Obstetrics and Gynecology in 1996 concluded: “…the supine position is associated with a significant post-epidural decrement in cardiac output, not identified by a change in heart rate.” (11)

Meaning: the heart beats at the same rate, but it is less effective at moving the blood and therefore less oxygen is getting to cells.

Summarizing epidural side effects as demonstrated by research

• Epidurals make it much more likely that you will need a cesarean section
• Epidurals slow down labor
• Epidurals make both mother and baby’s heart beats less effective
• Epidurals put both mother and baby at risk for not receiving enough oxygen
• Epidurals can cause brain damage to the baby
• Epidurals can cause severe headaches to the mother for 6 months or more following birth. 
• Epidurals can cause seizure disorders both temporarily or permanently.
• Epidurals can either temporarily or permanently paralyze women from the waist or neck down. 
• Epidurals can cause severe blood pressure changes. 
• Epidurals lead to a high rate of forceps and vacuum extraction deliveries. 
• Epidurals can cause a fever, which may result in aggressive treatment to the baby like spinal taps and separation. 
• Epidurals are associated with a high incidence of breastfeeding problems
• Epidurals can cause death - in either the mother or the baby or both. 

So here is the question for you to decide.  When and under what circumstances is it worth it to you to have an epidural …given the risks?

The American Medical establishment encourages the use of epidural anesthesia.  

Despite all of the research showing the dangers, the American medical system has always supported the use of epidural anesthesia.  They have also prevented pregnant women from having accurate information about the risks.

Despite evidence demonstrating that epidural anesthesia reaches the baby and has negative effects on both mother and baby, the American College of Obstetricians and Gynecologists put out a pamphlet in 1974 that encouraged the use of regional anesthetics (like epidurals) stating “I personally am in favor of using a regional anesthetic whenever possible, principally because it does not ordinarily enter the blood stream and cannot reach the baby’s system.” (6)

This was known to be false then, and it remains untrue today.  Women are flat out being lied to.  

Why haven’t there been any studies since 2000?

As far as we can see, there haven’t been any studies on the safety of regional anesthesia since 2000.  This is in alignment with a change in the way basic research grants are funded.  

In the past, funds were available for basic research conducted without any bias for outcome.  Since the mid 90’s, there has been an emphasis on the “commercial potential” for any research proposal.  Allegedly this was because research funds, which come from taxpayers, should lead back to products and findings which will directly benefit taxpayers.  

In reality basic research funds have been used as a tool for big businesses to conduct research at college campuses for “free” using government funds.  Current studies have clear biases and usually either demonstrate the hoped for outcome or remain unpublished. 

When it comes to epidural anesthesia, no one the pharmaceutical industry or the American Medical association wants to fund a study which proves, yet again, that epidural anesthesia is detrimental to the mother, the baby or both.

What you are likely to hear from your friends who have had epidurals or cesarean sections

Everything was fine, but I was tired, in a lot of pain and I was scared so when I got to the hospital, they gave me my epidural. For several hours everything was OK. 

Then:

• I stopped dilating
• Labor was taking too long
• My baby started to be in distress (heart beat went down with contractions, oxygen levels got low, baby stopped moving, etc.)
• I started developing a fever
• Some other tragic-sounding potential event occurred. 

Like it just happened. It just fell out of the sky or something; and the cesarean saved the day, or the baby, or the mother, or whatever. 

Never does anybody explain to the mother that the epidural caused the problem.

Worse yet, the problem is almost always blamed on the mother.  It can be very subtle.  Your friend is told, “Honey, it wasn’t your fault”:

• "Your cervix just wasn’t opening"
• "Your baby was in distress"
• "Not all mothers are cut out for this birthing thing"
• "You were just too tired"
• "You were at the end of your rope"

It is very unlikely that a doctor or someone on nursing staff would say: 

• “We know epidural anesthesia caused the problem.”  
• “With a little education and preparation you very likely could have delivered naturally.” 
• “If you hadn’t had the epidural, it is unlikely that you would have needed a cesarean or that your child would have had trouble breathing or latching.”

Are we saying that women shouldn’t have the choice of having epidural anesthesia?

Absolutely not.  We believe in choices and empowering women to make the best decisions for themselves and their baby.  And that means that they need to have all of the facts. That they should be provided all of the facts before they are in labor.

• There are times when an epidural is very helpful
• There are times when a cesarean is necessary.

Our point is that hospital interventions are OVERUSED to the detriment of both moms and their babies.  The USA ranks very low when it comes to both maternal (mother) and infant mortality rates.  Countries that support natural childbirth and/or don’t have all of the “lifesaving equipment and practices” that the USA does have much better maternal and infant outcomes.  Can you imagine?  It is safer to deliver in some world countries than it is to have your baby in the USA.

To have a true choice, pregnant women need to have all the facts.  Our goal is to provide information and to motivate others to do some research about both pregnancy and childbirth so that you are consciously making choices that you feel confident are the best choices for you and your baby.  

The hospital and medical establishment is making its choices based on what is most convenient for them, what costs the least to deliver, what makes the most profit and, what is most likely to be defend-able in court (typical standard of care).  

What can you do?

• Get educated about natural childbirth.  Pain is your body or your baby trying to tell you something … like change positions. 
• Choose your birth environment carefully
• Choose like-minded people you trust who will be your advocate to be with you when you are in labor and during delivery. 

To learn more

Read more about effective ways for women to give birth

• Learn more about labor pain and how to deal with it
• Read our best childbirth tips
• Read tips for giving birth in a hospital
• Get our Natural Parenting and Childbirth advice e-book
• Read our free pregnancy e-guide (click on the link above)
• Take an online natural childbirth class
• Take an in-person Bradley Method of Natural Childbirth class
• Ask your questions on our Childbirth Forum!

References

1. Nelson, Harry. “Anesthetic Held Danger to Baby During Delivery”. Los Angeles Times. (March 11, 1970).

2. Fox, Howard. “Effects of Maternal Analgesia on Neonatal Morbidity”. University of Kansas, Department of Neonatal Medicine. Reprinted in: “Preventability of Perinatal Injury” Progress in Clinical and Biological Research, New York, Alan Liss (1975): 163-186.

3. Rosenblatt, Deborah, et al.. “The Influence of Maternal Analgesia on Neonatal Behaviour: II Epidural Bupivacaine”. British Journal of Obstetrics and Gynecology 88 (1981): 407-413.

5. Shnider, Sol and E. Way. “Plasma Levels of Lidocaine (Xylocaine®) in Mother and Newborn Following Obstetrical Conduction Anesthesia”. Anesthesiology 29 (1968): 951-958.

6. “Anesthesia and Analgesia During Childbirth”. American College of Obstetricians and Gynecologists (1974). Reprinted by ACOG from Redbook

7. Lieberman, Ellice, et al. “Association of Epidural Analgesia With Cesarean Delivery in Nulliparous”. Obstetrics and Gynecology 88 (1996): 993-1000.

8. Thorp, James, et al.. “The Effect of Intrapartum Epidural Analgesia on Nulliparous Labor: A Randomized, controlled, Prospective Trial”. American Journal of Obstetrics and Gynecology 169 (1993): 851-858.

9. Traynor, Jeffrey, et al.. “Is the Management of Epidural Analgesia Associated with an Increased Risk of Cesarean Delivery?” American Journal of Obstetrics and Gynecology 182 (2000): 1058-1062.

10. Newton, Edward, et al.. “Epidural Anesthesia and Uterine Function”. Obstetrics and Gynecology 85 (1995): 749-755.

11. Danilenko-Dixon, Diana, et al.. “Positional Effects on Maternal Cardiac Output During Labor with Epidural Analgesia”. American Journal of Obstetrics and Gynecology, 157 (1996): 867-872.

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