Sunday, December 9, 2012

Doula Without Guilt

This blog is in response to a book published in 2011 Epidural Without Guilt.
Below the author addresses "epidural myths" and attempts to dispute them.  Quite often he avoids the real truth and topic at hand, so I've taken each issue and readdressed it.

"* Epidurals will slow down my labor

This is a commonly believed myth, but in fact is not true. Since 2005, there have been four scientific studies published on this issue. Three of the studies found that instead of slowing down labor, pregnancy epidurals and spinal epidurals actually speed labor up – especially when pregnancy epidurals are given before the cervix is 4 cm dilated. The fourth (and largest) of the studies showed no difference in how long labor lasted, whether or not a pregnancy epidural was used. So pregnancy epidurals do not slow labor down – they may even speed it up."

If a woman has been in labor for a long time (whatever she deems as long) an epidural can indeed relax her enough and provide her with much needed rest to continue and even speed up her labor.  Until you get it, you don’t know how you’ll respond to it, therefore a better option may be to hire a doula and take childbirth education classes that teach you natural coping methods.  There are plenty of natural techniques and tools for relaxation; water and breathing to name a couple.  Ina May’s sphincter law explains why relaxation is so essential. 
The problem with receiving an epidural before 4 cm dilated lies in the increased risk for baby going to NICU.    Quite commonly when a woman has had an epidural she will develop a fever; medical personnel have no way to determine whether or not this is due to an infection and therefore baby will be sent to NICU “just in case.”  The longer a woman has an epidural the higher her temperature may be.
An epidural comes with an I.V., a blood pressure cuff, continuous fetal monitoring (which since began has not shown a decrease in infant mortality but an increase in cesarean rates) and the inability to move.  This limit to mobility is what results in a slower labor and increased risk for a cesarean.  A better option would be to keep your mobility.  Use your doula to help you find a rhythm.  Trust your body to birth and you’ll naturally find the positions best suited to work with your labor.  Doula’s are experienced in labor and can help with suggestions for comfort and assist in helping baby into the best position resulting in a more efficient labor.

"* Epidurals will increase the chance that I will need a cesarean

This is an old myth will not go away, even though many studies from different parts of the world have found that pregnancy epidurals do NOT increase the chance of needing a cesarean. So why all the confusion despite solid scientific evidence? It’s because pregnancy epidurals are associated with cesareans, but they don’t cause cesareans. What do I mean by this? Well, women who have difficult, painful labors are more likely to need a cesarean. And these are the SAME women who are more likely to ask for a labor epidural – so there is an association between labor epidurals and cesareans. But the labor epidural does NOT make a cesarean more likely."

On the side of medical interventions, what an epidural does negatively interfere with is pushing; resulting in the increased use of vacuum or forceps extraction and an increased risk for tearing. 
Cesarean rates are increased for women receiving an epidural accompanied with induction or augmentation.  When Pitocin is administered contractions are more erratic and forceful, due to this most of those women receive an epidural.  Pitocin will gradually be increased throughout labor based on physician direction and other medical protocol.  Once the epidural is administered, the woman no longer feels the pain of the contractions and therefore will not direct stopping the drip.  The epidural has cut off this(pain) necessary means of communication.  Meanwhile, though contractions weren’t feeling stronger for mom, they were becoming increasingly stressful on baby.  The only way baby communicates stress is a drop in the heart rate.  Once this happens, even if Pitocin is turned off its affects can still be felt for an hour, which is far too long for a decreased heart rate in baby, resulting in a c-section.  Pitocin and Epidural do a dance together, as they each have opposite effect.  One relaxes and one stresses and therefore as you give one you necessitate the other.  The real problem of the two being pitocin.
Doulas are beneficial no matter what type of birth you plan on having.  Studies show that using a doula decreases the incidence of cesarean!

"* Epidurals will cause backache

It turns out that backache is very common during pregnancy and after pregnancy. In fact many women experience backaches after they deliver that can last for many months. Scientific studies of backache after delivery have found that the chance of having a long-lasting backache is the same whether or not the mom got a labor epidural."

Backache is the least of your worries if you are faced with PDPH, better known as Postdural puncture headache.  When signing the informed consent form, most women are not told that it is a blind procedure and that every woman is different!  Due to this and the precise location the medication needs to be administered into, it is not uncommon that the needle goes a bit too far causing a leak in spinal fluid.  What happens then is your brain is compressed heavily against your skull and no longer cushioned by the fluid resulting in an extreme headache when in any position besides lying flat.  The best fix for this problem being the epidural blood patch.
Due to not being able to feel when pushing, it is not uncommon that women overstrain themselves, therefore resulting in more of a backache than they may have had.  Pushing with an epidural can take longer because the woman may not be pushing as effectively as she could be.  Women pushing with epidurals are generally pushing as directed.  There are numerous benefits to pushing on instinct that are hindered by epidurals.  You’ll never know, so why not take the more natural approach and use a doula to help with coping during labor.  If you don’t have an epidural you can (ideally) push in any position you’d like.  More optimum pushing positions result in more effective pushing and less strain.  Listen to your body and trust birth!

"*Epidurals are dangerous for my baby

This is a particularly wicked myth, because it makes women feel guilty for wanting to their pain relieved. Although there are certain problems with labor epidurals that could be bad for babies, for example, a significant lowering of the woman’s blood pressure – most effects of labor epidurals are actually helpful for the baby. An example of this is the labor epidural lowering the woman’s stress level and thus getting more blood flow and oxygen to the baby during labor and delivery."

I feel this completely is avoiding the topic at hand- that epidurals are derived of cocaine.  No matter how you spell it, drugs cross the placental barrier and baby is receiving the drug as well.  The bonding between mom and baby is threatened from an epidural in that it reduces the suckling desire, causes baby to be drowsy and increases the risk of baby being sent to NICU resulting in a loss of that precious bonding time.  The safest bet for baby and bonding is a natural labor allowing the amazing hormones of pregnancy to do their thing.  Epidurals interfere with the natural flow of hormones that are so important for bonding.
Using a doula reduces the likelihood of requesting an epidural.  Doulas can help you relax and manage the sensations of labor without drugs.  A doula is there to help you have your ideal birth; if you plan on using pain medication and doula can most definitely support you in that as well. 

"*Epidurals will prevent me from breastfeeding my baby

I hear this myth repeated all the time, but the scientific evidence is scanty, at best. Modern pregnancy epidurals and spinal epidurals use such low doses of medication that it’s hard to imagine a negative effect on breast-feeding the newborn. In fact, pain after delivery can be bad for breast-feeding. Pain reduces the amount of milk a new mother produces. And a new mom in pain may be less likely to want to interact with her new baby. So I suggest something that isn’t usually considered: think about using a very low-dose labor epidural after a difficult vaginal delivery, and certainly after cesarean. It’s the best way we have to make the mom comfortable without being drowsy."

It has been proven that women who receive epidurals are more likely to have pain once it has worn off because they have not received the necessary hormones that flow in a natural labor and they have possibly strained more than necessary while pushing.  When a woman uses natural coping methods and allows the natural flow of hormones she experiences elation after the birth of her baby, experiencing the unsurpassed “birth high.”  She is able to get up and walk around, without pain and bond with her baby as nature intended.  A doula can help a new mother begin breastfeeding.  A baby who has not received epidural drugs will root for the nipple and latch on its own.   

After birth, a woman feels “after-pains” which is the uterus contracting to return to its original size and place.  This is a necessary part of birth that does become more intense after each child.  These after-pains can be felt for days after birth; it took nine months for your uterus to expand, it needs sometime to return to its original shape and size!  Oxytocin is the hormone that stimulates the uterus to contract and is released while breastfeeding.  Your milk, which won’t come in until a few days postpartum, will not be hindered by this as the paragraph in the book seems to be suggesting! 

Whether you have the epidural or not, your doula will be there to help you start breastfeeding; lean on her again to relax and breathe through the after-pains.  However you do it, do it without guilt; this amazing part of the Journey of Life.

No comments:

Post a Comment

Contact info

Jennifer Valencia | Labor & Postpartum Doula | 928.300.1337


Blog Directory