When you consider that 50–80 percent of women in high income countries will have an epidural during labour, it’s surprising how little women know about the impact this procedure can have on their babies.
Most care providers believe epidurals have little to no effect on babies.
But new research is beginning to paint a different picture.
Researchers from the University of Granada (Spain) looked at the births of over 2,600 babies and found epidural use has some adverse effects on newborns.
These effects include: low Apgar scores, higher risk of resuscitation, reduced early breastfeeding, and admission to a neonatal intensive care unit.
Breathing Problems For Baby
Babies whose mothers have an epidural are more likely to develop respiratory distress syndrome in the period immediately after birth. The most common form of epidural used is a local anaesthetic with a narcotic or opioid.
Most care providers believe the small amount of epidural medication that reaches the baby is not enough to cause any ill effects. We know, however, that opiates can cross the placenta during labour and cause respiratory depression. This means the baby is not getting enough oxygen and can’t excrete enough carbon dioxide.
Babies who develop respiratory distress syndrome will need help with breathing. In some cases, babies cannot breathe efficiently on their own at birth and will need resuscitation, which is an emergency and can be a very stressful and frightening experience for parents.
There is also medication that can reverse the respiratory depression caused by opiates in babies. This medication is given intravenously (through a vein) and the effects are usually quick and last for about 2 hours.
Lower Apgar Scores
If babies are born with breathing trouble, following an epidural, it makes sense they will not have high scores on their Apgar chart.
The Apgar score is a quick test performed on newborns at 1 and 5 minutes after birth. The 1-minute score shows how well the baby tolerated labour and birth. The 5-minute score determines how well the baby is doing outside the mother’s womb.
The test looks at:
- Breathing effort
- Heart rate
- Muscle tone
- Reflexes
- Skin color
The Apgar score is based on a total score of 1 to 10. If the score is lower than 7 the baby will need medical attention.
Post Birth Separation
After having breathing problems and poor Apgar scores, babies who have been affected by epidurals, as a follow-up measure, will probably be taken to a neonatal intensive care unit (NICU) for observation and continued medical attention.
While staying in the NICU doesn’t seem to be harmful in itself, it means that mother and baby are separated immediately after birth. This can have significant effects on the baby’s physical wellbeing, as well as on the emotional wellbeing of both mother and baby.
Babies who are separated from their mothers are less likely to experience early breastfeeding. Being held skin to skin promotes oxytocin production in both mother and baby. Oxytocin stimulates the milk let down reflex, and promotes mother-baby bonding. The production of this hormone in mothers, however, is lowered when epidurals are used.
Babies are also more likely to have problems regulating their temperature when they are separated from their mother’s body. Separation also increases a baby’s distress; babies are biologically developed to signal to their mothers to be held, fed and kept safe. If these needs are not met, babies can go into what is known as a despair state, where they become still and quiet.
Tips For Post Epidural Support
The choice to have an epidural is a personal one, and should be made while taking into consideration the risks and benefits. You might wish to avoid an epidural, but perhaps your care provider has a high induction rate (epidurals are more common with inductions), or you have a fear of birth and worry about coping with the pain of labour. Ensure you are well informed about your options for birth, so an epidural doesn’t have to be automatic at some point.
If you do choose to have an epidural, being aware of how this might affect your baby will help you to work with your care providers so as to provide the best start to your baby’s life. Here are a few ways you can promote a positive experience after birth:
- Leave the umbilical cord: while the cord is left intact babies are receiving vital oxygenated blood stores. If your baby’s breathing isn’t ideal after birth, he will still be getting oxygen for several minutes while the cord continues to pulsate.
- Keep your baby near you: talk to your care provider about providing resuscitation methods on the bed, where you and your baby will be after birth. Most resuscitation methods can be provided simply, such as giving oxygen via a mask, or stimulation.
- Keep your baby close: skin to skin contact is one of the most vital aspects of post birth support for your baby. Your baby will feel warm and safe. If you aren’t able to do this for some reason, ask your partner to strip off his shirt and hold baby close to his chest and heart.
If your baby needs more help and support in NICU, talk to your care provider about having as much skin to skin, and breastfeeding support, as possible. BellyBelly has more information here about coping with a baby in NICU.
Recommended Reading: Epidural During Labour – Everything You Need To Know.
