Epidural: Risks For Mother and Baby

Use Of Epidural first time was in 1885, when a New York neurologist J. Leonard Corning injected cocaine into the spinal cord of patients suffering from "spinal weakness and incontinence semen." 1 More than a century later, epidural analgesia has become the most popular method, or painkillers, in the delivery room in the U.S.. In 2004, nearly two-thirds of women reported that they were granted maternity epidural, including 59 percent of women who gave birth to pervagina (2). In Canada, about half of women who give birth normally use an epidural, (3) and in Britain, 21 percent of women given an epidural before giving birth (4).

Epidural is an injection of local anesthetic drugs (from cocaine) and injected into the epidural spaces that protect the spinal cord. In a conventional epidural will numb both client sensory and motor nerves. Within five to ten years, epidurals have been developed with the concentration of drug (local anesthetic), and with a combination of local anesthetics and opiate (a drug similar to morphine and meperidine) pain killer to reduce motor block, and to produce what is called epidural "walk".

 

 
Spinal analgesia has also been increasingly used in childbirth to reduce the motor block. Spinals injected drugs penetrate the dura and into the space (intrathecal) spine, and produced only short-term analgesia. To prolong the pain-relieving effects of childbirth, the dose can be added as needed
Epidurals and spinals offer the most effective form of pain relief in childbirth aid are available, and women who have been using analgesia to reduce pain have a high level of satisfaction of this method, however, satisfaction did not experience this pain is not the same as the overall satisfaction overall labor (5) other than that it turns out the epidural also may endanger the safety of mother and baby.
Epidural and hormone delivery
Significantly interfere with the use of epidural labor several major hormones, which can have a negative impact on the birth process (6). WHO said that epidural analgesia is one of the most striking example of the medicalization of normal deliveries. who, alter physiological event into a medical procedure (7).
For example, oxytocin, known as the hormone of love, which is also a natural uterotonic-a substance that causes a woman's uterus to have contractions during childbirth. Epidural makes the body's natural oxytocin production decline and even disappear (9). Epidurals also eliminate the peak of excretion of oxytocin which should occur when the baby is born (11)-but this is the hormone oxytocin that helps mothers and infants to fall in love at first meeting. Other hormones that are important in such uterotonic, prostaglandin F2 alpha, is also reduced in women who use epidural (12).
B eta-endorphin is a naturally occurring hormone that works to help women who give birth to cope with pain. Beta-endorphin is also associated with altered state of consciousness in the delivery process. These hormones also help guide the mother to struggle and work instinctively with her body and her baby, so that sometimes a woman giving birth is often used movements and sounds. Epidural reducing the production of beta-endorphin in the body of a woman (13.14).
Adrenaline and noradrenaline (epinephrine and norepinephrine, known as catecholamines, or CA) are also released or in production under conditions of stress, and natural increase during labor without medication (15) In the final stage when the second delivery, a natural hormone surge gives mothers energy to push the baby out, and make her excited and fully alert at first meeting with her baby. This is known as the fetal ejection reflex (the fetal ejection reflex) (16)
But labor can be resistor with a very high level of CA, which can be released when the woman was hungry, cold, scared, or insecure during childbirth (17). This makes sense because if senses danger the mother says, then her hormones will slow or stop labor and give him time to "escape" to find a safe place to give birth. And this is normal in the process of human evolution.
Epidural reduced CA production in the actual help birth mothers in childbirth. However, the decline in CA final production can contribute to the difficulty of a woman to have a desire to push or spirit to push the baby out. So finally this greatly increases the risk of instrumental delivery (forceps and vacuum)
Effects on the birth process
Epidurals make labor more slowly, because the evidence from research that the local anesthetics used in epidurals can inhibit muscle contraction by directly affecting the uterus (18).
For example, epidural also make the pelvic muscles feel numb / numb, when pelvic muscles are important in guiding and changing the baby's head to move toward the best position to be born. Epidural make the risk four times higher in the likelihood of occurrence posterior position baby's head on stage akhhir in an event study, 13 percent higher compared to women who give birth without an epidural that only 3 percent (21). This posterior position of course would reduce the opportunity for spontaneous vaginal delivery in one study, only 26 percent of mothers who gave birth the first time (and 57 percent of mothers who experienced) with baby baby posterior to vaginal delivery with a spontaneous, direct others do forcep , vacuum or even SC (22).
The risk for infants, with the help of instrumental delivery can increase the risk of short-term such as bruises, facial injuries, and cephalohematoma (blood clot under the skin of the head) (24) Risk of intracranial hemorrhage (bleeding in brain) was increased in a study of more than four times for babies who was born with forceps compared with spontaneous birth, (25), although two studies showed no differences detected for the birth of a child development forceps (26.27
Epidural also increase the need for Pitocin to increase contractions, women who give birth with the epidural almost three times more likely to be given Pitocin (29). The combination of epidural and Pitocin, can cause abnormalities in fetal heart rate (Foetal Heart Rate) that trigger fetal distress, thus significantly increasing the risk of surgery (forceps, vacuum, or cesarean). DiAustralia In one survey, about half the mothers who first give birth and ends with childbirth epidural given SC (30)
Epidural side effects
Drugs used in labor with epidural that is strong enough to make numb, and often disabling, and can affect the mother's blood pressure, so it is not surprising that there would be significant adverse effects for mother and baby.
Side effects for the mother
1. The most common side effects of epidural is a decrease in blood pressure. This effect is almost universal, and usually preceded by giving IV fluids before giving an epidural. Hypotension can cause complications ranging from feeling faint of heart attacks, 37 and also can affect blood supply to the baby. Hypotension can be treated with more IV fluid administration and, if severe, with an injection of epinephrine (adrenaline).
2. Inability to urinate (and the need for urinary catheter placement)
3. itching of the skin (pruritus) (39.40)
4. chills (41)
5. nausea and vomiting (43)
6. Epidurals can also cause an increase in maternal body temperature.
7. Ddapat cause unexpected trouble breathing for the mother (47)
8. Increases the risk of post partum persarahan (48-53)
9. cause severe headaches that can last up to six weeks (57.58)
Side effects to baby
1. Birth trauma (71)
2. The risk of addiction in later adolescence (71)
3. Changes in fetal heart rate that can cause distress
4. Oxygen supply is reduced due to the reduced maternal blood pressure
5. Apgar less
6. One of the researchers have recorded ten-fold increased risk of newborn encephalopathy (signs of brain damage) in infants born to mothers with a fever due to an epidural (76).
7. The risk for having seizures in the newborn period is higher, compared with normal infants (75)
8. several studies of the condition of infants at birth, and nearly all babies born after epidurals compared with children born after exposure to opiate drugs, which are known to cause drowsiness and difficulty breathing.
9. Several studies comparing babies exposed to epidurals with babies whose mothers did not receive drugs that have found significant neurobehavioral effects, (86.88)
Epidurals can also affect the experience and success of breastfeeding through several mechanisms. First, babies exposed to epidurals may have neurobehavioral abnormalities caused by exposure to drugs that may be maximal within a few hours of birth-a critical time for initiation of breastfeeding. Recent research has found a (rather obvious) that the higher the score neurobehavior in newborn infants, the higher their value for feeding behavior (108)
In another study, infants exposed to epidural and spinals more likely to lose weight in hospital,
second, the epidural can affect the behavior and condition of new mothers, making it more difficult to breastfeed. This is possible if she has experienced a long labor, instrumental delivery, or separation from her baby, who were all more likely in persalinanepidural. Hormonal disorders also play a role given the hormone oxytocin is a major in nursing process
Conclusion
Epidural may have benefits but also have a significant risk for birth mothers and their babies. This risk is well documented in medical literature, but it can not be disclosed to the mother giving birth. Well if you want a normal delivery and smooth start trying to do from now on with the efforts of natural and healthy and safe.
Reference
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29. See Note 19.
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31. See Note 19.
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34. See Note 23.
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38. See Note 36.
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40. See Note 36.
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42. See Note 36.
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44. See Note 19.
45. See Note 32.
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54. See Note 48.
55. See Note 35.
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60. See Note 37.
61. See Note 56.
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65. See Note 37.
66. See Note 62.
67. See Note 63.
68. See Note 64.
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70. See Note 37.
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77. See Note 75.
78. See Note 32.
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81. Ibid.
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83. See Note 71.
84. T. Hale, "The Effects on Breastfeeding Women of Anaesthetic medications Used During Labor," The Passage to Motherhood Conference, Brisbane, Australia (1998),
85. See Note 32.
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88. S. H. Halpern et al., "The neurologic and Adaptive Capacity Score is Not a Reliable Method of Newborn Evaluation," Anesthesiology 94, no. 6 (2001): 958-962.
89. See Note 32.
90. A. D. Murray et al., "Effects of Epidural Anesthesia on Newborns and Their Mothers," Child Dev 52, no. 1 (1981): 71-82.
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93. See Note 90.
94. See Note 91.
95. See Note 92.
96. See Note 71.
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98. See Note 23.
99. See Note 90: 71.
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112. D. J. Baumgarder et al., "Effect of Labor Epidural Anesthesia on Breast-Feeding of Healthy Full-Term Newborns Delivered Vaginally," J Am Board Fam Pract 16, no. 1 (2003): 7-13.
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114. See Note 103.
115. See Note 105.
116. S. Kannan et al., "Maternal Satisfaction and Pain Control in Women Electing Natural Childbirth," Reg Anesth Pain Med 26, no. 5 (2001): 468-472.
117. J. M. Green et al., "Expectations, Experiences, and Psychological Outcomes of Childbirth: A Prospective Study of 825 Women," Birth 17, no. 1 (1990): 15-24.
118. B. M. Morgan et al., "Analgesia and Satisfaction in Childbirth (The Queen Charlotte's 1000 Mother Survey)," Lancet 2, no. 8302 (1982): 808-810.
119. M. C. Klein et al., "Epidural Analgesia Use as a Marker for Physician Approach to Birth: implications for Maternal and Newborn Outcomes," Birth 28, no. 4 (2001): 243-248.

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