Tag Archive | epidurals

Personal Mastery and Birth

I wanted to share a link to a post I wrote recently for the ICEA blog. In this post I discussed some research from the book Childbirth Education: Research, Practice, & Theory:

The book also shares the research that when mothers were interviewed postpartum who had had epidurals, their comments following birth focused almost totally on the baby. Women who had relied on relaxation and other non-pharmaceutical coping methods talked about the baby AND about the emotional and psychological benefits of their birth experiences. Women in both groups expressed satisfaction with their birth experiences, but for those in the epidural group “the element of personal accomplishment or mastery was missing in their comments.”

I believe that starting out the parenting adventure with a sense of “personal accomplishment and mastery” is a tremendous gift and I wish all expectant couples had the opportunity to experience birth in this way. In my classes, I strive to emphasize that both process (giving birth) and product (healthy baby, healthy mom) are important!

As long as I’m discussing posts I’ve made elsewhere, I wanted to also link to my CfM blog post this week which was about what are we thankful for? (in the “birth world”). I have a lot to be thankful for and hope you do as well!

Do Epidurals Impact Breastfeeding?

There was a question recently on a list I belong to about the impact of epidurals on breastfeeding. The person asking the question had been told by several hospital based childbirth educators that epidurals do not “cross the placenta’ and thus do not have an impact on the baby. Since this is an issue of concern, I thought I’d share some of my response/thoughts regarding this question here. I was happy to hear Linda J. Smith speak at the LLLI conference luncheon session about this very issue–the impact of birth practices on breastfeeding–and she covered a ton of material about the impact of epidurals on breastfeeding (she also wrote a book on the same topic with the late Mary Kroeger). There is some good information, though much less complete, on her site. The biggest problems with epidurals are the impact on the mother rather than the baby, though the medications used in epidurals DO cross the placenta and get to the baby, they are much less seriously impactful than IV or IM narcotics. An epidural refers to the means of medication delivery not what is actually being delivered into the body, so it is hard to say definitively that one has no effect, because different anesthesiologists use different “cocktails” of drugs in their epidurals. They usually use bupivacaine as the anesthetic, but there are opoids included as well, such as *morphine* or other related opoids like that.

All the books I have as a CBE say that medications used in epidurals do make it to the baby, but effects vary. Most effects are connected to what is happening to mom—i.e. mother gets a fever as a side effect of the meds and that stresses baby. Fluid overloading leads to more fluid in baby’s lungs, etc. The main breastfeeding impact on the mother’s side is excess fluid retention in the breasts due to the fluid “bolus” administered prior to an epidural. Baby is a little sleepy following birth and then can’t latch to severely swollen breasts (which are not “normally” engorged, but excessively so due to excess fluid), and so it goes. You often hear from mothers that their nipples are “too flat” for the baby to latch on to and as you probe further you find that the flatness has NOTHING to do with the mother’s true anatomy, but has to do with that excess fluid. Women are so programmed to look inward and blame themselves for problems that it is really unfortunate (like mothers who “aren’t making enough milk” when it is really a pump with bad suction).

Basically most breastfeeding problems that have to do with birth practices are not correctly attributed to the source—the birth practices—and are instead blamed on the mother (“flat nipples”), the baby (“lazy suck”), or breastfeeding (“sometimes it just doesn’t work out”).

Natural Childbirth

I have been asked if my classes are appropriate for people planning a medicated birth.

I do focus on natural childbirth (meaning unhindered birth that progresses on its own timeline, under the woman’s own power, and takes place without medication), but I also recognize that many couples choose epidurals. Since women are not generally given an epidural instantly or immediately, most of the “natural childbirth” information is still helpful and valuable to have (in terms of “up until you have the epidural” instead of “up until the baby is born.”). So, a class on labor support could be focused on labor support prior to an epidural and also about working with the epidural for an optimal birth experience. I also like to remind people that you don’t have to necessarily make up your mind before your go into labor about medications or not—you can take the labor one contraction at a time and see where it leads you. It might lead you to an epidural or it might lead you to not have one.