For most women requesting pain relief during labor, epidural anesthesia is the preferred method. With this type of regional anesthesia, the laboring mother is conscious and awake, yet is numb in the lower extremities. This seems like the ideal solution for labor pains, but when a mother is considering the use of anesthesia in labor, she must weigh the risks for her and her baby with her desire for relief.
Fetal Distress
Whatever affects the laboring mother will also affect her baby before birth. This is true with epidural anesthesia as well. When the anesthesia is given, it often lowers the mother's blood pressure. This lower blood pressure then has risks for the baby as well. When maternal blood pressure drops, the amount of oxygen and nutrients available to the baby decreases. This is noted as fetal distress. Providers see this in the baby's lowered heart rate and abnormal variations in fetal heart rhythms. This distress can endanger the baby, as well as put the mother and baby at risk for delivery interventions, such as pitocin, to speed labor unnaturally, forceps or vacuum assisted delivery, or Cesarean section.
Difficulties After Birth
The side effects of epidural anesthesia are also noted in babies after birth. According to childbirth educator Debbie Amis in "Prepared Childbirth the Family Way" within 10 minutes of the mother's receiving anesthesia, the drug cocktail in the epidural space crosses from the mother's bloodstream to the baby's. This dose of medication can change the demeanor or the newborn, causing either drowsiness or irritability and fussiness. In either case, it hinders the baby's ability to nurse, bond and recover properly after delivery. Problems nursing immediately postpartum can cause delays and reductions in the mother's milk supply and can hinder or slow the development of a healthy breast-feeding relationship.
Effects of a Longer Labor
According to the American Congress of Obstetrics and Gynecology, labor generally lasts 45 to 90 minutes longer with epidural anesthesia than without any pain medications or anesthesia. The problem in this artificial lengthening of labor is that it increases the time a fetus is exposed to medications, thus intensifying the side effects listed above.
In addition, if the amniotic sac has ruptured, there is an increasing chance of infection as time passes. This longer labor also means a longer time in the birth canal, putting pressure and stress on the baby's head. Physicians can speed the pushing stage of labor through interventions, such as a forceps or vacuum delivery, but these also have increased risk for the new baby.
The choice for anesthesia in labor is a welcome one for many new mothers, but it is decisions that must be weighed carefully against the risks for both mother and child.
References
- American Congress of Obstetrics and Gynecology: Pain Relief During Labor and Delivery
- "Prepared Childbirth the Family Way;" Debby Amis and Jeanne Green; 2008
- "The Complete Book of Pregnancy and Childbirth;" Sheila Kitzinger; 1996
