New Active Birth: A Concise Guide to Natural Childbirth. Janet Balaskas

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СКАЧАТЬ environment in the uterus, entering the baby’s circulatory system and hence the baby’s brain within seconds or minutes. Contrary to what many women are told, this includes regional anaesthetics such as epidurals (4).

      The baby’s central nervous system forms and develops rapidly in the last part of pregnancy, during the birth itself and during infancy, and is susceptible to the effects of drugs given around the time of birth and after. We have only to recall the thalidomide tragedy to realise that the testing of the safety of these medications is often sorely inadequate. Of course, it is important also to bear in mind that babies vary in their vulnerability to the effects of these drugs and, in instances of real need, the judicious and minimal use of medication is usually successful. However, in antenatal clinics and hospitals, mothers are usually uninformed about the hazards or side effects involved in taking such medications and are deluded into assuming that there are no risks involved.

      Let us take a look at some examples of the most widely used medications for labour and birth, and their more common side effects. I have deliberately omitted the more severe and rare complications but readers who are interested can look up the research references listed here.

      THE PROMISE OF PAIN RELIEF

       Pethidine (Demerol in the USA)

      This is a narcotic-like analgesic used to ‘take the edge’ off pain. Given usually as an intramuscular injection, some women find it makes labour more tolerable and others that it causes them to lose control. There are possible side effects to the mother, such as nausea or dizziness, and it will slow down the mother’s breathing and respiration, hence reducing the baby’s oxygen supply. Often Pethidine is mixed with sedatives to reduce nausea and these too will cause sleepiness and enter the baby’s bloodstream.

      It is now common knowledge that Pethidine can depress the baby’s respiratory system and jeopardise the start of breathing after birth, resulting in the need to resuscitate the baby (5).

      Traces sometimes remain in the baby’s system after birth so that, in addition to adjusting to life outside the womb, the baby’s system will have the added burden of detoxification (6). They can also depress the baby’s sucking reflex and because they remain in the baby’s system for several weeks they can affect the initiation of breastfeeding and mother-infant bonding (7).

       Epidurals

      This is known as a regional anaesthetic which is injected locally into the epidural space between two lumbar vertebrae in the lower spine. When it works effectively the result will be a blocking of pain impulses, bringing numbness from the waist through the lower body.

      While the effects of the drugs used for epidurals on the baby are not the same as Pethidine, we know that they enter the baby’s circulation and brain tissues within minutes (6). Their immediate and long-term effects on the neurological development of the baby are relatively unknown and direly under-researched, despite the widespread use of this form of pain relief, worldwide.

      Side effects for the mother, such as severe headaches following the birth, can occasionally occur (these are caused by accidental scratching of the membrane surrounding the spinal cord by the injection needle), and a lowering of maternal blood pressure is common.

      An epidural will certainly increase the need for obstetric intervention. Of course the mother will be immobile and reclining so contractions tend to be less efficient, and labour is often much longer and may need to be artifically stimulated with an oxytocic drip.

      All these factors contribute to a lessening of the blood supply to and from the uterus, so foetal distress (lack of oxygen) is far more likely. Sometimes the pelvic muscles become limp and do not help the baby to rotate in the usual way (with the added disadvantage of being without the help of gravity).

      An epidural can also inhibit the mother’s ability to push her baby out spontaneously and, one way or another, the risk of a forceps delivery or a Caesarean section is increased.

      When mothers give birth actively, with the help of a midwife, the forceps rate rarely rises above 5 per cent and drugs are only used in cases of unavoidable distress or to save a life. By contrast, in countries such as the USA, the incidence of forceps deliveries can be, according to Doris Haire, as high as 65 per cent in some hospitals. An unnecessary forceps delivery can be traumatic for both mother and child and can occasionally result in injury or damage to the baby (8).

      Although, at times, the total freedom from pain offered by an epidural may be indispensable, it is important, for a successful outcome, to weigh this advantage against the attendant risks, which are considerable. Occasionally the price of a few hours of comfort can be a damaged baby and may very well be a complicated birth (9-12).

      So, might it not be better in the long run to learn how to use your body to release, minimise and transform the pain of labour and to have access to a pool of warm water or a shower – an effective and totally harmless way to reduce pain? If an epidural is really needed, then its use can be minimal and, in this way, the attendant risks are reduced.

      STIMULATING LABOUR

       Induction

      An induction may be used to initiate labour or to stimulate contractions once it has begun. It is usually done by introducing an intravenous drip of Syntocinon (Pitocin in USA), a powerful synthetic hormone, into a vein in the mother’s arm.

      Normally, when the uterus contracts, the blood vessels which carry blood to the placenta are temporarily constricted. In between contractions, blood is stored in the placenta to keep up a constant supply to the baby during contractions. When contractions are stimulated by Syntocinon they tend to be longer, stronger and closer together than in a normal labour. The periods of constriction are therefore longer than usual so that the overall oxygen supply to the baby is reduced and foetal distress is therefore more likely. Doris Haire writes in Drugs in Labour and Birth,‘The situation is somewhat analogous to holding an infant under water and allowing the infant to come to the surface to gasp for air but not to breathe.’

      The incidence of postnatal jaundice in babies who have been induced is also thought to be higher (13-14).

      In addition, strong contractions usually occur as soon as the drip begins to work so the gradual build-up in intensity of a normal labour is absent. This often means that the mother cannot cope with the pain of the stronger contractions and will need pain relief, so the baby will end up with the combined effect of painkillers and the drugs used for induction.

      Of course, continuous foetal monitoring will probably be necessary with all these risks and so the snowball effect continues as one intervention necessitates another.

      Studies have shown that there is no evidence of any natural advantage in routinely inducing births that are ‘overdue’ and a failed induction frequently ends up as a Caesarean section (15-18).

      Would it not be better to reserve this option as a last resort and discover how to change position to stimulate contractions, or how to improve the birthing environment so that the mother can secrete her own natural hormones? Learning how to allow the normal physiology to unfold without disturbance is the most effective way to ensure that the mother will secrete her own hormones.

      Birth Before Obstetrics

      Historical studies show the СКАЧАТЬ