Thursday, June 9, 2011

Do Epidurals Affect Babies?

Do Epidurals affect Babies?

While some medical professionals claim that epidurals have no affect on babies, others say that epidurals do reach babies. What do we know about the way babies are affected by epidural analgesia?

Nov 1, 2006
Brenda Lane

: Babies affected by epidurals? -Witold Cizmowski

Epidurals are administered to a growing number of women in labor today. A frequent question women want to know is whether an epidural will affect their baby.

Recent statistics show that anywhere from 60-90% of women today choose epidurals for labor. Though epidurals have been called the "cadillac" of medications due to their ability to reduce labor pain, controversy exists about whether or not epidurals affect the baby.

Epidurals do have the potential to affect a baby in two ways: either directly by crossing the placenta into the baby's bloodstream and/or indirectly by affecting the health of the mother.

Indirect effects to the Baby from Epidurals

One of the ways that epidurals can affect babies is if the mother's blood pressure drops during labor. Regional anesthesia tends to dilate a person's blood vessels, which can sometimes cause their blood pressure to drop. This is generally more of a risk if the mother already has low blood pressure. A drop in a mother's blood pressure in labor will cause the baby's heart rate to fall as well.

Ads by Google

BabiesRUs -Official Site Top Brands, Great Prices. Find everything you need at BabiesRUs. www.BabiesRUs.com

Family Care Physicians Medical care for the entire family Serving the Magic Valley www.fcpjerome.com

Epidurals cause the mother to lose most or all of her sensation and feedback to push. So, another indirect effect of epidurals to the baby is when mothers cannot push effectively. Research does show that women push longer when they have an epidural. Between exhaustion and not having feedback to push, instruments are used more often to help get the baby out, such as forceps or vacuum extractors. The use of these instruments are both considered to be "complicated vaginal deliveries" and can cause bruising and/or swelling on the top of the baby's head.

A 1997 study in Pediatrics has shown that epidurals are more likely to cause the mother's temperature to increase. In this case, medical staff is required to out rule that the mother may have an infection. So another indirect effect of epidurals can lead to a 350% higher chance of the baby being tested for infection (called a sepsis work-up) and 400% higher chance of being given antibiotics. In most cases, no infection is found in the baby.

Direct effects to the Baby from Epidurals

One way to look at the potential effect of epidurals on babies is to study their behavior as compared to babies from non-medicated labors. Researchers in Sweden have discovered that epidurals and other medications do affect babies in the first hours after birth with regard to pre-breastfeeding, latching-on and other behaviors. In a 2001 study published in Birth, infants were videotaped and their behaviors were recorded. The study showed that compared to babies whose mothers did use use pain medication, infants whose mothers used epidurals or a combination of epidurals with other medications:

READ ON

Made significantly less hand to mouth movements
Touched the nipple and areola much less
Did not remained attached to the breast
Cried more
Had significantly higher skin temperatures

Researchers concluded that, "Spontaneous breast-seeking behavior in newborns is part of the interaction between the mother and her newborn and is based on coordination of body movements, sensory stimuli, and communication behaviors. This study indicates that maternal analgesia during labor might disturb and delay the important aspects of the newborn's interactive behavior and increase the newborn's skin temperature and crying."

According to authors Jensen, Benson and Bobak, (Maternity Care, the Nurse and the Family) analgesics and anesthetics do cross the placenta. "Many drugs cross the placenta readily (e.g., antibiotics, narcotics, analgesics, anesthetics)."

The medication used in epidurals (local anesthetics such as bupivicaine) crosses the placenta by diffusion. This means that when epidurals are administered, the medication rapidly diffuses across cell membranes, crosses the placenta and enters the bloodstream of the baby. According to one study, bupivicaine (administered via an epidural) was found in blood samples taken from newborns after the mothers had an elective cesarean.

While it is clear that epidurals cross the placenta and reach the baby and can both indirectly and directly affect babies, we still don't know exactly how epidurals can affect the baby in every situation and for every mother and baby.

You Can't Spoil a Baby

Stressed out: Studies show babies become anxious if ignored for even two minutes by mother

By FIONA MACRAE

Last updated at 8:17 AM on 25th August 2010

Stressed: Babies deprived of attention become worried and anxious, says new Canadian research

They may have barely mastered sitting up by themselves.

But six-month-old babies become stressed out when they don't get the attention they feel they deserve.

Levels of the stress hormone cortisol soar when they are ignored by their mother, and even a day later they are worried about the same thing happening again.

A baby who is deprived of its mother's love for just two minutes is anxious about being ignored again the next day, a study found.

Experts in child development said that repeated episodes of stress could have a huge effect on a youngster's health and on his or her course in life.

To investigate whether six-month-olds are capable of anticipating trouble, the Canadian researchers invited 30 mothers and babies into their laboratory and divided them into two groups.

Babies were placed in car seats and their mothers played with them and talked to them as normal.

The play was then interspersed with two-minute periods in which the mother simply stared over her child's head, keeping her face free of emotion.

The next day, she took her child back to the laboratory. Levels of cortisol were measured several times on both days. Amounts of cortisol shot up when the babies were ignored.

They then fell off, before rising again when the youngsters were taken back into the laboratory, despite them not being ignored on the second day.

More...

A second group of babies went through the same process, but without being ignored at any time, and their hormone levels barely changed.

The findings suggest that being taken back into the laboratory led the youngsters who had been ignored to anticipate there being more trouble ahead, the journal Biology Letters reports.

Researcher Dr David Haley, of the University of Toronto, said: 'The results suggest that human infants have the capacity to produce an anticipatory stress response that is based on expectations about how their parents will treat them in a specific context.'

Professor Jay Belsky, of Birbeck College, University of London, said factors such as depression could affect a mother's relationship with her baby and send cortisol levels soaring time and time again.

This could lower a baby's immune system, while a troubled upbringing may also mean the child going on to become a less than perfect parent itself.

How Media Affects our Views of Childbirth

“Here in America, surveys of women tell us that pain and pain relief do not generally play major roles in satisfaction with the childbirth experience, unless expectations regarding either are unmet. It’s that part about expectations that seems to matter. Since our response to pain is culturally defined, scenes from movies like “Knocked Up” — or “Rosemary’s Baby” or “Now and Then” or “Nine Months” — probably help set the cultural and psychic stage for excruciating pain, and help women decide well in advance of even getting pregnant to go for an epidural.”

This from a very thought-provoking, intelligent piece over at Salon today by pediatrician and father, Rahul Parikh. The topic is one I think about a lot: How does the culture around pain in childbirth impact our expectations for and even our experience of labor?

Have the terrifying, screaming scenes of agony typical of Hollywood births contributed to a kind of mythology of pain in childbirth? And does that mythology manifest in such a deep (as to be unnoticeable or normalized) fear and anxiety, we’re bound to buzz for the anesthesiologist, whether we plan on it or not? There’s quit a lot of research showing that pain is exacerbated by fear.

By Dr. Parikh doesn’t think mass media are the only ones to blame for whatever dread most women feel for birth :
“More important, we in medicine have ourselves to blame (or thank, depending on how you look at it) for our cultural perspectives on labor pain. There was a time when women birthed children at home, with the help of midwives, family and close friends. With the march of progress, birth became medicalized, the noble intent being to keep women and children safe and healthy through the process. Doctors are motivated to persuade women to eradicate pain for multiple reasons: We’ve never been taught or made any effort to discriminate birthing pain from any other kind, and don’t want to see our patients suffer; pain is viewed now as a “vital sign” that, like blood pressure or pulse, has to be tightly controlled; managing pain medically requires less effort on the part of nurses and doctors (as Cassidy’s book also points out) — just sit back, jab the catheter in and wait, instead of coaching, breathing and other supportive measures, all of which have been shown to help women in labor manage pain better; last but never least, medicine is a business — we can bill for the drugs, the needles, the catheters and all of the labor involved in keeping women pain free. (While the vast majority of women have hospital births, the rise of the doulas and the media attention to home-birthing suggests many people are actively searching for alternatives to this.)”

At the end of his piece, Parikh tells us that though he supported and massaged his wife through labor, “none of those things replaced the potency of the mighty epidural when it came to making her, and me, feel better about having a baby.”

I’d love to hear everyone’s thoughts on this.

Here are some of mine:

1. We need to see more kinds of births.
Not just painful ones. Not just orgasmic ones. Not just un-medicated ones. Not just screaming hospital emergencies (of which, in reality, there are very few). We need more balance. Here is the antidote to the Knocked Up birth scene, and this one is real!

2. Our idea of what “normal” is in birth needs to be readjusted. Birth may not be a walk in the park for everyone, but it is actually just a normal physiological process. Sometimes it becomes abnormal, but at it’s most basic level it’s a bodily function. We need to become more enlightened, as individuals and as a culture, about the physiology of normal birth.

3. Birth can be painful.
Yup, even when you “trust it.” It might not be painful but rather “intense,” or maybe it’s “agony.” Some of this has to do with semantics, but there’s also just a huge range of experience. Having said that, pain/work/challenge is not the same as something scary or medically worrisome. Reducing fear can reduce pain. Some say it eliminates it altogether, but I’m not convinced this is true for all women or births. I think getting rid of a whole lot of fear can take the edge off the pain and make the difference between out-of-control feeling and manageable labor. How we are made afraid is very complex… movies, “medicalization” of birth… just the fact that you enter the hospital through “triage” evokes some fear right there. Could they just come up with another word for that initial check-in? This stuff undermines us… little by little.

4. A positive childbirth experience is not about whether or not you get the epidural…
It’s about whether you were treated with kindness and respect at a time of incredible vulnerability. It’s about being informed and empowered to make the choices that are right for you.

5. Hospitals should offer more than epidural when it comes to pain relief.
What if there were tubs in all the rooms? And all women were treated to doulas? Epidurals are really efficient at getting rid of pain. I’m so glad we have them! But what if you would prefer to try something else? It can be hard. You go into a lot of hospitals today and there’s really just one thing on the pain-coping menu: the epidural. I feel for women who’d like to attempt a non-medicated birth–they have to BYO pain-coping resources and they have to resist the culture of medical birth at each step of the way. (Don’t let “triage” undermine your confidence!, etc) It can be done, but boy would we be better off if having a normal birth didn’t have to involve “fighting” for it.

New Advice on Getting Baby to Sleep

By ELENA CHERNEY | Staff Reporter of THE WALL STREET JOURNAL

It's one of civilization's most vexing problems: How to get a crying baby to fall asleep.

Some of the nation's leading sleep authorities are softening their long-held positions. In a coming new edition of his landmark 1985 book, pediatrician Richard Ferber is backing off his controversial system for training babies to sleep. The approach, which involves leaving a child to cry for progressively longer intervals until he or she falls asleep, has many ardent followers. But the crying method has also drawn loud criticism as being neglectful.

Dr. Ferber now says that letting children cry "was not meant to be the way to treat all sleep problems" and his updated book, coming this spring, will make it clear that he offers other solutions besides crying.

The Sleep Landscape

Take a look at some views on infants sleep.

At the same time, pediatrician William Sears, the most prominent opponent of the Ferber method, is relaxing his so-called attachment parenting approach that dictates, among other things, that parents respond to their children on demand, day or night. Dr. Sears has long advised parents to sleep with their children and to view nighttime as a chance to do more parenting -- say, by sitting up with them if they protest bedtime. But in his new book published last month, "The Baby Sleep Book," Dr. Sears tells parents that they, too, need to get some rest. For example, he suggests that if the mother is sleep-deprived, it may be time to wean the baby off nighttime feedings.

These shifts are among the latest in a flurry of new guidance that seems aimed at offering practical solutions for parents -- neither too harsh nor too permissive. Last month, the American Academy of Pediatrics issued a series of pronouncements on sleep strategies, from a task force convened to combat sudden infant death syndrome. Among the suggestions: Parents should try using a pacifier to soothe infants to sleep -- despite concerns artificial nipples may interfere with breast feeding. The group recommended for the first time against the increasingly popular practice of babies sharing their parents' beds, after concluding that it is associated with a higher risk of SIDS. But they said the crib should be in the parents' room, so as to remain close.

There is certainly no clear magic bullet yet to get children to sleep, and the efficacy of any approach will vary from family to family. But many parenting experts say this new round of advice represents a welcome break in a debate that had become increasingly caustic, with experts and their followers often hurling public criticisms at one another.

Much of the argument has played out on Internet message boards, where the tone has gotten so intense that one Web site, ivillage.com, banned discussion of different approaches from its sleep-training forum. "We don't want people to feel attacked," says Tamara Amey, an ivillage forum moderator.

The quest by busy, affluent parents to get a good night's sleep has spawned a huge advice industry in recent years, with experts touting books, videos and private sleep-consulting services. Products to help babies to sleep are a booming business: A Toys "R" Us Inc. spokeswoman says new offerings arrive all the time. Popular items at the store now range from fleece swaddling blankets with Velcro fasteners to remote-controlled crib mobiles.

A host of book authors have found success mining a middle ground between the two poles traditionally represented by Drs. Ferber and Sears. Pediatrician Marc Weissbluth, whose "Healthy Sleep Habits, Happy Child" sold 500,000 copies and has just been reprinted in hardcover with a new introduction, emphasizes frequent naps and putting the child down drowsy but awake. And last May, Elizabeth Pantley published a sleep book focused on toddlers and preschoolers, as a follow-up to her 2000 "No Cry Sleep Solution" for infants. Dr. Sears wrote a foreword to her first sleep book, but Ms. Pantley says she advises gradual bedtime routines as a middle ground between the "nighttime neglect" of the Ferber method, and the demands on parental sleep that come with Dr. Sears's method.

There are still plenty of points on which the experts disagree -- particularly when it comes to babies sharing their parents' beds. Despite the AAP's recommendation against so-called co-sleeping, many experts continue to recommend it. Co-sleeping is central to the attachment parenting approach touted by Dr. Sears and others. Even Dr. Ferber, who had been opposed to the practice, now says that sharing a bed can be effective for families.

Already some sleep experts are challenging the AAP's recommendation. Judith Owens, the director of the Pediatric Sleep Clinic at Hasbro Children's Hospital in Providence, R.I., says co-sleeping has been shown to be safe in other parts of the world where almost all babies sleep with their parents. In her own book published last month, "Take Charge of Your Child's Sleep," Dr. Owens says that bed-sharing is a safe alternative for families.

Dr. Ferber, 61, says that he has been largely misunderstood. When he first published his book in 1985, "there weren't any others," he says. The book, which has been reprinted 45 times, contains advice on a range of sleep issues, from bed-wetting to teens who can't get up for school on time. But he is most known for his signature controlled-crying method, which involves leaving a baby alone in the crib to cry for progressively longer intervals until he or she falls asleep. Parents are instructed to go into the room at the end of each interval to console -- but not touch or pick up -- the child.

Dr. Ferber, who is also director of the Center for Pediatric Sleep Disorders at Children's Hospital in Boston, says that now, "we've had a lot more experience. There really are a lot of different ways" for children to learn good sleep habits.

Dr. Ferber says that he will be revising his book because some parts need to be updated. For instance, he says new research suggests that babies don't need as much sleep as he originally advised. And he wants to clarify that his crying technique was targeted at a specific problem: the child who can fall asleep only while being rocked or held. While he still presents this approach in his new edition, he says he tells parents they can use gradual steps to wean a child off of rocking and soothing behaviors. And he clarifies that some children such as those suffering from anxiety will not be helped by the crying method.

Krista Rushing, a mother of a 2-year-old boy in West Monroe, La., has not been a fan of Dr. Ferber's classic method, and says she always goes to her son when he wakes in the night. "It's a good thing" Dr. Ferber is revising his book, she says.

Dr. Sears, whose new book is one of several written with his wife Martha, had long disparaged Dr. Ferber's method -- often called "Ferberizing." The Searses tell parents that such methods are appropriate for training pets, not raising children.

In softening his own approach, Dr. Sears says he now thinks his earlier books placed too much emphasis on catering to the baby's needs, and did not address the parents' needs enough. "It's also a parent-centered approach," he says of his new book. "What your baby needs is a happy, rested mother."

The Myth of the Vaginal Exam

Vaginal exams. I don't know a single woman who likes them.

However, there is a myth perpetuated in our society that vaginal exams at the end of pregnancy are beneficial. The common belief is that by doing a vaginal exam one can tell that labor will begin soon. This is not the case.

Most practitioners will do an initial vaginal exam at the beginning of pregnancy to do a pap smear, and other testing. Then they don't do any until about the 36 week mark, unless complications arise that call for further testing or to assess the cervix. If your practitioner wants to do a vaginal exam at every visit, you should probably question them as to why.

Vaginal exams can measure certain things:

Dilation: How far your cervix has opened. 10 centimeters being the widest.
Ripeness: The consistency of your cervix. It starts out being firm like the tip of your nose, softening to what your ear lobe feels like and eventually feeling like the inside of your cheek.
Effacement: This is how thin your cervix is. If you think of your cervix as funnel-like, and measuring about 2 inches, you will see that 50% effaced means that your cervix is now about 1 inch in length. As the cervix softens and dilates the length decreases as well.
Station: This is the position of the baby in relation to your pelvis, measured in pluses and minuses. A baby who is at 0 station is said to be engaged, while a baby in the negative numbers is said to be floating. The positive numbers are the way out!
Position of the baby: By feeling the suture lines on the skull of the baby, where the four plates of bone haven't fused yet, one can tell you which direction the baby is facing because the anterior and posterior fontanels (soft spots) are shaped differently.
Position of the cervix: The cervix will move from being more posterior to anterior. Many women can tell when the cervix begins to move around because when a vaginal exam is performed it no longer feels like the cervix is located near her tonsils.

What this equation leaves to be desired is something that is not always tangible. Many people try to use the information that is gathered from a vaginal exam to predict things like when labor will begin or if the baby will fit through the pelvis. A vaginal exam simply cannot measure these things.

Labor is not simply about a cervix that has dilated, softened or anything else. A woman can be very dilated and not have her baby before her due date or even near her due date. I've personally had women who were 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that her cervix is high and tight, she's been told that this baby isn't coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start.

Using a vaginal exam to predict advisability for a vaginal birth is usually not very accurate, for several reasons. First of all it leaves out the factor of labor and positioning. During labor it's natural for the baby's head to mold and the mother's pelvis to move. If done in early pregnancy it also removes the knowledge of what hormones like Relaxin will do to help make the pelvis, a moveable structure, be flexible. The only real exception to this is in the case of a very oddly structured pelvis. For example, a mother who was in a car accident and suffered a shattered pelvis or someone who might have a specific bone problem, which is more commonly seen where there is improper nutrition during the growing years.

During labor vaginal exams can't tell you exactly how close you are either, so keeping them to a minimum then is also a good idea, particularly if your membranes have ruptured.

Okay, so there's not really a great reason to have a vaginal in exam done routinely for most women. So are there any reasons not to have vaginal exams? There sure are.

Vaginal exams can increase the risks of infection, even when done carefully and with sterile gloves, etc. It pushes the normal bacteria found in the vagina upwards towards the cervix. There is also increased risk of rupturing the membranes. Some practitioners routinely do what is called stripping the membranes, which simply separates the bag of waters from the cervix. The thought behind this is that it will stimulate the production of prostaglandins to help labor begin and irritate the cervix causing it to contract. This has not been shown to be effective for everyone and does have the aforementioned risks.

In the end only you and your practitioner can decide what is right for your care in pregnancy. Some women refuse vaginal exams altogether, so request to have them done only after 40 weeks, or every other week or whatever she feels comfortable with.

http://pregnancy.about.com/cs/interventions/a/vaginalexam.htm

Breastfeeding Advice to Ignore

Three Pieces of Breastfeeding Advice to Ignore!

Posted by Carrie Lauth on May 29th, 2011

Breast Feeding Baby

“Don’t nurse your baby all the time or she’ll become too dependent. You must wait and feed your baby every few hours.”

This is possibly the most damaging piece of breastfeeding advice you’ll ever hear. Not only can following this advice lead to clogged milk ducts and breast infection, it can sabotage your entire breastfeeding relationship.

In short, don’t do it.

Don’t breastfeed your baby like a bottle-feeder. Scheduled feedings apply to formula fed babies, not nurslings. Unlike formula, breastmilk is quickly digested and since babies have small stomachs, expect your little one to “cluster feed” through most of the day-and night-in the early weeks. It’s normal for newborns to appear hungry every hour or so for part of the day.

According to the American Academy of Pediatrics, newborns should be nursed whenever they exhibit hunger cues: rooting, putting hands to mouth, mouthing, fussing, or crying, which is actually a late sign of hunger. Listen to them.

Unlike formula, breastmilk works on the law of supply-and-demand. The more baby nurses, the more milk you’ll make and vice versa. Babies on scheduled feedings may not nurse enough to build up an adequate milk supply.

And as for the line about babies becoming dependent? Babies are supposed to be dependent on you. After all, there isn’t much a baby can do for himself. So throw those schedules in the diaper pail.

“Whatever you do, don’t let baby sleep in your bed.”

While co-sleeping may not be the answer for all families, it can make nighttime breastfeeding (and sleeping) less of an ordeal for parents and babies. Most families throughout the world sleep next to their babies. The US is one of a few countries where this act is considered taboo. But why?

According to the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, babies and mothers who co-sleep receive more sleep than those who sleep separately.

But what about long-term negative effects of co-sleeping? Research shows there aren’t any. While some parents seem to have an irrational fear of “over-lying”, this simply isn’t an issue unless a parent is under the influence of mind altering substances – in which case, they shouldn’t be caring for a baby anyway.

Actually, babies who co-sleep tend to have something in common-they’re thriving-both physically, mentally and intellectually. And they’re nursing well. Babies who co-sleep tend to eat more at night, maintaining mom’s milk supply and promoting natural child-spacing.

Co-sleeping makes nighttime nursing much easier and is safe, provided you take some safety precautions and are nonsmokers. If baby wakes during the night, all you have to do is roll on your side and let the nursing begin. Then you can continue getting your snooze on while baby nurses back to sleep.

Ignore those people who say you might roll on your baby (highly unlikely if you’re sober) or are being a sap. People talk like sleeping next to your baby is a slippery slope-do it once and you’ll never have a child-free bed until the teenage years roll around. But this isn’t necessarily true. As with everything, do what works in your family’s situation.

“Babies shouldn’t breastfeed beyond [six months, one year, etc]. Mothers who nurse their toddlers are doing it more for themselves than for their babies.”

There is nothing wrong with breastfeeding toddlers. The American Academy of Pediatrics (AAP) claim there’s no evidence of psychological or developmental harm in babies who breastfeed beyond age one.

In addition, extended nursing has many benefits. Research shows that babies over a year old still receive substantial amounts of nutrients from breastmilk. Even though toddlers need nutrition from solid foods, breastmilk is still a valuable part of their diet, providing high amounts of vitamin B12, vitamin A, folate, vitamin C and protein. The composition of milk even changes to fit baby’s growing needs.

Even though the sight of nursing toddlers isn’t at the forefront of society, extended breastfeeding isn’t extreme. The AAP recommends breastfeeding for at least a year and longer as mutually desired by mama and child and the World Health Organization urges moms to nurse for at least two years.

Welcome!

Pages

Thursday, June 9, 2011