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The Epidural
By Jami Howard

Right now, you are probably wondering to yourself, what is an epidural? Epidural anesthesia or analgesia refers to total or partial loss of sensation in the trunk between the fundus and the pubis or lower. An anesthetic agent, a narcotic, or a combination of the two is injected into the lower space between lumbar vertebrae two and five. Epidurals should not be used during labor by women in labor because of the negative effects such as increased length of labor, increase in cesarean delivery, and interference with mother-infant bonding.

One negative effect of epidurals during labor is an increased length of labor. Researchers at the Southwest Medical Center in Texas have completed a study that says that epidural anesthesia used in labor does cause delays in the length of labor, and therefore increases the use of Pitocin (to speed labor), cesarean sections because of the prolongation of labor can lead to fetal distress, and to instrumental deliveries (forceps/vacuum). Researchers led by Dr. James M. Alexander of the University of Texas Southwestern Medical Center in Dallas, studied 19 women of normal pregnancies who were admitted to the hospital with labor contractions. The women were given the choice between and epidural injection for pain or intravenous Demerol. Women in both groups entered labor spontaneously, had similar degrees of cervical dilation when pain medication was given and received equal dosages of oxytocin-a drug given during labor to stimulate uterine contractions. However, researchers reported that the active first stage of labor and the time from admission to delivery were all significantly longer among women who received an epidural. A prolonged second stage of labor can weaken the muscles in the uterus necessary to push the infant out during delivery. Of the 126 woman who received an epidural, length of labor averaged nearly eight hours, compared to approximately six and a half hours among the 73 women who chose Demerol.

Another negative effect of epidurals is an increase in Cesarean Sections. In a Cesarean Section, the baby is delivered through the uterine and abdominal walls. Cesareans may be elective, meaning planned ahead of time, and they can be done either before or after labor begins. This is, obviously not a natural method of birth. Many studies associate epidural anesthesia with a greater incidence of cesarean delivery (which is associated with 2-9 times greater maternal mortality than a vaginal delivery), and it has been proven that an increase in Cesarean Sections has been linked to the usage of epidurals during labor.

According to studies revealed at the November 1997 meeting of SELCA- Southeastern Lactation Consultants Association a regional division of ILCA- International Lactation Association, there is an increase of inversion of otherwise non-inverted nipples of women possibly due to epidurals causing lack of muscle tone, therefore interfering with the ability of mom to easily breastfeed. This keeps the mom from having the mother-child bond during the time that the mother is breastfeeding, if she chooses to do so. The importance of the relationship of mother and child has recently been reported in USA Today, April 6, 1998. The major indicator of a child's success in social adjustment is the bond between mother and child. A baby born whose mother has epidural anesthesia is almost 4 times more likely to be admitted for septic work-up than a baby born without epidural anesthesia. The mothers can sometimes spend two days in ICU with IV antibiotics away from their babies Adverse effects of the physiological disruption of the birth process by the epidural anesthesia is shown in animal studies.

One myth about epidurals is that they ease away the pain and create an easier, more comfortable birth. According to a Robbie Davis Floyd study, some women reported effective pain relief from the drugs they were given. Others reported that the drugs had no effect on the pain, but only made them drowsy and less able to deal with their contractions. The women who felt that pain medication was forced upon them resented the interference in their experiences of labor and the lack of support for their desire to avoid medication. So, all in all, the negative effects of epidurals thoroughly outweigh the positive effects. Some of the negative effects include an increased length of labor, an increase in Cesarean Sections linked to the usage of epidurals during labor and an increase of inversion of otherwise non-inverted nipples of women. These are just a few of the numerous reasons negative consequences of choosing to use an epidural during labor. Hopefully, in some way, knowledge had been gained by the reader that will encourage him or her in a positive way.

-Jami Howard
May 26, 1998

Jami wrote this as a special project for chemistry. She is a 17 yr old daughter of Teresa Howard. growing up in a doula's home has certainly had it's effect. she plans to work with special needs children in the future. she is involved with sports at her high school. Her plans also include homebirth eventually some day!

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