I was recently having a conversation with my friend who is graduating from nursing school in mid December, and she told me that she had learned in her clinical that day that epidurals have no affect on the baby whatsoever. In fact her words were that the anesthesia doesn't cross the blood/brain barrier, and therefore does not enter the baby's system at all.

I was shocked to say the least. She went on to say that her teacher(a physician) said this was a "common misconception" in the birthing community.



Is this doctor and teacher flat out lying to his students or is he severely undereducated? How is it that we have men and women poised to enter the health care field so hugely mis-educated???

Or perhaps I'm hugely mis-educated?

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Since the epi effects Mom's heartrate and blood pressure it affects the way oxygen goes to the baby and the way carbon dioxide leaves the baby's system. This can cause low levels of oxygen and high levels of carbon dioxide in the baby's system when they are born.

Not only is the baby's body working to make the natural switch to breathing on their own using their lungs and switching the way their heart works they are struggling to eliminate the higher amounts of carbon dioxide in their system and bring up the amount of oxygen in their blood stream. In utero a fetus has an oxygen level in their blood of 30-70%. After birth it needs to come up to at least 90-95%. Basically the baby starts out with a deficit they have to work harder to overcome to in addition to transitioning to the requirements of life on the outside. This is why epi babies have respiratory problems after birth.

Another effect of epi's: they tend to effect the contraction pattern which further puts physical stress on the baby during labor & delivery. Labor takes longer so baby has to deal with the stress longer. Mom can't move around which also effects the circulation to/from the placenta.

This added physical stress on the baby's heart & oxygen levels during L&D is part of why they have problems latching on and seem listless or drugged: they have been through a harder birth and the effects are that they don't adjust as quickly/easily to life on the outside. Their birth has been harder, longer, and more physically draining than those babies born without epis. (plus Moms that get epis are more likely to recieve other drugs/interventions than Mom's that don't--and those other interventions often DO directly effect the baby and enter its bloodstream)

I also believe that medical staff are more likely to whisk the baby away, even if its just to the other side of the room, for observation just after birth which interferes with the first few moments of bonding and latching on. This has to effect the baby. Rather than its first moments being on Mom gently held and carressed they are under a bright light, being poked and prodded and suctioned. Its no wonder they are "in shock" when they finally get to Mom. In my experience, I felt so much different after an epi birth than I did without one. I have to believe that this also effects those first few minutes/hours.

I am in total agreement with you that the effects of an epi--regardless of what is causing them, are apparent in newborns. And I don't really care what is causing the effects. The why seems irrelevant to me. The fact that there are effects seems like the only thing that really matters. No epi for me. I will gladly deal with the pain during to fully experience the bliss (and the nursing baby) after :)
I don't believe that it can be a completely closed system. I may be considered closed because there is limited access. If one accepts the closed system idea as truth: How does meningitis transfer from a virus outside the body to a spinal cord infection/infection around the brain; How, if there is a leak in spinal fluid does it ever get replaced? We would also have to accept the fact that a human is born with a limited amount of spinal fluid for life-never to be increased or replenished. If it leaks you never get it back. Or if something extra is put into the spine-like a continuous spinal injection of drug (epidural) then the spine would eventually explode because there would be no way to void. If there is a way to void/or replenish spinal fluid, do one then accept that that there is some direct connection directly from the mouth to the spinal cord and then to the bowels? I’m not medical professional but I’m pretty sure there is no such direct connection. If we accept an ability for the spinal fluid to void or be filtered in some way, isn’t the only option a connection to the circulatory system?

There has to be some connection between the circulatory system and spinal fluid-no matter how limited. And if there is connection-then it would be possible to pass what is in the spinal fluid to the mother's blood stream. And if it gets into the mother's blood stream if must, even if in the most untraceable amounts, get to the fetus.

A critical analysis of what we know to be true-the above, does not comport with this blood/barrier concept feed to the medical community and, therefore, to mothers.

Or is there fault to this logic?
No, you are right. It's just that some drugs are able to cross over this system and some aren't. Though, I don't completely believe that the medications used in epidural don't. That is just the prevalent idea out there. As you know, medicine is always changing it's mind:)
wait a minute. we're in the line of thinking that epidurals are placed directly into the spine. and they're not. they're placed in the area near the dura cavity that surrounds the spine.

http://www.privatehealth.co.uk/private-operations/anaesthesia/epidu...

that changes things doesn't it? it's no longer a blood/brain barrier thing because it's not actually IN the spine.
The medications in epidurals, typically bivucaine and fentyl do cross the placental barrier and reach baby.
http://books.google.com/books?id=vJ8A0Xgl8gUC&pg=PA795&lpg=...
So why do they keep feeding this line to moms? I believe that an epidural is a matter of personal choice. But it really must be an informed choice. And the fact that they keep giving this line to nurses, mothers and fathers is atrocious. I'm sure most Ob/Gyns and family practitioners believe it also, just because they keep being taught it in med school and don't really think about it. I think it was Ina May that made the point that most doctors are not trained in the critical analysis of data. Case in point. This maybe why they keep saying planned homebirth is unsafe-when all data points the other way. They do not normally analyze the data in a critical and scientific way. Next time a doctor/nurse feeds a mother the line about the blood/brain barrier maybe see should point this out.
The text that jumped out at me states that the medications from the epi. may be present in fetal circulation in "great" amounts. Great link.
I've been hearing that a lot lately. I just gave birth two weeks ago (home birth with a midwife) and had gone in to be monitored (41weeks 3 days) and the nurse was telling me how my baby was too big to be birthed vaginally and I would need a c-section. She tried to make it sound so wonderful by saying they could start my labor and give me an epidural so I could labor 'naturally' until the doctor was ready to do a c-section. I told her I wasn't interested in any interventions and that I didn't want a 'trial labor' because I wasn't going to expose my daughter to the epidural. She told me it didn't affect the baby at all and only very small amounts have been seen in some babies but most never receive any of the medication.

This took me by complete surprise. A few days later I birthed my 9lb 4oz little girl with a midwife at home and had the most amazing time. I am so glad I didn't listen to that nurse.
my second son was 9lbs 5oz! I felt powerful after his birth! lol
Congrats! My first was "only" 8lbs! I had a much harder time with his birth. It was a very long labor and I tore really bad. He was also a homebirth with a midwife. This one, I didn't push at all. I didn't even realize I was in labor until about 30 minutes before she came! I started feeling really crampy, felt like I had to have a bowel movement NOW and instead she came out! I couldn't imagine losing that incredibly powerful experience by giving it over to a doctor and an epidural!
This has been a really great discussion!

I think that there is so much about the birth and bonding process that we don't understand, and I wonder if 50 yrs from now we'll look back and think, "Oh maybe we shouldn't have done that." like with so many things we do in medicine.

I also wonder if the bonding problems after delivery are maybe partially related to the mother, and how her body reacts to the epidural. We know how important labor is to get hormones going and maybe the "pain" and emotional intensity of the experience triggers a mothering instinct,or a hormone even,that motivates both mom and baby towards each other.

My friend delivered her daughter in a fairly short( 4hrs) labor and delivery, under the influence of Stadol, and her exact words to me when her daughter came around to wanting to nurse 8 hrs later were "She wanted to nurse but I was too annoyed to do it." She said she felt agitated, tired, and unmotivated to feed the baby. Lot's of factors can make a mother feel this way, but she really feels it was the Stadol.

I think assuming we have it figured out is an healthy combination of ignorance and arrogance. We interfere every step of the way and expect that we are in control to the degree that our interference doesn't have any consequences. This way of thinking has always backfired on us.
Stadol makes for "floppy babies" as we call them here at my L&D unit.
It is horrible for the mother and the baby. If you can't handle the labor, then take ab epi. It's much better for the baby. Stadol babies are born really high. It's sad. This drug should be banned. She's lucky her baby wanted to nurse at all.

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