I Liked My Epidural, Before I Read this Report

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Credit: Steven Depolo on Flickr, under Creative Commons

(WOMENSENEWS)–In a recent article in Health Affairs, Carla Keirns chronicles the frustrating and traumatic effects of giving birth in a health care system that relies too heavily on unnecessary medical interventions during labor and delivery.

In the end, Keirns delivered a healthy baby, but only after she endured two days of induced labor, unable to eat or get out of bed; repeated threats of what would have been an unwanted and unneeded C-section; a hemorrhage caused by prolonged exposure to synthetic hormones; and the arrival of a boy who was blue and not breathing.

What’s more? Keirns is a doctor.

If she had trouble preventing interventions in labor and delivery that she didn’t want or need, what hope do the rest of us have?

Not much, according to a by Childbirth Connection, a program of the National Partnership for Women and Families that works to improve the quality and value of maternity care.

The Jan. 13 report depicts the kind of health care system that Keirns describes in her riveting article: one that messes with rather than supports human biology, often to the detriment of mothers and their babies. It portrays how common medical interventions, such as C-sections, epidurals and induced labor, interfere with hormonal systems that have evolved over the millennia to promote maternal and infant health.

"We have come to use interventions that were developed to meet very specific needs in a very casual way," said Carol Sakala, director of programs at Childbirth Connection. "We should rethink many of the common practices in our maternity care." The system, she added, is "out of whack."

Sky-High C-Section Rate

The sky-high U.S. C-section rate is one indication of that. Nearly one-third of deliveries in the United States are done by C-section, according to the Centers for Disease Control and Prevention. That’s two-to-three times higher than the goal of between 10 percent and 15 percent set by the World Health Organization and about six times higher than the U.S. rate in 1965, when it was first measured here.

C-sections, of course, are life-saving procedures for countless women and are needed more frequently than in the past due to demographic changes. U.S. mothers, for example, are giving birth at older ages, are more likely to have chronic conditions and weigh more than peers from earlier generations, Sakala said.

But those factors don’t account for the high rate of C-sections, which the authors say interfere with biological processes that help prepare newborns to breathe and promote breastfeeding and bonding and also carry risks for the mother and child.

The risks, indeed, are many, according to Childbirth Connection: infection, blood clots, emergency hysterectomy, pelvic pain, infertility, complications in future pregnancies and even death–and that’s just for the moms. Babies born by C-section are more likely to have breathing problems and to develop chronic diseases like diabetes, allergies and asthma.

Pain-numbing epidurals, meanwhile, are used in nearly three-quarters of labors in the United States (including, I confess, both of mine). They alleviate pain and suffering in laboring women (to which I can attest) and are crucial under certain circumstances.

But they too interfere with biological processes in ways that many women–like myself–might not realize, the report finds, and carry their own risks.

I knew, for example, that epidurals can make it difficult for women to know when to push the baby out, increasing the risk of labor assisted by vacuum or forceps. But I did not know they can cause low blood pressure, fever and increased risk of perineal tears.

Risks for the baby are scarier, and include jaundice and life-threatening complications like low blood pressure, respiratory or cardiac arrest and severe allergic reaction.

Un-medicated delivery, on the other hand, allows the free flow of natural hormones, which reduces the risk of hemorrhage, supports early lactation and promotes breastfeeding, the report finds.

Informed Decision

It’s hard to know whether I would have taken a different course of action if I knew then what I know now about epidurals. If anything, though, I would have been making a more informed decision about the effects and risks of taking the drug. And a better-informed population is one of the report’s key goals, Sakala said.

The report also documents how other common practices in maternity care, such as scheduled births, induced labor, loud, stressful birthing environments and the separation between mother and baby after birth, also interfere with hormonal physiology and, ultimately, health.

It comes amid "growing recognition that patterns of maternity care in the United States are contributing to unnecessarily high rates of maternal and newborn morbidity and excess costs," Debra L. Ness, president of the National Partnership for Women and Families, said in a

One sign of that growing recognition just came on Jan. 22 when organizations representing women’s health care providers proposed a classification system to promote regionalized care so pregnant women at high risk can go to facilities that are prepared to meet their specific needs. They say a similar model has helped neonatal outcomes in recent decades, but the focus of these efforts has primarily been centered on the newborn, rather than the mother. In the meantime, maternal mortality rates in the United States have actually worsened in the past 14 years.

The United States ranks 60th in the world when it comes to maternal mortality, according to a report by the Institute for Health Metrics and Evaluation, below almost every other developed nation. And the U.S. infant mortality rate is higher than most other developed nations, according to the CDC. African American women and other racial and ethnic minorities experience especially high rates of maternal and infant mortality, according to the American College of Obstetricians and Gynecologists.

This report, as Ness said, "should be a wake-up call for the maternity care system and for childbearing women. We need to ensure that, going forward, we use our precious resources wisely and in ways that benefit women and babies."

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