The lowdown on epidurals
What effects might an epidural have on your baby?
AJOG did a systematic review of all of the literature on epidurals. It’s tricky – because most of the studies do not have random assignment – so that makes the study less powerful because it’s possible there is a difference in the types of women who elect epidurals from the kinds that don’t. For example, women are more likely to request an epidural during a prolonged or difficult labor, which in turn is more likely lead to an assisted vaginal birth. But from the few studies that were sound, they did conclude the following:
Epidurals cause:
Longer labors
Higher incidence of forceps/vaccuum deliveries
No increase in C-section rates
Higher risk of fever in mom (20% vs 7% for natural deliveries), but it turns out that most epidural fevers are not caused by infection, and don’t necessarily need to be treated with antibiotics, and are resolved very quickly. Even so, some pediatricians may be over cautious and may prescribe antibiotics for neonates. Early antibiotic exposure has implications for future antibiotic resistance.
No differences in lactation outcomes
No difference in apgar or other neonatal outcomes
No other significant differences on other measures
There are some articles on effects of epidural and lactation, but at this point they are mainly anecdotal and published findings do not demonstrate a causal pathway (ie maybe women who are more likely to stop breastfeeding earlier, are also more likely to request pain medication – the relationship might be reverse.) All of the (few) randomized studies have found no difference in lactation and lethargy of babies that were born under epidural anesthesia. So the main documented (very small) effect on baby is a a slightly elevated chance of receiving antibiotic treatment.
Of course there are still other reasons to opt for an epidural free birth – prolonged labor and operative deliveries are not a walk in the park. But if you are concerned just about baby, you can approach the epidural question logically, and discuss your choice with your doctor.
http://www.ajog.org/article/S0002-9378%2802%2970181-6/abstract
