Wednesday, July 11, 2012

Dumb Models & Drugged Babies

My mom called me yesterday to ask if I had seen anything about Victoria Secret model/Orlando Bloom's wife, Miranda Kerr's comments on not wanting an epidural because they can affect the baby and breastfeeding, and then the news anchor said something like "I'm not taking my medical advice from a model." I hadn't, so I looked up her birth comments and found an article on her interview with Harper's Bazaar. The interview seemed fine to me, maybe because I'm aware of the facts about possible epidural complications and effects. However... from what I read in the comments not only were other mothers not aware of the effects, they lashed out at Miranda as if she had personally accused each one of them of shooting their babies up with heroine.

 Here is what Miranda said:
"I had been watching all these baby bonding videos and [without an epidural], when the baby comes out it goes straight onto the breast." When the mom had an epidural: "The baby was a little bit drugged up and I was like, well, I don’t want that, I wanted to give him the best possible start in life I could." 
Here are how some mothers responded:
"Another idiot telling the masses what she thinks is best. This is misinformation. Read the literature, sweetie, and stop going on anecdotal 'evidence!'"  
"I am sick of these judgmental women that think they ‘know better’ and ‘do better’ then anyone else. Do you really think that every woman that has an epidural is DRUGGING her baby?? Get a grip, Miranda. Mothering is not a competition. I don’t know what it is with models."  
"Um… that’s not how epidurals work + it’s only to help the mother get through child birth. Why torment yourself with agonizing pain when you don’t have to? – that’s just stupid and selfish."  
"Holy misinformation! I had an epidural and my baby came out looking for my breast. It’s going to depend on the baby. If you want a natural birth that’s fine but don’t assume you know what you’re talking about when you don’t."  
"It’s not as if the epidural is inserted into the baby’s arm. Let’s get a little bit of perspective people. I had three children, all with epidurals, and I was able to nurse all of them almost immediately. The only reason I couldn’t nurse them immediately was because they had to be cleaned first….as with all babies that are not born under a tree." 
If someone shared that they lost 50 pounds because they were concerned about heart disease, consider how unreasonable it would be if other people who were 50 pounds over weight responded in outrage because they did not have heart disease. Fine, you don't, but studies show that if you are over weight you increase your chances of health complications. The decision to lose 50 pounds for your health is an evidence based decision and arguing against that decision is ridiculous, as is arguing against epidural anesthesia having any affects on a baby.

I used some passages from Henci Goer's The Thinking Woman's Guide to a Better Birth because the number of studies she has compiled is just amazing and makes for an excellent one stop shop for birth research.
"Studies have shown that bupivavaine, the anesthetic most used in epidural, crosses the placenta and is absorbed into the fetal tissues and that fetal dose rises with epidural duration. Researchers have measured umbilical vein levels at bupivavaine one-third that of maternal levels." 
And also from the official FDA information on Bupivacaine
"Bupivacaine hydrochloride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. This does not exclude the use of Bupivacaine Hydrochloride at term for obstetrical anesthesia or analgesia... Local anesthetics rapidly cross the placenta, and when used for epidural, caudal, or pudendal block anesthesia, can cause varying degrees of maternal, fetal, and neonatal toxicity."
I saw one woman post that where the epidural is injected is nowhere near the baby... well where you inhale the smoke from a cigarette is also nowhere near the baby. The injection takes place in the spinal cord, but it does enter the mother's bloodstream and therefore the baby's. It lowers the mother's blood pressure (that is why you are given IV fluids before, to keep your BP stable) and therefore potentially decreases oxygen to the baby, leading to fetal distress and a possible c-section. Until the cord is cut, what affects mom affects the baby, can we please stop arguing this fact? Now whether it is safe or not all depends upon who you ask.
"Doctors often feel unconcerned about the side effects, even life-threatening side effects, provided they know what they will do to treat them and that the life-threatening ones occur reasonably rarely. So, two doctors writing for their colleagues can say reassuringly: 'These [epidural] complications should not cause fatalities if trained personnel and adequate resuscitation facilities are available.'"
The medical community is aware of the risks because there are procedures in place to minimize the effects. A local labor and delivery nurse I know said she chose natural childbirth because of the effects of epidurals on babies. Some of my friend's OB's have joked that "so baby will be a little sleepy, who doesn't like a sleepy baby?" My OB told me that Milo's breathing problems were likely due to having the epidural (which was in place for 12 hours). A nurse also made a "sleepy epidural baby" comment, but no one was concerned because Milo was easily resuscitated. If that does not bother you (it was a risk I was aware of and chose to take) then that's fine, you are making an informed choice, but don't deny that it's even true!

Some physicians will deny risks associated with many interventions, but that is not because there is debate over whether the risks are real. I don't know many teachers that take the time to read up on the latest teaching approaches in their spare time once they are out of college and in the workforce. Same is true for many obstetricians and nurses. They may be completely unaware of newly published data, not want to change their good enough practices, or be bound by hospital policy/peer's expectations to play down the risks.

I don't think women who get an epidural don't care about their babies. I don't think women who don't know about the adverse effects are stupid. There are times where an epidural can even be beneficial to the mother and baby. Every intervention has its place. However, an epidural does have very real risks to both the mother and baby and refusing to consider what they might be just because you feel defensive in your decision and you want to be right at all costs is obnoxious.

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