Epidurals used during childbirth present long term risks

By Daphne Singingtree, CPM

Epidural anesthesia is a pain relief measure used in childbirth. It involves placing a needle between in the epidural space located between the spinal vertebrae and injecting medication. It is used by the majority of women delivering in hospitals in the US today.

What most women do not realize is by having an epidural not only do they increase their risks of a cesarean, forceps delivery and a host of other complications, but by interfering with the natural birth process, important biochemical mechanisms are interrupted. When a woman gives birth without drugs, the way nature intended, there is a complex and interconnected exchange of hormones, neurochemicals, and body reactions between mother and infant. Technology and science can not exactly duplicate these substances and are just starting to understand the impact they have on both mothers and babies. The epidemic use of epidural anesthesia may have consequences that we will not understand for generations.

A 2000 study by Judith Rooks, in the Japanese Journal for Midwives has shown that women who have epidurals during labor have longer labors due to reduced levels of prostaglandins and oxytocin, than women who do not; consequently, need other interventions to speed up labor, a two-to-four times greater chance of having a cesarean, higher rates of forceps deliveries and episiotomies, increased need for urinary catheters postpartum and a very small, but real risk of spinal injury or respiratory distress. In addition, epidurals in labor can cause maternal fever which may affect the baby, a risk of prolonged headaches from spinal cord leakage and an increased incidence of long term back pain. Babies born after mothers who have epidural anesthesia are slower to breastfeed and are less responsive and alert than infants without anesthesia. Studies by Morton (1994), Martinez (2002), Howell (2001) Muir (1996) corroborate Rooks results.

The medical risks notwithstanding, the subtler and less understood risks of interfering with the complex process of natural birth may have longer term consequences. Oxytocin is one of hormones produced by the body during labor, which has been previously known to affect how mothers and babies bond. In the July 1999 issue of Psychiatry, researchers at the University of California, San Francisco have shown oxytocin to be associated with the ability to maintain healthy interpersonal relationships and healthy psychological boundaries with other people. "This is one of the first looks into the biological basis for human attachment and bonding," said Rebecca Turner, PhD, UCSF adjunct assistant professor of psychiatry and lead author of the study. "Our study indicates that oxytocin may be mediating emotional experiences in close relationships."

Additional research by (Kendrick, 2004) in the Journal of Neuroendrocrinology, show the neuropeptides oxytocin and vasopressin when released in the brain through giving birth or mating, are involved in promoting parent-offspring and monogamous bonds in animals such as sheep and voles. In humans, dysfunctions in these same systems can be associated with autism and, when we see people we love, these systems become activated.

How humans bond with our children, our mates, and our long term ability to feel love and an interconnection to others is tied to the birth process. The use of epidural anesthesia interferes with neurobiological factors which may have adverse affects we do not yet fully understand.

Beyond the medical and health advantages of giving birth without drugs, the overall benefits are harder to quantify. Giving birth without drugs is hard , it hurts , it is harder still to be in intense pain when you know relief is possible, but you know it is best for your baby. It is empowering for women , it can give a sense of inner strength that prepares women for an even harder job ahead, motherhood.

During labor a woman counts on her partner for support, both emotionally and physically , the labor process can be difficult, but going through it together can create bonds between partners that can last lifelong.

As a midwife for the last thirty years, I have been to thousands of deliveries, at home, in the hospital, in birth centers, c-sections, drugged, and natural, and I can tell you without the slightest hesitation; that there is no comparison to a natural and unmedicated birth experience versus a drugged delivery. While almost all births are filled with the happiness and joy of welcoming a new baby, there is a level of interaction and connectedness that happens between families as a whole in natural births. Mothers experience a sense of accomplishment that is both empowering and engaging. Babies respond better, partners feel more included, and mothers experience a profound sense of wellbeing and happiness, that is both physical and emotional.

The human body was created with perfect homeostatic mechanisms to reproduce and be healthy. While medical intervention can be lifesaving if problems occur, routine intervention with such a fundamental process such as giving birth may have long term adverse affects on children, family bonds, and society as a whole.

Works Cited

Howell, C.J., Kidd, C., Roberts, W., Upton, P., Lucking, L., Jones, P.W. & Johanson, R.B. (2001).A randomized controlled trial of epidural compared with non-epidural analgesia in labour. [Electronic version] BJOG: An International Journal of Obstetrics & Gynaecology 108 (1): 27-33.

Kendrick, KM . (2004) The neurobiology of social bonds. [Electronic version] J Neuroendocrinol. 2004 Dec;16(12):1007-8.

Martinez, AM, Fernandez, F, Nieves, R. (2002). Relationship between epidural analgesia and type of delivery [Electronic version] Rev Enferm. 2002 Feb;25(2):68-71.

Morton, SC., Williams,MS., Keeler,E., Gambone, J., Kahn., (1994). Effect of epidural analgesia for labor on the Cesarean delivery rate. [Electronic version] Obstetrics & Gynecology 1994 83: 1045-52.

Muir, H. (1996). Epidural Misadventures: A review of the risk and complications
associated with epidural anaesthesia retrieved on March 19, 2008, from http://www.oyston.com/anaes/local/muir.html

Rooks, J (2000). Epidural analgesia as used during childbirth in the United States
[Electronic version]. The Japanese Journal for Midwives2000; 54(10):9-14

Turner, R., Altemus, M., Denise N., Kupferman, K., Fletcher, D.,Bostrom, A., Lyons, D., Amico, J. (2002). Effects of emotion on oxytocin, prolactin, and ACTH in Women [Electronic version] The International Journal on the Biology of Stress 2002 5 (4):269 – 276.

Turner RA, Altemus M, Enos T, Cooper B, McGuinness T. (1999) Preliminary research on plasma oxytocin in normal cycling women: investigating emotion and interpersonal distress. [Electronic version] Psychiatry. 1999 Summer;62(2):97-113 .