From: ooblick@intercon.com (Mikki Barry)
Subject: Re: "Missing out" (was. re:  Justin...)
Date: Wed, 9 Sep 92 18:32:32 GMT
Reply-To: ooblick@intercon.com (Mikki Barry)
Organization: InterCon Systems Corporation, Herndon, VA

Apologies if you've seen this before, but news at our site is a bit flakey of 
late.  

From "The Midwife's Pregnancy and Childbirth Book" by Marion McCartney 
(without permission)

Epidurals

Regional anesthetics include bupivacaine (Marcaine, Sensorcaine) and 
lidocaine (Xylocaine), among a number of others.  They are given in the form 
of an epidural, spinal, saddle, or pudendal block or as a local shot for an 
episiotomy.  Epidurals and spinal blocks numb women from the waist down.  
Saddle and pudendal blocks numb the perineal area.  Why do so many women 
today end up with drugs and epidurals during labor and pregnancy?  Pregnant 
women are sometimes told that their pain can decrease the oxygen supply to 
their babies.  No research has ever confirmed this statement.  Many women are 
also led to believe that the pain of childbirth will be so awful they won't 
be able to handle it on their own.  This is untrue.

Recently, I spoke with an obstetrical anesthesiologist about epidurals and 
the improvements that had been made, which were impressive.  Then I asked him 
how many women actually got through labor in his hospital without any 
anesthesia and found it was only about 15 percent.  Most were multips (having 
a second or third baby).  In our birth center, on the other hand, all mothers 
(except for the 12 percent who transfer to a hospital for complications), 
both first-timers and multips, manage to labor and deliver without 
painkillers or anesthesia.  I asked why he thought so many women in his 
hospital needed anesthesia.  He said that the patients got very little 
support from the nurses and doctors to labor without anesthesia.  (This, 
again, shows how imporant attitudes and practices are.)  When I am with a 
woman in labor, I try to help her through these difficult moments - not 
because I think women should "tough it out," but because I know that with a 
little encouragement and support they usually find the pain bearable and can 
use it as a positive force in the birth of their baby - and, perhaps most 
important, because birth without unnecessary drugs is SAFER for both mother 
and baby.  Women in labor are very vunerable to suggestion and need an 
experienced, confident person to stay with them to encourage and coach them.  
The word midwife, in fact, means "with the woman."

It is wrong to condemn the epidural across the board because, when necessary, 
it is by far the best form of anesthesia available for childbirth.  If it is 
needed, it is always the anesthesia of choice.  The point is that it is 
usually not needed.  It is a cultural belief that women need epidurals to 
deliver, not a medical fact.

When You May Need This Procedure

1  Severe back labor or complications may cause the woman a great deal of 
pain.  With an epidural, the woman is awake and aware but without pain from 
navel to knees.  Epidurals can be used from the middle of labor (about 5 
centimeters) through delivery.

2  The epidural can calm the woman who feels out of control due to the pain 
of labor.  The drug can be allowed to wear off toward the end of labor so 
that the woman can push more effectively.

3  The epidural's effects can be stepped up so a C-section can be done or 
forceps used. (Medication is added via catheter so there is no further 
discomfort)

4  The woman usually has no urge to push and therefore can more easily wait 
for those caring for her to arrive.  On a busy labor floor, this makes for 
less rushing around and the staff can control the pace of everyone's births 
better.

5  The woman feels nothing and can be pleasant to everyone, including her 
coach, as labor progresses.  She can even nap or sleep during the most 
difficult parts of labor, and yet she will be awake to receive her baby after 
birth.

6  If the woman is exhausted and very tense, epidurals will allso much more 
complete relaxation to occur, often helping the cervix to dialate.

7  If Pitocin is used to stimulate the labor and the woman can't cope with 
the intensity of the contractions that Pitocin causes, the epidural will give 
good pain relief.

Why You Might Not Want This Procedure

On the down side, the epidural has many serious disadvantages:

1  An epidural often leads to longer labors

2  Labors tend to slow down once an epidural is working, which may 
necessitate augmenting the labor with synthetic hormones.  Pitocin is often 
used to speed up labor in these cases.

3  Pitocin, a synthetic hormone, can, in turn, cause fetal distress and make 
other interventions more likely.

4  There is more postpartim urinary catheterization following epidurals, due 
to bladder dysfunction caused by the drug and/or the use of forceps

5  There is a higher incidence of episiotomy.

6  Being numb, the mother is unable to bear down effectively during the 
pushing stage.

7  There is a higher incidence of tears and damage to the perineum (the 
mother cannot feel the usual burning sensation that lets her know how to 
control her pushing)

8  Forceps are used more frequently following an epidural because the woman 
can't push as effectively.  (Furthermore, there is an increased risk of 
postdelivery hemorrhage after Pitocin and forceps have been used.)

9  There is an increased incidence of C-section after epidurals. (Pelvic 
muscles may become limp.  An epidural can lead to dysfunction of the pelvic 
muscles, which normally rotate the baby into the proper position for delivery)

10  Though it rarely occurs, the needle may puncture the dura, causing spinal 
fluid to leak and resulting in severe headache with nausea, vomiting and 
vertigo.  Treatment involves lying flat on the back in bed, as sitting up 
makes the symptoms worse.  Obviously, a woman in this condition will have a 
very difficult time breast feeding or enjoying her newborn.

11.  Extrememly rare but serious complications have been reported, ranging 
from convulsions to loss of sensation or paralysis of the lower limbe.  A 
more common serious complication is maternal hypotension, which is a drop in 
maternal blood pressure.  The blood pressure drop may mean that the fetus is 
no longer getting enough oxygen.  In the mother, it can cause nausea and 
fainting.

12.  The safest way for a healthy woman is to give birth without anesthesia.  
Period.  It is safer for her and safer for her baby.  Epidurals are wonderful 
for complications, but they are not the best thing for normal deliveries.