Samantha* gave birth to a baby girl with Down Syndrome. The
diagnosis was a shock for parents and care providers alike. She
listened, just minutes after birthing, to a neonatologist
explaining tests to come in the morning. Samantha, fully mobile
and coherent, was un-medicated at the time of delivery. Her baby
was alert and able to latch onto her breast, an accomplishment
that surprised the doctors and nurses. With the baby's heart
problems affecting her breathing, it was fortunate that
narcotics or epidural anesthesia didn't depress her tiny system.
The outcomes were optimal because Samantha had endured the pain
of labor to bring her child into the world as safely as
possible. Although an extreme example, Samantha's experience
illustrates the remarkable benefits of un-medicated childbirth:
"present" mothers with no unpleasant or dangerous side effects,
healthier babies, and enhanced breastfeeding and bonding
experiences.
According to the 2006 Listening to Mothers II Survey and
Report (visit
www.childbirthconnection.org), 86% of women polled across
the nation used some form of pharmacological pain relief during
childbirth. Part of this number can be attributed to medication
used during cesarean sections, which rose to a record high of
31.1% of all births in 2006, according to the Centers for
Disease Control's National Vital Statistics Report released in
December 2007. Sometimes too a difficult labor mandates pain
medications. For example, Jane* was being induced at 37 weeks
gestation for preeclampsia. Her care providers were so concerned
with her blood pressure that she had to lie in bed for the
duration of the labor. Confinement to bed kept her from moving
freely to alleviate severe back pain. Jane opted for an epidural
and progressed quickly from that point on. For most women,
however, the risks of medicated delivery far outweigh the
benefits for both mother and child.
The most commonly used pain medication, an epidural can
negatively affect a woman in a number of ways. More severe side
effects include permanent paralysis, seizure, and long-term back
pain at the epidural site. Lesser-known but possible effects
include severe itching and a feeling of loss of breath. A Guide
to Effective Care in Pregnancy and Childbirth (on
www.childbirthconnection.org), which presents an overview of
extremely reliable research results, reports that epidurals can
also increase length of labor, need for Pitocin, and malposition
of the baby, which translates to increased risk of cesarean
birth. Epidural anesthesia necessitates various monitoring
devices to be connected to the mother. She typically receives a
bladder catheter as well, because she is confined to bed. Such
confinement can make it difficult to cope with labor pain that
may not be alleviated by an ineffective epidural.
Narcotic analgesia, which is a systemic medication, also
restricts a woman to bed. Penny Simkin, Janet Whalley, and Ann
Keppler list the risks and disadvantages of narcotics in their
2001 book "Pregnancy, Childbirth, and the Newborn" as including
drowsiness, hallucinations, dizziness, respiratory depression,
nausea and vomiting, lowered blood pressure, interference with
comfort measures, and temporarily stalled labor. Women with past
substance abuse problems should also be especially leery of any
narcotic medication. Additionally, it is often overlooked that a
woman's body is designed to birth, and to feel the sensations of
the process. Ina May Gaskin, world-renowned midwife residing in
Tennessee, stresses that a mother's body and brain, when not
dulled by pain medications, will work to help her birth her baby
as comfortably as possible. In her 2003 "Guide to Childbirth,"
Ina May explains, "endorphins are nature's opiates, a blessing
because they actually block the reception of pain. When we
expend a lot of physical effort, endorphin levels rise
correspondingly." Pharmacological pain relief interferes with
these natural chemical responses to the sensations of
childbirth, and exposes the woman to uncomfortable and
potentially hazardous side effects.
Many mothers who choose natural childbirth do so not for
their own benefit, but for the health of their baby. As Simkin,
Whalley, and Keppler point out, "any medication you receive
affects your baby directly or indirectly." Epidurals increase
the chance of fever in the mother and therefore the newborn.
Maternal and infant fever are investigated with blood tests to
rule out infection. Typically, until infection is ruled out,
mother and baby are treated with antibiotics. The baby may be
kept in the Neonatal Intensive Care Unit (NICU) for observation
and even subjected to a complete septic workup, which includes a
spinal tap. Narcotics influence a mother and a baby
systemically, meaning the drug affects their entire bodies. It
can affect fetal heart rate readings, as well as depress a
newborn's respiratory system. For this reason, most care
providers try to avoid giving narcotics within a few hours of
birth, but have oxygen and resuscitation equipment handy just in
case. Because a newborn's system is much less mature than the
mother who received narcotics, it takes longer for him to
metabolize the drug, and the medication can alter his behavioral
responses for days or even weeks, as is emphasized in
"Pregnancy, Childbirth, and the Newborn."
Pain medications crossing the placenta may alter an infant's
physical well-being and behavioral responses, potentially
complicating bonding and breastfeeding. Barbara Harper,
registered nurse, maternity care reformer, and waterbirth
expert, writes in her 2005 book "Gentle Birth Choices" of the
period following birth when mother and child first meet, and,
aided by hormonal processes, begin forming a lifelong
attachment. "The presence of her baby on the mother's chest
evokes another chemical response that is more powerful than any
synthetic drug. Within the first few moments of birth the
mother's body will experience the high of a lifetime. This
blissful feeling...is nature's way of making her fall completely
and desperately in love with her tiny infant." A delayed
meeting, due to unfavorable conditions in mother or infant, will
not take place under the same hormonal auspices. Breastfeeding
that does occur immediately after birth is more successful
without the effects of pain medication lingering in a baby's
system. Un-medicated newborns have the amazing ability to crawl
up to the breast and self attach, as seen in the video "Delivery
Self Attachment" by Dr. Lennart Righard. When behavioral
responses are affected, breastfeeding can be impeded by lack of
interest, inability to latch on, and poor suck.
Happy, healthy families are born every day to medicated and
un-medicated mothers alike. Women can have a satisfying and
successful breastfeeding experience even if they miss out on a
few initial feedings. Mothers and babies will share a lifelong
love with or without an initial bonding period. There are times
when pain medication isn't optional, such as during cesarean
birth, and other times when it is highly useful, such as in long
and difficult labors. But under normal circumstances the
consistently positive results of un-medicated childbirth speak
for themselves. Women who plan for a natural birth are often
told, "you won't get a medal for going through all that pain."
This is true, but mothers who are able to forgo medication
during the birthing process give their babies and themselves the
gift of the healthiest possible start.
Sarah Winfrey, CD(DONA), mother of two, is a birth doula
living in Fredericksburg, Virginia. Contact
fredericksburg_doula@yahoo.com or visit
birthbeauty.com. Heidi
Horner, birth and postpartum doula, is also a mother of two in
Fredericksburg. Contact
hmhorner@hotmail.com or visit
motherwitdoula.com.
*Names have been changed to protect the privacy of the
families mentioned.
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