Epidural: Wolf in Sheep's Clothing

by Kelly Brogan Healthy Pregnancy, Baby & ChildComments: 106

Epidural anesthesia

By Dr. Kelly Brogan MD

The modern woman is task-oriented. She lives in a world demanding of her competence, attention, and efficiency. We use technology, tap into our communities, plumb the depths of our reserves to navigate an often hyper-masculinized world while retaining our most vital feminine powers. The power that fundamentally defines our exemption from this contemporary lifestyle trajectory is baby making.

This primal empowerment forms the bedrock of a woman’s most untouchable gifts.

We have lost sight of this fact; however, and have allowed our inner compass to be co-opted. It’s certainly no wonder, that after 9 months of hypermedicalized pregnancy “management” (often following months to years of assisted reproductive technologies), birth is considered another task on the to-do list to complete.

As a type-A taskmaster, myself, I understand the lure of a predictable and painless depositing of your newborn after the long and fear-punctuated journey of pregnancy.

I’m here to tell you; however, what your obstetrician won’t.

Labor is a physiologic process that recruits neurochemical, endocrine, and immune systems into a dance that we barely have the tools to conceptualize.

When we meddle with this, when we attempt to standardize it, we put women and their babies at grave risk – physically, psychologically, and even spiritually. We rob women of an opportunity for psychospiritual transcendence.

As a science-minded medical doctor, I don’t wield this phrase with ease!

The process of conception, gestation, and birth cannot, however, be reduced to daily activities and routine life occurrences. There is something built into our consciousness that makes room for its own expansion around these life transitions. The process of bodily separation – woman from her newborn – involves a passage through a space of trance-like awareness.

I can only describe it as the sensation of floating and grounding, simultaneously. It is an experience that demands we move out of the space of our mind and into a space of sensation without judgment. It is being present, truly present, to behold a glimpse of what we are capable of as mammals and most importantly, as a human female.

In this way, a natural birth is an opportunity for redefinition and reconnection to one’s most core self. It is the way women were intended to pass through the gates of motherhood, to the next chapter of their actualization.

If you buy the potential significance of these considerations, you may want to know what represents your greatest obstacle and impediment in achieving this life milestone. You may be surprised to learn that it is epidural anesthesia. This discussion is meant to shine a light on elective epidurals – that, “Why not? Who wants to feel crazy intense pain?” choice that 2/3rds of women (and up to 90% in some hospitals) opt for every day. In my opinion, the epidural intervention is the most reprehensible of all – because of its largely dismissed risk profile, and because of its auspicious position in a cascade of interventions, unnecessary, ill-conceived, and rife with unintended consequences including death.

If we can empower women to question the validity of this procedure, then they can retain the right to preserve the integrity of their birth experience.

What’s the big deal with Epidurals?

A 60% rise in C-sections since 1996 is prompting the American College of Obstetricians and Gynecologists to fidget self-consciously in their white coats. A study revealing the prolongation of the second stage of labor thanks to epidurals has been influential in identifying the iatrogenesis doctor-caused harm – at the root of the cesarean problem.

It appears that, thanks to an antiquated but still sanctioned construct – Friedman’s curve – the hospital clock starts ticking loudly upon arrival, and the alarm goes off after 3 hours of second stage labor with a epidural. At this non-evidence-based juncture, interventions including IV fluids, continuous monitoring, food and drink restriction, and immobilization conspire to invite pitocin, forceps, vacuum, episiotomy, and surgery into the delivery room.

Obstetrics is vulnerable to practicing consensus medicine – habitual practice that is not predicated on sounds science. As I discuss here, metanalysis has demonstrated that only 30% of current obstetrical recommendations are based on quality data. What’s the rest based on? Fear-mongering and personal opinion? Let’s look at what the evidence suggests about the risks of epidurals, considering that up to 41% of women never properly consented for this intervention.

Epidurals are offered with a plethora of accoutrements including catheters for involuntary urination, blood pressure monitoring and IV fluids for changes to vascular physiology, and continuous fetal monitoring because of risk to the baby of decreased oxygen flow.12

The changes to natural labor progression are compounded by risk of fever in the mother that leads to further separation of mom and baby after birth, secondary to testing and assessment for infection. This separation represents a stress to the shared adaptation to early postpartum life and may predispose to psychiatric pathology in both mom and baby through early epigenetic influences on gene expression.345

This separation may also interfere with breastfeeding establishment. In this way, epidurals may be directly and indirectly responsible for breastfeeding struggles67. Breastfeeding appears to prevent the onset of postpartum depression if it is established within 3 months, in addition to being a continual source of immunologically essential information trafficked from mom to baby.

Shooting Up You and Your Baby

epidural catheter_miniEpidurals are a delivery method for narcotic pain-killers that pass through the placenta to the baby and have largely unpredictable effects on the birthing woman. Evidence supports risks to the baby including reduced tone, poor feeding, jaundice, withdrawal, and sensorimotor impairment.8

Physiologic risks to the mother include acute and persistent problems such as numbness, tingling, dizziness, respiratory paralysis, cardiac arrest, nerve injury, abscess, and death.910A user-friendly description of these considerations was explored by Pathways to Family Wellness, here.

Hurrying Up

When epidurals lengthen the second stage of labor, Pitocin, or synthetic mimic of the brain hormone, oxytocin, is delivered to augment the process. Because Pitocin does not cross the blood-brain barrier, it does not stimulate endorphin release. It also interferes with feedback loops suppressing natural oxytocin production while hyperstimulating the uterus without appropriate relaxation between contractions. The significance of this is just being revealed and may even reach to risk factors for autism.

Cutting Up

The increased risk of c-section1112 in the wake of epidural anesthesia is easily explained by relaxation of pelvic muscles that detach a woman from the instinctive guiding forces of an uninhibited labor, by the baby’s increased distress secondary to narcotic exposure and malposition, by the recruitment of Pitocin which causes uterine and therefore fetal distress, and fetal monitoring which, while superficially reassuring results in increased interventions (2-3x c-section rate) without improved outcomes.

Your doctor may fail to mention that a surgical birth brings with it these risk considerations: protracted recovery, infection (including necrotizing fasciitis), organ damage, adhesions, hemorrhage, embolism, hysterectomy, wound dehiscence, early infant separation, higher risk of respiratory problems for baby, and an exponentially increased risk of placenta accreta, a potentially lethal complication of surgical birth, contributing to a 3.6 fold increase in maternal death after cesarean relative to vaginal birth.

Of primary interest to clinicians who appreciate the role of the gut microbiome in child and adult health, abdicating a vaginal transfer of beneficial bacteria may set the stage for chronic disease including a 20% increased risk of obesity.

Opting out of epidural anesthesia: Choosing to feel

What are the best ways to help your body, mind, and spirit align for this tumultuous but life empowering journey?

Movement – Staying active during pregnancy is optimal mind-body medicine. Yoga, home-based routines, and swimming in unchlorinated water are excellent choices, at least 3 times weekly.

Chiropractic – With advanced perinatal training, holistic chiropractors are critical experts in proper alignment and nervous system support to facilitate a physiologic birth.

Acupuncture – Applied before and even during labor, acupuncture can gently and effectively facilitate a healthy labor and delivery. According to a Cochrane Review, acupuncture and hypnosis meet evidence-based efficacy criteria for pain management in labor.

Controlled Breathing/Meditation – Perhaps the most important tool for a new mother, learning to engage the relaxation response in pregnancy will help you to know what it feels like to be present to the labor experience, to go inward, quiet your mind, and release fear. Hypnobabies and hypnobirthing are well-regarded methodologies.

Diet – The physical experience of labor and delivery is best supported by stocking the shelves up front for a healthy hormonal response with minimization of inflammation and maximization of nutrient-density. Eat sustainable, organic meat, fish, eggs, veggies including root vegetables and squash, fruit, nuts, and seeds. Leverage the complexity of food-based information to promote optimal gene expression in that growing baby, and support a healthy delivery and postpartum experience.

Doula – Preparation for labor, and support for mother and spouse have been traditionally left in the hands of a woman’s most doting partner, a doula. No woman should birth in a hospital without this advocate. Evidence supports a doula’s ability to help you achieve an intervention-free birth.

While my most heart-filling emails every day are from my homebirthing patients, I aim to sit in a place of true advocacy for the women that I treat and advise. I believe in informed consent, and I observe that this is not occurring in hospitals today. Explore resources that will help to expose you to the known risks and popularized benefits, so that you are making your own decision with your eyes wide open.

As most women who have experienced natural birth would attest – just when you think you can’t do it and your mind demands surrender – you meet your baby, and the world stands still in a moment of unparalleled beauty and wonder.

About The Author

As an undergraduate at M.I.T., Dr. Kelly Brogan studied Cognitive Neuroscience and worked with Harvard undergraduates to create a public forum for the discussion of alternative medicine, directing conferences for the Hippocratic Society.

She attended Cornell Medical School where she was awarded the Rudin Scholarship for Psychiatric Oncology and began her work in Reproductive Psychiatry, which she went on to train in during her residency at NYU/Bellevue.

A strong interest in the interface of medicine and psychiatry led her to pursue a fellowship in Consultation Liaison/Psychosomatic Medicine at NYU/Bellevue/VA Hospital.  Since that time, she remains on faculty and has focused her efforts on her private practice where she cares for women across the life cycle including pregnancy and postpartum.

A passion for holistic living, environmental medicine, and nutrition are the bedrock of her functional medicine practice. She has published in the field of Psycho-Oncology, Women’s Health, Perinatal Mental Health, Alternative Medicine, and Infectious Disease.  She is Board Certified in Psychiatry, Psychosomatic Medicine, as well as Board Certified in Integrative and Holistic Medicine.

You can learn more about her at www.kellybroganmd.com, and connect with her on FacebookTwitterand through her monthly newsletter

Sources:

1 http://www.ncbi.nlm.nih.gov/pubmed/15957994

2 http://www.ncbi.nlm.nih.gov/pubmed/12011872

3 http://www.ncbi.nlm.nih.gov/pubmed/24552992

4 http://www.ncbi.nlm.nih.gov/pubmed/12011872

6 http://www.nutricionhospitalaria.com/pdf/6395.pdf

7 http://www.internationalbreastfeedingjournal.com/content/1/1/24

8 http://www.ncbi.nlm.nih.gov/pubmed/12011872

9 http://onlinelibrary.wiley.com/doi/10.1016/S0091-2182%2897%2900052-9/abstract

10 http://www.ncbi.nlm.nih.gov/pubmed/17447690

11 http://www2.cfpc.ca/local/user/files/%7B8030D89F-B698-4F9D-B6A7-190AD9866E59%7D/Kotaska%20Klein%20epidural%20oxy.pdf

12 http://summaries.cochrane.org/CD000331/epidurals-for-pain-relief-in-labour

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