Posts Tagged ‘Epidurals’

Epidural anesthesia remains the most popular form of pain relief in labor. Nurses, physicians, and many midwives like epidurals because the mother is comfortable and quiet, resulting in less work for hospital staff.

Laboring women like epidurals because they can remain awake and alert, while feeling little or no pain during labor.

Many negative aspects of epidurals have been debated among researchers. Downsides to epidurals reportedly include delay in labor, increase in vacuum/forceps deliveries, and increase in c-sections.  But aren’t these possible side effects outweighed by the positive effect of a pain-free labor?

In one research study, investigators found that women who had pain eliminated during labor still reported that they suffered!  Concluding that no pain did not necessarily mean no suffering, Wuitchik¹ emphasized the need for women with epidural anesthesia to have continual labor support available.  In this study, women described distress over itching, numbness, and nausea–all side effects of epidural anesthetic.  The women also reported concern over the baby’s well-being.  A common effect of epidurals is a prolonged drop in the baby’s heart rate. While hospital staff may take this in stride, it can be very frightening to the laboring woman.  Another interesting finding was that women reported feelings of incompetence and fear over being left alone once they were “comfortable”. Wuitchik concluded, “With epidurals, pain levels were reduced or eliminated.  Despite having virtually no pain, these women also engaged in increased distress-related thought during active labor.  The balance of coping and distress-related thought for women with epidurals was virtually identical to that of women with no analgesia”.

Women who had epidurals expressed just as much need for continued support as women who had unmedicated births, concludes another research study.²  In fact, satisfaction with the support received during labor had more influence on the woman’s satisfaction with her birth experience than her level of pain relief did, according to Mother-Friendly Childbirth — Highlights of the Evidence.

If you are planning an epidural, or even if you are not planning an epidural but plan a hospital birth — do yourself a favor and hire a doula for continuous labor support.  It can make a huge difference in your satisfaction with your experience.  I think the fact that continuous support influenced birth satisfaction more than pain relief  explains why many studies conclude that women who had unmedicated births (most often these are women who have doulas and/or midwives during labor) were happier with their experiences than those with medicated births.  It’s not the medication or the absence of medication that made the difference, but the presence of someone there to give continual support.  A partner may give excellent support, but partners need support, too!  Partners get tired, need to eat, go to the bathroom, get discouraged, just like laboring moms do.  A doula is there for both of you, and a good doula will give you your space when you need it, time for just the two of you when you need it, yet be there with just the support you need at the right moment when it is needed.

1.  Wuitchik M,  et al.  (1990)  Relationships between pain, cognitive activity, and epidural analgesia in labor.  Pain 41:136-142.

2.  Lally JE,  et al.  (2008)  More in hope than expectation: A systematic review of women’s expectations and experience of pain relief  in labour.  http://www.biomedcentral.com/1741-7015/6/7/abstract

Newborn immune systems are undeveloped and need antibodies from their mother’s milk to stay healthy. Studies have shown that artificially fed babies are up to 15 times more likely to be hospitalized in their first year. Breastfed babies receive a whole arsenal of immune components while formula fed babies receive none.  So how to do make sure that you will be able to breastfeed?  We commonly hear from mothers share that “I didn’t have enough milk” or “My baby liked  the bottle better”, etc.   Lacation experts say the one reason women have troubles breastfeeding is lack of support and education. Follow these steps to make sure you reach your breastfeeding goals:

1. Get good information: Go to a breastfeeding class and bring your partner, family members and other care givers. It’s important they learn the basics so they can help you and won’t unintentionally sabotage your efforts. Read a breastfeeding book like “Breastfeeding Made Simple” or “The Womanly Art of Breastfeeding”. Check out www.breastfeeding.com for great articles and advice.
2. Connect with nursing moms: Spend time and befriend women who successfully breastfed. Don’t take advice from people who didn’t. (I know it sounds obvious, but I made that mistake!)  Look for a mother to mother support group or La Leche League meeting.  Make these connections before you have your baby.
3. Choose your birth location carefully: Deliver at a “Baby Friendly” hospital, birthing center or at home. Ask the hospital if they have lactation consultants to help you. Some staff nurses don’t have much lactation training and/or have never breastfed themselves. We were told by a mom recently that when she asked for help  at an Anchorage hospital they gave her a bottle instead. Not good.  And don’t keep any formula samples you get in the mail or from the hospital.  It’s too tempting to have it in the house.
4. Plan a drug free, normal birth: IVs, epidurals, c-sections and narcotic drugs in labor all make breastfeeding harder. The more drugs, fluids and painful incisions you have, the harder it will be for the baby to latch on and the longer it will take for you to produce milk. Choose midwife or obstetrician that supports natural birth. Learn about and practice mental and spiritual techniques like non-focused awareness, prayer, hypnobirthing, and visualization.  Take a childbirth education class that focuses on natural birth. Find out if you will have access to a birthing tub, shower, birthing ball, food during labor, etc.  Hire a doula.  If you do need pain medications, ask for the lowest dosage.
5. If you have concerns, get professional lactation support immediately: WIC offers free breastfeeding support for their clients. Some pediatric offices have lactation consultants on staff . You can call the hospital where you delivered and get phone help. Most home birth and birthing center midwives will visit you in your home. ANMC has a program where they will come to your house and help you as well. LLL leaders and members are another great resource. Don’t wait to get help if things aren’t going well. Pick up the phone instead of a bottle.
6. Pediatrician or nurse practitioner: Find a provider that not only supports breastfeeding but that can give you specific help and advice. Some medical schools offer ZERO lactation education. Other pediatricians have done extensive training and have breastfed their own children. Ask about their training, experience and philosophy.  Consider using a nurse practicioner or naturopathic physician.
7. Plan for pumping at work: Delay returning to work as long as possible.  Try to arrange for job sharing, part-time, work from home or creative scheduling.  Nurse your baby at night to make up for lost nursing and cuddle time. Make sure to find a place to pump before you take maternity leave. We know women who have left their jobs to go to others that were more breastfeeding friendly.
   Going back to work and maintaining milk supply is a major challenge for women.  Remember that even a little breastmilk is valuable and better than none at all.  With enough support, you can do it!