Ten lies my natural childbirth educator told me

Several people have expressed reluctance to join a Facebook group entitled Fed up with natural childbirth on the grounds that they have no objection to choosing unmedicated birth, or more generally, no objection to women making whatever choices they prefer. But natural childbirth is not simply a specific set of choices; it’s a philosophy that idealizes a specific set of choices and makes value judgments about women who choose differently. Moreover, it is a philosophy that rests on specific empirical claims; claims that are disingenuous, untrue, or occasionally outright lies.

Below is a list of the most popular NCB falsehoods and lies, the ones that are promulgated by natural childbirth celebrities and organizations, and faithfully transmitted even by purportedly neutral childbirth educators:

#1. Childbirth is inherently safe.

This is an outright lie. Childbirth is inherently dangerous. Childbirth is and has always been, in every time, place and culture, a leading cause of death of young women. For babies, the day of birth is the single most dangerous day of the entire 18 years of childhood.

This lie is a bedrock assumption of natural childbirth philosophy. On this false belief that childbirth in nature is inherently safe rests the claim anything that modifies childbirth must be dangerous or not as good as childbirth in nature.

#2. Fear causes the pain of childbirth.

This stems from a spectacularly racist lie. Grantly Dick-Read, the father of the NCB movement, was a eugenicist whose primary goal was to prevent “race suicide” by encouraging white women of the better classes to have more children. He claimed that primitive (i.e. Black) did not have pain in labor, in keeping with the pervasive racist beliefs of the age that Black women were hypersexualized, and gave birth without pain because they did not fear their natural role. Grantly Dick-Read based his entire philosophy on this lie, hence the title of his book, Childbirth Without Fear.

Contemporary natural childbirth advocates no longer make the absurd racist claims, but they are stuck on the notion that the pain of childbirth is inherently controllable by the mind, and that the mind can therefore be trained to minimize and manage the pain.

#3. Labor is not inherently painful.

This bizarre claim rests on a false assumption that labor pain is qualitatively different than other forms of pain. It’s not. It is exactly like any other form of pain, is initially received by the same types of neurons, passes exactly the same way up the spinal cord to the brain, and is perceived by the brain in exactly the same way as any other form of pain.

#4. Epidurals are dangerous and unnecessary

NCB advocates insist that epidurals are unnecessary because the pain of labor should be managed in other ways, or better yet, should be endured. The claim is both philosophical and empirical. The philosophical claim rests on the naturalistic fallacy and belief in essentialism. The naturalistic fallacy is the claim that because something is a certain way in nature, it ought to be that way all the time. Essentialism is the belief that women share an essential nature and are “empowered” by expressing that nature.

NCB also insist that epidurals are “dangerous” to both baby and mother. That’s nothing more than a lie, created by grossly inflating the purported risks of epidurals.

#5. Interventions are “bad.”

Obviously, if you operate under the mistaken belief that childbirth is inherently safe, it is impossible to recognize the benefits of interventions. However, if you recognize reality, that childbirth is inherently dangerous, interventions represent nothing more than preventive medicine. Knowing that complications are common and often preventable, it follows quite logically that pregnant women should be monitored for a variety of complications so they can be prevented, or treated early when there is the greatest chance of successful treatment.

Since NCB advocates insist that interventions are generally worthless, they are forced into the bizarre position of arguing that medical professionals deliberately offer worthless practices and technology because they are benefiting financially.

#6. Inductions are dangerous and unnecessary.

This lie was adopted by NCB advocates only recently. It flows inevitably from two other mistaken beliefs, the belief that childbirth is inherently safe and the belief that since there are no inductions in nature, there must be no need for inductions.

NCB advocates bemoan the rising induction rate while conveniently ignoring the fact that the stillbirth rate has dropped as a result.

#7 Cesareans are almost always unnecessary.

Again, this is nothing more than an empirical lie. It is well known that in countries where the C-section rate is under 5%, mortality rates are appalling. Indeed, in countries that have C-section rates less than 10%, mortality rates are still extraordinarily high. At a minimum, then 1 in 10 women derive major benefit from a C-section. That is hardly a procedure that is unnecessary.

#9. Vaginal birth is inherently superior

This is a philosophical claim that rests on the naturalistic fallacy. Since everything that is natural is “better” and vaginal birth is natural, it must be “better.” Most women consider that a birth that results in a live baby and live mother is inherently superior, and for a significant proportion of women, that birth is a C-section.

#10. Women who love their babies choose NCB

This is the most hateful claim, but a claim that flows inevitably from all the other lies. When you erroneously believe that natural is inherently safe and that everything else is inherently dangerous, interventions wrongly take on the specter of unnecessary risks. When you wrongly believe that epidurals are dangerous, opting to treat your own pain implies that you value your feelings over the risks to your baby.

***

Natural childbirth advocates will be the first to tell you that NCB is not merely a vaginal birth without pain medication. It is a belief system that necessitates choosing vaginal birth without pain medication and without interventions of any kind. As we have seen, it is based on a variety of philosophical and empirical claims that range from false to outright lies. Natural childbirth explicitly idealizes certain childbirth choices and derides others. More importantly, it asserts that women who make those idealized choices are better women and better mothers than everyone else. And that’s why I’m fed up with natural childbirth.

929 Responses to “Ten lies my natural childbirth educator told me”

  1. Sara
    May 17, 2017 at 3:37 pm #

    The only thing that matters is that women are safe and healthy and give birth in the way that THEY choose. Unfortunately many women think that by undergoing the birth process with interventions and drugs, the they are saving themselves from certain disaster, assuming that something very dangerous is right around the corner. The truth is that the vast majority of women who are expecting are LOW RISK women whom are very healthy and could give birth perfectly safely if there is no interference or intervention, and if she feels SAFE, PROTECTED, RESPECTED, and SUPPORTED. Unfortunately the vast majority of women are not aware of what a normal birth looks like, or how amazing and miraculous the entire process can look like if she were only left the hell alone. She should be free to make her own choices, hopefully based on the most unbiased information and current information available.

    Consider this:

    The high risk category of expectant women range between 6 and 8 percent respectively. Why then is our C-section section rate averaging around 30% in many hospitals? Isn’t the idea that the high risk category of women expecting COULD but won’t certainly deal with some complications that may necessitate emergency intervention such as a csection? Where are all of these unforeseen emergencies coming from?

    What about all the reasons that OB’s give to an expectant mother for NEEDING to perform a C-section on them? Things like CPD and “big baby”. We literally have no accurate ways of assessing whether or not these women would birth on their own and do perfectly fine if they were left to utilize the natural process and not be abused and messed with and made to feel inadequate like our bodies are not performing like they should. Perhaps it’s because the medical model of care for childbirth is made for high risk women and not for the everyday woman that just wants to be cared for with respect, dignity, and compassion and not receive disrespect from doctors and medical professionals that don’t know them or anything about them. Statistically the truth is that women are experiencing higher levels of mortality along with their infants because interventions are being utilized too often and putting these low risk women in a higher risk category because of the potential health problems and risks associated with interventions. A low risk woman is very quickly becoming high risk because this interference is unnecessary and not medically required. Inform yourself, it will empower you. If your birth team does not truly care about women and babies and creating the birth experience that YOU are comfortable with, they will impede the process of labor. Birth should be woman centered period. Profits have no place in a mother’s womb.

    • demodocus
      May 17, 2017 at 4:08 pm #

      My mother had her first 6 children without anything for pain or interventions. In the hospital. Including the triplets. 1975-1987, 3 different hospitals in 3 different states. Three were stillborn, including 2 of the triplets.

      The only thing they strongly recommended with me until my blood pressure suddenly went from fine to about-to-stroke-out was antibiotics to make sure my son didn’t get an infection. Kid was born vaginally 14 hours later, because they gave me pitocin and magnesium sulfate.

      In fact, my sister is the only person in my circle with kids under 10 who has had a c-section. Emergency, after 24 hours labor, with what had turned out to be a uterus and umbilical cord so riddled with metastasised ovarian cancer that they check my nephew for ovarian cancer every year or two and they didn’t expect her to see the next season.

      OBs are well paid, but not nearly so much as say cardiologists or plastic surgeons.

      What the hell is dignified about childbirth?

    • Poogles
      May 17, 2017 at 4:51 pm #

      “The high risk category of expectant women range between 6 and 8 percent respectively. Why then is our C-section section rate averaging around 30% in many hospitals?”

      Because women (and their fetuses) who have been “low-risk” all through pregnancy and even after the start of labor can become “high-risk” in the blink of an eye and need a CS. Fetal distress, maternal or fetal infection, cord prolapse, maternal exhaustion, placental abruption, etc. – there are many things that can happen in a previously low-risk pregnancy/labor and delivery that call for a CS.

      It’s not like once you’re deemed “low-risk” you have nothing to worry about and nothing can change. Until the baby is out, the placenta is out and the uterus has clamped all the way back down, shit can hit the fan.

      “Things like CPD and “big baby”. We literally have no accurate ways of assessing whether or not these women would birth on their own and do perfectly fine if they were left to utilize the natural process”

      You’re absolutely right – we do not have a completely accurate way of measuring how the baby will fit. We would need to be able to accurately measure the size of the baby, the size of the pelvis and the position of the baby. Since we only have imperfect ways of doing this currently (ultrasound), most people (doctors and mothers alike) prefer to err on the side of caution and do a CS if the baby looks like it might not fit. When you consider that if the baby *doesn’t* fit, the baby may end up with serious injury (or may even die) and the mother may also end up with major pelvic and/or vaginal injuries, many people don’t want to even take the chance.

      “Statistically the truth is that women are experiencing higher levels of mortality along with their infants because interventions are being utilized too often and putting these low risk women in a higher risk category because of the potential health problems and risks associated with interventions.”

      Wrong – the causes of maternal mortality in this country are *not* due to too many interventions; if anything, technology is not being used enough, allowing complications to go undiagnosed and untreated until too late. http://www.skepticalob.com/2017/05/what-propublica-didnt-explain-and-possibly-didnt-even-know-about-maternal-mortality.html

    • Nick Sanders
      August 19, 2016 at 6:48 pm #

      Aww, such a cute list of lies. Try harder.

  2. Dr Kitty
    June 15, 2016 at 9:20 am #

    For anyone who has problems understanding the blood-brain barrier and epidurals.

    In epidurals and spinals local anaesthetics like bupivicaine and marcaine are injected around the spinal cord, where they stop the nerves sending pain messages. The drugs even stay around a particular part of the spinal cord, and don’t usually travel higher than we want them to.

    HOWEVER IV local anaesthetic is usually life threatening, because it causes cardiac arrythmias.

    The reason why an epidural infusion of marcaine, over a period of several hours is safe, while a few mls of IV Marcaine is potentially fatal is because the epidural marcaine won’t leak into the blood stream and get to the heart.

    Same goes for any opioids (usually fentanyl, sufentanyl or duramorph, not straight morphine sulphate).

    Whether or not YOU personally consider your labour pain to be severe enough to warrant epidural analgesia is a personal decision, but concerns about foetal exposure to opioids severe enough to cause respiratory depression requiring naloxone is such an unlikely event that most reasonable patients would not factor it into their decision making.

    • Molly B
      June 21, 2016 at 12:07 am #

      Respiratory depression can occur in Mom which can cause decels in fetus resulting in diagnosis of fetal distress and lead to cesarean.

      • The Bofa on the Sofa
        June 21, 2016 at 8:40 am #

        You are going to have to explain something to me.

        1) How does respiratory depression in the labouring mother cause decels? Can you explain how decels depend on the mother’s respiration?

        2) If the mother is suffering from respiratory depression, how can they do a c-section? I’m not an anesthesiologist, but don’t they have to get her breathing properly before they can actually do surgery?

        • Molly B
          June 21, 2016 at 10:38 am #

          1) Respiratory depression in mom decreases oxygen flow to fetus resulting in decels.
          2) Oxygen and other measures can be provided to mom but since epidural meds cant be stopped with immediate results sections can become necessary as decels are interpreted as emergency in some circumstances.

          • The Bofa on the Sofa
            June 21, 2016 at 2:14 pm #

            Oxygen and other measures can be provided to mom but since epidural meds cant be stopped with immediate results sections can become necessary as decels are interpreted as emergency in some circumstances

            Why would that be? They know that mom is in distress, why would they do surgery before stabilizing?

            Again, I am not an anesthesiologist, but this doesn’t make sense.

          • Molly B
            June 21, 2016 at 2:25 pm #

            Its not that Mom would be in distress, Fetus would be in distress. Fetal decels

          • The Bofa on the Sofa
            June 21, 2016 at 4:42 pm #

            If the Mom has depressed respiration and/or crashing BP, which is a side effect of an epidural, then she would be in distress.

          • Molly B
            June 22, 2016 at 2:12 am #

            I didnt say crashing BP. I said drop in BP. There is a difference. Also waiting until Mom is stable isnt always an option because Mom may not be able to be stabilized.

          • sapphiremind
            June 22, 2016 at 4:20 am #

            Neo person here – We wait until Mom is stabilized. They aren’t going to cut mom open for a c-section to take the baby out if it is going to kill her unless she’s already dead. Something about it violating some sort of ethics and oath we take…?

            Anyway. They intubate mommy, push fluids, blood and pressors like mad if needed and what the baby needs more than anything in that case (if it is deceling from maternal reason) is mom to be stabilized.

            Hell, we had a mom go on ECMO not too long ago. If they had tried to take the baby first, it would have killed her and it would have taken a lot of consents, possibly court orders and ethics consults to get that done.

          • Guest
            June 21, 2016 at 2:30 pm #

            Man, I’m a relative lay person, but even I know that’s not how that happens. If mom’s BP drops they push meds. If the baby is having oxygen issues they actually put oxygen on mom, flip you over, etc. My best friend had an epidural that made her pass out (bp dropped to 80/20). She didn’t have her c-section for another 8 hours and it was because she’d been stuck at 5cm for 8 hours.

            I know you think your educated, but you’re not. I’m not either despite spending many hours reading about this stuff. An OB is going to spend thousands and thousands of hours studying this and then observing and actually practising the things they learned. Even if you spent a hundred hours on this your knowledge is just inadequate. You clearly don’t understand anatomy, physiology, and chemistry, to name a few.

            Can you provide even one example of this scenario ever happening? I worked in an L&D for 2 years as a secretary – so anecdotal – but I never once heard of something like that happening (epidural followed by crash section).

          • Molly B
            June 21, 2016 at 2:37 pm #

            Me

          • guest
            June 21, 2016 at 2:44 pm #

            Yep. I had an induced birth and eventually an epidural. I didn’t get my epidural right away, I waited until I realized the pain was too much for me. After that, my daughter had worrisome heart decels. First my midwife had me change positions and moved the fetal monitors around. Then she called in the doctor on duty, and he did the same. I don’t know how long this went on, but my guess is at least a half an hour. When none of that worked, they told me that they thought a c-section was the safest option at that point. There was no epidural-decels-OMG CUT HER OPEN NOW to it at all.

            I know Molly B will probably say my daughter’s decels were because of the epidural, but since mine worked perfectly and none of the anesthetic got to her, I don’t see how. I had no blood pressure drop myself. The far more likely reason for it was that labor was intensifying (that’s WHY I got the epidural just then) and my little premature four pounder just couldn’t take it. Or perhaps she could take it – all might have been fine with a vaginal birth. But I saw no reason to play games with her life, so I consented to the c-section as soon as the doctors recommended it.

          • Molly B
            June 21, 2016 at 2:46 pm #

            BP didnt drop so how is that the same as what we are discussing? I sounds to me like fetal distress was more likely due to a natural anomaly or hyper uterine stimulation caused by induction. Also baby was preterm has to be factores into what you are saying

          • guest
            June 21, 2016 at 2:51 pm #

            No hyper uterine stimulation, Molly. Why do you always assume medical procedures are the cause of everything? This is exactly why it relates: you find fault in every medical birth practice just because you want it to be at fault. My labor and delivery looks like the cascade of interventions everyone was warned about. It wasn’t that at all! Had I gone natural, one or more of us would very likely have died. The interventions were the seatbelt that saved our lives, not the distraction that caused the accident in the first place.

          • Molly B
            June 21, 2016 at 2:52 pm #

            I do nt always assume medical procedure are the cause. If you read what I wrote I gave two non medical possibilities for it as well…that 2-1

          • Guest
            June 21, 2016 at 2:54 pm #

            No, you didn’t. You suggested hyper uterine stimulation caused by induction or natural anomaly (that’s two possibilities) in spite of the fact that I already told you what I think caused it – but you can’t accept that I have a lot more information about my own birth than you do, so you had to make up reasons why I am wrong.

          • Molly B
            June 21, 2016 at 6:41 pm #

            or due to preterm baby (3). Also induction medications stimulate the uterus resulting in longer, stronger contractions than normal labor contractions

          • guest
            June 21, 2016 at 9:10 pm #

            I said it was prematurity, not you. And told you it was NOT because of the induction. I’ve seen no solid evidence that induced contractions are stronger when properly handled, but in any case we’re talking about MY labor now. I was there; you weren’t. It wasn’t the induction.

          • Molly B
            June 21, 2016 at 10:34 pm #

            Actually I stated that the fact that baby was preterm also had to be factored into it. So, yes I did.

          • guest
            June 22, 2016 at 10:07 am #

            No, you took the reason I gave for it, and made up two other reasons because my stated reason wasn’t good enough for you, for some reason.

          • Molly B
            June 21, 2016 at 2:49 pm #

            I had epidural ater 18 hours of labor within 1 hour BP dropped, baby deceled, given oxygen, deceled a second time into 20’s along with2nd BP drop, didnt work rolled to OR for cesarean.

            Women are not alway told that BP drop can lead to decels in baby and need for emergency cersarean.

            Full disclosure is needed.

          • guest
            June 21, 2016 at 2:52 pm #

            Sounds like a natural anomaly to me, and I’m as qualified as you to say so.

          • Nick Sanders
            June 24, 2016 at 1:56 am #

            And you don’t think the 19 hours of labor had anything to do with it? Anything at all?

      • swbarnes2
        June 21, 2016 at 11:20 pm #

        If you HONESTLY wanted to clear up your position, it would be very easy. Post what you think the mg/kg does in an epidural is, what mg/kg does you think gets into a woman’s bloodstream, and then post what you think is the mg/kg that a fetus receives when an epidural is used in labor. Then post what mg/kg dosage you believe is required to get whatever effects you claim the medicines in epidurals cause.
        If you refuse to put any hard numbers to your claim, people will draw conclusions.

        • Molly B
          June 22, 2016 at 2:06 am #

          To state ‘what I think’ is only setting myself for other to say ‘site it’. Therefore I will site a NIH article that state anesthesia shows up in newborn urine 36 hours after birth. This mean that the fetus does receive the anesthesia and since a fetus is alive they are effected by meds the same as anyone else.

          http://www.ncbi.nlm.nih.gov/pubmed/3578847
          also:
          http://www.ncbi.nlm.nih.gov/pubmed/10617697
          and:
          http://www.ncbi.nlm.nih.gov/pubmed/7225300

          • The Computer Ate My Nym
            June 22, 2016 at 3:16 am #

            From the abstract of your first reference: “No bupivacaine was detectable in neonatal plasma 24 hr after delivery.”

            The second reference was about maternal fever and its effects on newborns, which can be associated with epidural anesthesia but is hardly an inevitable feature. The paper concluded that the effects were transient, though long term follow up to ensure that there are no lasting effects would be reasonable.

            The third is a 35 year old paper from a time when the dose of medication given in epidurals was considerably higher.

            Incidentally, you are aware that bupivacaine is not an opiate, right?

          • guest
            June 22, 2016 at 10:06 am #

            Molly B is incapably of understanding epidurals. She’s demonstrated that repeatedly. I’m still waiting for her to explain who there can be informed consent when the patient can’t understand the procedure. We’ve spent *days* trying to explain it to her. If she were a woman in labor, she’d be well past needing one by now. Maybe that’s what she wants: Epidurals are technically available (so she can still claim to be for patient choice), but the consent process takes so long that no woman will ever get on before labor is over.

          • swbarnes2
            June 22, 2016 at 12:44 pm #

            Just dropping citations isn’t helpful. We need NUMBERS. You need to show that the amounts present are high enough to have any effect.

            Your second link is about elevated temperatures, not about epidurals.

            Your third link is 35 years old. The first is about 30 years old. Is this really the best you can do? You are banking your reputation as an educated person on the grounds that nothing has changed in the practice of epidurals or the evidence in 30 years?

          • Daleth
            June 22, 2016 at 2:54 pm #

            The two studies you cited about epidural drugs being present (in tiny amounts) in babies’ urine date from, respectively, 1981 and 1987. Can’t you find anything more recent? No? Did it occur to you that the reason you can’t find anything more recent is because the drugs and doses used to do epidurals and spinal anesthesia have changed since then?

            Specifically, the drugs have changed and the doses have gone down.

            So you’re citing studies about a medical practice that nobody does anymore. What makes you think that’s relevant to the practice that’s done these days?

          • MaineJen
            June 22, 2016 at 3:09 pm #

            Molly, what you’re trying to say is “cite it.”

          • Roadstergal
            June 22, 2016 at 4:37 pm #

            From paper #1 (1987): “No bupivacaine was detectable in neonatal plasma 24 hr after delivery.” And from the Discussion, “The key finding is that bupivacaine crosses the placenta and reaches the fetus, but in very low amounts.” Basically, what everyone has been saying – trace amounts can leak through, but they are trace and transient and, as per the studies discussed below, have no measurable effect on the fetus.

            Paper #2 is studying transient effects maternal fever has on the newborn. They specifically say in the Methods: “Epidural analgesia was not part of the trial protocol.” They noted that febrile women had larger babies, longer gestations, and longer labors than afebrile women, which confound any analysis they could have made with epidurals if they had wanted.

            Paper #3 is so old (1981) it isn’t available online. If you’ve read it, by all means post the PDF – but I’m guessing you don’t read papers, you just look for keywords in the abstract that seem to support your pre-determined conclusion. All I can tell from the abstract is that it wasn’t blinded and there was no control group – it doesn’t even say the size of the group, it could have been 5 babies – so even as an evaluation of the state of late ’70s pain control, it’s not terribly informative.

            So, one paper that says not much, one paper that says even the state of epidurals thirty-plus years ago was pretty safe for the fetus, and one paper that doesn’t have anything to say about epidurals.

          • Nick Sanders
            June 24, 2016 at 1:51 am #

            And a poppy seed bagel will make you fail a urine test for opiods. But it’s not going to affect your breathing unless you choke on it.

  3. Molly B
    June 14, 2016 at 6:43 pm #

    Had OB appointment today. Dr said any narcotic administered to a laboring mother regardless of the mode of delivery can get into the blood stream and can cause negative side effects to fetus. Asked about morphine specifically. Said it used on low doses but still has risks to mom and fetus. In the case of severe respiratory depression from things like allergic reaction or medication interactions Naloxone is kept on L&D Unit and can be administered as needed.
    Done. Fuck all of yall who want to make 30 responses in one day a d then no one takes the time to read my other responses to other people so now no one has a clue what is going on and keeps trying to argue things that have already been resolved. Enjoy yourselves. I have better things to do than sit on here all day writing outdated responses to people. Get lives, get jobs, good luck.

    • fiftyfifty1
      June 14, 2016 at 7:00 pm #

      You, for sure, should NOT have an epidural! You don’t WANT an epidural. You have heard all you want to hear about epidurals and you are going to say NO!

      Good for you. Now go away and leave other women alone.

      • Roadstergal
        June 20, 2016 at 6:34 pm #

        Seriously, can we just chip in $0.50 each to get Molly B a “I didn’t get an epidural or vaccinate my kids, so I’m a better mom than you” shirt and be done with it?

        • Molly B
          June 21, 2016 at 12:02 am #

          No but we can get you an I pass judgement and make claims about people that are untrue based on a preconceived notion of one single opinion someone has and automatically classify in them as an member of a certain group of thinkers
          #1 I have had an epidural before. I’m fact I have three children. One by epidural, one by cesarean, and one by vbac.
          ALL of my children have received vaccines to some degree except those which they have medical contraindications to.

          • guest
            June 21, 2016 at 12:04 pm #

            “I’m fact I have three children.”

            I thought you never posted in online forums unless you were certain you wouldn’t make any grammar errors?

          • Roadstergal
            June 21, 2016 at 1:52 pm #

            That was AK. I know, it’s hard to tell them apart, as they co-parachuted and share many of the same odd ideas.

          • guest
            June 21, 2016 at 3:01 pm #

            Well at least one thing in this absurd debate is consistent, at least.

    • Nick Sanders
      June 14, 2016 at 7:09 pm #

      Much like you pointed out that “not routinely used” isn’t “not used”, “can” is not “will”.

      • Molly B
        June 14, 2016 at 8:38 pm #

        Someone on here earlier said to me that naloxone was only used for drug overdoses and not on L&D Unit. That’s what the comment was in reference to.

        • Nick Sanders
          June 14, 2016 at 8:57 pm #

          That has nothing to do with what I said.

          • Molly B
            June 14, 2016 at 9:08 pm #

            Then what “can” and “will” were you referencing?

          • Nick Sanders
            June 14, 2016 at 10:10 pm #

            “can get into the blood stream and can cause negative side effects to fetus”

          • Molly B
            June 21, 2016 at 12:04 am #

            “Can” is still not “cant” therefore risk to fetus is there no matter what your opinion or my opinion is on the amount or severity. The risk is still there.

          • Nick Sanders
            June 23, 2016 at 2:37 am #

            And? Trying a new food for the first time carries a risk to the fetus, so does getting in a car, or having a metabolism. If the point is to avoid all risks to the fetus, no matter how small or what other risks they replace, the only option is for no one to ever get pregnant again.

          • Daleth
            June 23, 2016 at 1:10 pm #

            Postpartum depression, which can be caused by not having an epidural (we already discussed those studies so I won’t repost the links), is in itself a risk to the fetus. The risk is inadequate bonding, neglect, and in severe cases, physical harm, because a depressed mom is not up to being a mom.

            Do you really think being cared for by a severely depressed woman for many months is safer for a baby than the risk of slight, very temporary breathing problems–which any hospital can take care of, no problem–for an hour or so after birth? Why?

        • Monkey Professor for a Head
          June 14, 2016 at 10:33 pm #

          Are you referring to Dr Kitty’s comment? Because that’s not what she said at all. She was replying to your statement that neonatal opiate toxicity from epidurals was so common that an antidote was invented. She was pointing out that the antidote in question (naloxone) was developed for the treatment of non obstetric related opiate toxicity.

    • Who?
      June 14, 2016 at 7:14 pm #

      Good luck with the baby. Don’t make yourself too many big promises before labour-it can be a wild ride.

      • Molly B
        June 14, 2016 at 8:36 pm #

        This is my fourth child. 1 prior induction and epidural, 1 Cesarean, 1 VBAC. I’m well aware of all risks and what goes on.

        • Who?
          June 14, 2016 at 9:46 pm #

          So you know it can be a wild ride.

          It’s a shame you’re so focussed on this one thing, and on risks which are way smaller than the risks of a normal delivery, which presumably the doctor spent most of the day explaining in excruciating detail. Three previous pregnancies and deliveries are not nearly enough to know more than practically nothing about it, as I’m sure you’d agree.

          • Molly B
            June 21, 2016 at 12:11 am #

            No I would say that I am well informed in the possible outcomes of birth, risks of natural birth and risks of medical interventions. And its not thre previous pregnancies…..its three previous births.

          • Who?
            June 21, 2016 at 2:39 am #

            I think it’s sweet that you imagine that three personal experiences give you a wide understanding of any physical experience, particularly one as complex as pregnancy and delivery.

            You’ll see, if you care to read my comment above, that I referred to ‘pregnancies and deliveries’, so thanks for the unnecessary correction there.

            You’re very good at rewriting others’ remarks with a view to insinuating the remarks are wrong.

          • Molly B
            June 21, 2016 at 10:41 am #

            If you have no real comment then dont comment. Your wanna be southern f u charm doesn’t do crap for me

          • Irène Delse
            June 21, 2016 at 11:58 am #

            My, my. Some people get nasty when their BS is called out.

          • guest
            June 21, 2016 at 12:02 pm #

            Funny, that.

            I’m going to get myself a t-shirt that says “I <3 My Epidural."

          • Charybdis
            June 21, 2016 at 12:19 pm #

            Epidurals rock. So do well baby nurseries, pacifiers and formula.

          • guest
            June 21, 2016 at 3:00 pm #

            Oh, yes. We had a NICU stay, and thank goodness because there was no well-baby nursery otherwise. I don’t think I would have left the hospital with my sanity otherwise.

          • Molly B
            June 21, 2016 at 12:03 pm #

            Actually my bs wasn’t called out. My personal experiences have given me.insight into the issue at hand. My research because of my personal experiences has made me informed. Also its upsetting when someone who has posted on other articles that they don’t even have kids thinks they can tell me what my personal experience is having 3 has or has not afforded me. Who? It making a call.aboit something they have ZERO knowledge of

          • guest
            June 21, 2016 at 12:16 pm #

            “I got pregnant and read a bunch of stuff on the Internet,” says Molly B. “Therefore I am an authority who can tell other women what they should be doing, because I know better than medical professionals.”

          • Molly B
            June 21, 2016 at 12:58 pm #

            I have given birth to three children and educated myself through reputable nonbiased sources, therefore I feel qualified to tell women that they should seek full disclosure from medical personnel/midwife in regards to informed consent.

          • MaineJen
            June 21, 2016 at 1:04 pm #

            Full disclosure…like those consents I signed before getting both of my epidurals? Pretty sure that was full disclosure. And pardon me very much, but I felt that pain relief was very much necessary. Made my deliveries 100% better, I was awake and alert and so were my babies. I knew there was a miniscule chance I could have a bad reaction to the epi, but taking that chance was worth it to me. There are also risks associated with unmedicated delivery, wouldn’t you agree?

            You don’t feel pain relief is necessary! Good for you. Not sure why you’re trying to tell others what to do.

          • Molly B
            June 21, 2016 at 2:10 pm #

            When I say necessary I am speaking in the term of medical necessity. No doubt your epidural were very much wanted and appreciated by you. I have no doubts about this as a epidural recipient myself and also med free birther with another child (not by choice), but based on your statement that they were solely for labor pain relief they were not medically necessary

          • momofone
            June 21, 2016 at 2:19 pm #

            What qualifies you to determine medical necessity?

          • Molly B
            June 21, 2016 at 2:22 pm #

            If pain was relief was necessary for childbirth then women would not be able to birth without it.

          • momofone
            June 21, 2016 at 2:22 pm #

            That’s not what I asked.

          • Sarah
            June 21, 2016 at 2:33 pm #

            Does it not occur to you that it’s possible for something to be medically needed by some women and not others? The ability of some women to give birth without pain relief tells us nothing whatsoever about whether another woman, perhaps dealing with malpositioning or exhaustion or both, might require.

          • Roadstergal
            June 21, 2016 at 2:53 pm #

            My friend had her VBAC all nacheral and unmedicated because what you’re spouting about the Dangers of Epidurals is the party line among midwives in her country. The pain was so prolonged and intense that she blacked out, and had flashbacks in nightmares for months. I guess actually remembering the birth of her son wasn’t really necessary. Certainly it wasn’t important enough to give her informed consent about.

          • fiftyfifty1
            June 21, 2016 at 3:11 pm #

            “If pain was relief was necessary for childbirth then women would not be able to birth without it”
            Ah, I see that you are not familiar with the term “medically necessary”. You see, it’s not the same as “absolutely necessary”. There are lots of things that are medically necessary that humans have done without in the past. Pain relief in general is one. It’s quite possible to do a surgery without anesthesia. You can tie the patient down, or punch him in the head and knock him out, or get him passed-out drunk. But doctors (and insurance companies) consider anesthesia to be medically necessary anyway.

          • guest
            June 22, 2016 at 10:30 am #

            Can you imagine if insurance companies were allowed to refuse coverage on the basis of absolute necessity rather than medical necessity?

            And once upon a time, they did refuse to cover the cost of epidurals.

          • MaineJen
            June 22, 2016 at 4:10 pm #

            I had to pay for my epidural. My husband had to pay for his too. I have no idea if what I was paying was the whole shebang, or just a portion of the cost (I don’t look at those statements too closely; I’m depressed enough as it is), but I know that insurance either doesn’t pay the whole thing or doesn’t pay for it at all.

          • guest
            June 22, 2016 at 5:30 pm #

            Ug, are they still doing that? That sucks.

          • guest
            June 21, 2016 at 3:12 pm #

            If medical care was necessary for bullet wounds, then people would not be able to survive one without it. And yet, some of them can.

          • sapphiremind
            June 22, 2016 at 4:32 am #

            We used to do surgery on babies without pain meds. Do you think we should stop using them? I mean, we can just paralyze them so they don’t squirm.

            bee-tee-dubs, one magical thing about an epidural that is also a rare thing, but important, is that if something goes horribly wrong and they have to crash section you, if you have an epidural, they don’t have to put you under general anesthesia. You want to talk about affecting the baby? General anesthesia knocks the baby right out. I see thousands of babies from epidurals and never notice any difference in their breathing or behavior. General anesthesia babies are limp noodles that can’t breathe.

          • The Computer Ate My Nym
            June 22, 2016 at 4:41 am #

            Heck, we used to do surgery on adults without pain meds. Therefore pain meds are unnecessary during surgery. The people who complain about the cost of medical care will be very pleased: Anesthesia is expensive!

          • MaineJen
            June 21, 2016 at 3:03 pm #

            Thanks for assuming my epidural was only for “my own selfish comfort,” and not for relief of, say, uncontrolled pushing on an incomplete cervix, which may have caused swelling and actually complicated my labor. And so what if it was for relie of pain? Relief of pain is a medical necessity in and of itself.

            When my husband had major abdominal surgery, no one even thought of suggesting that his epidural wasn’t “medically necessary,” even when it caused a dip in blood pressure during his surgery.

            So why is pain relief in men considered a medical necessity (and it damn well was), but pain relief in women experiencing an equally painful event is considered “not medically necessary?” This is the worst kind of sexism and it makes me so angry.

          • Molly B
            June 21, 2016 at 2:18 pm #

            Did the consent outline the risks and benefits? I read my consent for each child ( I signed consent for everything with the knowledge that anything can happen and I can verbally refuse whatever I want to refuse).
            One of the anesthesia consent and the one for current pregnancy simply states That I consent anesthesia including epidural/IV/General and that all the risks and benefits have been explained to me. they are not anywhere in writing on the consent form. Consent for is a half page with signatures for other consent including video, photography, recording, allowing equipment reps in OR and allowing students and resident in room during childbirth or surgery and allowing residents to perform surgery under supervision of Physician.

            That is not informed consent. Not in the case of what hospitals are wantin gme to sign. They e ven tried to tell me that I couldnt get a paper copy ahead of time because consent were signed electronically on comp when woman presernted to hospital in labor…

            SideNote: I have crossed out certain things on this current consent.

          • MaineJen
            June 21, 2016 at 3:04 pm #

            Well you sound like an absolute treat to care for.

          • Molly B
            June 21, 2016 at 3:08 pm #

            My job is not to make my hospital stay pleasant for the medical staff. It is to birth my child in the way that I feel is best for me and my child. That includes talking to anesthesia ahead of time and determining a plan of care for anesthetics should I choose to use them since I have had bad outcomes in the past. That include not allowing unnecessary people in my Room or OR if I don,t want them there and that includes not allowing my privates or my child to be filmed or photographed if I dont that done and that includes not having a resident perform surgery on me if I dont want a resident to perform surgery on me. Its my legal right.

          • guest
            June 22, 2016 at 5:29 pm #

            Talk to your anesthesia all you want; it won’t affect the outcome.

          • Charybdis
            June 21, 2016 at 3:19 pm #

            Medicine is not ala carte, nor is it a buffet or Burger King.

          • Amy Tuteur, MD
            June 21, 2016 at 1:16 pm #

            What reputable non biased sources?

            Based on what you’ve been writing, you’re not educated; you’re just regurgitating propaganda.

          • Molly B
            June 21, 2016 at 2:07 pm #

            ACOG AJOG NIH WHO British Med Journals etc

          • guest
            June 21, 2016 at 2:59 pm #

            You are a complete and total idiot, is what you are. Having children and reading a few online articles doesn’t make you an expert in anything except, perhaps, self-righteousness.

            If that’s how it worked I could have self-published my book and read some Google Scholar articles to earn my PhD.

          • Molly B
            June 21, 2016 at 3:02 pm #

            Apparently you are the idiot who cant read because I specifically stated that I was not an expert.

          • guest
            June 21, 2016 at 3:13 pm #

            Then shut up already and stop claiming that you know how epidurals work and what the risks are.

          • Linden
            June 22, 2016 at 6:07 am #

            I guess I’m just going to have to go with what Dr Amy is saying, because she actually is an expert. Thanks for clearing that up! For a moment there, I couldn’t decide who to trust: a woman who’s given birth to a few kids, or the woman who’s given birth to a few kids, been educated in one of the best universities in the country on this topic, attended births in their thousands and works tirelessly for the safety of women and babies even now.

          • momofone
            June 22, 2016 at 10:00 am #

            “I’m not an expert, but I know more than those who actually are.”

          • Charybdis
            June 22, 2016 at 10:41 am #

            Further downthread she admits her pissitivity level is cranked up because doctors are not letting her dictate the parameters of her second VBAC.

          • rosewater1
            June 22, 2016 at 11:37 am #

            If you solicit opinions-from anyone-you need to be prepared that you’ll hear opinions you won’t like.

          • The Bofa on the Sofa
            June 22, 2016 at 5:57 pm #

            That’s why I never ask anyone what they think. I don’t care. All that matters is what I think.

          • momofone
            June 22, 2016 at 1:19 pm #

            Ah. Well, how dare they. She’s an expert, don’t they know?

          • momofone
            June 22, 2016 at 7:29 pm #

            Finally found her post. Four OBs. At least three who are thanking their lucky stars that she moved on. Made me think of something I saw by a woman who had been to seven veterinarians in the past six months with her sick dog. I’m sure the issue is the vets’ not knowing their business. (If I don’t stop rolling my eyes, I’m sure they’re going to get stuck like this.)

          • Who?
            June 22, 2016 at 9:11 pm #

            ‘Pissivity’ has now entered the Who? lexicon.

            Part of me feels bad for Molly, now that the real trouble is revealed. However, even that part of me wants her to get her big girls pants on (so to speak) and realise that given the baby is coming out, one way or the other, it might as well be in the way recommended by the experts she has sought out. Go hard or go home.

          • Roadstergal
            June 23, 2016 at 11:45 am #

            I don’t have a part that feels bad. She comes here trumpeting to the skies the risks of epidurals to the fetus – and then we find out that the reason she’s doing that is because she wants to take the far more pressing risk to her soon-to-be-baby by risking surgery under GA – or not timely surgery in the first place – if she has a catastrophic rupture for her VBAC. “Hypocritical” doesn’t even start.

            I’d feel a little bad if she were just bitching about not liking the VBAC requirements. Hell, if she were understanding the reasons and willing to go through it, but just bitching about having to, I would be right there nodding sympathetically.

          • Amy Tuteur, MD
            June 21, 2016 at 12:21 pm #

            You think giving birth to three children makes you knowledgeable about childbirth? That’s like saying you’re educated about aeronautics because you took 3 plane trips.

            Being educated about childbirth means learning obstetrics and delivering hundreds of babies, not having a handful of births.

          • Molly B
            June 21, 2016 at 12:56 pm #

            No saying I have flown a plane three times make me educated in aeronautics is like saying having given birth three time makes me educated in giving birth. I never claimed to an expert.

          • Irène Delse
            June 21, 2016 at 12:58 pm #

            This is getting pathetic.

          • Amy Tuteur, MD
            June 21, 2016 at 1:15 pm #

            In other words, you doesn’t make you educated.

          • Molly B
            June 21, 2016 at 2:12 pm #

            No, I am educated, just not an expert and even experts make mistakes so expertise does not relieve you of being human, having bias, or making mistakes.

          • Monkey Professor for a Head
            June 21, 2016 at 5:32 pm #

            You are educated. But you railed against doctors not treating epidural related hypotension with naloxone when epidural related hypotension is not caused by opiates. You seemed to think that opiates can cause fetal distress via respiratory depression in utero. You think that even the tiniest trace of opiate getting to a fetus is dangerous, ignoring the fact that most adverse effects of opiates are dose dependent. But you are educated.

            I don’t think anyone here is against informed consent. But they disagree with what you think the risks are. I have already asked you once, and you sidestepped the question, but if you had to educate a woman on epidurals as part of informed consent, what exactly would you say?

          • Molly B
            June 21, 2016 at 1:01 pm #

            At a minimum, then 1 in 10 women derive major benefit from a C-section. That is hardly a procedure that is unnecessary.

            Yet the US cesarean rate is 3 out of 10.

          • AllieFoyle
            June 21, 2016 at 1:02 pm #

            What is your point?

          • Molly B
            June 21, 2016 at 2:06 pm #

            Have you read her article? Also, the comment was not directed to you so…

          • Sarah
            June 21, 2016 at 2:36 pm #

            She hasn’t got one.

          • Empliau
            June 21, 2016 at 2:25 pm #

            How many babies derive benefit from it? And what is major? Is a 7% brain function loss minor? Seriously, wtf?

          • Monkey Professor for a Head
            June 21, 2016 at 6:08 pm #

            Let me give you a hypothetical example to try and illustrate why the c section rate is what it is. Let’s say there are 100 pregnant women with condition X. We know that if these women deliver their babies vaginally, 10 babies will die. We have no way of knowing in advance which babies will die. If they deliver by c section, then likely none will die. Given these circumstances, most doctors would recommend c section, and most women would agree. This will result in 90 “unnecessary” c sections, but will result in 100 alive healthy babies. In order to avoid those 90 “unnecessary” c sections, you would end up with 10 dead babies.

            Our current level of technology lets us determine which babies are at increased risk during vaginal birth (note, it is never no risk), but it does not enable us to know exactly which c sections are “necessary” and which ones are “unnecessary”. It’s a delicate balancing act between the risks of vaginal birth and the risks of c sections to the individual mother-fetus pair. Where would you draw the line.l? Until you understand this, all your opinions on the c section rate are meaningless.

          • Molly B
            June 21, 2016 at 7:32 pm #

            This scenario does not account for all ceseareans only select group of women who have cesareans

          • Monkey Professor for a Head
            June 21, 2016 at 8:48 pm #

            I guess it doesn’t cover maternal request c sections. Which is a comparatively small proportion. But I think it illustrates the reasoning behind most medically indicated c sections.

          • Daleth
            June 22, 2016 at 2:53 pm #

            What group of women getting c-sections does Monkey Professor’s scenario not account for?

            It looks to me like the scenario covers every woman who gets a c-section (emergent or scheduled) for a medical reason. For instance, among all women who have emergent c-sections due to fetal distress, as well as all women who have planned c-sections due to the baby being breech or transverse or due to having had a prior c-section, we know that out of 100 or 1000 or whatever vaginal births, a certain number of babies will die or be brain damaged. We therefore recommend c-sections for all these women because we don’t know–we literally have NO WAY of knowing for sure–which of these women are going to be the lucky ones and which will be the unlucky ones.

            So the scenario covers every medically justified c-section. And it even covers the tiny number of women who opt for a c-section with no medical indication for it, because women with no risk factors can still experience shoulder dystocia, placental abruption or cord prolapse during vaginal birth, so for every X number of women with no risk factors who give birth vaginally, some babies are still going to die or be brain damaged who would not have been if mom had delivered by c-section.

            I’m just not seeing how this is a “select group” or how any group of women who deliver by c-section is being left out of the scenario. Can you explain?

          • Molly B
            June 21, 2016 at 1:03 pm #

            Also pain relief is unnecessary in labor…though greatly appreciated by many…thats why its call ELECTIVE

          • Charybdis
            June 21, 2016 at 1:19 pm #

            See, that is a bass-ackwards way of shaming women who opt for pain relief. Saying it is UNNECESSARY is uncalled for. Saying that it is ELECTIVE and that you can have it if you want it is different than saying it is flat out unnecessary, but hey, you whining little wimp, you can have pain relief during labor and delivery if you want.

            But know, first and foremost, that it is UNNECESSARY.

          • Molly B
            June 21, 2016 at 2:06 pm #

            No. Pain relief is not necessary in a laboring Mom but Im not faulting anyone for accepting it. Are you seriously trying to say that think no one can birth child unless they have pain relief that every womans body will not allow here to labor with medication?

            No. Because thats not true. A womans body can labor and birth without the meds but it hurts….like hell. And if a woman wants pain relief then hey thats her choice, maybe she doesnt want the au naturale experience and as a mom who has had a med free birth I cant blame her on ebit. I just want people to make sure they are getting all the info first.

          • AllieFoyle
            June 21, 2016 at 4:17 pm #

            >>Pain relief is not necessary in a laboring Mom

            In your opinion, is pain relief ever medically necessary? When? How do you determine the necessity or lack thereof?

          • Molly B
            June 21, 2016 at 7:35 pm #

            Based on the level of pain the person is experiencing, but that doesnt mean a doctor or nurse should push any intervention on a woman who doesnt want it no matter how much pain she is in.

          • momofone
            June 21, 2016 at 7:40 pm #

            Offering is not forcing. They can offer; she can decline.

          • AllieFoyle
            June 21, 2016 at 8:53 pm #

            How do you determine the level of pain someone else is experiencing? Really, I want to know. Presumably you think pain relief is medically necessary in some situations, but not ever in a laboring mom.

          • AllieFoyle
            June 21, 2016 at 1:32 pm #

            I suppose it depends on your definition of necessary. Many medical procedures/interventions are not strictly necessary but are offered to relieve suffering or improve quality of life. Relieving severe and potentially traumatic pain certainly seems to me to fall into that category. If your ONE experience of unmedicated childbirth was not severely painful then I suggest that you simply consider yourself lucky.

          • Molly B
            June 21, 2016 at 2:01 pm #

            Stick with the Laboring Mom and lets nor drift into other areas such as hospice care. I am tired of lengthy arguments with people who want to argue up broken bones and other bs.

            In a healthy laboring Mom pain relief is elective

          • momofone
            June 21, 2016 at 2:03 pm #

            “I am tired of lengthy arguments with people who want to argue up broken bones and other bs.”

            And yet, despite your exhaustion, you persist.

          • Molly B
            June 21, 2016 at 2:35 pm #

            My labor and birth was painful. I thought the pain would kill me, but unfortunately I was not in a hospital as I had planned to be in one and I was unable to get to one.
            But what if the intervention causes problems that make you scared or traumatize you? Trauma is possible no matter what you choose.

          • AllieFoyle
            June 21, 2016 at 2:55 pm #

            Interventions are recommended or requested and accepted or declined. Unlike going unmedicated and avoiding interventions, which has risks that are much more rarely addressed by informed consent. No one claims that there aren’t risks to interventions, but the reason interventions are offered in the first place is that they offer the potential of allaying or minimizing risks and trauma. People feel that there is a legitimate need for pain relief during labor and epidurals are the result of that. Why you think your one unmedicated birth and internet research makes you more qualified to decide when pain relief is necessary is beyond me. You’re literally discounting the experiences and expertise of countless women and doctors.

            And I’ve already dealt with the physical and emotional trauma of what happens when people don’t offer interventions (usually because they share your biased mindset). The dangers of epidurals (which are only given with signed consent forms) is not, IMHO, even close to the most pressing concern in maternity care at the moment.

          • Molly B
            June 21, 2016 at 2:58 pm #

            Not being offered interventions is wrong unless a mother has specifically asked not to be offered interventions. Even then If a doctor thinks the intervention has become medically necessary he or she should discuss that with Mom.
            Also, please note that I stated my unmedicated birth was not by choice.

          • AllieFoyle
            June 21, 2016 at 3:30 pm #

            So why aren’t you equally up in arms about women who aren’t offered interventions? I don’t think you’re being honest about your intentions. You’ve already stated that you don’t believe pain relief for childbirth is really necessary. You came here specifically to argue that epidurals are dangerous and that women would choose not to have them if they were fully informed even though you have no idea how epidurals work and your beliefs are based solely on personal experience and picking and choosing stuff off the internet out of context. You’re not interested in informed consent. You’re interested in giving people your uninformed opinion about epidurals so that they will try to avoid them. The end.

          • Molly B
            June 21, 2016 at 3:50 pm #

            Because Im almost certain if a woman wanted med she would damn sure make sure everyone knew it. I stat ed that I dont believe it is medically necessary.
            I did not come to argue that epidural are dangerous. i never said they were dangerous and I have already had a discussion with you specifically regarding how the whole epidural thing got started and what my position was on interventions, informed choice and full disclosure.
            Dont try to go there

          • AllieFoyle
            June 21, 2016 at 4:08 pm #

            Don’t try to go where?

            If you didn’t come to argue that epidurals are dangerous then what is the point of your first twenty or so posts in which you did try to enumerate the risks of epidurals that you thought women weren’t being told about?

            I wanted meds and I didn’t get them either time thanks to jerks like you who think pain relief isn’t necessary.

          • Monkey Professor for a Head
            June 21, 2016 at 6:31 pm #

            “Epidural have risks associated with them such as possible paralysis, permanent nerve damage, spinal headaches (think migraine on steroids), depressed breathing with can effect mom and fetal heart rate etc. Though most of these are not common they are still inherent risks. Think about it…a needle is being placed in an opening in the vertebra and into the spinal cavity. Thats pretty serious stuff there.”

            This is your first post here (it also had a section copy and pasted from the product insert for morphine sulphate, I omitted that to save space). But you didn’t come here to argue that epidurals are dangerous

          • Molly B
            June 21, 2016 at 6:44 pm #

            No i came here to argue that SkepticalOB telling women that natural birth is dangerous and interventions are safe is wrong. BOTH HAVE RISKS. Most people are familiar with epidural so I used that and an example.

          • guest
            June 21, 2016 at 9:15 pm #

            Waking up in the morning has risks. Possibly even more risks than getting an epidural.

          • Molly B
            June 21, 2016 at 10:08 pm #

            Site your source

          • guest
            June 22, 2016 at 10:23 am #

            Read the obituary column of any newspaper.

          • Charybdis
            June 22, 2016 at 9:50 am #

            Most people are already aware that “medical things” have risks and that those risks are discussed with you before “things happen”. You can’t even get blood drawn without hearing about potential issues (if you feel faint, tell me, if you feel sick, tell me, don’t lift heavy things for X amount of time, or the site can start bleeding again, I’m drawing 3 tubes of blood, etc). Before you get a vaccination, the potential risks and side effects are discussed. Things to watch out for, how to report an adverse reaction, etc. People KNOW that medical anything has potential risks and are prepared to accept or reject them as they see fit.

            On the other hand, the NATURAL BS also has potential risks, but no one is talking about them. Because it is NATURAL, then it must ALWAYS be fine and there will be no bad side effects/outcomes, because natural is always better. Women have been having babies since forever and the human race has continued, so labor and delivery are perfectly safe. Things like 3rd and 4th degree tears, a fractured coccyx, cervical tears, PPH, pelvic floor damage, urinary and fecal incontinence, prolapses, a ruptured uterus, placental abruption, retained placenta, uterine atony, infections, amniotic embolism, aneurysms, muscle and ligament damage, etc are very real and potentially devastating risks of vaginal delivery. These things are not really discussed with pregnant women, because somehow, natural things will not hurt you. Not talking about the risks of vaginal delivery does not qualify as informed consent and people view it as fearmongering, because, you know NATURAL IS BETTER AND WILL NEVER HARM YOU.

            That is what Dr. Amy is arguing for: women to have ALL the information about possible risks and less than desirable outcomes for both CS and vaginal birth and all those options entail. True informed consent, not just fearmongering from the Natural At All Costs side (Epidurals! Opioids! Needles jabbed into your spine! Meds from epidurals can adversely affect the baby! CS is inevitable if you are in a hosptial and get an epidural! Not listening! Pushing/pressuring you to have pain relief! All bad things happen in a medical setting!).

            And how is presenting the risks of vaginal birth considered dangerous? People don’t really think there are any.

          • Irène Delse
            June 21, 2016 at 4:30 pm #

            ^So much this.

            I’m living currently with chronic pain, hopefully not definitively but let’s say it’s slow to get better. However, this is the improved situation: two months ago, I had surgery of the knee to relieve what was then excruciating pain. The surgeon suggested an operation but it wasn’t strictly necessary: some people would rather take pain medication and/or do PT. Well, I had tried PT and it didn’t help. My GP also gave me a prescription for codeine – but I really disliked the side effects, and anywa

            y opioids are not something you want to take every day for the long term. So I chose surgery: a medical procedure with its own risks, but with a good shot at making my pain better. So far, it’s worked: I have recovered a near-normal degree of mobility, and the pain is a lot more manageable.

          • Who?
            June 21, 2016 at 7:38 pm #

            Great the operation went well. Dad had a double knee replacement about 5 years ago, it was a wonderful lifechanging surgery. He’s now out and about all the time, and not in pain.

            Modern medicine is amazing.

          • Irène Delse
            June 22, 2016 at 1:32 am #

            Thanks. And that’s great for your dad.

          • Empliau
            June 21, 2016 at 2:22 pm #

            Well, until the 19th century, people survived (often, not always) amputations without anaesthetic. Maybe we shouldn’t use it for diabetics losing limbs, combat injuries … it’s unnecessary. And yet I think, offered the choice between agony or pain relief, that I know what most would choose.

            Nobody here cares what you do. Have your baby unmedicated. Just don’t think that it makes you better than someone else who chooses an epidural. Also, you should really leave explaining how epidurals work to the adequate mother, who administers them. Her expertise is valuable. Yours is confined to relaying what you understood your doctor to have said, which may or may not be what your doctor actually said. Human memory is unreliable, and you have no relevant training (and no, your three experiences of childbirth don’t count. I have been driving safely for 40 years, but I can’t fix an engine!)

          • Molly B
            June 21, 2016 at 2:30 pm #

            You are a freaking idiot. Severing a limb is not the same thing as birthing a child.
            I never said women should not have the option. In fact I have stated more than once that I am all for having options.
            I never once said how I would be birthing my child or whether or not I would be using pain relief medications.

            Being an Anesthesiologist with children does not make you an adequate mother. It makes you a mother who is an anesthesiologist

          • Empliau
            June 21, 2016 at 2:32 pm #

            I consider being called a freaking idiot by you a badge of honor.

          • Empliau
            June 21, 2016 at 2:51 pm #

            I should clear up any possible confusion: theadequatemother is an anaesthesiologist who posts here. There is a link to her blog on the right, where you can read about what epidurals are and how they affect the fetus. I put spaces because I dislike the little red underlines when programs diagnose spelling errors.

          • Molly B
            June 21, 2016 at 3:17 pm #

            Pushing for me to read an article by someone who is being vouched for on a site run by someone I dont agree with is not going to happen. I have read NIH ACOG and WHO all of which have stated a known connection between epidurals and negative fetal outcomes. I will stick with that.
            That being said the negative outcomes are not every bay or every frequent, but they do exist and women need to be made aware of the risks.
            A doctor saying “Epidural are safe” Is not full disclosure. It is up to a mother to determine whether she risks to benefits ratio is a good fit for her and for that she needs to be fully informed and doctor have a responsibility to provide that information.

          • Empliau
            June 21, 2016 at 3:29 pm #

            If you cannot tell the difference between a suggestion and pushing I am not surprised you feel you have not experienced informed consent.

          • LibrarianSarah
            June 21, 2016 at 3:44 pm #

            Pushing for me to read an article by someone who is being vouched for on
            a site run by someone I dont agree with is not going to happen.

            And that’s a problem. Refusing to read a source simply because “I don’t (or more accurately) agree with them” is pretty much the definition of Confirmation Bias and is one of the major components of information illiteracy in today’s society.

            If you had REASONS why theadequatemother is not a valid source of information that would be one thing. But you would have to have read her blog in order to know that.

            But I can’t have children so what do I know about the proper use of information.

          • Irène Delse
            June 21, 2016 at 4:19 pm #

            A blog you don’t agree with – but keep coming to. Interesting. But it’s unfair of you to refuse to even read the posts by theadequatemother simply because her blog is featured here. As an anaesthesiologist, she knows inside out how epidurals work, and I’ve always found her explanations clear, complete, precise and above all helpful. If you imagine that it only amounts to “a doctor saying epidurals are safe”, you’re sadly mistaken. Time to rethink your position!

          • MaineJen
            June 21, 2016 at 3:08 pm #

            They are on the same pain scale…

          • Who?
            June 21, 2016 at 8:14 pm #

            Well no but they both hurt-not that I’ve lost a limb, but smart people who know all about it say it does. They both change your body in many ways, and have effects that you live with forever. I guess giving birth is something you think in advance about, whereas most amputations probably happen quite quickly from decision to deed.

            One of the big differences though is no one would suggest that amputation without pain relief is good for anyone.

          • Daleth
            June 23, 2016 at 1:06 pm #

            Severing a limb is not the same thing as birthing a child.

            You’re right. It’s actually much faster and, compared to many women’s labors, less painful–an amputation is over and done with in maybe 30 minutes (including the time to sew everything back up), and the actual cutting part only probably takes maybe 2-5 minutes depending on what limb we’re talking about.

            Who can’t bear horrific pain for a mere 2-5 minutes? Pain relief for amputations is clearly “unnecessary.”

            But seriously… you have no right to say whether it’s necessary or not. That call is to be made by each individual woman, not by you.

          • Molly B
            June 21, 2016 at 2:54 pm #

            Because being a driver and being a mechanic are not the same thing.

          • guest
            June 21, 2016 at 2:56 pm #

            And being a mother and being an OB-GYN are not the same thing, do you not see that?

          • Molly B
            June 21, 2016 at 3:01 pm #

            I do see that. But being a mother and being informed and advocating for informed consent and full disclosure is not claiming to be an OBGYN.

          • guest
            June 21, 2016 at 3:15 pm #

            No, it means that you don’t know a damned thing about what you’re talking about. If you can’t understand what it is that you want a consent form for, you shouldn’t be advocating for one – for starters, because you can’t have informed consent until you understand what you are consenting to.

          • Empliau
            June 21, 2016 at 3:12 pm #

            Actually, I really like my analogy. We learn the rules of the road, we push when it’s time, etc. On the other hand, I don’t know everything that can go wrong, nor how to fix it when it does; my doctor and my mechanic, depending on whether it’s childbirth or my car, are the ones who truly understand. I leave the mechanics of childbirth to doctors and the mechanics of cars to mechanics. That’s why I trust them – because they are the experts.

            As the great Blackadder said: I am one of those people who are happy to wear cotton, but have no idea how it works.

          • Molly B
            June 21, 2016 at 7:40 pm #

            So you trust any mechanic who tells you anything then??

          • Nick Sanders
            June 24, 2016 at 2:13 am #

            Well, if there were several national and international mechanics’ organization , whose very existence depended on the quality and credibility of their advice and the knowledge and ethics of their members, and they all said more or less the same thing, and had all these trials and studies full of data on which they based what they were telling me…

          • Who?
            June 21, 2016 at 8:09 pm #

            I like it too.

            It’s too exhausting to try to be an expert on everything. Find good and well qualified people who you can work with, and let them do the hard work: mechanics, hairdressers, doctors, builders, gardeners and on it goes. Use the time you save to get even better at whatever it is you actually need or want to do, secure in the knowledge that the other stuff is in hand.

          • Nick Sanders
            June 24, 2016 at 2:07 am #

            Are you blind to irony, or have you just never heard of the concept?

          • Erin
            June 21, 2016 at 4:34 pm #

            Having had a big headed baby spend 75 hours trying to exit via my spine with my first contraction hurting as much as my last, I would debate that statement. I’m good with pain usually, I don’t bother with local anesthesia for fillings etc because I hate the numbness more than the pain. I didn’t need any medication post emergency c-section and I got up and dressed myself 4 hours after surgery. My labour pains almost killed me though, I’ve never ever known pain like it and that’s the thing…we all labour differently. My Mother went from 1cm to 10cm in under 4 hours and described it as twinges. A Friend of my MiL’s said she never had any labour pain at all until the baby was crowning, my back to back baby hurt like hell.

            I’m a huge believer in women having access to pain relief if they need/want it but saying it’s unnecessary is in my book wrong. It might be and certainly I managed without for 60 odd of those hours (not through choice I assure you) but seeing statements like that, which don’t always take into account how much labour pains can vary (as can the length of labour), contributes to women ending up with PTSD/PnD.

          • Molly B
            June 21, 2016 at 7:34 pm #

            Saying it is not necessary is not saying it shouldnt be offered.

          • Erin
            June 22, 2016 at 4:12 am #

            I’m well aware of that. However when people go around saying its unnecessary, it makes (some) women feel like they failed when its necessary for them. Its a very common theme at the Birth Trauma group I attended.

          • Who?
            June 21, 2016 at 7:44 pm #

            No needle at the dentist? Wow. You must have a good relationship with them-I don’t think our dentist would want to do that.

            I don’t care for the dribbling after, but I just go to my happy place while they work then go quietly home to dribble in private for a couple of hours.

          • Erin
            June 22, 2016 at 4:32 am #

            Its the NHS…saves them time and money so win/win.

            When I was a teenager my dentist (different one) had a poster telling you to be careful whilst numb and the centre piece was someone who bit their lip off. It terrified me and put me off anesthesia.

          • Who?
            June 22, 2016 at 5:58 pm #

            It’s a wonder you get to the dentist at all.

            There were no needles when I was a kid, and the drill was slow. I really don’t like the dentist but the lovely needles make it possible for me to sit in the chair without sweating through whatever I’m wearing at the mere thought of what’s coming up next.

          • Erin
            June 22, 2016 at 7:02 pm #

            I get more freaked out by the thought of someone putting their hands in my mouth and the possibility that my breath might smell than anything else.

            I have weird priorities. My husband still tells everyone who will listen that my major concern in the run up to my emcs wasn’t that I might feel pain (a concern of the anesthetist because of the location of my epidural…lower than he wanted) or wasn’t that I might die (apparently a concern of everyone else in the room) but having discovered that my son was fine, just stuck and I was the one with issues, my only problem was that any belly fat I may have would be too disgusting for them to have to fish a baby out of. Despite their assurances that I wasn’t fat, I kept apologizing randomly until I passed out.

            Unfortunately things went down hill from there.

          • Who?
            June 22, 2016 at 9:09 pm #

            We’re all different. Sometimes when something big is on it’s easier to focus on the ‘little’ stuff.

          • Linden
            June 22, 2016 at 5:56 am #

            Pain relief is also “unnecessary” in impacted wisdom teeth removal, passing kidney stones and viral meningitis, but doctors give it anyway, because they are not effing sadists.
            Foxtrot Uniform if you think it wasn’t necessary that I receive pain relief during my birth. What an appalling person you are. You’ve gone from “we need to inform women of the risks!” which you can’t adequately quantify to “pain relief isn’t necessary for childbirth” Your internalized sexism could not be clearer for everyone to see.

          • The Bofa on the Sofa
            June 22, 2016 at 8:50 am #

            You weren’t around when I underwent my dental implant this last half year. It started with an extraction, and ended up with an implant and a crown.

            For the extraction and the implant, I was given pain meds, but never asked if I wanted any. They just gave them to me.

            Is that elective?

            Make no mistake, I appreciated it. In fact, for the extraction, I asked for more because it wasn’t enough.
            But I was never given the option to forego it.

          • guest
            June 22, 2016 at 10:14 am #

            Ha. I had one earlier this year. Pain relief was discussed before things started, but mainly to find out if I was allergic to novocaine. I doubt the surgeon would have been willing to do the procedure without pain relief, but if I were unable to take any known form of pain relief, maybe someone would. We’ve certainly heard of the occasional crash section without anesthesia, but it’s an absolute last resort.

            I’m still waiting to scrape together the money for the implant.

          • rosewater1
            June 22, 2016 at 10:54 am #

            Come again?
            It may be unnecessary for you. If so, great. But who are you to say it should be so for everyone? YOU wouldn’t want someone deciding that you had to get an epidural…but you can say that everyone should go drug free???

          • Sarah
            June 21, 2016 at 2:35 pm #

            What’s that meme with the James Bond picture and the gynaecologist slogan?

          • Roadstergal
            June 21, 2016 at 2:45 pm #

            I don’t know, but please post it. I loved Daniel Craig as Bond (and the UST with Dame Judi’s M – sorry, I’m weird).

          • Who?
            June 21, 2016 at 7:30 pm #

            I really do not get the Daniel Craig thing. At all.

            Dame Judi is fab. Did you know that she was told, as a young actress, that she wasn’t pretty enough for television?

          • Roadstergal
            June 22, 2016 at 4:42 pm #

            Ugh, I unfortunately can believe that.

            For Daniel Craig, it’s not his physical attractiveness, it’s what’s in the head. I mean, a guy willing to do this:
            https://www.youtube.com/watch?v=gkp4t5NYzVM

          • Who?
            June 22, 2016 at 5:55 pm #

            That’s fairly cool, for sure.

            Just sent it to my son who is a huge DC fan.

          • The Computer Ate My Nym
            June 22, 2016 at 3:24 am #

            That’s like saying you’re educated about aeronautics because you took 3 plane trips.

            I’ve been on 3 plane trips and I say a plane on a conveyor belt will take off!

            Actually, I say that because planes lift with their wings, not their wheels, but I’m sure my experience on planes led me to that conclusion, not my having taken physics.

          • Who?
            June 21, 2016 at 7:03 pm #

            You have been stalking the wrong Who?, I have two (now adult) children.

          • Who?
            June 21, 2016 at 7:01 pm #

            I have no idea what you are talking about.

            Which makes two of us!

          • Molly B
            June 21, 2016 at 11:36 am #

            Do you have biological children? Have you ever given birth?

          • AllieFoyle
            June 21, 2016 at 12:58 pm #

            Can’t speak for OP, but I have biological children, have gone through L&D multiple times, and have done my own “research” (in quotes because I realize my reading doesn’t even come close to the experience and breadth of knowledge that a trained OB/GYN has, even though my professional education and training has included research and stats), AND I still think you are woefully misinformed when it comes to epidural anesthesia and labor pain. Why do you insist on spreading fear based on misinformation?

          • Molly B
            June 21, 2016 at 1:59 pm #

            What fear is being spread? The epi meds have risks to fetus. How is that causing fear? If women have not been told that before then I would highly question their level of informed consent.

          • AllieFoyle
            June 21, 2016 at 4:02 pm #

            What risks do epidural meds have for the fetus?

            I’m not suggesting they are zero, but what are they actually? Initially you were talking about things like addiction, teratogenicity, fetal overdose requiring naloxone, which aren’t really an issue with epidurals, and now you’re switching the goalposts to the idea that maybe an epidural could cause fetal distress and lead to a c-section. I can’t really say that that never happens, but it doesn’t seem likely that it happens often, and I really don’t see a c-section as necessarily a bad outcome in and of itself. Do you?

            What are the actual risks of epidurals that you think women should be told about as part of informed consent? Do you think that women should be told about the risks of going without epidurals as well?

          • Molly B
            June 21, 2016 at 7:22 pm #

            What are the benefits of epidural anesthesia?
            Allows you to rest if your labor is prolonged.
            By reducing the discomfort of childbirth, some woman have a more positive birth experience.
            Normally, an epidural will allow you to remain alert and be an active participant in your birth.
            If you deliver by cesarean, an epidural anesthesia will allow you to stay awake and also provide effective pain relief during recovery.
            When other types of coping mechanisms are no longer helping, an epidural can help you deal with exhaustion, irritability, and fatigue. An epidural can allow you to rest, relax, get focused, and give you the strength to move forward as an active participant in your birth experience.
            The use of epidural anesthesia during childbirth is continually being refined, and much of its success depends on the skill with which it is administered.

            What are the risks of epidural anesthesia?
            Epidurals may cause your blood pressure to suddenly drop. For this reason your blood pressure will be routinely checked to help ensure an adequate blood flow to your baby. If there is a sudden drop in blood pressure, you may need to be treated with IV fluids, medications, and oxygen.
            You may experience a severe headache caused by leakage of spinal fluid. Less than 1% of women experience this side effect. If symptoms persist, a procedure called a “blood patch”, which is an injection of your blood into the epidural space, can be performed to relieve the headache.
            After your epidural is placed, you will need to alternate sides while lying in bed and have continuous monitoring for changes in fetal heart rate. Lying in one position can sometimes cause labor to slow down or stop.
            You might experience the following side effects: shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, or difficulty urinating.
            You might find that your epidural makes pushing more difficult and additional medications or interventions may be needed such forceps or cesarean. Talk to your doctor when creating your birth plan about what interventions he or she generally uses in such cases.
            For a few hours after the birth the lower half of your body may feel numb. Numbness will require you to walk with assistance.
            In rare instances, permanent nerve damage may result in the area where the catheter was inserted.
            Though research is somewhat ambiguous, most studies suggest that some babies will have trouble “latching on” causing breastfeeding difficulties. Other studies suggest that a baby might experience respiratory depression, fetal malpositioning, and an increase in fetal heart rate variability, thus increasing the need for forceps, vacuum, cesarean deliveries and episiotomies.

          • guest
            June 21, 2016 at 9:12 pm #

            Not discomfort. Unbearable pain. Torment. Discomfort is a room that is slightly too warm.

          • Monkey Professor for a Head
            June 21, 2016 at 10:07 pm #

            I agree. I felt like my sacrum was going to rip open. I wouldn’t call that discomfort.

          • guest
            June 22, 2016 at 10:11 am #

            I didn’t even get to transition and I couldn’t take it anymore. I’ve been uncomfortable many times in my life but never needed pain relief like I did then.

          • BeatriceC
            June 22, 2016 at 10:13 pm #

            I literally fell off a mountain when I was 17. Approximately 30 feet straight down and bounced and rolled another 70 or so yards into a ravine (how the hell I’m still alive, nobody really knows). That recovery was a cakewalk compared to labor.

          • MaineJen
            June 21, 2016 at 10:32 pm #

            …where did you get that? Epidurals do not lead to more c sections, nor do they prolong labor. At best, that’s outdated information.

          • Who?
            June 21, 2016 at 11:08 pm #

            It’s a copy of the text of a document that Molly linked to earlier.

          • guest
            June 22, 2016 at 10:11 am #

            She copied it word-for-word from here: http://americanpregnancy.org/labor-and-birth/epidural/

          • The Computer Ate My Nym
            June 22, 2016 at 4:36 am #

            Interesting that nowhere in this, I presume, proposed informed consent for epidurals is the main benefit of epidurals mentioned. The word “pain” is mentioned only in terms of recovery from c-section. Nowhere does the proposed form state that labor is painful.

            I have experienced both labor and recovery from c-section. Labor pain is a 10/10 on the pain scale. C-section recovery was maybe a 4 at its worst. I really wish I hadn’t believed the hype about how c-section recovery is worse than labor. If I hadn’t been scared by that hype, I wouldn’t have taken opiates post-op unless I had severe pain (which I never did) and might have spared myself an extremely unpleasant bout of constipation.

          • guest
            June 22, 2016 at 10:10 am #

            Molly B plagiarized this from here: http://americanpregnancy.org/labor-and-birth/epidural/

          • Megan
            June 22, 2016 at 2:52 pm #

            Don’t forget about the risks of not getting adequate pain relief. My pain before I got my epidural was so severe that it caused fetal tachycardia from all of my circulating catecholamines (which also cross the placenta).

          • Molly B
            June 21, 2016 at 7:38 pm #

            Initially I presented an article to show that narcotics pass the placental barrier. Other people made an issue about the entirety of the article my repeated statements that the article was only to show narcotics pass the placental barrier. I have also repeatedly stated the issue from the beginning is informed consent and full disclosure

          • Daleth
            June 22, 2016 at 2:45 pm #

            What happens to narcotics that are taken orally or via injection/IV–which is what you posted about–is not something anyone here disagrees on. If the narcotics go right into mom’s bloodstream, then of course it matters whether they cross the placental barrier, because (to put it in plain English) mom’s bloodstream is going to take the drugs to the placenta. It matters particularly because the doses that you need to take orally or by IM or IV to even make a dent in labor pain are HIGH.

            But that does NOT tell us what happens to much smaller doses of narcotics that are injected straight into the mother’s epidural space. Drugs that are taken that way only make it into the bloodstream, if they make it at all, in tiny amounts. As a result, at most the fetus is going to be exposed to the even tinier amount that manages to cross the placenta. That was true even back in the 1980s, according to the 1987 study YOU posted that found “that bupivacaine crosses the placenta and reaches the fetus, but in very low amounts.” (http://www.ncbi.nlm.nih.gov/pubmed/3578847). It’s all the more true with the drugs and techniques used these days.

          • Who?
            June 21, 2016 at 7:00 pm #

            I have two children, and have given birth twice.

            Your point?

          • Monkey Professor for a Head
            June 21, 2016 at 4:52 pm #

            Dr Tuteur has had 4 babies vaginally I believe, 2 medicated and 2 unmedicated. So even discounting the whole medical degree/years of practice as an obstetrician, she must be more qualified than Molly B.

          • Molly B
            June 21, 2016 at 2:52 pm #

            My focus is on informed consent and full disclosure the epidural thing is only to show that women are not always given full disclosure

    • Charybdis
      June 14, 2016 at 7:37 pm #

      Wonderful. Sounds like you got the answers you were wanting and looking for. It doesn’t sound as if the doctor gave you any different information than you were getting here, you just found it more palatable from him/her than from folks here.

      And for the record, you were the one who dug up a five year old post and gave it new legs. I certainly hope you remembered to ask about the risks associated with non-medicated vaginal birth, because, as you have been banging on about ad nauseum, you cannot make a completely informed choice without ALL the potential variables being addressed. Or you found a doctor who would cater to your preconceived notions regarding pain relief during labor and delivery and are happily smug having “proved” the folks here wrong or misinformed in some way.

      Thanks for playing! Door’s that way>>>>>>>>>>

      • Molly B
        June 14, 2016 at 8:39 pm #

        The only point I had was that narcotic pass the placental narrier even with epidurals and have potential risks to fetus and that women should be given full.disclosure about epidurals.

      • Molly B
        June 14, 2016 at 9:11 pm #

        Actually more than one person on here said that the narcotic in an epidural dont enter the blood stream.

        • Daleth
          June 23, 2016 at 1:02 pm #

          What we said is that epidurals, unlike every other way of administering narcotics, are administered directly into the fluid around your spine and NOT into your circulatory system. The meds don’t even normally travel elsewhere in your spine, much less elsewhere in your body.

          What your doctor said is that they CAN travel from the epidural space elsewhere, not that they do. That’s what I said several days ago: if the needle nicks a vein on the way in, for instance, or if there’s difficulty inserting the needle and the hole in the sheath around the spine ends up bigger than it needs to be, the meds can leak–that is, tiny amounts of the already tiny dose can leak–and get into mom’s bloodstream. From there, they will travel to the placenta and, in incredibly tiny amounts, cross it.

          The effect of such minuscule amounts on the baby, though, is nothing even remotely close to the effects of oral, IM (injected) or IV pain meds. Those doses are much higher than epidurals, and unlike epidurals the dose goes right into mom’s bloodstream.

  4. Molly B
    June 3, 2016 at 10:40 pm #

    Epidural have risks associated with them such as possible paralysis, permanent nerve damage, spinal headaches (think migraine on steroids), depressed breathing with can effect mom and fetal heart rate etc. Though most of these are not common they are still inherent risks. Think about it…a needle is being placed in an opening in the vertebra and into the spinal cavity. Thats pretty serious stuff there.

    http://americanpregnancy.org/labor-and-birth/epidural/
    After the catheter is in place, a combination of narcotic and anesthesia is administered either by a pump or by periodic injections into the epidural space. A narcotic such as fentanyl or morphine is given to replace some of the higher doses of anesthetic, like bupivacaine, chloroprocaine, or lidocaine.

    FENTANYL
    http://rcp.nshealth.ca/sites/default/files/clinical-practice-guidelines/fentanyl.pdf

    MORPHINE

    8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    Teratogenic Effects (Pregnancy Category C)

    No formal studies to assess the teratogenic effects of morphine in animals have been conducted. It is also not known whether

    morphine can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Morphine should be

    given to a pregnant woman only if clearly needed.

    In humans, the frequency of congenital anomalies has been reported to be no greater than expected among the children of 70 women

    who were treated with morphine during the first four months of pregnancy or in 448 women treated with morphine anytime during

    pregnancy. Furthermore, no malformations were observed in the infant of a woman who attempted suicide by taking an overdose of

    morphine and other medication during the first trimester of pregnancy.

    Several literature reports indicate that morphine administered subcutaneously during the early gestational period in mice and hamsters

    produced neurological, soft tissue and skeletal abnormalities. With one exception, the effects that have been reported were following

    doses that were maternally toxic and the abnormalities noted were characteristic of those observed when maternal toxicity is present.

    In one study, following subcutaneous infusion of doses greater than or equal to 0.15 mg/kg to mice, exencephaly, hydronephrosis,

    intestinal hemorrhage, split supraoccipital, malformed sternebrae, and malformed xiphoid were noted in the absence of maternal

    toxicity. In the hamster, morphine sulfate given subcutaneously on gestation day 8 produced exencephaly and cranioschisis. In rats

    treated with subcutaneous infusions of morphine during the period of organogenesis, no teratogenicity was observed. No maternal

    toxicity was observed in this study, however, increased mortality and growth retardation were seen in the offspring. In two studies

    performed in the rabbit, no evidence of teratogenicity was reported at subcutaneous doses up to 100 mg/kg.

    Nonteratogenic Effects

    Controlled studies of chronic in utero morphine exposure in pregnant women have not been conducted. Infants born to mothers who

    have taken opioids chronically may exhibit withdrawal symptoms, reversible reduction in brain volume, small size, decreased

    ventilatory response to CO2 and increased risk of sudden infant death syndrome. Morphine sulfate should be used by a pregnant

    woman only if the need for opioid analgesia clearly outweighs the potential risks to the fetus.

    Published literature has reported that exposure to morphine during pregnancy is associated with reduction in growth and a host of

    behavioral abnormalities in the offspring. Morphine treatment during gestational periods of organogenesis in rats, hamsters, guinea

    pigs and rabbits resulted in the following treatment-related embryotoxicity and neonatal toxicity in one or more studies: decreased

    litter size, embryo-fetal viability, fetal and neonatal body weights, absolute brain and cerebellar weights, delayed motor and sexual

    maturation, and increased neonatal mortality, cyanosis and hypothermia. Decreased fertility in female offspring, and decreased

    plasma and testicular levels of luteinizing hormone and testosterone, decreased testes weights, seminiferous tubule shrinkage,

    germinal cell aplasia, and decreased spermatogenesis in male offspring were also observed. Decreased litter size and viability were

    observed in the offspring of male rats administered morphine (25 mg/kg, IP) for 1 day prior to mating. Behavioral abnormalities

    resulting from chronic morphine exposure of fetal animals included altered reflex and motor skill development, mild withdrawal, and

    altered responsiveness to morphine persisting into adulthood.

    8.2 Labor And Delivery

    Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. Morphine sulfate is not

    Reference ID: 3075779

    recommended for use in women during and immediately prior to labor. Occasionally, opioid analgesics may prolong labor through actions

    which temporarily reduce the strength, duration and frequency of uterine contractions. However this effect is not consistent and may be offset

    by an increased rate of cervical dilatation, which tends to shorten labor. Closely observe neonates whose mothers received opioid analgesics

    during labor for signs of respiratory depression. Have a specific opioid antagonist, such as naloxone, available for reversal of opioid-induced

    respiratory depression in the neonate.

    8.3 Nursing Mothers

    Low levels of morphine sulfate have been detected in maternal milk. The milk:plasma morphine AUC ratio is about 2.5:1. The

    amount of morphine sulfate delivered to the infant depends on the plasma concentration of the mother, the amount of milk ingested by

    the infant, and the extent of first-pass metabolism. Because of the potential for serious adverse reactions in nursing infants from

    morphine sulfate including respiratory depression, sedation and possibly withdrawal symptoms, upon cessation of morphine sulfate

    administration to the mother, decide whether to discontinue nursing or to discontinue the drug, taking into account the importance of

    the drug to the mother.

    8.4 Pediatric Use

    The safety and effectiveness and the pharmacokinetics of Morphine Sulfate Tablets in pediatric patients below the age of 18 have not

    been established

    • June 3, 2016 at 11:06 pm #

      Yes, epidurals have risks. We know this. They tell you those risks before they place the needle. Those risks are low, as you pointed out, but they do exist. Using opioids at all has risks, but we do that because pain really, really hurts. Would you suggest that we not give IV morphine to a man with a broken bone because there is a small risk of complications from the morphine?

      There wouldn’t be any teratogenic effects because the whole point of the needle-in-spine thing is to avoid getting drugs into the bloodstream and fetus, so that part of your post is irrelevant. In fact, your entire discussion of opioids is irrelevant because how epidurals work negates all those concerns. That’s a feature, not a bug.

      Furthermore, your quote only discusses chronic use of opioids (to treat chronic pain, or when abused), use of morphine sulfate for labor pain in not-epidural form, and non-epidural morphine use in breastfeeding mothers. Obviously, none of it applies to epidurals.

      • Molly B
        June 11, 2016 at 9:25 pm #

        Not all the risks of an epidural are always explained to a mother and there lacks informed consent. ANY narcotic including ones administered through a spinal cross the placental barrier. A small amount of the epidural narcotics does enter the blood stream and these pass through the placental barrier to the fetus. Most medications/drugs also have a higher toxicity for the fetus. I am aware that my article is about street drug use of morphine but morphine in a pill and morphine sulfate are both morphine and both are narcotics that can result in addiction and BOTH have known impacts for the fetus. In regards to morphine sulfate there are potential side effects to fetus including bradycardia (drop in HR/BP) and decreased oxygen flow to fetus which will in most cases trigger physician recommendation for a cesarean section.

        • Azuran
          June 11, 2016 at 10:08 pm #

          Find me 1 woman who ever got addicted to morphine after an epidural. Possible addiction is a worthless argument when it come to epidurals.

          Teratogenic effect are a mesure of safety during the development of the baby. An epidural or even IV opioid during birth is not going to have any more teratogenic effect on a term baby that it’s going to have on an adult who takes 1 dose of the drug.

          Sure, epidurals have risks and every woman needs to be properly informed of this (very low) risk. But many of those ‘risks’ you pointed out are very long stretches.

          • Molly B
            June 12, 2016 at 12:08 am #

            My argument was not about addiction in relation to morphine via an epidural. It was that the drug crosses the placental barrier.

            “An epidural or even IV opioid during birth is not going to have any more teratogenic effect on a term baby that it’s going to have on an adult who takes 1 dose of the drug.

            Sure, epidurals have risks and every woman needs to be properly informed of this (very low) risk. But many of those ‘risks’ you pointed out are very long stretches.”

            Part of FDA Insert

            http://medlibrary.org/lib/rx/meds/morphine-sulfate-16/page/3/

            MORPHINE
            8 USE IN SPECIFIC POPULATIONS
            8.1 Pregnancy
            Teratogenic Effects (Pregnancy Category C)
            No formal studies to assess the teratogenic effects of morphine in animals have been conducted. It is also not known whether
            morphine can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Morphine should be
            given to a pregnant woman only if clearly needed.
            In humans, the frequency of congenital anomalies has been reported to be no greater than expected among the children of 70 women
            who were treated with morphine during the first four months of pregnancy or in 448 women treated with morphine anytime during
            pregnancy. Furthermore, no malformations were observed in the infant of a woman who attempted suicide by taking an overdose of
            morphine and other medication during the first trimester of pregnancy.
            Several literature reports indicate that morphine administered subcutaneously during the early gestational period in mice and hamsters
            produced neurological, soft tissue and skeletal abnormalities. With one exception, the effects that have been reported were following
            doses that were maternally toxic and the abnormalities noted were characteristic of those observed when maternal toxicity is present.
            In one study, following subcutaneous infusion of doses greater than or equal to 0.15 mg/kg to mice, exencephaly, hydronephrosis,
            intestinal hemorrhage, split supraoccipital, malformed sternebrae, and malformed xiphoid were noted in the absence of maternal
            toxicity. In the hamster, morphine sulfate given subcutaneously on gestation day 8 produced exencephaly and cranioschisis. In rats
            treated with subcutaneous infusions of morphine during the period of organogenesis, no teratogenicity was observed. No maternal
            toxicity was observed in this study, however, increased mortality and growth retardation were seen in the offspring. In two studies
            performed in the rabbit, no evidence of teratogenicity was reported at subcutaneous doses up to 100 mg/kg.
            Nonteratogenic Effects
            Controlled studies of chronic in utero morphine exposure in pregnant women have not been conducted. Infants born to mothers who
            have taken opioids chronically may exhibit withdrawal symptoms, reversible reduction in brain volume, small size, decreased
            ventilatory response to CO2 and increased risk of sudden infant death syndrome. Morphine sulfate should be used by a pregnant
            woman only if the need for opioid analgesia clearly outweighs the potential risks to the fetus.
            Published literature has reported that exposure to morphine during pregnancy is associated with reduction in growth and a host of
            behavioral abnormalities in the offspring. Morphine treatment during gestational periods of organogenesis in rats, hamsters, guinea
            pigs and rabbits resulted in the following treatment-related embryotoxicity and neonatal toxicity in one or more studies: decreased
            litter size, embryo-fetal viability, fetal and neonatal body weights, absolute brain and cerebellar weights, delayed motor and sexual
            maturation, and increased neonatal mortality, cyanosis and hypothermia. Decreased fertility in female offspring, and decreased
            plasma and testicular levels of luteinizing hormone and testosterone, decreased testes weights, seminiferous tubule shrinkage,
            germinal cell aplasia, and decreased spermatogenesis in male offspring were also observed. Decreased litter size and viability were
            observed in the offspring of male rats administered morphine (25 mg/kg, IP) for 1 day prior to mating. Behavioral abnormalities
            resulting from chronic morphine exposure of fetal animals included altered reflex and motor skill development, mild withdrawal, and
            altered responsiveness to morphine persisting into adulthood.
            8.2 Labor And Delivery
            Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. Morphine sulfate is not
            Reference ID: 3075779
            recommended for use in women during and immediately prior to labor. Occasionally, opioid analgesics may prolong labor through actions
            which temporarily reduce the strength, duration and frequency of uterine contractions. However this effect is not consistent and may be offset
            by an increased rate of cervical dilatation, which tends to shorten labor. Closely observe neonates whose mothers received opioid analgesics
            during labor for signs of respiratory depression. Have a specific opioid antagonist, such as naloxone, available for reversal of opioid-induced
            respiratory depression in the neonate.
            8.3 Nursing Mothers
            Low levels of morphine sulfate have been detected in maternal milk. The milk:plasma morphine AUC ratio is about 2.5:1. The
            amount of morphine sulfate delivered to the infant depends on the plasma concentration of the mother, the amount of milk ingested by
            the infant, and the extent of first-pass metabolism. Because of the potential for serious adverse reactions in nursing infants from
            morphine sulfate including respiratory depression, sedation and possibly withdrawal symptoms, upon cessation of morphine sulfate
            administration to the mother, decide whether to discontinue nursing or to discontinue the drug, taking into account the importance of
            the drug to the mother.
            8.4 Pediatric Use
            The safety and effectiveness and the pharmacokinetics of Morphine Sulfate Tablets in pediatric patients below the age of 18 have not
            been established

          • Box of Salt
            June 12, 2016 at 12:53 am #

            Hey Molly B,
            could you paraphrase the parts of that insert you think are the most relevant?

          • Molly B
            June 13, 2016 at 7:55 am #

            8.2 Labor And Delivery

            Opioids cross the placenta and may produce respiratory depression and psycho-physiologic effects in neonates. Morphine sulfate is not

            Reference ID: 3075779

            recommended for use in women during and immediately prior to labor.

            Closely observe neonates whose mothers received opioid analgesics during labor for signs of respiratory depression. Have a specific opioid antagonist, such as naloxone, available for reversal of opioid-induced
            respiratory depression in the neonate.

            Naloxone is rarely offered….its off to the O.R. with you.

          • The Computer Ate My Nym
            June 13, 2016 at 8:18 am #

            Naloxone is generally only given when someone is in respiratory distress and about to die from opiate overdose. The reason is that it blocks the opiate receptors, meaning that the patient has NO pain relief at all and cannot get pain relief for some time because their receptors are blocked. It is so unpleasant that occasionally people who are being treated with opiates for pain are simply intubated and put on breathing support until the opiates wear off to avoid the period of intense and unrelievable pain.

          • Monkey Professor for a Head
            June 13, 2016 at 8:52 am #

            I think you’re confused. The part of the insert you reference speaks about using naloxone to treat respiratory depression in the neonate. Yet you say that women are taken to the OR instead of being offered naloxone – I presume you mean to have a c section. A baby in the womb cannot be in distress because of respiratory depression because they are not breathing air – they are getting their oxygen through the placenta.

          • Charybdis
            June 13, 2016 at 9:42 am #

            The amount of opioid in an epidural is very small and unlikely to require Naloxone.

            However, if you are getting Stadol, Demerol, Fentanyl, Dilaudid, etc via IM/IV route, then there are potential effects to the baby, as the dosage is higher and absorbed into the bloodstream .

          • Dr Kitty
            June 12, 2016 at 4:12 pm #

            He’s the thing Molly- teratogenicity, literally, “creating a monster”- is only possible during pregnancy while a foetus is developing.
            So, first trimester.

            Teratogenitcity is IMPOSSIBLE after all organs are fully formed, so it isn’t a risk of intrapartum analgesia, even big whacking doses of IV morphine won’t be teratogenic, because the foetus is fully formed.

            Epidurals allow very low doses of opioids to provide very effective pain relief. They do NOT have a risk of teratogenicity.

          • Monkey Professor for a Head
            June 12, 2016 at 5:26 pm #

            Can’t up vote, so I just want to second this!

          • Molly B
            June 13, 2016 at 7:49 am #

            I was not the first one to make an argument for teratogenic affect. My point was that the meds cross the placental barrier and have side effects for the fetus in labor.

          • AllieFoyle
            June 13, 2016 at 12:54 pm #

            Why do you keep posting the FDA drug insert for oral morphine? What does that have to do with epidurals?

            I think (?) you are trying to show that opioids in the maternal bloodstream can cross the placenta, but the whole point of epidural anesthesia is that only a small amount of medication is necessary and it largely stays out of the maternal circulation, and therefore very, very little can be passed on to the baby. The possible drop in BP (a real and acknowledged risk) is a different phenomenon altogether.

            The information you keep posting has to do with ORAL opioids, which do enter the bloodstream in appreciable quantities and could be passed on to the infant and cause respiratory depression, etc. The whole point of giving epidural pain relief is that by administering the medication to the epidural space you only have to use small amounts that don’t transfer into maternal or fetal circulation in dangerous amounts.

            And of course, at term, teratogenicity is not a concern.

          • Molly B
            June 12, 2016 at 12:12 am #

            The second sentence of the insert and Section 8.2 Specifically

          • Azuran
            June 12, 2016 at 12:16 pm #

            and again. This refers to chronic use of morphine during the early or whole pregnancy. 1 dose given during the birth will not have any kind of effect on the baby’s development.
            It could cause sedation or the foetus, which is why epidurals are preferred as the dose that actually makes it to the fetus is extremely small.

          • Molly B
            June 12, 2016 at 4:26 pm #

            Epidural can also cause drop in bp of mother resulting in fetal distress and an emergency cesarean that may not of happened otherwise.

          • demodocus
            June 12, 2016 at 4:46 pm #

            that would have been nice for me, since mine was too high both times, despite having uncomplicated pregnancies.

          • Azuran
            June 12, 2016 at 7:14 pm #

            The very super long text you posted also said this: ‘Occasionally, opioid analgesics may prolong labor through actions which
            temporarily reduce the strength, duration and frequency of uterine
            contractions. However this effect is not consistent and may be offset by an increased rate of cervical dilatation, which tends to shorten labor.

            So…..It may shorten or speed up labour depending on women.

            Thing is, as we all said: No one here is claiming that epidurals do not have risks. And if a women thinks that a less painful labour in worth a slightly increased chance of a c-section (got any actual number or source on that claim?) than it is absolutely her right. Pain itself can also have effect on the blood pressure of the mother and could also have negative effects on the baby, btw.

          • Molly B
            June 13, 2016 at 7:47 am #

            Yes pain relief regardless of the mode of delivery. Most women are not full informed of these risks. No one tells a woman, we can give you this medication for pain but it the side effect can increase your chances of a cesarean delivery. If your blood pressure drop we can give you a medication to counter act it but here are the risks and benefits of that medication to you and the fetus.
            Women need to know. I truly believe that some women would ask more about other measures of pain relief it they were more informed. Other may feel that the benefits of the pain relief outweigh the risks and this also a perfectly acceptable and personal choice, so long as on both ends of this the woman is given full disclosure to make her choice.

          • Monkey Professor for a Head
            June 13, 2016 at 8:32 am #

            If you were to take consent from a woman prior to an epidural, how would you explain the risks and benefits?

            I haven’t worked in the states, but, if you’re interested, this is the standard consent form for where I used to work in Australia.
            https://www.health.qld.gov.au/consent/documents/anaesthetic_05.pdf

          • Molly B
            June 13, 2016 at 9:20 am #

            I would explain all the risks and their likelihood (common vs rare, not %) can happen if those occur and how they can be corrected and the major risks associated with the corrective measures. I would explain the benefits in full as well, though most Doc seems to explain the benefits quite well.

            This is a consent form for Texas.
            Consent requirements do vary by state here so its quite a to each his own situation although there are rules establishing minimums

            http://www.anesthesiallc.com/publications/anesthesia-industry-ealerts/529-texas-statute-requires-anesthesia-informed-consent

          • Monkey Professor for a Head
            June 13, 2016 at 10:00 am #

            That all sounds very nice (although I do suspect that might be a little underhand dig at doctors). But I would be interested in the actual words you would use.

          • Heidi_storage
            June 14, 2016 at 12:51 pm #

            Very nice. Simple, concise description of the epidural, the risks being clearly laid out (and classified by rarity of occurrence).

          • Heidi_storage
            June 14, 2016 at 12:47 pm #

            So informed consent, according to you, looks something like this: “Before giving you this epidural, please be aware: It doesn’t always work. Also, it may stall your labor and increase your risk of cesarean delivery. Opiates in the epidural will cross the placental barrier to your baby. Some studies indicate that newborns will have trouble feeding after an epidural. Your blood pressure may drop to dangerous levels, and this could affect the baby. You could develop a severe headache, which may persist. You might be paralyzed.”

            Yeah, that’d be some excellent informed consent to give to a woman in pain from labor contractions.

          • Monkey Professor for a Head
            June 13, 2016 at 8:42 am #

            That shows an association, but it does not prove causation. There may very well be other factors at play. You’ve already been given one example of a confounding factor – babies in a suboptimal position can cause more painful labours, which would mean that more epidurals would be requested.

          • The Computer Ate My Nym
            June 13, 2016 at 8:48 am #

            Do we need to have that discussion about causation and correlation again? Because this looks like a classic case of confusion between correlation and causation.

            The key point about this study is that it is a population based study. So let’s look at the population: women giving birth in hospitals in New South Wales. I note immediately that their epidural rate is lower than is typical in the US, which suggests that standard of care is not to offer an epidural as pain relief in all or most cases, as it is in the US. Therefore, it is likely that epidurals are only given when the woman is having issues already.

            Now, certainly it is possible for a woman having a perfectly normal labor to be unable to tolerate the pain and want relief. She may well decide that an epidural is the best solution for her. However, if she is having severe pain, it is more likely that she is having issues, possibly including obstructed labor or fetal malpositioning, than if she is not. So the epidural population is enriched for women who have, at least, malpositioning and fetuses of dubious ability to be delivered vaginally.

            Finally, this is one study on one population. Other studies on other populations have found the opposite: that there was no difference in risk of c-section rate with epidural analgesia. What reason do you have to say that this study should be considered definitive over the others?

          • The Computer Ate My Nym
            June 13, 2016 at 8:55 am #

            Not to mention the issue that a c-section is not, in and of itself, a bad outcome. C-sections have their risks, but they have their benefits as well. Avoiding an epidural to avoid a c-section and having the woman end up with PPD and chronic pain seems to me a bad trade.

          • Charybdis
            June 12, 2016 at 8:46 pm #

            The blood pressure drop is temporary and can be countered with some epi relatively quickly.

          • Molly B
            June 13, 2016 at 7:43 am #

            Temporary yes but many doctors will insist on surgery if the CTG shows signs of distress. Naloxone is not always given or even mentioned as an options

          • Monkey Professor for a Head
            June 13, 2016 at 8:22 am #

            Isn’t the hypotension usually caused by blockade of the sympathetic nervous system from the local anaesthetic agent. Naloxone would only counteract the opiate, so would not be a particularly effective treatment.

          • Charybdis
            June 13, 2016 at 9:33 am #

            They are aware that a temporary drop in blood pressure can occur with an epidural, so that is why they have things they can do to bring the blood pressure back up: increase fluids to the mother, administer epinephrine, roll the mother on her side, etc.

            The drop in blood pressure is caused by the blocking of the sympathetic nerves by the local anesthetic used in the epidural. Naloxone reverses the effect of opioids, so it would NOT be used, as the amount of opioid medication used in an epidural is very small.

            I’m not exactly sure what you are wanting or trying to prove. We understand that epidurals are generally very safe and quite effective in addressing labor and delivery pain for women. They are not 100% safe and/or effective, because NOTHING is 100% safe and/or effective. The dosages of the local anesthetic agent and the opioid agent are very, very small, as they only have to work right there on the spinal nerves to block the pain signals from reaching the brain. Since the medications are administered locally, into the epidural space, the medications do not have a direct entry into the bloodstream, so they do not have an effect on the baby. We cannot say 100% that NO medication gets into the mother’s bloodstream, because again, nothing is 100% certain. But, since the original dose to the mother’s spinal nerves is very small to start with, the amount, if any, that gets into the mother’s bloodstream is smaller than the original dose. Now, unless you subscribe to the homeopathic mind set, the amount of opioid, if any, that reaches the baby is extremely, extremely small and unlikely to have a deleterious effect on the baby, even if the mother needs a subsequent dose in her epidural catheter.

            If the mother’s blood pressure drops, it is generally temporary and easily remedied by increasing fluids, rolling the mother onto her side and/or administering epinephrine. The drop in blood pressure is a direct result of the local anesthetic agent on the sympathetic nervous system, it is not because of the opioid used in the epidural. So, Naloxone use would not be indicated in that case. It is not generally mentioned as a treatment because it is not necessary: they are not mainlining heroin into the mother’s epidural catheter.

            So, to sum up: epidurals are not 100% safe, but nothing is 100% safe. They are VERY safe and very effective in treating labor/delivery pain and the risk to the baby is very, very small because the amount of medication used is small and locally confined to the mother’s epidural space. The mother’s blood pressure can drop because of the effect of the anesthetic agent on the sympathetic nerves. This drop is temporary and common enough that the medical staff is ready to deal with it using various measures (fluid, epi, rolling onto side, etc). Naloxone is not used because no one is overdosing on an opioid. Epidurals do not automatically mean you are going to have a CS.

          • Irène Delse
            June 13, 2016 at 10:15 am #

            I’m amazed at the way epidurals and CS have been demonised, especially their rebranding as something vaguely harmful to the baby . Last time a woman in family had a baby, her OB discussed the possibility that she would have a C-section, due to the baby being breech. She phoned me in tears (I’m the go-to person for scientific questions on my family…) and asked what I know of the risks. Assuming she was anxious about the operation, I gently told her: “Well, it’s surgery, but doesn’t have particular risks, in fact they don’t even have to put you under GA, it should be fine.” I was very surprised when she replied: “No, I mean the risks for the baby.”

            What’s going on? In the 1980s, I was hearing stories about epidurals making women numb from the waist down, and that was used as a way to promote “natural” childbirth. But then epidurals have become safer and carry less side-effect for the woman, so I guess the alt crowd have switched to rumour mongering about issues to the baby.

          • The Bofa on the Sofa
            June 13, 2016 at 10:38 am #

            She phoned me in tears (I’m the go-to person for scientific questions on my family…) and asked what I know of the risks…I was very surprised when she replied: “No, I mean the risks for the baby.”

            As opposed to having a breech baby? Sheesh!

          • Irène Delse
            June 13, 2016 at 4:34 pm #

            Exactly. The weirdest thing is, she did understand a breech presentation was risky by itself, and she hadn’t intended to refuse the C/S, she just was terrified by it all.

            It was all moot, anyway: a few days later, the baby turned by herself and my relative was able to give birth the “normal” way, in peace with herself. She even agreed to an epidural during labour… a thing she hadn’t planned to do. But it’s hard to ignore the pain of “your body turning inside out” (direct quote here)!

          • Molly B
            June 14, 2016 at 2:58 am #

            Please look up FDA info regarding opiods in epidurals and also effects of epidurals (with any medication in them) to fetus/baby and.risks to fetus/baby. Please make.sure your sources are reputable. I’m not asking you to post the info or.even tell me.if you looked it up. I’m just asking you to check it out for yourself. Acog nih who ajog etc

          • guest
            June 13, 2016 at 4:55 pm #

            Oh, look, it’s the “many doctors” fallacy again. Molly, PROVE to me that “many” doctors perform unnecessary c-sections because of a temporary and correctible blood pressure dip due to an epidural.

          • Heidi_storage
            June 14, 2016 at 12:55 pm #

            That’s funny; when my blood pressure dropped, the doctor gave me some epinephrine, rather than yelling for a section. Must be an anomaly.

          • The Computer Ate My Nym
            June 13, 2016 at 8:23 am #

            This is true. It is also true that epidurals can end tragically. I know of a total of one case where the woman had a catastrophic decrease in BP and ended up in a persistent vegetative state. The baby, incidentally, was absolutely fine.

            Failure to provide adequate pain relief can also end in tragedy. I know of several cases of PPD related to unrelieved pain in labor and at least one suicide attempt probably related to same.

            The standard consent form for an epidural mentions the risk of BP drop, among other risks, including the risk of death. No responsible anesthesiologist would put one in if the woman in labor refused to consent after hearing the risks.

          • Molly B
            June 13, 2016 at 9:01 am #

            I understand your points and they are well taken. That being said PPD and PTSD occur in childbirth due to numerous reasons and in both modes of delivery.
            Not everyone is given a consent form to sign or read. Many who do are women presenting to L&D in active and painful labor amid a chaotic environment of puts this on, needle stick here, hooking up CTG, whats your history, vag exam etc and many dont take the time to read the form due to pain and chaos. They just want to get to their room and lay down and have a moment to think and to breathe.
            Full disclosure is also not always given. If you are told that it could cause a drop in your BP are you told of how this will effect the fetus? Are you told of what the possible outcomes are and all the alternative methods of correction if BP becomes a concern or fetal distress at onset of low BP?
            Not everyone is informed. I personally know of someone who was not told of the risks of the epidural beyond “You have to stay very still or this could paralyze you” Moms BP dropped within 30 minutes of being given epidural. She was placed on oxygen, fetus deceled multiple times within 15-20 of onset oxygen therapy and baby was delivered my emergency cesarean.
            Not every woman has complication with epidural, not every fetus has complication with epidural, but many women are not told all the risks and options of various treatments and intervention during labor and delivery and this is concerning.

          • Monkey Professor for a Head
            June 13, 2016 at 9:12 am #

            I agree with you that informed consent is very important and should always be obtained before any procedure (excepting of course, emergencies where this may not be possible). But it is important that people are given accurate information about the risks and benefits. That information should be provided without emotion or moralising attached.

            I am curious as to how you would lay out the information that you feel a woman should receive prior to consenting to an epidural. I suspect your answer would be revealing.

          • The Computer Ate My Nym
            June 13, 2016 at 9:40 am #

            True, but the rate of PPD is lower with both epidurals and c-section compared to “natural” labor. Shouldn’t these data also be included in the consent form if your complaint is lack of full disclosure? Or perhaps as part of the discussion of the risk of refusing analgesia?

            I don’t know how your consent process went, but I actually consented for an epidural both in advance, when I was not in pain and had all the time in the world to consider the risks and benefits (which were fully presented, including the very rare risk of permanent damage to me or the baby and of death, again either) and again when the procedure was actually done at my request. (Well, okay, my midwife suggested it, but I agreed.)

            Is inadequate consent sometimes given? Certainly. Just like in any other medical procedure. But there is no particular evidence that I have seen that there is a specific problem with inadequate consent around epidurals.

          • Daleth
            June 13, 2016 at 1:47 pm #

            I can’t remember if this risk was covered in my consent, but did anyone ever tell you that if you do NOT have an epidural and you end up needing an emergency c-section, then:

            – You’re at high risk of needing general anesthesia (because you don’t have an epidural that they can top up for the surgery);

            – General anesthesia goes into your bloodstream immediately and will sedate the baby;

            – General anesthesia has an exponentially higher risk of killing or injuring the mom? (Still a low risk, but dramatically higher than any risk from an epidural.)

          • demodocus
            June 13, 2016 at 10:42 am #

            your hospital makes people lie very still with an epidural? Neither of mine did.

          • The Computer Ate My Nym
            June 13, 2016 at 10:45 am #

            I would assume that Molly means while the epidural is being placed. You do have to be still while it is being placed.

          • Charybdis
            June 13, 2016 at 11:23 am #

            True, I wonder how much of this is an example of “Doctor said “THIS”. I heard “THAT” and you can’t convince me otherwise, because I was THERE.

            You know, because anything but the mother’s side of the story is outright wrong, manipulative, and skewed to an interventionist viewpoint.

            Not that the mother’s side of things is EVER skewed, manipulative and totally anti-interventionist.

          • Nick Sanders
            June 14, 2016 at 12:53 pm #

            The more I talk to her, the more convinced I become it has nothing to do with any misunderstanding and everything to do with not letting the facts get in the way of a good narrative.

          • The Bofa on the Sofa
            June 14, 2016 at 2:23 pm #

            The more I talk to her, the more convinced I become it has nothing to do with any misunderstanding and everything to do with not letting the facts get in the way of a good narrative.

            The more I read, the more I come to the conclusion that I don’t know what the “narrative” even is.

          • Nick Sanders
            June 14, 2016 at 2:37 pm #

            “Epidurals bad, doctors lie, opiates everywhere.”

            Something like that.

          • demodocus
            June 13, 2016 at 11:24 am #

            but you sit for that…

          • Roadstergal
            June 13, 2016 at 7:01 pm #

            I was talking to two friends who have had children – one American, epidural both times, and the other Dutch, two typical Dutch homebirths with no pain relief. The latter dwelled rather extensively on the “freedom to move around” thing ) and it really sounded like she was trying to find some silver lining for not being allowed pain relief. She talked about her first birth being so painful that she had to get to a distance in time where she had forgotten about how horrible it was before she had her second.

            For both women, the second birth was easier, and it was barely three pushes for the US friend with the epidural. Listening to the NCB folk, it should have taken her days. 😛

          • Molly B
            June 14, 2016 at 2:52 am #

            All hospital do when the anesthesiologist is inserting the needle and until he removes it leaving only the cath in place. If your hospital did not have you stay very still during this time I am quite surprised

          • demodocus
            June 14, 2016 at 12:46 pm #

            you said lie very still, i was sitting, so i’m confused. Also, they did warn me and the be very still part is only a few minutes, even when interrupted by a contraction or three

          • Molly B
            June 21, 2016 at 12:18 am #

            When epidural needle is being inserted some have Mom.lay on side others have Mom sitting up.

          • AllieFoyle
            June 13, 2016 at 12:00 pm #

            I agree with you about the importance of informed consent, but I disagree that the risks of epidurals are neglected more than other decisions. Personally, I felt that I was acutely aware of the risks of medical interventions and that there was great pressure on everyone involved to “avoid interventions” as a general principle. The part of the informed consent conversation that was most missing was about the potential benefits of various interventions and the risks of forgoing them. I went to a hospital-affiliated CNM practice and was never told that epidurals were not routinely offered at my hospital. Nor was I given any options to avoid a painful, difficult, dangerous delivery with a large baby. So I couldn’t choose a prophylactic c-section or epidural anesthesia because “interventions are dangerous” but I had to suffer excruciating pain, pelvic injury (and subsequent surgery), and my baby had shoulder dystocia with the risks of oxygen deprivation, damage to brachial nerve, and even death.

            So, yes to informed consent (I suggest a comprehensive pamphlet given out well before labor), but let’s make sure that we include all the risks and all the benefits of both intervention and non-intervention and we don’t just focus on demonizing one aspect of the process.

          • Sarah
            June 13, 2016 at 1:13 pm #

            Nothing to say about the risks of not getting pain relief when a woman needs it, then?

          • guest
            June 13, 2016 at 4:50 pm #

            Not every woman shows up at the hospital never having heard of epidurals and ALREADY DECIDED whether or not she wants one.

          • guest
            June 13, 2016 at 4:52 pm #

            Bah, that got mess up. But the point is that most women ALREADY KNOW about epidurals *and* the possible complications, and they arrive knowing whether or not they want one anyway. And some will arrive with one idea and change their minds, and they have the right to. That’s no reason to scaremonger women about epidurals.

          • Molly B
            June 12, 2016 at 4:31 pm #

            Most women do not receive one dose. They are topped up throughout labor.

          • Monkey Professor for a Head
            June 12, 2016 at 5:17 pm #

            Evenso, that’s very different than chronic use throughout pregnancy.

          • Azuran
            June 12, 2016 at 7:09 pm #

            my point remains, a few doses in the span of a labour is neither going to cause teratogenic effect nor addiction in the mother nor the foetus. So those are not a concern for the safety of epidurals.

          • Molly B
            June 13, 2016 at 7:41 am #

            Again, as I have stated many time the article on addiction was to prove to one person that opiods do cross the placental barrier. Teratogenic affects is not the only concern. The increased likelihood of a cesarean delivery or other complications due to epidurals is the issues. Also your original point was specifically that “1 dose given during the birth will not have any kind of effect on the baby’s development.” Complications during labor inc fetal distress due to epidural meds and fetal development are two separate issues.

          • Azuran
            June 13, 2016 at 8:06 am #

            And again, Teratogenis effects is not ‘not the only’ concern. is is ABSOLUTELY not a concern.
            So, basically you posted: XYZ are the effects on adult, it can cross the placental barrier, therefore XYZ are the effects on the baby.
            It doesn’t work this way. Addiction doesn’t matter in this case, teratogenic doesn’t matter. And you talking about those is just trying to scare people and add more fake argument in your favour to try and make your point more valid. You shouldn’t even be mentionning any of those things because they are irrelevant no matter if opiod cross the placental barrier. If you want your arguments to be taken seriously, don’t drown them in false claims and useless data.

          • Molly B
            June 13, 2016 at 8:16 am #

            AGAIN…addiction and teratogenic effects was NOT the point or argument. That portion as I have said many time was to point out that oipiods cross the placental barrier. Period. Opiods cross the placental barrier is not a false claim.
            I have removed the section on addiction and teratogenic effects so long as you realize that the opiods cross the placental barrier.

          • Daleth
            June 13, 2016 at 1:45 pm #

            I have removed the section on addiction and teratogenic effects so long as you realize that the opiods cross the placental barrier.

            Are you going to remove all your posts when you realize that:

            (1) Epidural meds don’t get into the woman’s blood stream, and thus don’t even have the opportunity to cross the placenta, unless they leak out of the epidural space (the fluid-filled area around the spine where the needle is placed). That usually doesn’t happen.

            (2) Even when epidural meds do leak and do make it into the blood stream, the amount that crosses the placental barrier is minuscule and has approximately zero effect on the baby, both because the dose given to the woman is tiny compared to oral or injectable opioids and because the minuscule fraction of that dose that leaks out is even tinier.

          • Molly B
            June 14, 2016 at 1:22 am #

            No because evidence I have provided states that it does in fact cross the placental barrier. If you are going to do a partial quote make sure you dont the change the meaning of the whole communication in the process. I stated that I was removing it since everyone was stuck on the addiction part and not the part that I pointed out was the basis for my posting that particular section which was that opiods do cross the placental barrier.

          • Daleth
            June 14, 2016 at 1:00 pm #

            A substance can’t cross the placenta unless that substance is in the mother’s bloodstream. The umbilical cord is not connected to the mother’s epidural space and the spinal fluid in that space, where the epidural medication goes, is not in any way connected to the mother’s circulatory system; blood doesn’t flow in and out of there.

            That’s why epidurals, unlike injected or oral opioids, provide pain relief without making the woman high and without any risk of addiction: because epidural meds don’t travel around her body and end up affecting her brain. They generally stay where the anesthesiologist puts them, with perhaps a tiny amount of leakage.

            *IF* the needle nicks a vein on the way in *AND* the meds leak out of the epidural space into the surrounding area, then a small amount of the meds could get into the circulatory system and whatever’s left after mom’s body metabolizes them could get to the baby. That does happen, no doubt about it. But because epidural meds are delivered directly to the space around a woman’s spinal cord, the dose needed to achieve pain relief is lower than the dose that would be needed orally or by injection.

          • moto_librarian
            June 14, 2016 at 1:28 pm #

            Christ, you are willfully dense, aren’t you, Molly B? Yes, theoretically, the substance can pass the placenta, but only if it actually enters the mother’s bloodstream! You are asking doctors to disclose something that simply doesn’t happen when an epidural is administered.

          • AllieFoyle
            June 14, 2016 at 5:27 pm #

            FFS, opioids can cross the placenta, yes! No one disputes that. Don’t take opioids if you are pregnant and don’t need them. What you don’t seem to grasp is that the opioid meds need to be circulating in the woman’s bloodstream in order to cross the placenta. The advantage of an epidural is that the medicine IS NOT placed in the bloodstream, so there is very little, if any, to be transferred to the baby. The drug monograph you are referencing refers to morphine given orally or injected — it has nothing to do with an epidural!

          • Molly B
            June 14, 2016 at 1:23 am #

            You say opiods via epidural do not cross placental.barrier and when they do the risks to fetus is approximately zero. Provide a source for this argument.

          • Daleth
            June 14, 2016 at 1:03 pm #

            Do you understand that to even get to the placenta, a substance has to be in the mother’s bloodstream?

          • Heidi_storage
            June 13, 2016 at 2:09 pm #

            If you’re not worried about addiction and teratogenic effects, why do you keep belaboring this bit about the opioids crossing the placental barrier?

          • Azuran
            June 13, 2016 at 11:09 pm #

            I never refuted that opioids cross the placental barrier. I’m a vet, I use opioids, I know they do. But ‘crossing the placental barrier’ in itself is not an argument and isn’t a risk by itself.
            Before you can decide it’s it’s really a bad thing, you have to know how much it crosses the barrier when it’s given IV to the mother and also when it’s given as an epidural. At what maternal dose does it result in a foetal dose that causes problems to the foetus. If it does, how big of a risk is it and what can you do about it? It also happens that one of the best advantages of opioids is that there are also drugs to reverse their effects. If a mother has adverse effect to opioids, you can reverse them, if a baby is born under the influence of opioids, you can give it reversal drugs as well, reducing the risk even more. So, really, risk to the foetus is a lot more complicated than ‘it crosses the placental barrier’

          • Molly B
            June 14, 2016 at 1:16 am #

            Crossing the placental barrier is a risk especially when as you pointed out there are drugs to counteract bad side effects to the fetus which means this had happened often enough that an anecdote needed to be found.
            So your arguments is more drugs to counter drugs that likely weren’t necessary in the first place and mom probably didn’t provide true informed consent on? That sounds good for baby!

          • Monkey Professor for a Head
            June 14, 2016 at 3:02 am #

            “So your arguments is more drugs to counter drugs that likely weren’t necessary”

            I think that’s a revealing statement. Pain relief is not necessary.

          • Molly B
            June 14, 2016 at 3:23 am #

            Um…no.it is not always necessary. Would I let someone perform open heart surgery on me without pain management….absolutely not. Would I labor without pain meds…yeah. Do all women have the same opinion on pain management during labor as me…absolutely not and that is awesome! We have choices and the right to choose for ourselves! Medical professional should provide full disclosure so our choices are truly informed choices. Many women are not given full disclosure or.true informed.consemt. Period end of story. This was.more.or less.rhe entire point of what I had to say but people want to drag shit out (inc me) to argue various side points and branched.

          • Monkey Professor for a Head
            June 14, 2016 at 5:12 am #

            So you don’t think that the epidural was “likely unnecessary”? Or do you think that most women who receive epidurals do so against their wishes?

          • The Computer Ate My Nym
            June 14, 2016 at 5:35 am #

            But anesthesia in open heart surgery is more dangerous than that used in labor. I think you should be told in great and condescending detail how dangerous and stupid your decision to have anesthesia during open heart surgery is. In the name of full disclosure. Did you know, for example, that some analgesics can cause the iron in your red blood cells to change to the wrong form, resulting in your suffocating*? Was that on the consent form, hmm…You must have gotten an inadequate consent, then.

            *Methemoglobinemia.

          • Heidi_storage
            June 14, 2016 at 12:24 pm #

            I have seen no one on this thread argue against informed consent. If that is the point you’re trying to make, then congratulations, everyone agrees with you. What they DON’T agree with is exaggerating the risks (and downplaying the benefits) of epidurals, such that patients may choose either a less effective or less safe alternative, or experience severe psychological distress from foregoing pain relief.

          • Azuran
            June 14, 2016 at 4:34 pm #

            You know what else crosses the placental barrier: Water and oxygen. So no, crossing the placental barrier by itself is not a risk.

            The fact that an antidote exists absolutely does not mean that the mother was not informed of the risks, or that we just use administer it blindly at dangerous doses because you can reverse it if anything goes wrong. That not how any of this works.
            But it does make the use of the drug safer because IN CASE the mother is for some reason hypersensitive to it or has a bad reaction to a standard dose of the drug, because then we can reverse it.
            It is absolutely not a case of ‘pushing more drugs to cover more drug’ But between using 2 drugs, one which you can reverse and one you cannot, the one with an antidote is safer.

          • AllieFoyle
            June 14, 2016 at 5:21 pm #

            That is the point of the epidural — to administer the medication in such a way that mother gets pain relief with very little medicine making it into circulation, thus minimizing the baby’s exposure.

            Naloxone is used for opiate overdose in many situations. It has nothing to do with L&D, really. Babies simply do not get enough opioids from maternal epidurals to need rescue Naloxone — that’s why it isn’t used for that. It is used for babies whose mothers have gone without epidurals and then receive injected pain relief like Nubain, Stadol, etc. So if you are concerned about newborns being exposed to opioids, you should advocate against those medications, not epidurals.

          • Dr Kitty
            June 14, 2016 at 5:57 pm #

            Shock horror!
            Opioids can can respiratory depression!!!!
            An antidote had to be found!!!!

            Yes, it did.
            But it wasn’t newborns with respiratory depression due to epidurals that led to the creation of naloxone.
            It was good old fashioned junkies dying of heroin ODs.

            You assume the the intrapartum epidural “likely wasn’t needed”- why is that?
            People in severe pain generally need pain relief in order to be coherent and comfortable.

          • namaste863
            June 14, 2016 at 1:39 pm #

            We get it, already. Opioids (When they’re used) cross the placental barrier. So the hell what? When injected into the epidural space the amount that makes it into the mother’s bloodstream, let alone the baby’s, is far too small to do a damn thing. The effect on either is negligable to non-existant.

          • Linden
            June 14, 2016 at 11:36 am #

            Specify, using a graph if you like, the dose vs risk for the baby. Please be specific. Your feelings aren’t enough. If you want women to be informed of the risks, you need to have the knowledge to do so.

          • Molly B
            June 21, 2016 at 12:34 am #

            http://americanpregnancy.org/labor-and-birth/epidural/

          • Irène Delse
            June 21, 2016 at 2:07 am #

            Hello? This page isn’t a reference to what you’re talking about, it’s general information about epidurals. There isn’t much about risks to the baby except some “research is ambiguous but” verbiage. And no source given.

            I find that underwhelming.

          • Who?
            June 21, 2016 at 2:09 am #

            It also doesn’t address the dose v risk issue that Linden specifically asked about.

          • Molly B
            June 13, 2016 at 8:00 am #

            8.2 does not refer to chronic use! It is specific to the use of opiods during labor. Hence the section being titled “8.2 Labor And Delivery”

          • Nick Sanders
            June 13, 2016 at 3:37 pm #

            Specifically, one opiod, morphine sulfate. From that, you have tarred all epidurals with the same brush, regardless of what they actually contain.

          • Molly B
            June 14, 2016 at 12:59 am #

            As others have also sated Epidural I assumed that you as well would follow that the discussion was in regard to morphine sulfate via epidural….

          • Nick Sanders
            June 14, 2016 at 1:37 am #

            Except it’s far from the only, or even primary, ingredient in epidurals.

          • Molly B
            June 14, 2016 at 1:50 am #

            To state this so late in game….grasp at straw much?? Obviously the opiod is diluted and 100% morphine is not being injected ….

          • Nick Sanders
            June 14, 2016 at 1:56 am #

            I didn’t say it before because you have already been told this by others. I’m not grasping at straws, I’m getting exasperated with a person who WILL NOT LISTEN and continues on hammering points after they have been shot down repeatedly.

            NOBODY gets 100% morphine. It’s a hospital, not some abandoned tenement full of druggies shooting up. But even when the epidural contains opioids, which is not every time, they are a secondary medication, not the primary one, and is in an extremely small dose. You have been told this more than once, yet you continue to act as if an epidural is just morphine and saline. At this point, you remind me of nothing so much as one of those antivax idiots who goes on and on about the “massive quantities of aluminum” in vaccines.

          • Molly B
            June 14, 2016 at 2:16 am #

            Everyone on here is stating their viewpoints. Personally I dont care what narcotic is being used. It’s the point that full disclosure needs to be given and this sis often not done…as I have said several time already. And yes, actually I am antivax, to a degree. No.i dont not believe that there are massive amounts of aluminum in vaccinations. I also believe we that people should be given full.disclosure and to have their choices with regards to their healthcare and body respected.

          • Heidi_storage
            June 14, 2016 at 12:20 pm #

            Why am I not surprised that you don’t like one of the most effective public health measures in human history?

          • Molly B
            June 14, 2016 at 2:36 am #

            I realize that there is more to.an.epidural.than morphine. I have had one before for a.surgical procedure. Also, dosage strengths vary by medications. 100mg of.one med.may be a starting dose and 10mg of another could be deadly. A low dose of particular med such as a starting dose can still.be powerful and can still have severe side effects. I already told you I really could care less what narcotics is being used its.the fact that women are not given full.disclosure. It full disclosure scares them oh well. They have the right to know and its not up to the doc to decide how much info they should get or to be bias towards one side or. the other. Last pregnancy I asks OB what the risks were to my child.if I chose epidural pain relief (I already knew side effects). I was told that there was no.risks to fetus, period. We all.know this is not true. Yet doctors tell women things like this. My friend.was told a 4th cesarean was perfectly safe and routine procedure….full disclosure and respecting a patients rights to make informed decision should be a priority not an “if I don’t.think it will make.them choose something other than what I recommend”

          • Monkey Professor for a Head
            June 14, 2016 at 2:41 am #

            I think Nick is referring to the local anaesthetic agents (which are different to opiates) rather than any diluting agents. Those local anaesthetic agents provide much of the effect of epidurals. They are also the reason why epidurals cause hypotension – which is why naloxone (as you suggested) is not useful in that situation. Before you try and educate us all on the risks of epidurals, you may want to learn a bit more about what they actually involve.

          • Nick Sanders
            June 14, 2016 at 12:51 pm #

            I think Nick is referring to the local anaesthetic agents (which are different to opiates) rather than any diluting agents.

            I was. 🙂

          • Molly B
            June 14, 2016 at 2:17 am #

            I would.like to know who previously posted this fact as you said it has been brought up on this discussion before.

          • Molly B
            June 14, 2016 at 2:43 am #

            Morphine or opiods.in general. Read the article your sited from American.preganacy. It states that anesthetic.is used and I many cases morphine or one other are drug to lessen high doses.of anesthetic. Plus saline. Done

          • Azuran
            June 13, 2016 at 11:02 pm #

            If you only wanted us to read 8.2, why post the whole thing?

          • Molly B
            June 14, 2016 at 12:58 am #

            I am so tired of telling you the same stuff over and over.
            AGAIN….the beginning was to show you evidence that opiods cross the placental barrier. The rest was to show evidence of my point regarding medical use in labor.

          • The Computer Ate My Nym
            June 14, 2016 at 3:37 am #

            What about section 8.2? That opiates can cross the placental barrier? Yep. That’s why epidurals are preferred to IV opiates for pain relief: Lower dose, given directly into the CSF means lower levels in the blood stream and lower fetal exposure. What was the point, then?

          • Monkey Professor for a Head
            June 14, 2016 at 3:51 am #

            I think Molly B is working on the assumption that even the most minuscule trace of opiates is potentially harmful. Perhaps she is not familiar with the concept of dose related adverse effects.

        • Nick Sanders
          June 12, 2016 at 12:58 am #

          https://www.ncbi.nlm.nih.gov/pubmed/22161362

          Epidural analgesia had no statistically significant impact on the risk of caesarean section, maternal satisfaction with pain relief and long-term backache and did not appear to have an immediate effect on neonatal status as determined by Apgar scores.

          • Molly B
            June 12, 2016 at 10:46 am #

            Same article…

            https://www.ncbi.nlm.nih.gov/pubmed/22161362

            However, epidural analgesia was associated with …and an increased risk of caesarean section for fetal distress.

          • Box of Salt
            June 12, 2016 at 12:46 pm #

            Molly B, I’m going to turn this on its head for you.

            Do you think it’s possible that a baby poorly positioned for vaginal delivery might result in a longer, more painful delivery for its mother?

          • Monkey Professor for a Head
            June 12, 2016 at 3:22 pm #

            368 days ago today, I was in labour with an OP baby. I can testify that it was agony.

            I was repeatedly told by midwives for 12+ hours that I wasn’t really in labour (they wouldn’t examine me to confirm – when they did I was at 7cm) and that I couldn’t have any pain relief. It was traumatic, and I’m still a little angry about it. If a woman does not want pain relief, then that’s fine, but if analgesia is desired, it should not be withheld without a very good reason.

          • Molly B
            June 13, 2016 at 7:49 am #

            Your experience was a terrible one and to my knowledge uncommon. Stories like yours truly upset me in regards to the lack of proper care you were shown my the medical staff.
            No one is saying that pain relief should be withheld from anyone who desires it.

          • AllieFoyle
            June 13, 2016 at 12:14 pm #

            Well, actually, I’d say that a lot of people are saying that epidurals aren’t desirable or necessary because they interfere with “natural childbirth,” which is seen as a good unto itself. Check out the practices in many of the northern european countries that natural childbirth proponents want us to emulate — it is very difficult to get an epidural in many of those countries.

            In some research studies epidurals are counted as a negative effect or outcome. Nevermind that it may have been seen as a profound positive by the women who requested one.

            And in my (former) local hospital, midwifery care is promoted as the norm, and epidural anesthesia is not available, no matter how much pain a woman is experiencing.

            I have never ever understood the people who get upset about epidurals being offered. If a woman doesn’t want one she can simply decline. It’s the woman in terrible pain who wants an epidural but doesn’t get one that seems more troubling to me.

          • Molly B
            June 14, 2016 at 12:55 am #

            My argument is that women do not receive full disclosure to truly provide informed consent. I have stated before that pain relief should not be withheld from a woman who wants it. Only that she be told of all the risks and benefits in full of the medications.
            It is sad that a hospital would refuse pain relief to women across the board. It is also sad that other hospitals demand certain women.receive certain pain medication/managements across the board. It is also sad that women.are not alway given full disclosure in regard to their pain management choices

          • Linden
            June 14, 2016 at 11:32 am #

            How about informed consent about the fact that the risk of PPD and PTSD is increased without adequate pain relief? Do you support doctors and midwives in making this clear to women?

          • Molly B
            June 21, 2016 at 12:37 am #

            That’s a load of bull. Well a half load to be exact. PPD and PTSD also occur in women who have had adequate pain relief but wound up having multiple intervention or emergency cesarean after interventions. It’s not about pain, its about the way a woman perceives her Labor and birth

          • Irène Delse
            June 21, 2016 at 1:57 am #

            Citation needed. You’re the one making assertions without evidence, here.

          • Who?
            June 21, 2016 at 2:08 am #

            Exaggerating the risks of an epidural, as you are doing, doesn’t help in the decision making process. A woman who is scared out of an epidural by your misinformation, and believes there is no safe and effective pain relief for labour might well be very frightened going in to labour.

            Would you feel you had done a good day’s work if, based on your ‘information’ a woman decided the best thing to do is have a general and a cs, to avoid the whole issue?

          • guest
            June 21, 2016 at 12:10 pm #

            I would have been a lot less fearful if it hadn’t been drummed into me that epidurals cause a “cascade of interventions.” Once I experienced the pain, I got one anyway, but I could have avoided weeks of anxiety if I had been correctly informed about epidurals.

          • Molly B
            June 21, 2016 at 12:28 pm #

            I am not exaggerating a risk. Exaggeration is saying 75% of women who receive epidurals will have drop in BP or respiratory distress and cause fetal decels requiring emergency surgery.

            I am saying hey there is a chance that some.women.can have complications from epidural that result in fetal.distress and cesarean deliveries and all women.should be informed.of all the risks.and benefits of interventions and of not receiving an.intervention by the doc

          • Amy Tuteur, MD
            June 21, 2016 at 12:35 pm #

            You lack basic knowledge about risks. You think what you read on the Internet — propaganda from the natural childbirth industry — is accurate. Getting information about childbirth from the natural childbirth industry is like getting information on solar power from the oil industry. You need to be less gullible.

          • Charybdis
            June 21, 2016 at 9:37 am #

            It is NOT about how a woman “perceives her labor and birth”. It is about the fact that labor and childbirth freaking HURT and that women should not be denied pain relief when they ask for it. Notice I said WHEN they ask for it, not MANDATORY.

            If you feel like you can have a baby by using breathing, balls, showers, baths, walking, changing positions, squatting, downward dog, hypnosis, whatever coping mechanisms you wish, go right ahead. But if, and only if, you decide somewhere in the middle that the pain is too much and you would like pain relief, then YOU SHOULD GET IT IMMEDIATELY.

            Cesareans are not the evil thing here. Are some traumatic? Sure. We have a regular poster whose CS was a shambles. Some have to be done as a crash CS, using general anesthesia, which will affect the baby, because there is no epidural in place. Most CS’s are reasonably pleasant experiences, especially if they are planned.

            Positive thinking and visualization alone will not make the birth of a baby painless and easy for the mother. Stop implying that it does.

          • Molly B
            June 21, 2016 at 10:22 am #

            #1 I never said a woman shouldn’t get pain relief if she wants it.
            #2 I ever said alternatives to pain medication make labor painless.
            Do not put words in mouth.
            It is about how a woman perceives birth. If to one woman her birth was excruciating and she wanted pain relief and didn’t or wasn’t able to get it, then yes that can be traumatic. If another woman didn’t want medical pain relief and it wad forced on her or she was rolled into an.OR in an.emergency fearing for her or her baby that can be traumatic too.
            I am not pro medication or pro “natural birth”
            I do not know why people keep fighting with me calling me anti-vac and anti this or that. I am simply anti not being informed. I agree that doctors dont tell a woman everything that can go wrong in a vaginal delivery but I am also aware that people have brought up the argument with me on here of whether or not a doc should have to tell a woman everything that can ho wrong with an intervention.
            It is common knowledge that woman can die in childbirth. I do not feel it is common knowledge what the risks to intervention are. Yes many women, if not most, know that there are risks to inventions but do they know what those risks are?
            And saying that you know is not most women, its only you.

          • AllieFoyle
            June 21, 2016 at 11:36 am #

            The problem is not informed consent, it’s that you want women to be told things that aren’t true in order to sway them to the choice you think is best. Misinformed consent, if you will.

            What is your goal here? To help women? Save them from suffering? Help their babies?

            I suppose that by pushing women to avoid epidurals you might help some people, but there will invariably be others who are not helped and end up going without pain relief that would have made their labors more positive experiences or spared them trauma of varying severity. And I believe that the psychological trauma of unrelieved pain can have a real, lasting impact on a person — which is especially worrisome for a new mother who will be providing care and nurturing around the clock for a newborn.

            I’m also going to disagree with you that the idea of childbirth being deadly is commonplace. Maybe people are aware that childbirth used to be dangerous, but few people today see it that way. But I’d guess that many pregnant women have heard quite a lot of rhetoric around the supposed dangers of interventions and superiority of natural childbirth. I certainly did. If the propaganda scales are tipped one way or another, I’d say that things are biased in favor of exaggerating the risks of interventions and ignoring the dangers and disadvantages inherent in the natural process.

          • Molly B
            June 21, 2016 at 12:22 pm #

            Any intervention carries risks. Women are not always told all the risks. I do not take a.stand on medicalized vs NCB.
            Only that women should.be given full disclosure.

          • guest
            June 21, 2016 at 12:09 pm #

            NO ONE is forcing pain relief on laboring women. Stop making up strawmen to cloud your argument.

          • Molly B
            June 21, 2016 at 10:38 pm #

            Actually doc told me that if I want to vbac (2nd vbac mind you) I must have an epidural or sign AMA form and pay for.the entire hospital bill myself or agree to schedules cesarean. But no one is ever forced, right??

          • swbarnes2
            June 21, 2016 at 11:07 pm #

            I’m sure you could have told them not to give you any medication through the epidural, they just want it in place because obviously you are at a substantially higher risk for needing an emergency C-section, and GA is a big risk.
            Surely you are prepared to rattle off the risks of GA off the top of your head, since you are so deeply informed as to all the potential risks of childbirth?
            But no, they still weren’t forcing you to do anything, except to be financially responsible for the consequences should you choose to ignore their advice. I thought that’s what you wanted; for women to accept responsibility for their medical choices.

          • Who?
            June 21, 2016 at 11:32 pm #

            You were offered 2 options. Both unpalatable. And I get that’s tough. Forcing you, though? No.

            You can choose to stay home and have the baby, you can choose to turn up in labour at emergency and see what you get, you can choose to keep looking for a doctor and hospital to meet your wishes. A second opinion could be useful as part of the third option.

            What you can’t do is insist that anyone provide you with medical treatment against their professional judgement or the requirements of their employment. It is your absolute right to refuse treatment, should you wish to do so. It is not your right to treat medical professionals like short order cooks and waiters.

          • Molly B
            June 22, 2016 at 12:48 am #

            This is my 4th OB for this pregnancy, because I want to VBAC. I am currently being seen at a Level III trauma center which should my Doctor quoted 1.8% chance of Uterine Rupture with a 30% chance of that 1.8$ being catastrophic I am in the best place I can be.
            Doc clearly said that AMA was because of fear of lawsuit should somethimg go wrong, but not because it was medically inadvisable. He is comfortable with VBAC if i sign AMA because that it what the legal Department requires for VBAC Moms. That is wrong on many levels. It also intimidates Moms into a cesarean who worry about having to pay the hospital bill although ACOG clearly state that up to 2 prior cesarean is ok and even better if mom has had prior vaginal deliver.
            Doc said that epidural could not be unmedicated cath ‘just in case’. He wants me on surgical level of meds and to lay in bed not mving, but they will gladly prop me on my side.
            I even asked about not scheduling section and alloowing for spontaneous labor before section, this was also shot down. I am not being given much a choice now am I?
            Its “Standard of care per ACOG says this, but fuck all that, we want you AMA and laying on a bed with high doses of epidural meds….just in case.
            Because I dont want to get sued in the 0.6% chance you have a catastrophic rupture (30% of 1.8%)
            Oh and you have to pay for it yourself and you still have to have an epidural even if your AMA

          • Who?
            June 22, 2016 at 1:58 am #

            It sounds complex.

            And I know it’s hard when you do your homework and do everything right, and things still don’t work out the way you want them to.

            What you are being offered is a first world safety net, strung up to the hospital’s specifications. It seems like what you want is a first world safety net, strung up to your specifications. The maths tells the doctors that your style of safety net won’t allow them to do their best job for you, so they can’t agree to it. One of the things that allows your hospital to be at the level it is is the policies and insurance. It’s rotten when they don’t suit you, but without them a hospital like that wouldn’t exist.

            If you want the hospital, you will need to choose to accept their rules. It’s in your hands. You can carry on being angry, knowing you are, in the end, going to take their advice, and accept their requirements, or you can square your shoulders and get on with enjoying being pregnant and looking forward to your expanded family. With a filter over the bits in between you’re not happy with. Big picture-that baby is coming out one way or another, and you get one go at it. Make it count for something real.

            It’s not the choice you want, but it’s the one available to you.

            Nothing is guaranteed, and nothing is promised. But if what you really want, on the other side of the delivery, is a live, undamaged baby, and for yourself to be as well as you can, please take your doctors’ advice, because doing so is your best chance.

          • guest
            June 22, 2016 at 10:42 am #

            It’s sort of like how I wasn’t given a choice about having general anesthesia for my appendectomy. My god, what monsters those doctors are, forcing me to have GA when there is no other suitable option!

          • Roadstergal
            June 22, 2016 at 11:49 am #

            Ah, so it all comes out.

            Nature has dealt you a shitty hand in the context of the number of babies you want to have. The best medical care that gives the best chance of survival for your baby and yourself would involve you doing things you don’t want to do, so you’re on a screaming campaign against the one bit you feel is most ‘elective,’ the epidural. (And you know why that’s on the table, yes? Taking a miniscule amount of risk to yourself re: the epidural vs a much larger risk to yourself and a massively larger risk to the baby with general anesthesia if things go pear-shaped?)

            So, if the best medical care that gives the best chance of survival for your baby and yourself isn’t what you want – if what you want is an unmedicated VBAC at all costs – stay home. If you rupture, the baby dies, but no big, that’s obviously not the point. At home, you won’t get an epidural or a C/S, period, and that’s what you want above all else.
            BTW, you have no problem with drunk driving? Because driving drunk with your kid in the car is an orders of magnitude lower risk to the kid’s life than the chance of you having a catastrophic rupture.

          • fiftyfifty1
            June 22, 2016 at 12:13 pm #

            “This is my 4th OB for this pregnancy,”

            If a doctor tells you something you don’t want to hear, it’s very reasonable to get a second opinion. But when you are on your 4th opinion and still not hearing what you want to hear, then the problem isn’t them, it’s you.

          • Box of Salt
            June 22, 2016 at 12:37 pm #

            Molly B “my Doctor quoted 1.8% chance”

            You think you are one of the 98, don’t you?

            Will you be able to live with yourself if you are wrong?

          • AllieFoyle
            June 22, 2016 at 12:50 pm #

            Why do you think the doctor wants you to have an epidural if you plan a VBAC? What did the other three OBs say about it?

          • Erin
            June 22, 2016 at 1:04 pm #

            I imagine for the same reason it was it was discussed with me, assumption of failure and not having to use general anesthesia in an emergency. However in my case it was presented as an option, to have it as a condition is in my opinion horrific
            .

            Speaking as someone whose birth plan is frowned upon by pretty much everyone I know (Doctors and Natural birthers alike), I think there needs to a middle ground.Explain the risks and let women make their own minds up maybe.

          • Irène Delse
            June 22, 2016 at 1:45 pm #

            Gee, with a 1.8% risk of uterine failure, plus a non-negligible risk of needing an emergency CS, I would wish my patients had an epidural from the get-go. If I was evil, I’d ask them if they agreed to surgery without anesthesia in case something bad happened. (Granted, that last one would be illegal, but still.)

          • The Computer Ate My Nym
            June 23, 2016 at 6:06 am #

            This is my 4th OB for this pregnancy, because I want to VBAC.

            So you went through three OBs before finding one that was willing to risk his or her license on your risky plan. And it doesn’t bother you at all that it took that many tries to find an OB willing to agree to it?

            Doc clearly said that AMA was because of fear of lawsuit should somethimg go wrong,

            Yes, and when do doctors fear lawsuits? When their patients insist on risky plans that have a high chance of going disasterously wrong. You quoted your OB–the one who agreed to try the VBAC without pre-existing epidural–as saying that you had a 0.6% chance of a catastrophic uterine rupture, which carries a high risk of death for both the baby and for you as well as a high risk of requiring a hysterectomy, transfusions, and a whole lot of other things far riskier and more invasive than an epidural. Would you fly on an airline that had a record of 6 crashes per 1000 flights? I wouldn’t, not even if they had five star chefs making their in flight meals.

            Not to mention that a belligerent patient is a risk factor for a lawsuit in and of itself, regardless of quality of care.

          • Charybdis
            June 23, 2016 at 9:04 am #

            Now, now, she’s not “belligerent”, she’s “educated and informed”. She has already stated that it is not her job to make her hospital stay pleasant for the medical staff. Wait, here’s her post….

            My job is not to make my hospital stay pleasant for the medical staff. It is to birth my child in the way that I feel is best for me and my child. That includes talking to anesthesia ahead of time and determining a plan of care for anesthetics should I choose to use them since I have had bad outcomes in the past. That include not allowing unnecessary people in my Room or OR if I don,t want them there and that includes not allowing my privates or my child to be filmed or photographed if I dont that done and that includes not having a resident perform surgery on me if I dont want a resident to perform surgery on me. Its my legal right.

            She wants it her way, no negotiating allowed. The doctor is not a concierge and dammit, she should be allowed to dictate to medical professionals how they manage the risks inherent in a second VBAC.

            Clearly the doctor she found that would even entertain the notion of a second VBAC isn’t aware of the risks involved in labor and delivery; or more precisely, these risks somehow don’t apply to HER.

          • Azuran
            June 23, 2016 at 9:28 am #

            And? Do you really think that we are going to take pity on you over all this? You are really privileged to be able to switch between 4 OBs to find one willing to do a VBAC

            You have the right to chose, but those choices come with consequences and you have to accept them and take responsibility for them.
            You want a VBAC, even though it’s a riskier procedure and you want a doctor to assist you in this, well then you are going to have to make some concession, princess. Such as signing a form stating that you understand the risks you are taking and that if anything goes wrong it’s not your Doctor’s fault (you are so intent on full impartial consent, well then there you have it) and allowing him to put some measures in place to safe your life should something happens.
            Honestly, what’s the point of having a doctor if you don’t want him to do anything to make this safer for you and your baby? Just stay home at this point, the result will be the same.

          • Molly B
            June 23, 2016 at 9:39 am #

            Having medicaid and multiple OBs in the surrounding areas that accept medicaid is not privileged.
            I dont expect anyone to feel sorry for me.
            Everyone keep saying trust the OBs and the medical system…but the medical system is telling me I have to sign AMA papers because of fear of lawsuit NOT BECAUSE THEY FEEL CSECTION IS BEST FOR MOM AND BABY.
            There is a difference between signing a waiver and signing ama. One is a promise not to sue, the other can effect if insurance pays.
            you said
            “Honestly, what’s the point of having a doctor if you don’t want him to do anything to make this safer for you and your baby?”
            Doc said VBAC was not allowed by hospital policy without a,b,c in place so that they couldnt be sued. That is notr saying its what is safest for me, thats saying its what is safest for hospital

          • The Computer Ate My Nym
            June 23, 2016 at 9:59 am #

            Why do patients sue? They sue for bad outcomes. Why is the hospital reluctant to give you a VBAC? Because they fear that you will have a bad outcome and sue. They want it to be crystal clear that you insisted on this course so that they have something to defend themselves with when they’re facing having to defend themselves against a grieving mother who has lost a child to a VBAC attempt or against a grieving father and husband who has lost his wife and child in the attempt. I’m sorry if that’s harsh, but that is what they are thinking. If you have a good outcome, you presumably will not sue and everything will be fine. If you have a bad outcome because of care restrictions you insisted on, the hospital wants to not be held responsible for your bad judgement. That’s what the restrictions are about.

          • Azuran
            June 23, 2016 at 10:14 am #

            Except that c-section IS safest for you and your baby.
            Your yourself said that you have a 1.8% chance of rupture (even a non castastrophic rupture means emergency c-section) and a 0,6% of a CATASTROPHIC rupture (which might result in you getting an hysterectomy or kill you or your baby)

            What’s your chance of serious or catastrophic complication from a c-section? I doubt it’s anywhere near those number.

          • Molly B
            June 23, 2016 at 11:05 am #

            Among women who have one cesarean delivery, more than 90% will deliver their subsequent pregnancies by cesarean.1 The more cesarean births a woman has, the greater risk there is for problems with future pregnancies, including problems with the placenta, the risk of uterine rupture, which can be life threatening for the mother and her unborn child, hemorrhage, and the need for hysterectomy (removal of the uterus) at the time of delivery.
            https://www.nichd.nih.gov/health/topics/obstetrics/conditioninfo/Pages/risks.aspx

          • Azuran
            June 23, 2016 at 11:52 am #

            And I’m pretty sure all those risks put together are still far lower than a 0,6% risk of catastrophic uterine rupture.
            And you think vaginal birth has 0 risks?
            First of all, your TOLAC might fail, you will then need a c-section which has a higher risks than a pre-labour planned c-section. Shoud you do succeed in having a vaginal birth, you still have ALL the risks of a vaginal birth, including but not limited to: tearing, shoulder dystocia, pelvic floor injury (which can need an surgery riskier than a c-section to repain), retained placenta, cord prolapse, post-partum hemorrage etc.

            I support your right to chose a VBAC. But it is not the safest option. This is why your doctors are taking so many precautions around you. You are not a martyr or anything.

          • MaineJen
            June 27, 2016 at 7:42 pm #

            Molly. You’re quoting back to us THE EXACT REASONS we are telling you that having an epidural in place is a good idea. You’re acting like a c-section is the worst thing that could happen here.

          • Daleth
            June 23, 2016 at 10:31 am #

            “Fear of lawsuit” means “fear that your baby will be brain damaged or killed.” There would be nothing for you to sue them about if your baby were fine.

            And they’re afraid of a lawsuit because the birth plan you want is much more dangerous for your baby than a repeat CS would be–the risk of brain damage or death caused by a repeat CS is effectively zero, which is a hell of a lot lower than 1 in 167.

            In other words they don’t feel, they KNOW that a c-section is safest for your baby, but they are willing to work with you on doing a VBAC instead–but only if you let them take reasonable precautions to lower the risk to your baby and yourself (such as having a working epidural in place, because that means they can get your baby out ASAP, and also you won’t face the risk of death that is inherent in general anesthesia).

          • Molly B
            June 23, 2016 at 10:57 am #

            They are afraid of lawsuit for any vbac. I have never showed my doc a birth plan or discussed a birth plan, only what my options were

          • Daleth
            June 23, 2016 at 12:02 pm #

            Of course they are–who wouldn’t be, with a 1/167 risk of a dead or brain damaged baby?

          • Molly B
            June 23, 2016 at 11:00 am #

            Having a working epidural.in place for a 1.8% chance of uterine rupture of which only 30% are catastrophic…so 0.6% is not reasonable so that’s a 99.4% chance a rupture wont be catastrophic. The number I quoted are per my doc

          • Daleth
            June 23, 2016 at 12:02 pm #

            Yep, 166 out of 167 women in your position will not have a catastrophic uterine rupture (although all the other risks of vaginal birth remain: shoulder dystocia etc.). But every woman must weigh for herself whether she’s ok with a 1 in 167 chance of death or life-altering injury to her baby.

            For perspective, I think most people wouldn’t drive their cars if every trip carried a 1/167 risk of death or brain damage to themselves or a passenger. That’s probably why most women with prior CS choose another CS rather than VBAC. But again, it’s every woman’s decision to make for herself and her baby.

            The thing that puzzles me about what you’ve written is that you seem to not only want to have that choice (which of course anyone wants to have), but you seem to think you should be able to make the doctors do it exactly the way you want them to, rather than letting them take precautions to help prevent you from being that horrifically unlucky 1 in 167.

          • Amy Tuteur, MD
            June 23, 2016 at 12:09 pm #

            Wait, you think women would reject epidurals if they understood the “risks” to the baby, but you are opting for a VBAC that has a massively higher risk of death?

            Why is the risk of an epidural “too high” but the risk of killing your baby with a VBAC against medical advice perfectly acceptable to you?

            Perhaps you’re the one who doesn’t understand the risks (or a are hypocrite).

          • Amy Tuteur, MD
            June 23, 2016 at 12:11 pm #

            Thanks for proving the point I made in yesterday’s post: Women don’t understand the risks? http://www.skepticalob.com/2016/06/women-dont-understand-the-risks.html

          • Roadstergal
            June 23, 2016 at 12:18 pm #

            How does that risk of death to your baby-to-be compare, numerically, to the risk of death to your baby from driving drunk with babe in the car?

          • Azuran
            June 23, 2016 at 12:42 pm #

            I guess I should stop wearing my seat belt then.

            Seriously, a 0,6% chance of CATASTROPHIC outcome is really high, Catastrophic means death or severe brain damage. And your risk of rupture is actually 1.8%, and any rupture = emergency c-section. So it’s a 1.8% chance that you are going to need a crash c-section. There is no way for your OB to actually even know if your rupture is catastrophic before he’s actually doing the c-section and looking at your uterus.

            Would you shot your baby with a gun that had a 0,6% chance of having a bullet in it? Because that’s what you are doing.

          • Roadstergal
            June 23, 2016 at 12:45 pm #

            Or would you shoot your baby with a gun that had a 1.8% chance of having a bullet in it, and a 0.6% chance of being aimed at a vital organ…

            This isn’t even getting into the odds of a non-rupture event that would require a C-section. Those risks are lower, of course, which is why the hospital doesn’t require an epidural in place for every laboring woman – but those risks are _on top of_ the rupture risk.

          • guest
            June 23, 2016 at 10:32 am #

            But why do you think the hospital has that policy? Because they think it’s fun? Or because their risk assessment analysis shows that it’s not safe to do a VBAC without “a,b,c” in place?

          • Molly B
            June 23, 2016 at 10:56 am #

            Doc said it is because docs have more control over a cesarean and its harder for.people to sue when something goes wrong

          • Charybdis
            June 23, 2016 at 12:35 pm #

            I doubt you would even hear them or register the fact that a repeat CS is safest for you and the baby, if they have said that.

            And yes, AMA is a legal condition for certain medical situations. Situations where the doctors have explained all the risks of certain actions (leaving the ER to go home after a heart arrythmia that has not been explained, refusing care strongly recommended by the doctor/doctors, opting for non-intervention in whatever medical issue is going on, etc) and stressed that Very Bad Things can (not necessarily WILL) happen, up to and including death or permanent disability, but that you (general you) accept these potential outcomes and are rejecting/opting not to follow the best medical advice they can give. Because you do have a right to decline medical attention, as an autonomous person.

            But they also have the right to document your (again, general your) refusals for treatment, state that they will care for you if certain conditions are met that will reduce their liability if things go very, very wrong. Then they can show that they counseled the patient about what to expect with refusing treatment, explained how things could go awry, and explained why they were recommending the treatments they felt were best for your situation.

            You stated that you regularly cross out things you are not agreeing to on consent forms. The doctors and hospitals also have that right. They can stipulate what they are not willing to agree to. You just don’t like it when your method is turned back on you.

          • Erin
            June 23, 2016 at 10:17 am #

            I feel a bit sorry for her actually. Having to fight for the birth plan which best protects my mental health and still feeling that I can’t just relax even though they’ve put it in writing that I can have a general anesthetic is horrible so I sympathize with her situation. However her forum manner would possibly be more suited to the average competitive gaming forum.

          • guest
            June 23, 2016 at 10:30 am #

            I am laughing over the fact that she wants to choose a much riskier form or birth than a c-section, but she’s balking at the minuscule risk of an epidural.

            Earth to Molly: Foregoing the epidural doesn’t offset the risk of a VBAC. Let it go already.

          • Daleth
            June 23, 2016 at 10:03 am #

            An 0.6% chance of a catastrophic rupture means you have a 1 in 167 chance that your baby will be killed or catastrophically brain damaged. With over three million babies a year being born in the US, and 30% of them (about 900,000) being born by c-section–in other words, 900,000 women whose next babies will be born via repeat CS or VBAC–that adds up very, very fast.

            How fast? Let’s say only 10% of those 900,000 women–so, 90,000–go on to have another baby, and only half of them (45,000) decide to VBAC. Do the math (divide 45,000 by 167): that means 270 babies die or are catastrophically brain damaged who would have been perfectly healthy if mom had chosen a repeat CS.

            Do you see why doctors generally prefer repeat CS over VBAC? They don’t want your baby to be killed or brain damaged. They also don’t want to be sued, but they wouldn’t be sued in the first place unless your baby was killed or brain damaged. That’s what they’re trying to avoid, and surely that’s your goal too? So why are you mocking them and feeling so hard done by just because they’re trying to keep your baby from being hurt or killed?

            As for the epidural not being “unmedicated ‘just in case,'” that is because if you rupture there isn’t time to go from zero anesthesia to surgical-level anesthesia before the baby is severely compromised or dead. You have to already be most of the way there, anesthesia-wise. The only alternative is putting you under general anesthesia, which out of everything that can happen during an operation is the single thing most likely to kill you. Not to mention, general anesthesia knocks the baby out too, so there can be breathing issues etc. when it’s born.

          • The Computer Ate My Nym
            June 23, 2016 at 10:20 am #

            Not to mention that if there is a catastrophic rupture, the patient is highly likely to need blood and fluid immediately and a hysterectomy as soon as possible. Trying to anesthetize a woman who is bleeding to death from a bad uterine rupture and has no anesthesia at all does not sound to me like a good time.

          • Molly B
            June 23, 2016 at 11:08 am #

            “How would have been perfectly healthy if deliver by section”
            You can not guarantee that a baby born by cesarean, especially repeat cesarean will be perfectly healthy. Surgery has its own risks.to mom and baby including uterine rupture (shocking!!!) hysterectomy and death….sounds familiar….

          • Daleth
            June 23, 2016 at 11:58 am #

            C-section does carry risks for mom (although planned CS is much safer for her than emergency CS), but the only risk that a c-section poses to the baby is being nicked by the scalpel.

          • Roadstergal
            June 23, 2016 at 12:02 pm #

            The risks of epidural and C/S (miniscule for the former, much lower if planned vs emergent for the latter) are all risks to the mom. The risks of rupture are to the mom and the baby, but worse for the baby (brain damage and death). So stop trumpeting about how much you care about the baby-to-be and what nonexistent effect that miniscule amount of epidural medication that might cross over is. You want to put all of the risks off of you and onto your future baby.

          • MaineJen
            June 27, 2016 at 5:55 pm #

            I love how you are blithely dismissing the 0.6% chance here. That’s not insignificant. And um…even a “non catastrophic” uterine rupture is…not good. You know that, right?

            Listen, it’s not about a mean lawyer breathing down anyone’s neck. It’s about a doctor being afraid for your safety. There’s obviously a very good reason that the first THREE doctors didn’t think you were a good vbac candidate. And we’ve already laid out the reasons why preemptive anesthesia is a good idea in your case. So…what’s the issue?

          • Molly B
            June 23, 2016 at 9:42 am #

            A patient asserting their right to refuse treatment or procedure they do not want is not treating anyone like a short order cook. Employment should require a medical professional to usurp a patients rights, its unethical.
            Doc didnt say it was against HIS judgement, it was against hospitals legal departments judgement.

          • The Computer Ate My Nym
            June 23, 2016 at 9:54 am #

            You have the right to refuse any medical treatment you wish to refuse. This is absolutely true. However, the more restrictions you put on your care, the harder you make it for your provider to take care of you, especially in an emergency situation and the more you increase your risk of unnecessary problems.

          • guest
            June 23, 2016 at 10:27 am #

            “I’ll have a VBAC but hold the epidural” is indeed treating doctors like short order cooks.

          • Molly B
            June 23, 2016 at 11:02 am #

            I would like to vbac but I dont want an epidural is laid.out in my.patient rights per the hospital!!! It’s my legal right per federal law!!! It’s not treating anyone like a short order cook! It’s saying that I have a legal right to choose what is and isn’t done to my body and exercising those rights!

          • guest
            June 22, 2016 at 10:39 am #

            You weren’t forced to have an epidural. You were told that no doctor was willing to risk a crash section with no anesthesia whatsoever given your high risk. You still had the option of choosing homebirth, choosing a scheduled c-section, or having the epidural line placed. You also had the option of not having another baby if you didn’t like any of these options.

            But one option you should never have is to force a doctor to perform a procedure in a way they consider unsafe. It goes against their ethics, and usually the terms of their insurance.

          • MaineJen
            June 22, 2016 at 4:27 pm #

            Molly, did it ever occur to you there might be a good reason for this? In the event of uterine rupture, just to name one example, they are going to want to go straight to c section, do not pass go. Having an epidural already in place is good common sense, and probably hospital policy.

            Why are they worried about uterine rupture? It’s rare, but it usually doesn’t turn out well for the baby when it does happen.

            They want you to have an epidural for the same reason they want women to do their vaginal twin deliveries in the operating room…things can and do go wrong, and they really, really want everyone to come out of this alive.

            These things are not decided on capriciously. They are in place for good reason.

          • Charybdis
            June 22, 2016 at 5:03 pm #

            No, apparently it is all just to piss her off and inconvenience her edumacated self.

          • guest
            June 22, 2016 at 5:51 pm #

            And even with the requirement that I deliver in the OR, I was allowed to labor in the rooms the other women got. I mean, otherwise I’d’ve tied up the OR for hours.

          • Azuran
            June 22, 2016 at 4:59 pm #

            Except that they are not forcing ‘pain relief’. They are taking precautions so that if things go south, they can save yours and your baby’s life with minimum risks.
            What next, are you going to complain that doctors are forcing epidurals or general anaesthesia before a c-section?
            I guess my mom should have been offered the possibility of standing very still while they did vascular surgery in her brain instead of ‘forcing’ general anaesthesia on her.
            It’s horrible that I wasn’t offered the possibility of biting a stick really really hard when they repaired my open arm fracture and was instead ‘forced’ to have general anaesthesia.
            Maybe I should give pet owners the options of holding down their pets while I do surgery on them, instead of ‘forcing’ general anaesthetist on them. (and yea, I’m bringing up the fact that I’m a vet just because I know how much you like it)
            For someone who cared so much about opioids crossing the placental barrier, you really don’t seem to be that worried about needing an emergency general anaesthesia if things go south.
            Do you even realize how ridiculous and clueless you are?

          • Linden
            June 23, 2016 at 8:56 am #

            http://www.medscape.com/viewarticle/828860

            http://www.ncbi.nlm.nih.gov/pubmed/14995921

            Those are literally the first two links when I googled this. DrAmy also pointed at the following:
            http://journals.lww.com/anesthesia-analgesia/Fulltext/2014/08000/Epidural_Labor_Analgesia_Is_Associated_with_a.21.aspx

            After all, there seems to be better evidence pointing to this effect, compared to your non-existent numbers for epidural risks for babies.
            After all, there seems to be better evidence pointing to this effect, compared to your non-existent numbers for epidural risks for babies.

          • Daleth
            June 23, 2016 at 10:11 am #

            Thanks, Linden. I’m just going to re-post those links with the titles of the studies, so that MollyB and others can see what they say without even having to click:

            Postpartum Depression: Epidural During Birth May Reduce Risk
            http://www.medscape.com/viewarticle/828860

            Does pain relief during delivery decrease the risk of postnatal depression?
            http://www.ncbi.nlm.nih.gov/pubmed/14995921

            Spoiler: the answer to the question posed in the second study is yes. Quote: “The adjusted risk of depressive scores at the first postnatal week was
            decreased in the epidural/paracervical group when compared with no analgesia group
            … Elective or emergency cesarean section did not increase the risk of high [depression] scores at the first week or at 4
            months postpartum.”

          • Molly B
            June 23, 2016 at 11:10 am #

            Those two links are about postnatal maternal depression LOL

          • Linden
            June 23, 2016 at 11:35 am #

            Those two links are exactly about what you said was bullshit: the link between PPD and inadequate pain relief.
            You must have the memory of a goldfish.

          • Daleth
            June 23, 2016 at 12:04 pm #

            Those two links are about postnatal maternal depression

            Right, because that’s what we are talking about. You said it was, quote, “a load of bull” that epidurals (adequate pain relief) can reduce the rate of PPD (postnatal maternal depression). I posted links showing that it was true, not a load of bull at all.

          • AllieFoyle
            June 14, 2016 at 4:44 pm #

            I’m all for informed consent, but I don’t know why you are focused on epidurals in particular. I’d say the most thorough informed consent processes I went through were for surgical procedures and anesthesia — which I imagine would be just like those for getting an epidural. In contrast, there was absolutely nothing about the risks of childbirth — just a blanket form authorizing care in the most generalized way, certainly nothing about options or risks vs. benefits of various courses of action. I’d like to see women better informed about all aspects of childbirth, especially the risks of forgoing interventions and the benefits of accepting/requesting them, but what you seem to be advocating is just that we tell women frightening things about epidurals that aren’t even true and ignore all the rest.

          • Sarah
            June 13, 2016 at 1:16 pm #

            Actually, a great many people are saying that.

            And the problem with some of the rubbish you’re peddling is that it has the potential to lead both women to refrain from pain relief when they might otherwise want/need it, and clinicians to be reluctant to administer it to a woman who wants it. There is, unfortunately, a problem with epidural denial. I’ve been there/

          • Molly B
            June 14, 2016 at 1:31 am #

            If its rubbish then provide sources to refute it.

          • Linden
            June 14, 2016 at 11:24 am #

            *You* provide the source that says epidurals harm babies. You haven’t yet. Specify your metrics. Increase in risk of death in micromorts. Difference in apgar scores. Specify how much discomfort should be enforced on women to mitigate whatever risk you come up with.

          • Sarah
            June 14, 2016 at 2:30 pm #

            I think you’ll find the onus is, in fact, on you to provide reliable sources to confirm it. Something you haven’t done very well at so far.

          • Charybdis
            June 14, 2016 at 1:54 pm #

            But somehow you think women are being tricked or forced into epidurals by medical staff and do not listen to the woman in question. Or you don’t like the fact that epidurals are a pain relief option, or that maybe the medical staff will ask several different times about your pain level and if you would like something for the pain. Because people’s minds can change and because they said “absolutely not” in the beginning does not mean that several hours later they will still refuse pain management.

            You are evaluated and assessed throughout your labor and because things can change, including the mother’s thoughts on pain relief. You can continue to refuse any and all pain control options each time they ask.

          • Molly B
            June 12, 2016 at 4:25 pm #

            There are many things that can cause a longer or more painful labor for a mother. The use of epidural or narcotic medications in labor is a personal choice.

          • Nick Sanders
            June 12, 2016 at 6:06 pm #

            A choice you seem absolutely determined to scare or browbeat them into turning down.

          • Molly B
            June 13, 2016 at 7:31 am #

            And a choice that you seem to insist is perfectly safe and browbeat me into changing my view on. Are you not here doing the exact same thing for the other side of the podium?

          • Nick Sanders
            June 13, 2016 at 3:34 pm #

            “Perfectly safe”? No, nothing is “perfectly” safe. What I am here to say is that the numbers do not bear out your nonsensical claims that epidurals are evil and the US should stop giving them.

          • Molly B
            June 14, 2016 at 12:50 am #

            What is nonsensical is you claiming that I stated epidurals were evil and the US should stop giving them. I have never said either one of these things. It’s sounds to me like you are running out of logical arguments and reverting to childish antics and false generalizations

          • Heidi_storage
            June 13, 2016 at 2:06 pm #

            Absolutely. I see no one on this thread arguing that we should force epidurals on all laboring women.

            Personally, I suspect my epidural did slow down both my labors. Which was fine–the delay was only a couple of hours, and instead of being in agonizing, debilitating pain, such that I felt like some external force was possessing me, I was able to rest and enjoy the impending arrival of my babies. I actually did have a complication with my first epidural–my blood pressure plummeted briefly (kid was okay)–and my second took a couple of tries to insert. I am aware of the risks, and remain a huge fan.

          • Molly B
            June 14, 2016 at 1:42 am #

            Still standing on my feet.

          • Monkey Professor for a Head
            June 14, 2016 at 2:31 am #

            And you have not yet addressed the question. The fact that you are attempting to brush it off without an answer makes me think that you do not have a good comeback.

          • Molly B
            June 14, 2016 at 2:39 am #

            No I answered it one comment down. Your question was a bit moot as the answer is obvious.

          • Monkey Professor for a Head
            June 14, 2016 at 2:54 am #

            I read that, I just don’t consider that to be an adequate answer. You were either trying to dodge the issue or you did not understand why the question was being asked.

            The point Box of Salt is making is that studies done on epidurals (which are not randomised control trials) are prone to confounding factors. If a woman is experiencing an especially painful or long labour due to a suboptimal baby position, they will be more likely to request an epidural and are more likely to require intervention. Therefore there will seem to be a correlation between epidurals and complications, but that does not mean that the epidural caused the complication.

            From a study design point of view, the best way to determine if there is a link or not would be to randomise women to either receive or not receive an epidural. However there is a big ethical problem with either refusing or enforcing pain relief for a woman in labour. In fact the study that you posted states in its introduction that previous randomised control trials did not show an association between epidurals and sections, but were hampered because of the high rates of crossover between groups.

          • Monkey Professor for a Head
            June 12, 2016 at 3:15 pm #

            Milky B, might I suggest you check out the link to the adequate mother in the sidebar. It has a series of articles written by an anaesthetist who runs through all the evidence on the potential risks of epidurals.

            I would also point out that all pain medication has side effects. However the benefits of providing pain relief in many cases outweigh the risks. Would you argue against giving pain relief to someone with a broken bone or a kidney stone? Also most side effects of opiates are dose dependent. The beauty of an epidural is that it enable a doctor to provide excellent pain relief with a much smaller dose compared to oral or IV opiates.

            Informed consent is important, but women need to be given accurate information, which is not what you are providing. And if they choose to have an epidural (as long as there are no medical contraindcontraindications), it should be provided promptly and without any negative moral judgement.

          • Monkey Professor for a Head
            June 12, 2016 at 3:28 pm #

            Molly B, damn autocorrect!

          • Molly B
            June 12, 2016 at 4:30 pm #

            I will look into articles.you mentioned. As for the argument of pain relief in regard to someone with a broken bone or kidney stone…
            #1 Are they pregnant? If so this should influence the pain relief measures used.
            #2 If they are not pregnant then your argument is invalid as my point is the effects to the fetus either directly or indirectly.

            What is not accurate about the information I am stating?
            Narcotic, including those given in a epidural or spinal cross the placental barrier.
            Any narcotic provided to a mother at any time.in her pregnancy including during labor has direct or indirect risks to the fetus.

          • Monkey Professor for a Head
            June 12, 2016 at 5:16 pm #

            If a woman is pregnant and suffers from, for example, a broken bone, then as a doctor I would take it into account when recommending options for analgesia, but I would not withhold pain relief solely on the basis of pregnancy. How much should a woman suffer to avoid a small risk to a baby?

            When you talk about opiates being teratogenic and when you talk about risks of addiction, you are providing inaccurate information.

            With an epidural, the amount of opiate that will cross the placenta is tiny. As I said, most risks of opiates are dose dependent.

          • Molly B
            June 13, 2016 at 7:33 am #

            As i have REPEATEDLY stated the article on addiction was solely to point out to one person that the medication does pass the placental barrier

          • demodocus
            June 13, 2016 at 10:30 am #

            I think their point is that it’s not much and not long. If we’d gotten into an accident on the way home and the newborn broke a bone, I’d expect they’d give her effective pain relief the same way they did for her toddler brother last summer.

          • Molly B
            June 14, 2016 at 1:39 am #

            For the sake of argument lets say the bone was not an open fracture and did not require surgery. Would you want them to provide opiods for your newborn? If it was an open fracture or required surgery would you want to be fully informed.of all the risks.and benefits to opiod medications for your newborn if that was the doctors recommendation?

          • Charybdis
            June 14, 2016 at 10:00 am #

            You bet your ass I would want pain management, even in the form of opioids for my newborn (or any child, regardless of age) if they had a broken bone or had required surgery for anything. Just because they are a newborn does not mean they cannot feel pain from surgery or a broken bone and they deserve to not be in pain while they are healing.

            I am guessing you wouldn’t or would refuse it if offered by the doctors until you had thoroughly researched it, discussed it to death on teh interwebs and agonized over the decision while your child was suffering? Or would you just tape an aspirin to it and hope for the best, as no opioids would then enter your child?

          • demodocus
            June 14, 2016 at 12:37 pm #

            Hell yes, i’d consent to opiods if recommended. I saw how much pain her brother was in when his leg was broken in an accident when he was 1. The bone didn’t poke out, but he was in agony, and they gave him oxycodone for the first several days. They have to anestetize toddlers to put the spica cast on, too. We were as fully informed as distraught parents can be. This is not a theoretical question for me.

          • Molly B
            June 21, 2016 at 12:24 am #

            So child didn’t just fall of the slide at playground and fracture bone. You are talking about a child who was in an automobile accident, had a severe I would assume femur break and if.in spica cast likely required femur to be manipulated back into correct position at break. Yeah that quite a bit more substantial than a simple.break

          • Who?
            June 21, 2016 at 1:04 am #

            What difference does it make? Child in pain equals child who needs pain relief. Qualified medical professionals advise on likely pain levels, what drugs will do what job, and what risks/benefits each have. Then the parents make a choice.

            Like adults, some kids are stoic, some are more demonstrative. The stoic child needn’t be left in pain, and the demonstrative one doesn’t need panadol every time they break a nail.

            Why would a parent choose to leave a child in agony, however the injury was caused, where there is relief at hand?

          • Molly B
            June 21, 2016 at 10:43 am #

            Not every level of pain requires a narcotic.

          • demodocus
            June 21, 2016 at 11:02 am #

            Of course not, but in my original statement I said if the docs recommended it. They most certainly did in my toddler’s case, and they hardly recommend against it in the case of labor.

          • Molly B
            June 21, 2016 at 11:08 am #

            But not everyone perceives their own individual pain the same way. If a woman want pain relief OK if she doesn’t OK. A doc shouldn’t pressure her either way

          • Charybdis
            June 21, 2016 at 12:18 pm #

            Asking if a woman wants pain relief periodically during labor is *not* pressuring her into having some. Pain levels change, pain perception changes, it might not be *bad* pain, but the mother is tired of feeling it now all can certainly happen during labor.

            Asking about or reminding the mother that there is pain relief of varying degrees available to her is not pressure. It is an evaluation of the mother’s pain level and if she wants pain relief, fine. If she doesn’t at that point, that’s fine too. But she will get asked about it several times as things change. Doesn’t make it pressure to have pain relief.

          • guest
            June 21, 2016 at 12:06 pm #

            The problem is the word “requires” here. Most injuries don’t “require” pain control. We do it because it’s cruel to make someone suffer unnecessarily, not because the pain has adverse effects (though in extreme and chronic cases, of course, it does that too).

          • Molly B
            June 21, 2016 at 12:19 pm #

            Requite is appropriate if you read the entire statement. That not every injury requires Narcotics.

          • guest
            June 21, 2016 at 3:10 pm #

            No, it doesn’t make sense. No injury “requires” narcotics. But it’s unethical to withhold them from patients who would benefit from them.

          • Roadstergal
            June 21, 2016 at 3:20 pm #

            Hell, my collarbone break didn’t ‘require’ surgery. But it had a great deal of utility for me in terms of reduced pain, increased mobility, and good long-term outcomes. You can’t just say a baby emerged in the absence of pain relief and determine pain relief wasn’t necessary. There’s more to it than that.

          • Irène Delse
            June 21, 2016 at 1:56 am #

            You must be joking, right? Why does it matter how the accident was caused? A broken bone is a broken bone. And if you think a “simple” break (I presume you mean without displacement) doesn’t hurt, well, think again.

          • Molly B
            June 21, 2016 at 10:42 am #

            It’s not that it doesn’t hurt, its about the degree of pain. Would you take.narcotics for a simple headache? No. Would you take narcotics for a.severe persistent headache that was excruciating? Maybe.

          • Charybdis
            June 21, 2016 at 11:31 am #

            But an infant cannot use words to tell you how much pain they are in. They can only cry, fuss, scream, etc. It is difficult to determine the degree of pain they would be in. Laughing, giggling, smiling, cooing – probably not a great deal of pain. Crying, screaming, fussing, restless- probably *some* pain. Crying and screaming inconsolably -probably a *great deal* of pain.

            I have mixed tension migraines, along with “plain” migraines. I manage every headache I have like it is a mixed tension migraine, and that involves using a Schedule IV controlled drug. So, yes, I DO take narcotics for a ‘simple” headache.

          • Molly B
            June 21, 2016 at 12:23 pm #

            A plain.migraine is not a simple headache. That is stupid to say it is. That is saying that all headaches are migraines

          • Irène Delse
            June 21, 2016 at 12:37 pm #

            Except that Charybdis never said that migraines are the same as headaches. Try reading what people write, not what you think they wrote.

            Also, lecturing someone who has migraines on what migraines are is, shall we say, misguided.

          • Molly B
            June 21, 2016 at 12:53 pm #

            She implied it “I have mixed tension migraines, along with “plain” migraines….So, yes, I DO take narcotics for a ‘simple” headache”
            By referencing a Plain Migraine as a Simple Headache

          • Charybdis
            June 21, 2016 at 1:15 pm #

            I implied no such thing, nor did I refer to a Plain Migraine as a Simple Headache.

            Mixed tension migraines, at least in my case, start as a “simple” tension headache that morphs into a migraine. My “plain” migraines the classic variety that are preceded by a prodrome period and an aura that starts small, then grows to seriously impair my vision. I don’t have any way of knowing if a tension headache will morph into a migraine, so I treat ALL my “simple, tension-type” headaches as potential migraines and take the appropriate medication.

            Most people consider a tension headache to be a “simple” headache, so I was stating that I do, in fact, treat my “tension/simple” headaches like migraines and take appropriate medication. The OTC Excedrin Migraine crap might as well be M&M’s for all the good it does me. Schedule IV for me!

          • Molly B
            June 21, 2016 at 1:17 pm #

            You said that you get tension migraines and plain migraines. That you treat both the same and so YES you do you narcotics for simple HEADACHES (you said headache, not migraine, this is saying that a simple migraine is the same as a simple headache)

            Your new clarification of the fact that you treat these simple headaches as potential migraines was not what you had stated before.

          • Charybdis
            June 21, 2016 at 9:02 pm #

            “I have mixed tension migraines, along with “plain” migraines. I manage every headache I have like it is a mixed tension migraine, and that involves using a Schedule IV controlled drug. So, yes, I DO take narcotics for a ‘simple” headache.”

            That up there is copied and pasted from my first post. I do believe it says that I do, in fact, treat every headache as a potential migraine. Or, in other words, I do not wait to see if it will turn into a migraine before grabbing the Schedule IV controlled drugs.

          • Who?
            June 21, 2016 at 9:26 pm #

            Our Molly regularly misquotes then misrepresents. It may be that her attention to detail is sloppy.

          • Molly B
            June 21, 2016 at 1:40 pm #

            Since when do most people consider a tension headache and simple headache to be the same? Tension headaches are not the same as your run of the mill everyday headache.

          • Monkey Professor for a Head
            June 21, 2016 at 5:37 pm #

            Tension headaches are the most common kind of headache. So yes, most people would consider tension headaches to be simple run of the mill everyday headaches.

          • Molly B
            June 21, 2016 at 1:38 pm #

            You are absolutely correct! And that is the point. Not every injury has the same pain level and therefore not every pain requires the same pain relief.

          • Irène Delse
            June 21, 2016 at 12:57 pm #

            ” It’s not that it doesn’t hurt, its about the degree of pain. ”

            Do you think it never occurred to nobody but you? Do you think women who do want epidurals don’t understand this,?

            And why do you switch from fractures to headaches as a comparison? Oh, yes, because the idea of a “simple fracture” as something that doesn’t hurt much has been exposed as a crock. So now you fall back to “simple headache” – as if being “simple” meant “not very painful”.

            Well, sorry to burst your bubble, but one can have terrible headaches that aren’t migraines and for which some people require narcotics, while some may prefer forgo them. The thing is, it’s *not* for you to decide. Strange, btw, how you go on and on about informed consent, but dismiss the pain of others! Child with a fracture? Not a big deal. “Excruciating” headache? Narcotics “maybe”. And comparing the pain of childbirth to a moderate headache is just plain ridiculous.

          • Molly B
            June 21, 2016 at 1:36 pm #

            The reference to the headache was to make a point about the broken bone argument someone brought to me. I tried to state that not every broken bone requires narcotics and that was apparently not understood so i referenced a headache to see if that would be more understandable.

          • AllieFoyle
            June 21, 2016 at 1:19 pm #

            I have never had a headache that was anywhere approaching the pain level of childbirth. Just equating the two makes your understanding of the potential pain involved suspect. You said you’d had a c-section, birth w/ epidural, and VBAC. Does that mean you’ve had ONE birth w/o pain meds? Why on earth would you think that your ONE experience means anything about the level of pain that other women may experience?

          • Molly B
            June 21, 2016 at 1:33 pm #

            The headache reference was to make the point for the argument brought to me by someone else about narcotic pain relief for a broken bone.

          • Empliau
            June 21, 2016 at 4:21 pm #

            Well, everybody is different – I had a precipitous childbirth, therefore unmedicated (they won’t give you an epidural at 10 cm). Two hours of pushing were extremely painful, but I’ve had many migraines worse than giving birth. The worst was five days in agony hiding in a darkened room. I’ve also had cluster headaches, which are their own special circle of hell. A reasonably short VB without serious complications was much easier than some of the headaches, and that is not saying that childbirth wasn’t painful. In the modern world, childbirth ends sometime (you never know when a migraine or cluster headache will end) and at the end you get a baby.

          • Empliau
            June 21, 2016 at 4:33 pm #

            Sorry – a lot of fellow migraineurs on the thread. I should finish reading, as it was already addressed, before I post.

          • AllieFoyle
            June 21, 2016 at 5:16 pm #

            I can’t even imagine a headache that could come close to the pain of childbirth, but I suspect that’s because I’ve been lucky in the headache department and unlucky in the childbirth department. I’d never dream of telling people that their migraine pain doesn’t require medication though. How would I know?

          • Empliau
            June 21, 2016 at 5:25 pm #

            I know – I’m sorry, tone is always a problem. I didn’t mean to imply that you were saying migraine doesn’t require medication, only that for some of us it’s equivalent or worse. (I am not sure I would say that the two hours of pushing were worse than migraine, as it was many years ago. But the first stage of labor was definitely *way* easier than the usual migraine. ) Sadly, the migraines are still a frequent feature of my life, so that pain is more vivid.

          • Roadstergal
            June 21, 2016 at 5:28 pm #

            I had a boss who had cluster headaches that would get so bad, he’d have to lie motionless in his home with the windows darkened to be able to bear it at all. He was on warfarin to try to control it, speaking of meds with side effects… yeah, I can’t imagine.

            (He was a neurologist, ironically enough. Like how my immunology professor had vitiligo.)

          • guest
            June 23, 2016 at 10:19 am #

            Well, thank goodness I don’t get a baby at the end of every headache. I generally support women having as many babies as they like, but I still have to draw the line at 500+.

          • Empliau
            June 23, 2016 at 12:39 pm #

            Amen, sister.

          • Molly B
            June 21, 2016 at 12:29 pm #

            When she said accident and stated injuries I assumed it was a car accident and that would mean factoring in other things and other injuries that would lead doctors to recommend certain pain relief measures

          • momofone
            June 23, 2016 at 2:23 pm #

            You seem to assume a lot.

          • Charybdis
            June 21, 2016 at 9:24 am #

            Even a “simple” break hurts like hell. Even with children and babies who are more likely to have a “greenstick” fracture, it still hurts. I would rather have the medication on hand and not need it than to realize that you need it at 1:30 in the morning on a weekend.

            Or does pain to a baby not matter?

          • Molly B
            June 21, 2016 at 10:28 am #

            The question raised wad not having whether or not to yo have meds on hand. It wad whether or not they are always necessary. So thanks for your response and statement that you would.want them.on hand just in case, meaning they may not be needed

          • Charybdis
            June 21, 2016 at 11:20 am #

            Let me rephrase then. HELL YES I would want effective opioid pain meds for my infant/child if they had a broken bone. I would give them for the first few days and then see how things were going. I would rather be safe (relieving pain) than sorry (not relieving pain) in a preverbal infant/child. If, after the first couple of doses, the baby/toddler in question doesn’t seem to be painful or uncomfortable, then I would consider skipping a dose or two.

            I have an outrageously high pain tolerance myself; I would not assume that my baby had the same. So yes, take home opioid pain meds after being discharged from the ER, where they would have given adequate pain relief. When that began to wear off, I would give an appropriate dose of the take-home prescription, I wouldn’t wait to see if “they were needed” at that point in time. I *know* they are needed, and as a parent, I would make the appropriate decision and medicate my child because BROKEN THINGS HURT, NO MATTER YOUR AGE.

          • demodocus
            June 21, 2016 at 10:49 am #

            Actually, the accident in question *was* at the playground. I tripped over the slide while carrying him, landed with one hand on his leg, and snapped his femur. There are reasons why I’m on zoloft.

          • Molly B
            June 21, 2016 at 10:59 am #

            Ok a femur being snapped in half is not the same as a hairline fracture or a green stick. That’s what I was saying. Pain relief depends on pain level.

          • MaineJen
            June 20, 2016 at 6:05 pm #

            For a broken bone? Hell yes. I don’t want my baby to be in unnecessary pain, thanks.

          • Molly B
            June 20, 2016 at 7:22 pm #

            Yes, but that doesn’t mean something as strong as an opiod would be necessary to relieve the pain.

          • demodocus
            June 20, 2016 at 7:27 pm #

            For a broken bone? You must have an extraordinarily high pain tolerance. My toddler doesn’t.

          • Charybdis
            June 21, 2016 at 9:18 am #

            What do you think would be adequate to relieve the pain of a freshly broken bone? Because ice, elevation and a couple of Tylenol or Motrin aren’t going to cut it.

            Broken bones HURT (for the record, I’ve broken 2 in my entire life: compression fracture in my left wrist in college and broken coccyx last year). Both required opioid pain meds for several days. Why would you want your baby to suffer?

          • Molly B
            June 21, 2016 at 10:33 am #

            Not all broken bones require narcotics. Severe breaks, yeah probably. I.have never had a severe break so I cant say from personal experience. I have broken multiple bones including my ankle at age 3 and left the hospital in a walking cast and walked to the car with the help of my mother for balance. No narcotics. It was ibuprofen and elevate.
            The question originally raised was about broken bones in general. That is a very broad statement encompassing a wide range of bones and breaks. That being said I stand by my remarks.that NO narcotics are not necessary in every situation.

          • Monkey Professor for a Head
            June 21, 2016 at 10:18 pm #

            Paracetamol can cause liver failure. Non steroidal anti inflammatories can cause renal failure. Of course these things are rare when used at appropriate doses for a short period time in patients without underlying contraindications. But still, better be safe and not treat the pain.

          • Charybdis
            June 22, 2016 at 10:02 am #

            NSAIDS can also cause gastric bleeding….

          • Molly B
            June 14, 2016 at 1:41 am #

            Labor can last for days requiring multiple doses of pain relief medication, in the case of this argument, opiods.

          • Nick Sanders
            June 14, 2016 at 1:49 am #

            Actually, by arguing against epidurals, you are effectively arguing for opioids, as IV opioids are the next most effective pain relief, if what I’ve read is correct.

            The primary pain relief from epidurals doesn’t come from opioids, but from anesthetics.
            http://americanpregnancy.org/labor-and-birth/epidural/
            http://www.acog.org/Patients/FAQs/Medications-for-Pain-Relief-During-Labor-and-Delivery

            Morphine:

            In recent years, morphine has not been routinely used as a method of pain relief during labor because it has been found to depress the baby’s ability to breathe.

            http://americanpregnancy.org/labor-and-birth/narcotics/

          • Molly B
            June 14, 2016 at 1:54 am #

            Arguing against lack of informed consent and full disclosure in relation to epidurals is not arguing for IV opiods. That like saying arguing against 2% Milk is arguing for all other forms of dairy. You are ridiculous. Also not routinely used doesn’t mean NOT USED.

          • Nick Sanders
            June 14, 2016 at 1:59 am #

            If you think you aren’t de facto arguing for opiates, let me ask you this, what do you expect to happen to all those women who decide not to get an epidural because you have scared them away from them? Because most of them are NOT going to opt for an unmedicated birth, they’re still going to want something to help with the pain.

          • Molly B
            June 14, 2016 at 2:04 am #

            Have you conducted a survey? Are you saying that women have told you they are.scared to get an epidural because of.what I have posted? You have asked me to sight sources for my statements and I have done that. One woman may be scared another woman may decide to go ask her doctors opinion another may choose to do her own research, yet another may feel the benefits to her outweigh the risks. Who are you to say what anyone else thinks?

          • Molly B
            June 14, 2016 at 2:06 am #

            I am not arguing for IV opiates. AGAIN.i am.arguing for full.disclosure being given to women. I have not stated the benefits in my argument simply because this seems to be.well.known. Great pain relief, when they work properly.

          • Charybdis
            June 14, 2016 at 1:46 pm #

            All righty then. How about, in the interests of full disclosure and informed consent, that people be told about all the potential negatives of vaginal delivery: pelvic floor damage, 3rd and 4th degree perineal tears, excruciating, unrelenting pain, infections to mother and baby, shoulder dystocia and associated issues (Erb’s Palsy, broken clavicle for baby), cord prolapse, placental abruption, uterine atony, varying degrees of PPH, cervical lacerations, broken coccyx, broken pelvis, nuchal cords, bladder prolapse, rectoceles, retention of the placenta, oxygen deprivation to the baby, tearing “forwards” through your clitoris, amniotic embolism, aneurysm, and death.

            If these potential outcomes were not presented by your doctor and thoroughly discussed so that you understood the things that *could* go wrong during a vaginal delivery, then you, by your standards, could not have given informed consent for a vaginal delivery of your baby. Horrors!

            It is still not clear how you think informed consent is missing in regards to an epidural. It is discussed with you by the nurse/doctor and again by the anesthesiologist when they come to place the epidural. They tell you what is going to happen, how they will proceed, along with any potential risks and side effects and how those will be addressed if they occur. Just because *you* don’t like how it is done, or think it should be done differently doesn’t mean the doctors are coercive or negligent.

          • Nick Sanders
            June 14, 2016 at 1:51 pm #

            Did you leave fistulas off that list, or are they there under a name I didn’t recognize?

          • Charybdis
            June 14, 2016 at 1:57 pm #

            Probably, although I didn’t mean to. Don’t they result from a 3/4th degree tear that heals improperly (no stitches). I listed those, but not fistulas specifically.

          • Nick Sanders
            June 14, 2016 at 2:04 pm #

            I don’t remember off the top of my head what causes them, only that first world medical care almost (but not entirely!!1!) eliminates them.

          • Molly B
            June 21, 2016 at 1:24 pm #

            I researched and spoke with my doctor before each birth. My doctor did tell me the risks of vaginal/cesarean/medicated/nonmedicated to what i thought was full disclosure ( i was very young at the time) and yes you are correct i was not given full disclosure about each birthing option and med vs non med.
            This is my point. That women should be full informed by doctors. Most women see a doc for months! There is no reason why Doc cant take some time at each appt to discuss risks and benefit in full over the course of the pregnancy

          • AllieFoyle
            June 21, 2016 at 1:44 pm #

            I would love to see more women being fully informed about the various risks in childbirth. The risks involved in epidural anesthesia though are probably among the most discussed and consented. If you were truly concerned with informed consent you would also be concerned about the risks of childbirth that don’t have to do with interventions, as listed by Charybdis above. The fact that you don’t, and are only concerned with epidurals shows that you are biased and have an agenda.

          • Molly B
            June 21, 2016 at 1:50 pm #

            Because I made an initial statement about epidurals and that that has taken off and while it is regrettable that I did not plan my opening comments more carefully or understand how it would take off like this I also regret that no matter how many time I keep stating that i am not Pro NCB or against epidural that seems to be what I continue to come up against is people arguing med vs no med with me. I have clearly stated multiple time that I am for whatever a woman chooses I just wish we had better informed consent measures in this country. While some docs and hospital do amazing jobs at ensuring women have full disclosure and informed consent, this is sadly not common.

          • momofone
            June 23, 2016 at 2:21 pm #

            There’s also no reason a woman can’t ask any questions she may have if the doctor hasn’t addressed them.

          • Charybdis
            June 14, 2016 at 8:54 am #

            Ahhh…now I see. You must be a NCB at all costs acolyte. If a woman is laboring in a hospital or other medical setting, labor isn’t allowed to go on for days, especially if her water has broken. Why? Because labor is stressful for both the mother and the baby and the longer it goes on, the higher the risks for infection to both mom and baby, exhaustion from pain and lack of sleep for the mother, and death or damage to the fetus.

            AGAIN, no one is denying that opioids can pass the placenta and affect the baby. However, an epidural is regional anesthesia and is placed so that the anesthetic effect is localized to the nerves in the spine that innervate the uterus, etc. The amount of medication is very small, because it is placed exactly where it is needed, and if an opioid is also used along with the anesthetic agent, it is also placed on the nerves involved. The medications do not generally enter the mother’s bloodstream (I say generally, because nothing is guaranteed 100%) and since they don’t enter the bloodstream, they cannot cross the placenta to affect the baby. If (again nothing is 100%) some medication DOES get into the mother’s bloodstream, it is an inf

          • Irène Delse
            June 14, 2016 at 9:51 am #

            It’s painfully evident that MollyB is moving the goalpost. “Epidural opioids are dangerous! See that article!” “Wait, that’s about addicts, epidurals use controlled doses.” “But, but, it can cross the placenta!” “Yes, and? We are talking teeny tiny doses, because the opioid is not injected in the blood but the CSF. Any leakage has to be minuscule.” “Aha, but what if the labour lasts for DAYS?!” And so on.

            Of course, the labour is not allowed to go on indefinitely in the hospital. It’s almost as if the hospital staff’s priority was helping their patients to the best of their abilities, with all the tools of evidence-based medicine. Go figure!
            /Snark

          • Molly B
            June 21, 2016 at 1:45 pm #

            Since your late to the game I will clarify for you that the article was posted only to show that narcotics cross the placental barrier.
            This has been stated and clarified many times.
            The labor can last for day was because someone stated that a single dose of opiod wouldnt have an impact on the fetus. This may or may not be true but epidurals are topped up and pain meds are given more than once during labor.
            These were the threads

          • Molly B
            June 21, 2016 at 1:42 pm #

            #1 Your information about epidural medication not entering the blood stream is innacuratew and I am not the only one on this thread who has said otherwise.
            #2 AGAIN…I am not Pro NCB
            AGAIN…I am Pro Full Disclosure regarding Informed Consent

          • AllieFoyle
            June 21, 2016 at 1:46 pm #

            As she said above, the point of the epidural is that it isn’t administered into the bloodstream. She explicitly said it wasn’t 100%.

            You’re arguing against epidurals because OPIOIDS! PLACENTA! FETUS! but you completely miss the point that epidurals are specifically designed to minimize the risks you are worried about.

          • Molly B
            June 21, 2016 at 1:56 pm #

            “and since they don’t enter the bloodstream, they cannot cross the placenta to affect the baby.”

          • Charybdis
            June 21, 2016 at 3:38 pm #

            Please use the entire quote:
            an epidural is regional anesthesia and is placed so that the anesthetic effect is localized to the nerves in the spine that innervate the uterus, etc. The amount of medication is very small, because it is placed exactly where it is needed, and if an opioid is also used along with the anesthetic agent, it is also placed on the nerves involved. The medications do not generally enter the mother’s bloodstream (I say generally, because nothing is guaranteed 100%) and since they don’t enter the bloodstream, they cannot cross the placenta to affect the baby. If (again nothing is 100%) some medication DOES get into the mother’s bloodstream, it is a tiny, tiny amount and is diluted by the mother’s blood.

            The important part is the last sentence: if some medication DOES get into the mother’s bloodstream, it is a tiny, tiny amount diluted by the mother’s blood.

          • Charybdis
            June 21, 2016 at 3:34 pm #

            Never said it didn’t enter the bloodstream. It mostly, generally, usually, the vast majority of the time it stays where it is placed, in the cerebrospinal fluid surrounding the spine, where it acts locally (means right where you put it) to block pain signals to the brain. There is *always* a chance, miniscule, but there is a chance that a small amount of an already small amount of medication could get into the mother’s bloodstream. IF it does, it can cross the placenta and get to the baby.
            Which is what you were after in the first place, wasn’t it?

          • Linden
            June 14, 2016 at 11:17 am #

            If labour is going on for days, ur doin it rong.
            And how is prolonged labour *not* a risk for mother and baby? Compared to an epidural, say.

          • Molly B
            June 21, 2016 at 1:40 pm #

            Laboring for days is not “doing it wrong” Labor can last 6 hours for one woman and 48 for another.

          • Linden
            June 23, 2016 at 12:55 pm #

            U R DOIN IT RONG
            Risks of Prolonged Labour
            Fetal Risks:
            Fetal Distress due to decreased oxygen reaching the fetus.
            Intracranial hemorrhage or bleeding inside the fetal head.
            Increased chances of operative delivery like Cesarian sections.
            Longterm risks of the baby developing cerebral palsy.
            Maternal Risks: ◦
            Intrauterine infections
            ◦Trauma and injuries in the maternal birth passage like vulvar hematoma, perineal tears, cervical tears and vaginal wall tears.
            ◦Postpartum hemorrhage.
            ◦Postpartum infection.

          • moto_librarian
            June 14, 2016 at 1:23 pm #

            Um, I would be demanding a c-section if my labor had lasted longer than a day.

          • Nick Sanders
            June 14, 2016 at 1:49 pm #

            That’s only because they aren’t obtaining properly informed consent before performing c-sections! Why, the surgeon might accidentally remove your liver instead of the baby, or do the surgery with a rusty scalpel that’ll give you a blood infection. But the hospital will never tell you about these risks, and they are underreported! Doctors label them things like “heart attack” and “preeclampsia”, but I know the real truth!

          • Charybdis
            June 13, 2016 at 11:17 am #

            No one is saying it doesn’t. The AMOUNT that crosses, however is miniscule to negligible.

          • Molly B
            June 21, 2016 at 1:14 pm #

            Actually more than one person on here has said that NO narcotics get the the fetus at all in a epidural, ever.

          • Heidi_storage
            June 13, 2016 at 1:59 pm #

            “The dose makes the poison,” does it not?

          • Molly B
            June 14, 2016 at 1:33 am #

            And what is a safe dose that will not likely result in side effects for a 7.5 lbs fetus?

          • Lucycavendish2002
            June 14, 2016 at 4:08 am #

            You tell us, you’re the one making the claim that epidurals harm babies. Be sure to clarify exactly how much danger and discomfort women should endure to reduce the miniscule risk to the fetus incrementally. Use micromorts as units, if you like. Be specific: “I believe women should have caesarians without pain relief if it reduces the risk of death to the baby by 1/1000000”

          • Molly B
            June 21, 2016 at 1:13 pm #

            My claim was that epidurals have risks to mom and fetus that women are not always informed of.

          • AllieFoyle
            June 21, 2016 at 1:40 pm #

            Childbirth, natural childbirth in particular, has risks to mom and fetus that women are not always informed of. Epidural anesthesia is the one aspect of childbirth in which women are very likely to receive explicit informed consent.

          • Roadstergal
            June 21, 2016 at 1:59 pm #

            What part of birth has the risks and benefits clearly laid out for the mom to sign – epidurals, or vaginal birth? You’re on the wrong campaign.

          • Amy Tuteur, MD
            June 14, 2016 at 8:48 am #

            Typical epidural hysteria promoted by natural childbirth advocates. They’re utterly wrong, as usual. http://www.skepticalob.com/2011/03/epidural-hysteria.html

          • Molly B
            June 21, 2016 at 1:13 pm #

            Siting a link to your own article that has no research sites is vain and uninformative. Also, if you have actually the time to read some of my comment you would of seen that I am in fact not NCB. So your references and comments are worthless, Doc.

          • Amy Tuteur, MD
            June 21, 2016 at 1:21 pm #

            Oh, I see. I studied biochemistry in college. I went to medical school for four years. I did an internship and residency in obstetrics (4 years), and then spent years in practice. But you think you know more about epidurals, how they are administered, what their risks are and how women are counseled about them than I do.

            Do you have any idea how ridiculous you sound?

          • Molly B
            June 21, 2016 at 1:27 pm #

            You have sited nothing to back up your claims.

          • Dr Kitty
            June 14, 2016 at 5:46 pm #

            Dose of Fentanyl in an intrapartum epidural is usually 50-100micrograms. It’s lower still for a spinal.

            The dose of IV Fentanyl appropriate to relieve severe pain in a 4kg neonate is 4-16micrograms (1-4mcg/kg).

            The amount of fentanyl which would cross from the epidural/intrathecal space to the maternal bloodstream, and thence to the foetus, is unlikely to be anywhere near as much as that.

            We’re talking about administering a drug to relieve severe pain in a woman.

            The baby is getting much less fentanyl than we would give if IT were the one in pain. Most neonatologists would feel that a baby’s severe pain would be appropriately treated by IV fentanyl, and that the benefit of pain relief outweigh the risks for the baby.

          • Molly B
            June 21, 2016 at 1:26 pm #

            ” is unlikely to be anywhere near as much as that.”
            Fetus, not baby.
            So in short…you have NO CLUE

          • Roadstergal
            June 21, 2016 at 1:57 pm #

            Splitting non-existent hairs, numbnuts. Epidurals are given for that whole ‘birth’ thing, which is the transition from a fetus to a baby – the kid doesn’t have a growth spurt as it’s exiting the vagina. The amount that it gets before the placenta detatches, even if the whole dizam bolus went straight from the mom’s spine, through the placenta, into the being-born-thing, is orders of magnitude less than what doctors find appropriate to give the just-born thing of the same size if it were in pain.