This was an interesting paper that one of my facebook friends shared. Written by a doctor (and presumably his wife), it begins:
Epidural anesthesia has become increasingly popular for childbirth. The popular book, What to Expect when You’re Expecting, for example, portrays epidurals as perfectly safe. The risks, however, may be greatly underplayed.Note: This is a site in progress. We are interested in detailing all the risks of epidural anesthesia for childbirth. There is currently a selection bias toward the risks. We welcome all readers to send us studies about epidurals regardless of the results, so that we can continue to work toward a balanced site. Our bias is that epidurals have risks and that these risks are under-communicated to women, and that true informed consent is not given.
Epidurals and Pain Relief
For the most part, epidural analgesia does effectively relieve labor pain.1 Obstetrical anesthesiologists continue to state that epidural analgesia has other, potentially catastrophic, adverse effects but, with safe clinical practice, these problems are extremely rare. We will suggest in the material that follows that these complications are not extremely rare, and that women are not receiving adequate informed consent about what these complications are and their accompanying frequency. Nor are they being offered any serious alternatives to epidural anesthesia. Despite this, anesthesiologists such as Eberle and Norris argue that specific anaesthetic techniques … or obstetrical management can limit or eliminate these risks of epidural labour analgesia. What must be remembered for any technical procedure, is that it is studied in major academic centers where highly skilled professors supervise residents and all outcomes are monitored closely. The actual practice, however, takes place in smaller institutions by less qualified individuals so that the actual complication rates of any procedure (obstetric, cardiac, pulmonary) are always higher than what are found in studies.
I’ve read a bit of it, and will read more in the future as I have opportunity. It promises to be interesting. It would be nice if hospitals kept track of their procedures and any negative outcomes, so that the general public were actually aware of the rates. After all, they have to know these things in order to bill them; surely such information could be collected in a way to provide statistics.
The authors include a statement from the package insert of a “medication used for epidurals (manufactured by Abbott Laboratories).” I’m not totally sure which drug this was taken from — I came up with a link to bupivicaine, which had the last paragraph; but it didn’t say anything about either placentas or parturient. However, a link to xylocaine did have some of the language from the first two paragraphs. There are different drugs that could be used in epidurals (which are actually many times not true “epidurals” but are “spinals”, fwiw), so I’m not sure if I’ve got the right one, or if they’re all so similar that what goes for one generally goes for the other. Anyway:
Local anesthetics rapidly cross the placenta, and when used for epidural, caudal or pudendal anesthesia, can cause varying degrees of maternal, fetal and neonatal toxicity….Adverse reactions in the parturient, fetus and neonate involve alternations of the central nervous system, peripheral vascular tone and cardiac function….
Neurologic effects following epidural or caudal anesthesia may include spinal block of varying magnitude (including high or total spinal block); hypotension secondary to spinal block; urinary retention; fecal and urinary incontinence; loss of perineal sensation and sexual function; persistent anesthesia, paresthesia, weakness, paralysis of the lower extremities and loss of sphincter control all of which may have slow, incomplete or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; increased incidence of forceps delivery; cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid.
And people think I’m weird for not having an epidural…
Filed under: epidurals, studies & stuff Tagged: | baby, birth, bupivicaine, C-section, cesarean sections, childbirth, epidural, epidurals, induction, labor, pregnancy, pregnant, spinal-epidural, xylocaine