Epidural Complications is the second part to Epidural Side Effects
As you read in part I, epidural side effects are not uncommon for you – the mother.
But what about your baby and your labor?
Do they remain unaffected?
As we are sure you know by now, the answer is no.
Any drug that you receive will pass through your placenta to your baby. Your baby is more vulnerable to their toxic effects of pharmaceutical drugs.
As far as epidural complications are concerned the maximum effects of epidural drugs will be seen at birth and in the hours immediately following birth. This is the case because the levels of drugs are at the highest at these times.
Are there studies about these epidural complications to your baby?
Yes there are.
Scientific studies have shown that at birth, epidural babies present just the same as babies born after being exposed to non legal opiate drugs. If you have an epidural be prepared for your baby to be drowsy. She may also have difficulty breathing.
A large-population survey from Sweden found that one of the epidural complications to your baby is lower APGAR scores at birth. Some people even reported some newborn drug toxicity from epidural medications.
Note: Keep in mind that your newborn baby’s ability to “detox” – process and excrete these drugs – is much slower than yours. She is born with an immature system. Here is an example: it takes 2.7 hours for you to excrete the drug bupivacaine from your system. However for your baby the same process takes 8.1 hours!
Epidural Complications: To Your Baby
- Fetal distress and abnormal fetal heart rate
This is a secondary side effect of the epidural and it is most likely due to a drop in your blood pressure or being in the supine – on your back – position or both.It is self evident that the diagnosis of fetal distress increases the likelihood that your baby will be delivered with the use of an operative device:
- Drowsiness at birth and a poor sucking reflex
This obviously will interfere with your ability to bond with your baby immediately following birth. A drowsy baby will not be as responsive as a baby who has no drugs in his system.
If you receive an emergency c-section and the epidural is administered just before surgery, the effects of the drugs on your baby will be lessened.
A drugged baby may have a poor sucking reflex which will interfere with breastfeeding. Moreover, a muscle relaxant is usually administered with the epidural and this will further impedes your ability to nurse your baby.Your nipples are a muscle and will be affected by these drugs. You may be labeled as having “flat nipples” when in actuality the drugs from the epidural are affecting your nipples’ ability to become erect and therefore your baby’s ability to latch on properly.
- A baby born with poor muscle strength and tone
If this occurs, there is a greater chance of your baby being taken to NICU to be observed and/or receive oxygen.
- Direct drug toxicity
Some studies show that drugs can have lasting effects on the fetal brain.
- If a maternal fever is present this may lead to fetal hyperthermia resulting in a neonatal NICU workup
- Neonatal jaundice:
- A recent review also found higher rates of jaundice for epidural-exposed babies.
- Another suspected long term side effect is hyperactivity up to seven years
Epidural Complications: Neurobehavioral Complications to Your Baby
Maybe the most disturbing epidural complications to your baby are the neurobehavioral aspects.
The effects of epidural drugs on your baby’s behavior used to be accepted as fact. Indeed older, more comprehensive studies show significant behavioral differences between epidural babies and “natural birth” babies.
On the other hand, newer studies with testing designed by pediatricians and anesthesiologists find little difference. However the data compiled by these tests has been criticized as unreliable.
The newest research shows that babies are indeed affected and some of the epidural complications are long term.
Epidural Complications: Your Labor
- Prolonged first stage of labor
- This is a common epidural complication. The anesthetic in epidurals weakens all the muscles below the epidural site. This can dampen the strength of your contractions.For you this can be very exhausting, boring, and discouraging.The medical staff is more likely to use Pitocin to strengthen your contractions which is stressful on your baby and/or uterus. This is linked to an added risk of c-section.With the use of Pitocin, there is also a greater incidence of maternal fever.
- Increase risk of malpresentation of your baby’s head: This occurs 20 to 26% of the time – or 1/4!Relaxation of your pelvic diaphragm predisposes malpresentations, as does your lack of mobility and your ability to switch positions.
- Increases the need for Pitocin augmentation.
- This occurs almost every time especially if the epidural is given before 5 centimeters of dilation.Some babies simply do not tolerate pitocin-induced contractions and this will results in abnormal fetal heart rate which may necessitate an emergency c-section.Be aware that Pitocin has a myriad of side effects.
- Prolonged second stage of laborThis is especially true for first time moms. Moreover, you also have an added risk of surgical delivery since most practitioners want your second stage to be over in 2 hours or less.
- Decrease in your ability to push effectively
- This is common since the build-up of anesthetic simply weakens your muscles to the point of ineffectiveness.You may be able to push a little but you may not be able to effectively help your baby to rotate and descend… obviously this increases the risk for surgery, forceps or a vacuum delivery.
- There is a fivefold increase of the likelihood of a forceps or vacuum extraction delivery
- This is quite significant.Less efficient contractions – keeping your baby from rotating naturally – coupled with a diminished urge to push – keeping your baby from coming down the birth canal – can affect the outcome and require the need for a surgical birth.
- Increases the likelihood of needing an episiotomyThis goes hand-in-hand with the increased use of forceps and vacuum extraction.You need to be aware that episiotomies are far more likely to tear beyond the original incision, not to mention they take longer to heal with greater scar tissue than natural tears.This causes you a lot of postpartum – after birth pain.
- A very real increased risk in cesarean section: 75% if you receive the epidural at 4 cmYou must be aware that Cesarean sections carry far more risks to both you and to your baby than vaginal births.Moreover, the postpartum recovery time is also significantly longer than with a vaginal birth.
Conclusion to Epidural Complications
If you need surgery, an epidural is wonderful as it gives you the ability to be awake and interact with your baby right away. HOWEVER, if you do not need an epidural you must be aware that they are not risk free.
If you are concerned about dealing with labor without medication, you may want to research the effects of having a doula present.
If you really want an epidural then do so knowing the benefits versus the risks and what will work best for you.
Sources for Epidural Complications:
- Cohen, Nancy Wainer. Open Season, 1991.
- Enkin, M., M. Keirse, and I. Chalmers. An Guide to Effective Care in Pregnancy and Childbirth, 1992.
- Goer, Henci. Obstetric Myths versus Research Realities: A Guide to the Medical Literature, 1995.
- Macauley, JH, et al. Epidural analgesia in labor and fetal hyperthermia in
- Obstetrics and Gynecology, October 1992 80(4):665-669.
- Rothman, Barbara Katz (ed.). The Encyclopedia of Chidbearing, 1993.