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
1. G. R. Hamilton and T. F. Baskett, "In The Arms of Morpheus: The Development of morphine for Postoperative Pain Relief," Can J Anaesth 47, no. 4 (2000): 367-74.
2. E. Declercq et al., Listening to Mothers: Report of the First U.S. National Survey of Women's Childbearing Experiences (New York: Maternity Center Association, October 2002): pg 1
3. Canadian Institute for Health Information, Giving Birth in Canada (Ontario: CIHA, 2004): pg 7
4. National Health Service, NHS Maternity Statistics, England: 2002-03 (Crown Copyright, 2004): pg 6
5. E. D. Hodnett, "Pain and Women's Satisfaction with the Experience of Childbirth: A Systematic Review," Am J Obstet Gynecol 186, Supplement 5: Nature (2002): S160-S172.
6. S. J. Buckley, "ecstatic Birth: Nature's Hormonal Blueprint for Labor," Mothering no. 111 (March-April 2002): www.mothering.com / articles / pregnancy_birth / birth_preparation / ecstatic.html
7. World Health Organization, Care in Normal Birth: A Practical Guide. Report of a Technical Working Group (Geneva: World Health Organization, 1996): 16.
8. V. A. Rahm et al., "Plasma Oxytocin Levels in Women During Labor Epidural Analgesia With or Without: A Prospective Study," Acta Obstet Gynecol Scand 80, no. 11 (2002): 1033-1039.
9. R. M. Stocche et al., "Effects of intrathecal Sufentanil on Plasma Oxytocin and Cortisol Concentrations in Women During the First Stage of Labor," Reg Anesth Pain Med 26, no. 6 (2001): 545-550.
10. Ibid.
11. C. F. Goodfellow et al., "Oxytocin Deficiency at Delivery with Epidural Analgesia," Br J Obstet Gynaecol 90, no. 3 (1983): 214-219.
12. O. Behrens et al., "Effects of Lumbar Epidural Analgesia on Prostaglandin F2 Alpha Release and Oxytocin Secretion During Labor," prostaglandins 45, no. 3 (1993): 285-296.
13. R. Jouppila et al., "Maternal and Umbilical Venous Plasma immunoreactive beta-Endorphins Levels During Labor Epidural Analgesia With and Without," Am J Obstet Gynecol 147, no. 7 (1983): 799-802.
14. T. J. Scull et al., "Epidural Analgesia in Early Labour Blocks the Stress Response Uterine contractions but Remain unchanged," Can J Anaesth 45, no. 7 (1998): 626-630.
15. A. Costa et al., "Adrenocorticotropic hormone and catecholamines in maternal, umbilical and neonatal plasma in Relation to Vaginal Delivery," J Endocrinol Invest 11, no. 10 (1988): 703-709.
16. M. Odent, "The Fetus Ejection Reflex," in The Nature of Birth and Breastfeeding (Sydney: Ace Graphics, 1992): 29-43.
17. R. P. Lederman et al., "Anxiety and Epinephrine in Multiparous Women in Labor: Relationship to Duration of Labor and Fetal Heart Rate Pattern," Am J Obstet Gynecol 153, no. 8 (1985): 870-877.
18. G. Arici et al., "The Effects of bupivacaine, Ropivacaine and Mepivacaine on the Contractility of Rat myometrium," Int J Obstet Anesth 13, no. 2 (2004): 95-98.
19. B. L. Leighton and S. H. Halpern, "The Effects of Epidural Analgesia on Labor, Maternal, and Neonatal Outcomes: A Systematic Review," Am J Obstet Gynecol 186, Supplement 5: Nature (2002): S69-S77.
20. Ibid.
21. E. Lieberman et al., "Changes in Fetal Position During Labor and Their Association with Epidural analgesia," Obstet Gynecol 105, no. 5 (2005): 974-982.
22. S. E. Ponkey et al., "Persistent Fetal Occiput Posterior Position: Obstetric Outcomes," Obstet Gynecol 101, no. 5, pt. 1 (2003): 915-920.
23. COMET Study Group UK, "Effect of Low-Dose Mobile versus Traditional Epidural Techniques on Mode of Delivery: A randomized controlled trial," Lancet 358, no. 9275 (2001): 19-23.
24. J. H. Johnson et al., "Immediate Maternal and Neonatal Effects of Forceps and Vacuum-Assisted Deliveries," Obstet Gynecol 103, no. 3 (2004): 513-518.
25. B. S. Jhawar et al., "Risk Factors for Intracranial Hemorrhage Among Full-Term Infants: A Case-Control Study," Neurosurgery 52, no. 3 (2003): 581-590 (discussion, 588-590).
26. W. G. McBride et al., "Method of Delivery and Developmental Outcome at Five Years of Age," Med J Aust 1, no. 8 (1979): 301-304.
27. B. D. Wesley et al., "The Effect of Forceps Delivery on Cognitive Development," Am J Obstet Gynecol 169, no. 5 (1993): 1091-1095.
28. S. H. Poggi et al., "Effect of Epidural Anaesthesia on Clinician-Applied Force During Vaginal Delivery," Am J Obstet Gynecol 191, no. 3 (2004): 903-906.
29. See Note 19.
30. C. L. Roberts et al., "Rates for Obstetric Intervention Among Private and Public Patients in Australia: Population based descriptive study," Br Med J 321, no. 7254 (2000): 137-141.
31. See Note 19.
32. E. Lieberman and C. O'Donoghue, "Unintended Effects of Epidural Analgesia During Labor: A Systematic Review," Am J Obstet Gynecol 186, Supplement 5: Nature (2002): S31-S68.
33. J. A. Thorp et al., "The Effect of Continuous Epidural Analgesia on Cesarean Section for Dystocia in Nulliparous Women," Am J Obstet Gynecol 161, no. 3 (1989): 670-675.
34. See Note 23.
35. L. M. Goetzl, "Obstetric Analgesia and Anesthesia," ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician-Gynecologists no. 36, Obstet Gynecol 100, no. 1 (July 2002): 177-191.
36. L. J. Mayberry et al., "Epidural Analgesia Side Effects, Co-Interventions, and Care of Women During Childbirth: A Systematic Review," Am J Obstet Gynecol 186, Supplement 5: Nature (2002): S81-S93.
37. D. B. Scott and B. M. Hibbard, "Non-Fatal Serious Complications Associated with Extradural Block in Obstetric Practice," Br J Anaesth 64, no. 5 (1990): 537-541.
38. See Note 36.
39. See Note 35.
40. See Note 36.
41. D. Buggy and J. Gardiner, "The Space Blanket and shivering During Extradural Analgesia in Labor," Acta Anaesthesiol Scand 39, no. 4 (1995): 551-553.
42. See Note 36.
43. Ibid.
44. See Note 19.
45. See Note 32.
46. E. Lieberman et al., "Epidural analgesia, intrapartum fever, and Neonatal Sepsis Evaluation," Pediatrics 99, no. 3 (1997): 415-419.
47. P. DeBalli and T. W. Breen, "intrathecal Opioids for Combined Spinal-Epidural Analgesia During Labor," CNS Drugs 17, no. 12 (2003): 889-904 (892-893).
48. N. S. Saunders et al., "Neonatal and Maternal Morbidity in Relation to the Length of the Second Stage of Labour," Br J Obstet Gynaecol 99, no. 5 (1992): 381-385.
49. L. St. George and A. J. Crandon, "Immediate Postpartum Complications," Aust NZ J Obstet Gynaecol 30, no. 1 (1990): 52-56.
50. E. F. Magann et al., "Postpartum Hemorrhage after Vaginal Birth: An Analysis of Risk Factors," South Med J 98, no. 4 (2005): 419-422.
51. T. M. Eggebo and L. K. Gjessing, ["Hemorrhage After Vaginal Delivery"], Tidsskr Nor Laegeforen 120, no. 24 (2000): 2860-2863
52. B. Ploeckinger et al., "Epidural Anaesthesia in Labour: Influence on Surgical Delivery Rates, intrapartum fever and Blood Loss," Gynecol Obstet Invest 39, no. 1 (1995): 24-27.
53. L. Gilbert et al., "Postpartum haemorrhage: A Continuing Problem," Br J Obstet Gynaecol 94, no. 1 (1987): 67-71.
54. See Note 48.
55. See Note 35.
56. M. J. Paech et al., "Complications of Obstetric Epidural Analgesia and Anaesthesia: A Prospective Analysis of 10.995 Cases," Int J Obstet Anesth 7, no. 1 (1998): 5-11.
57. P. C. Stride and G. M. Cooper, "Taps dural Revisited: A 20-Year Survey from Birmingham Maternity Hospital," Anaesthesia 48, no. 3 (1993): 247-255.
58. S. N. Costigan and J. S. Sprigge, "dural puncture: The Patients' Perspective. A Patient Survey of Cases at a DGH Maternity Unit 1983-1993, "Acta Anaesthesiol Scand 40, no. 6 (1996): 710-714.
59. See Note 56.
60. See Note 37.
61. See Note 56.
62. D. B. Scott and M. E. Tunstall, "Serious Complications Associated with Epidural / Spinal blockade in Obstetrics: A Two-Year Prospective Study," Int J Obstet Anesth 4, no. 3 (1995): 133-139.
63. J. S. Crawford, "Some Maternal Complications of Epidural Analgesia for Labour," Anaesthesia 40, no. 12 (1985): 1219-1225.
64. F. Reynolds, "Epidural Analgesia in Obstetrics," Br Med J 299, no. 6702 (1989): 751-752.
65. See Note 37.
66. See Note 62.
67. See Note 63.
68. See Note 64.
69. MIDIRS and The NHS Centre for Reviews and Dissemination, "Epidural Pain Relief During Labor," in Informed Choice for Professionals (Bristol: MIDIRS, 1999): pg 5
70. See Note 37.
71. R. Fernando et al., "Welfare Neonatal and Placental transfer of fentanyl and bupivacaine During Ambulatory Combined Spinal Epidural Analgesia for Labour," Anaesthesia 52, no. 6 (1997): 517-524.
72. J. Littleford, "Effects on the Fetus and Newborn of Maternal Analgesia and Anesthesia: A Review," Can J Anaesth 51, no. 6 (2004): 586-609.
73. G. Capogna, "Effect of Epidural Analgesia on the Fetal Heart Rate," Eur J Obstet Gynecol Reprod Biol 98, no. 2 (2001): 160-164.
74. C. J. Aldrich et al., "The Effect of Maternal Posture on Fetal Cerebral oxygenation During Labour," Br J Obstet Gynaecol 102, no. 1 (1995): 14-19.
75. E. Lieberman et al., "Intrapartum Maternal Fever and Neonatal Outcome," Pediatrics 105, no. 1, pt. 1 (2000): 8-13.
76. L. Impey et al., "Fever in Labour and Neonatal encephalopathy: A Prospective Cohort Study," Br J Obstet Gynaecol 108, no. 6 (2001): 594-597.
77. See Note 75.
78. See Note 32.
79. K. Thorngren-Jerneck and A. Herbst, "Low 5-Minute Apgar Score: A Population-Based Register Study of 1 Million Term Births," Obstet Gynecol 98, no. 1 (2001): 65-70.
80. M. Kumar and B. Paes, "Epidural Opioid Analgesia and Neonatal Respiratory Depression, J Perinatol 23, no. 5 (2003): 425-427.
81. Ibid.
82. T. Hale, medications and Mother's Milk "(Amarillo, TX: Pharmasoft, 1997): {pg. # S?}. p 76
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.
86. W. Camann and T. B. Brazelton, "Use and Abuse of Neonatal neurobehavioral testing," Anesthesiology 92, no. 1 (2000): 3-5.
87. R. Gaiser, "Neonatal Effects of Labor Analgesia," Int Anesthesiol Clin 40, no. 4 (2002): 49-65.
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.
91. C. M. Sepkoski et al., "The Effects of Maternal Epidural Anesthesia on Neonatal Behavior During the First Year," Dev Med Child Neurol 34, no. 12 (1992): 1072-1080.
92. D. B. Rosenblatt et al., "The Influence of Maternal Analgesia on Neonatal Behavior: II. Epidural bupivacaine, "Br J Obstet Gynaecol 88, no. 4 (1981): 407-413.
93. See Note 90.
94. See Note 91.
95. See Note 92.
96. See Note 71.
97. J. R. Loftus et al., "Placental Transfer and Neonatal Effects of Epidural Sufentanil and bupivacaine with fentanyl Administered During Labor," Anesthesiology 83, no. 3 (1995): 300-308.
98. See Note 23.
99. See Note 90: 71.
100. D. Krehbiel et al., "Peridural Anesthesia Disturbs Maternal Behavior in Primiparous and Multiparous Ewes Parturient," Physiol Behav 40, no. 4 (1987): 463-472.
101. M. S. Golub and S. L. Germann, "Perinatal bupivacaine and Infant Behavior in Rhesus Monkeys," Neurotoxicol Teratol 20, no. 1 (1998): 29-41.
102. M. S. Golub, "Labor Analgesia and Infant Brain Development," Pharmacol Biochem Behav 55, no. 4 (1996): 619-628 (619).
103. L. Righard and M. O. Alade, "Effect of delivery room routines on Success of First Breast-Feed," Lancet 336, no. 8723 (1990): 1105-1107.
104. M. K. Matthews, "The Relationship Between Maternal Labour Analgesia and Delay in the Initiation of Breastfeeding in Healthy Neonates in the Early Neonatal Period," Midwifery 5, no. 1 (1989): 3-10.
105. A. B. Ransjo-Arvidson et al., "Maternal Analgesia During Labor Disturbs Newborn Behavior: Effects on Breastfeeding, Temperature, and Crying," Birth 28, no. 1 (2001): 5-12.
106. E. Nissen et al., "Effects of maternal pethidine on Infants' Developing Breast Feeding Behavior," Acta Paediatr 84, no. 2 (1995): 140-145.
107. L. Rajan, "The Impact of Obstetric Procedures and Analgesia / Anaesthesia During Labour and Delivery on Breast Feeding," Midwifery 10, no. 2 (1994): 87-103.
108. S. Radzyminski, "neurobehavioral Functioning and Breastfeeding Behavior in the Newborn," J Obstet Gynecol Neonatal Nurs 34, no. 3 (2005): 335-341.
109. J. Riordan et al., "The Effect of Labor Pain Relief Medication on Neonatal Suckling and Breastfeeding Duration," J Hum Lact 16, no. 1 (2000): 7-12.
110. K. G. Dewey et al., "Risk Factors for Suboptimal Infant Breastfeeding Behavior, Delayed Onset of Lactation, and Excess Neonatal Weight Loss," Pediatrics 112, no. 3, pt. 1 (2003): 607-619.
111. S. Radzyminski, "The Effect of Ultra Low Dose Epidural Analgesia on Newborn Breastfeeding Behaviors," J Obstet Gynecol Neonatal Nurs 32, no. 3 (2003): 322-331.
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.
113. P. Volmanen et al., "Breast-Feeding Problems After Epidural Analgesia for Labour: A Retrospective Cohort Study of Pain, Obstetrical Procedures and Breast-Feeding Practices," Int J Obstet Anesth 13, no. 1 (2004): 25-29.
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.