Author of Natural Childbirth the Swiss Way
Educational Director, Ezer L'Laydah
President, The Swiss Society for the Promotion of Natural
Childbirth Practices
Writing in the American Journal of Obstetrics and
Gynecology, Professor Lieberman at Harvard Medical School
is not all that certain of the safety of epidurals.
Having conducted a systematic review spanning twenty years of
literature examining the unintended maternal, fetal and
neonatal effects of epidural analgesia, Prof. Lieberman
writes: "Much of the evidence is equivocal," a nice medical
way of saying the material is misleading and confusing.
Nevertheless, he concludes that in spite of all the
conflicting literature, "There is sufficient evidence that
epidural is associated with a lower rate of spontaneous
delivery, a higher rate of instrumental delivery (vacuum &
forceps) and longer labors, particularly in nulliparous
(first-time) mothers."
But what worries him the most is the fever 10%-30% of women
who take an epidural are known to develop.
Anesthesiologists and obstreticians have long dismissed this
fever as harmless: merely a side effect of a drugged central
nervous system no longer able to sweat; not a sign of
infection. But examination of post- epidurals showed
inflammation to be present in the placentas of mothers who
ran a fever of 38 degrees. Mothers who take epidurals run a
16-fold chance of developing this infection,
chorioamnionitis. Researchers came to the conclusion that
this intrauterine infection is due to longer first-stage
labor!
Unfortunately, the babies of these mothers will be given
`special' treatment in the nursery involving unpleasant
tests, some of them with substantial risks. When the
infection does pass over to the newborn, he runs a 19-fold
risk of developing cerebal palsy at some point and even
without signs of infection, he has a 9-fold risk of
developing C.P., with some studies showing C.P. with
chorioamnionitis at 8 per 1000 babies. This is the same
infection which gets hospital personnel into a frenzy when a
mother loses her amniotic fluid early in labor. Of course, in
the epidural mother who runs a fever and loses her amniotic
fluid, the baby's odds of developing C.P. goes up even
more.
Dr. Lieberman ends by writing, "Further research is needed to
advance our understanding of the unintended effects of
epidural. Improved information would permit women to make
truly informed decisions about the use of pain relief during
labor."
The authors of the almost biblical textbook, Obstetric
Anesthesia, claim that "every drug and method entails
risks" and "new drugs and therapies often cause problems in
completely unexpected ways." Obviously doctors are not as
naive as their patients.
For years, the use of anesthetics in the labor room has led
to many unexpected complications, all of which have
consistently confounded the medical establishment and kept
them running, always one step behind, trying to curtail the
latest monsters they themselves had unleashed.
But what's a doctor to do?
The way `they' tell it in Obstetric Anesthesia,
"Physicans resisted... questioning whether the benefits
justified the risk. But patients harbored few doubts and
persuaded physicians to use anesthesia, sometimes against the
physician's better judgment."
Women actually did demonstrate in the streets of America in
the early 1920's, demanding `twilight sleep,' the new,
improved childbirth anesthetic. Originating from Germany,
dammerschlaff was a nasty mixture of morphine and
scopolamine, an amnesiac drug which left many newborns
gasping for breath, and contributed to stillbirths. Yet most
physicians, not just mothers, failed to take note.
In reality, twilight sleep with its blurred vision, dizziness
and nausea was more of a nightmare; one which left a mother
with an unpleasant lingering memory of birth.
Dammerschlaff wasn't entirely without maternal risks,
either. One particularly well-known crusader ultimately died
in childbirth, putting a damper on the movement. Too late,
however, to curb the spread of twilight sleep in the labor
wards of America.
This new, improved pain reliever quickly rose up in the ranks
of acceptability, and the more routinely it was used, the
`safer' it became in the eyes of the public.
But where were the obstetricians and the pediatricians who
saw the fetal effects?
Dr. D. Caton, historian and professor of anesthesiology,
offers an answer to that puzzling question: "Experience
lulled them into complacency, which may explain their failure
to appreciate the threat posed by twilight sleep."
Apparently, years of doing the wrong thing does not guarantee
safety.
If epidurals don't slow down labor, why then are twice as
many epidural mothers getting inducement (oxytocin) as
mothers on `twilight sleep' (tishtush -- pethedine)?
Revving up labor contractions with drugs won't add any
discomfort to the epidural mother, who can't feel them
anyway, but her baby does, as every midwife and obstetrician
well knows.
Ever since the epidural `epidemic' infested the labor ward,
it has quietly undergone many revisions: reducing first the
main drug concentration following a spate of maternal deaths,
and then adding others. Constantly searching for a safer,
`ideal formula,' anesthesiologists are forever experimenting,
mixing and matching anesthetics with narcotics and/or other
anesthetics, often throwing in a dash of epinephrine for good
measure. Even the choice of needles has proliferated, with
the latest favorite, the micro- catheter, having been
recently recalled by the FDA due to suspicious cases of nerve
damage.
What do you get with an epidural? Is it the more risky but
highly popular combined spinal/epidural? Only G-d and your
anesthesiologist knows for sure.
But while Hashem knows exactly how anesthetics work within
the maternal and the fetal body, no one else does. After
almost two centuries of use, the mechanisms remain one of the
unsolved mysteries of pharmacology.
But please don't get me wrong. Epidurals are wonderful - -
for surgery. Especially for a C-section, vascular surgery of
an extremity and/or an abdominal aortic aneurysm. NOT FOR
CHILDBIRTH.
Articles extolling the virtues of epidural anesthesia for a
normal birth not only coddle a woman into a false sense of
safety, they rob her of any incentive to prepare herself for
a truly natural childbirth. Promoting drugs subtly sends a
message of fear and despair, feeding into the all-too-
prevalent "You can't do it" syndrome, which haunts so many
young women today.
If epidurals are the so-called `Rolls-Royce' of anesthetics,
Natural Childbirth is no horse and buggy! Nature is the GOLD
STANDARD, the universally accepted yardstick by which
perfection is always measured. Meddling with Hashem's
marvelously designed blueprint ultimately upsets the
ingrained ecosystem of the body, resulting in more harm than
good.
Every Jewish mother should be encouraged to GO FOR THE GOLD!
With her midwife, doctor and family cheering her on, all the
way.
Perhaps, part of public health funds now invested in
correcting many of the after effects of obstetrical drugs and
interventions in neonatology, would be better spent training
midwives in the art of helping a mother get over those last
few rough spots during labor.
To put it in the words of a recent editorial in the New
England Journal of Medicine entitled, "Specialist,
Technology and Newborns," "Overgrowth of specialty services
such as neonatal intensive care often comes at the expense of
under investment in less glamorous primary care that avert
poor birth outcomes."
Who, if not our precious mothers, deserve an extra ounce of
encouragement and the availability of such harmless, tried
and proven antics as: water therapy, upright positioning,
exercise bars, music, birthing chairs and balls? And if it
helps, why not beanbags?
Esther Marilus, tel. 02-5377-231; 054-270-007.
