I could not help but respond to the recent discussion on epidurals. At a
recent lecture I just gave, I contradicted a well known physician on the
topic of epidural medication. It has been known since at least 1977 that
bupivacaine reaches the fetus within ten minutes of it being administered to
the laboring mother. To say that these medications do not reach the baby is a
lie. The half life of bupivacaine in an adult is 1.25 hours. The half life in
a newborn is 18 hours. These medications including, fentanyl are all for the
most part measureable in cord blood which means that the drugs reach the
baby. We have at least 6 studies demonstrating the lingering effects on the
baby's behavior of these drugs. Women have the right to know that anything
given to them in labor will reach the baby. Some of the medications can have
an effect on the baby's behavior.

Anesthesiologists view labor as pathology and epidurals as therapy. For a
look at this read:
Brownridge P: The Nature and Consequences of Childbirth Pain. European
Journal of Obstetrics & Gynecology and Reproductive Biology 1995; (59 suppl):
S9-S15
He walks us through each natural response to stress and shows us how
epidurals fix it. "Unfortunately, the child-bearing public is sometimes
encouraged to adopt unrealistic expectations concerning the severity of labor
pain and is led to believe that pharmacological pain relief is both
unnecessary and harmful." One of his best sections is on the psychological
consequences of "severe childbirth pain." He reports of women who are angry,
guilty and lose their self esteem when they find out labor is painful. He
describes their partners as experiencing guilt and helplessness, and
requiring psychotherapy for impotence, phobias and depression!

The emphasis on this type of therapy also has consequences on the nursing
care laboring mothers receive. A recent study showed that only 6% of a
nurse's time is spent supporting a laboring mother. More than a quarter of
their time is spent in preparing equipment and drugs.

The goal in some units is to have 100% epidural rate. This happens when we
allow another discipline to take over and collect enough power to redefine
the nature of childbirth.

What the many epidural studies often fail to show is that not all women who
receive epidurals describe their childbirth experience as satisfying or
fulfilling. They forget about the side effects such as backache, forceps,
prolonged second stage, increased temperature, increased cesarean rates, etc.

These drugs have effects on babies too. No one wants to admit this because
the lucrative service might find that it is not quite as necessary as they
would like to imagine. Why do we sugar coat this information in childbirth
classes? Why do anesthesiologists come to these classes and dictate what can
and cannot be said about this therapy. This goes hand-in-hand with why we do
not talk about the side effects of artificial feeding.

We can provide this information in a positive non-threatening way to women.
Not providing it is paternalism at its finest. Don't tell women the possible
outcome of their decisions. We have to protect them from themselves.