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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Most of the doctors that I work with well tell moms that. I think they really believe that too. I don't know if it crosses the blood/brain barrier, but I do know that studies have shown that babies don't nurse as well right after birth(though it doesn't appear to affect nursing in the long run). You better believe, though, that I am on my toes watching the babies heart rate right after the epidural. I have seen times when mom is fine with a small blood pressure drop caused by epidural, but it really effects baby.

I think what most physicians mean when they say that, is that there are no problems caused by the epidural that more medical intervention can't fix:) If moms blood pressure drops, then they can give her medication to fix that. If mom isn't able to push then they can pull baby out for them. If baby isn't able to nurse well, then they can put an iv in the baby and give them a solution of sugar to help them out. If moms labors slow down, then we can give pitocin. There are implications to an epidural, the medical community is just able to step up with more interventions.
I am used to hearing that their are "no complications" for the baby caused by epidural. But what she said to me is that the the anesthesia does not reach the baby's blood stream at all. That seems physically impossible to me.
I think the research is up in the air on this one, so it depends on what the physician wants to believe. Some are very adamant that it doesn't reach baby and some believe it does. But in my opinion, it doesn't matter, because there are obviously other effects that that can harm baby that should be taken into account.
I really don't see how it could be possible that it doesn’t. I mean if we are told alcohol, everything you eat, other IV drugs including illegal use, smoking, everything in some way makes it way to the baby, how could something pumped directly into the mother's system not. What would be the miraculous thing about the epidural that makes that the one thing that does cross over?
This happened to me in a childbirth class where the educator said none of the epidural crossed the placenta to the baby. I was mortified! I didn't interrupt during the class (I was there as an observer) but I did question her afterward. She explained that she was at a conference where a doc talked about this issue of the epidural not crossing the blood-brain barrier, etc. That was beyond my scope of knowledge at the time, so I asked other childbirth educators and nurses. I was assured by all of them, and my research backed it up, that a small amount of medication administered via the epidural DOES cross the placenta and reach the baby. However, the amount of meds used in an epidural is much less than what is used in an IV (for example, intravenous morphine) so the effects to baby are usually undetected or minimal. But, if you talk with L&D nurses and lactation consultants, many will tell you that babies born with epidurals often have a tougher time nursing in the beginning and may be a bit more irritable. I don't believe this has been found in studies on effects of epidural, but it has been observed "in the field."

I went back to this educator and took research studies that talked about the blood-brain barrier issue and said that a small amount does cross the placenta. I am hopeful that she hasn't said this to another class :)
The thing with the blood brain barrier is that the epidural is administered into a space that is not connected to our blood system. The drug supposedly does not cross over into the blood, therefore baby does not get it. But I don't think that has been proven and there are research articles out there that show that it does effect babies nursing in the short term. But if the epidural is accidental placed into the blood stream, that can cause major problems for mom as well as baby (I'd assume).
The meds from an epi don't get into the fetus. The spinal colum is a closed system (the meds are in Mom's spinal fluid which circulates around the brain but does not cross from the spinal fluid into the bloodstream--this is the blood/brain barrier mentioned) and as long as it is done properly the meds do not enter the mother's blood stream so they cannot cross the placenta into the baby. This is a medical fact. The doctor is right and is not mis-informing your friend. However, what thay neglect to add, which is an important part of the info that is being left out, is that the side effects to the mom from the epi that do affect the baby.

It causes a severe drop in blood pressure and effects the mom's nervous system and heartrate. This affects the circulation from Mom to baby including getting oxygen and nutrients to the baby and removal of waste (including carbon dioxide) from the fetus/uterus. This means baby is getting less oxygen and is building up carbon dioxide in their bloodstream, which affects the baby's heartrate and oxygen levels. Plus, the Mom gets massive amounts of IV fluids to counteract the drop in blood pressure which can also mean the baby is getting infused with unnatural amounts of fuid, causing an electrolyte imbalance, low blood sugar, and physical stress on the baby handling all these extra fluids during and after birth. Many babies that are born after Mom gets an epi retain water and lose significantly more weight soon after birth than non-epi babies--just like mom must work out the extra IV fluids so does baby.

Just because the drugs don't cross the placenta and enter the baby doesn't mean that the side effects don't. Wonder what your nurse friend's professor/clinical director would say about that :)

BTW my sister is a RN and had a graduate degree in nursing and she is the one that explained this to me when I was PG with my last child.
Yes that is what she said about the blood/brain barrier.

So if we assume that in fact there is no actual trace of the anesthesia in the infants blood stream, as was stated, then the negative affects the infant experiences are a result of side effects the mother experiences.

So another question, I've often had mothers tell me they were opting out of an epi, but would be using Stadol(or something like it) to "take the edge off". They were under the impression that this is a "safer" alternative.

Clearly the best option is no medication at all, but what the lesser of the two evils? I know what i think, but I'm curious what other people in the field who have seen a greater number of varied medicated births think. Rachel? :)
Stadol does cross the placenta. It is used in early labor to "take the edge off" as Kate said. It can cause respiratory depression, but since baby's oxygen supply does not depend on their respiration while still in utero the "effects" are thought to be limited. It can also cause drowsiness but again they say that doesn't really "matter" if the baby is still in utero (this is not my opinion I am just stating the medical position). It also has a relatively short "half-life" (this is the medical term for how long the body takes to break it down and eliminate it from the body to the point it no longer works or effects the patient). However, it is NOT recommended to be given in delivery or within 4 hours of delivery because then it does effect the baby's breathing once they are born if it is still in their system. Problem: how can they tell for sure if you will/will not deliver in less than 4 hours? Seems like quite a gamble to me!

The best of two evils? Thats a hard one. I guess stadol since the effects are short term and if given well before delivery has less of an effect on the baby after birth. It does not create the same stressful physical situation for baby as an epi given throughout the labor & delivery and is usually only given in 1 dose to Mom in early-mid labor. But Stadol can also have side effects to Mom which would further effect the baby. I am for a unmedicated labor & delivery but IMO 1 dose of Stadol in early labor to prevent an epi for the entire L&D would be the lesser of 2 evils.
I agree with Sara on this one. I think the main effect of the epidural for me is the effects it has indirectly on baby that have already been mentioned. You won't see those same effects with Stadol or morphine. At least you can still push a baby out effectively with those, as well as not have the dramatic drop in blood pressure and fluid intake that has been mentioned. But that said, I don't think it has been properly researched. I would love to put moms in the bathtub first:) I think at that point it does more good anyways.
so if epidurals don't directly affect the baby then why does the baby have issues nursing?
Example: unable to latch, latches poorly, latches but suckles poorly. - compared to moms who have had no drugs in their systems.

Also, why does baby from an epidural mom have respiratory issues after birth?

often I've seen that it depends on how long mom has had the epidural (2 hours compared to 14 hours+)

Have you ever seen Delivery Self Attachment?
It's a video in which Lennart Righard MD took two groups of mom/baby duos. Moms who had unmedicated births and mom who had medicated births/c-sections. Then compared the baby's reactions to being placed on the belly.
Babies from unmedicated births crawled/scooted up to the breast, attached and nursed by themselves.
Compared to babies from medicated birth who were either too drowsy to crawl/scoot, or if they did make it to the nipple couldn't attach or nursed poorly.
It's pretty interesting to see, and you can definitely tell.. epidurals ARE having an affect on babies.
No matter WHERE it's coming in from.. it's affecting them.

I agree with the blood/brain barrier point. Otherwise infants would be having catastrophic affects on them from the drug directly in the blood stream. Not to mention mom!
But it IS in our bodies, and we do share our bodies with our babies. They have to be getting something from it.
I'm not sure about this one either. I wonder if it may have to do with the decreased oxygen/nutrients that maybe baby is getting once the moms pressure decreases.

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