Another Reason to Avoid an Epidural

I was reading a post on Optimal Fetal Positioning on a blog called "Doula momma." Because of her own baby's malpresentation that resulted in an emergency c-section, this woman subsequently did lots of research on fetal malpresentation with the intention of avoiding such a situation again. She learned many things she could have done differently such as better nutrition, regular exercise and proper posture. These things I already knew about, but what was most interesting to me was a research study that a reader sent her that found that epidurals significantly increased the rate of malpresentation.

Here's the conclusion of the study: "Significance for Normal Birth: Epidural use increases the risk of instrumental (forceps or vacuum) delivery in first-time mothers. Experts have proposed various reasons for this association, including diminished urge to push and changes in the tone of the pelvic floor muscles that inhibit proper rotation of the fetal head. Letting the epidural "wear off" has been thought to increase the likelihood of unassisted vaginal birth, however, this systematic review calls into question that common practice.

In normal birth, there are complex hormonal shifts that help labor progress and facilitate delivery. The laboring woman produces natural endorphins that help her manage the pain of labor. Her ability to move freely and assume a variety of positions while pushing work in concert with these hormonal changes. Epidural analgesia numbs the sensations of birth, and the production of natural endorphins ceases as a result of the disruption of the hormonal feedback system. When the epidural is discontinued, the woman's pain returns but her natural endorphins may remain diminished and therefore her pain may be greater than if the epidural had not been given in the first place. Furthermore, when an epidural is administered, the woman is usually confined to bed and attached to fetal monitors and an intravenous line. The woman and provider may become accustomed to laboring in the bed attached to machines. When the epidural is discontinued the restrictions! on her movement may persist. Under these conditions, it is likely that the impact of an epidural on normal birth may outlast the epidural itself."

Two of my own conclusions: First, given that most women giving birth in the hospital receive epidural anesthesia, it makes sense to me that this could be one very common reason so many women are having malpositioned babies that result in "failure to progress" and the subsequent c-section.

Second, every pregnant woman needs to learn during her pregnancy how to encourage her baby to be in the optimal position through proper nutrition, exercise, and posture. It's really sad that not only do most OB's never discuss this with their patients, they probably wouldn't even know what to tell their patients if they wanted to, as this woman learned when she researched what OB's learn at medical school in relation to OFP. (Another plug for Hypnobabies: the classses and the homestudy manual go in depth on how to encourage OFP. ) Check out Doula Mamma's post to learn more. It's very informative.