Sweet Pea Births

Chandler, Arizona

Sweet Pea Births

...celebrating every swee​t pea their birth

Blog

Warning Labels: Epidural Drugs

Posted on May 23, 2014 at 3:22 PM
In light of a research study published this week, we are highlighting this blog post today, originally written on May 28, 2013.

"Mainly, in all of the groups of labor pain medications and delivery method, we found that mothers who received labor pain medications were 2-3 times more likely to report [delay in the onset of lactation] DOL compared to mothers who did not use labor pain medications and delivered vaginally."

As stated below, this information is shared in the interest of true informed consent.  If a mother adds another piece to the puzzle, she may decide to choose other pain relief tools aside from pain medication, or do everything to delay pain medication as long as possible in order to give her and her baby their best opportunity to get breastfeeding off to a good start.

Bradley Method classes offered in Arizona: Chandler, Tempe, Mesa, Gilbert, Scottsdale, Ahwatukee, PaysonMay 28, 2013:
I am sharing the information below in the interest of furthering our goal that all our students have true informed consent: knowing all the benefits and risks of a drug or procedure.  It is very rare for anyone to read the drug information insert that comes in all drug packages.  To save you time and squinting, we are doing a “drug warning labels” series for the most commonly used drugs during labor and birth.  There will be two more installments in this series.  Next week we will look at the drugs used for induction, and we will conclude with drugs used for augmentation of labor.

We are passionate about helping families have their Best Possible Birth.  By that we mean the path that leads that individual family to a Healthy Mom, Healthy Baby outcome.  We want families to have a toolbox full of tips and techniques that help them manage the ebb and flow of labor.  We want them to be comfortable with the path of a normal, low-risk labor.  We want them to have true informed consent by having an open line of communication with their care providers.

Why do we spend time and energy preparing couples for natural birth, even when some of them will end up choosing an epidural, or maybe needing a cesarean for their Healthy Mom, Healthy Baby outcome?  We know that the longer drugs can be delayed or avoided completely, the less likely it is that mother and baby will be exposed to drugs that have never been proven safe for mother and baby.  As one of my favorite class handouts says, “When used wisely and at an optimal time, an epidural can give a laboring woman much needed relief and sleep.  But if you are not prepared for some of the risks, you may end up wishing you had known a little more.”  (read in more detail about epidurals HERE and HERE)

Unfortunately, some families don’t know the side effects or possible complications of the drugs that are used in childbirth today.  We assume that since they are offered, they must be safe.  After all, our care provider would not purposely put us in harm’s way, right?

Did you know that most drugs used in childbirth is used “off-label”?  There is no drug that has been proven safe for childbirth – you can’t run a control study on pregnant women by allowing some to be drug-free and then having others use the drug.  It would be highly unethical as the difference in outcomes might be devastating to the women and children involved.

In today’s post, I have pulled out five of the most common drugs used for epidural anesthesia.  I am not passing judgment on families that choose an epidural.  There are definitely times when the benefits outweigh the risks.  Each family has to make the choice that is right for them.

To be clear – we are not anti-care provider or anti-drug.  We are grateful for modern medicine that saves lives in circumstances when Mother Nature needs help.  It exists for a reason, and we are thankful for the opportunity to meet all the Healthy Moms and Healthy Babies when we hold a class reunion.

Please read and consider this information as you prepare for the birth of your baby.  I included the link to find the complete drug label on-line.  Everything underneath the drug name is in quotations because I *literally* pulled it off the label available online and onto this entry.

LIDOCAINE: Category B
“Lidocaine readily crosses the placental barrier.”

“Systemic toxicity may result in manifestations of central nervous system depression (sedation) or irritability (twitching), which may progress to frank convulsions accompanied by respiratory depression and/or arrest.” 

“The adverse experiences under Central Nervous System and Cardiovascular System are listed, in general, in a progression from mild to severe.”

“Central Nervous System: CNS reactions are excitatory and/or depressant and may be characterized by light-headedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. The excitatory reactions may be very brief or may not occur at all, in which case, the first manifestation of toxicity may be drowsiness, merging into unconsciousness and respiratory arrest.”

“Cardiovascular System: Cardiovascular reactions are usually depressant in nature and are characterized by bradycardia, hypotension and cardiovascular collapse, which may lead to cardiac arrest.”

BUPIVACAINE: Category C
“Local anesthetics rapidly cross the placenta, and when used for epidural, caudal, or pudendal block anesthesia, can cause varying degrees of maternal, fetal, and neonatal toxicity.”

“Maternal hypotension has resulted from regional anesthesia. Local anesthetics produce vasodilation by blocking sympathetic nerves. Elevating the patient’s legs and positioning her on her left side will help prevent decreases in blood pressure. The fetal heart rate also should be monitored continuously and electronic fetal monitoring is highly advisable.”

“Epidural, caudal, or pudendal anesthesia may alter the forces of parturition through changes in uterine contractility or maternal expulsive efforts. Epidural anesthesia has been reported to prolong the second stage of labor by removing the parturient’s reflex urge to bear down or by interfering with motor function.   The use of obstetrical anesthesia may increase the need for forceps assistance.”

“The use of some local anesthetic drug products during labor and delivery may be followed by diminished muscle strength and tone for the first day or two of life. This has not been reported with bupivacaine.”

CLONIDINE: Category C
“Clonidine Hydrochloride Injection (epidural clonidine) is not recommended for obstetrical, postpartum, or peri-operative pain management.  The risk of hemodynamic instability, especially hypotension and bradycardia, from epidural clonidine may be unacceptable in these patients.  However, in a rare obstetrical, post-partum or peri-operative patient, potential benefits may outweigh the possible risks.”

“Clonidine readily crosses the placenta and its concentrations are equal in maternal and umbilical cord plasma; amniotic fluid concentrations can be 4-times those found in serum.  There are no adequate and well-controlled studies in pregnant women during early gestation when organ formation takes place.  Studies using epidural clonidine during labor have demonstrated no apparent adverse effects on the infant at the time of delivery.  However, these studies did not monitor the infants for hemodynamic effects in the days following delivery.  Clonidine should be used during pregnancy only if the potential benefits justify the potential risk to the fetus.

“Labor and Delivery:  There are no adequate controlled clinical trials evaluating the safety, efficacy, and dosing of clonidine in obstetrical settings. Because maternal perfusion of the placenta is critically dependent on blood pressure, use of clonidine as an analgesic during labor and delivery is not indicated (see WARNINGS).”

“Nursing Mothers:  Concentrations of clonidine in human breast milk are approximately twice those found in maternal plasma.  Caution should be exercised when clonidine is administered to a nursing woman.  Because of the potential for severe adverse reactions in nursing infants, a decision should be made to either discontinue nursing or to discontinue clonidine.”
 
FENTANYL: Pregnancy Category C
Labor and Delivery
“Fentanyl readily passes across the placenta to the fetus; therefore, DURAGESIC® is not recommended for analgesia during labor and delivery.” 

“Serious or life-threatening hypoventilation may occur at any time during the use of DURAGESIC® especially during the initial 24-72 hours following initiation of therapy and following increases in dose.”

“Respiratory depression from opioids is manifested by a reduced urge to breathe and a decreased rate of respiration, often associated with the “sighing” pattern of breathing (deep breaths separated by abnormally long pauses). Carbon dioxide retention from opioid-induced respiratory depression can exacerbate the sedating effects of opioids. This makes overdoses involving drugs with sedative properties and opioids especially dangerous.”

SUFENTANIL: Pregnancy Category C
“Skeletal muscle rigidity is related to the dose and speed of administration of sufentanil. This muscular rigidity may occur unless preventative measures are taken (see WARNINGS).”

“Decreased respiratory drive and increased airway resistance occur with sufentanil. The duration and degree of respiratory depression are dose related when sufentanil is used at sub-anesthetic dosages. At high doses, a pronounced decrease in pulmonary exchange and apnea may be produced.”

"There are insufficient data to critically evaluate neonatal neuromuscular and adaptive capacity following recommended doses of maternally administered epidural sufentanil with bupivacaine. However, if larger than recommended doses are used for combined local and systemic analgesia, e.g., after administration of a single dose of 50 mcg epidural sufentanil during delivery, then impaired neonatal adaption to sound and light can be detected for 1 to 4 hours and if a dose of 80 mcg is used, impaired neuromuscular coordination can be detected for more than 4 hours."

"The use of epidurally administered sufentanil in combination with bupivacaine 0.125% with or without epinephrine is indicated for labor and delivery. (See INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION.) Sufentanil is not recommended for intravenous use or for use of larger epidural doses during labor and delivery because of potential risks to the newborn infant after delivery. In clinical trials, one case of severe fetal bradycardia associated with maternal hypotension was reported within 8 minutes of maternal administration of sufentanil 15 mcg plus bupivacaine 0.125% (10 mL total volume)."

DEMEROL: Pregnancy Category: B; D if used for prolonged periods or near term
“Lactation: excreted in breast milk”

Side effects: “Nausea, vomiting, constipation, dry mouth, flushing, sweating, lightheadedness, dizziness, drowsiness, and pain/redness at the injection site may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly… Tell your doctor right away if you have any serious side effects, including: slow/irregular/fast heartbeat, mental/mood changes (e.g., confusion, hallucinations, nervousness), numbness, shakiness (tremors), trouble urinating, severe stomach/abdominal pain, change in the amount of urine.  Get medical help right away if you have any very serious side effects, including: slow/shallow breathing, fainting, seizures.”

“Before using this medication, women of childbearing age should talk with their doctor(s) about the risks and benefits. Tell your doctor if you are pregnant or if you plan to become pregnant. During pregnancy, this medication should be used only when clearly needed. It may slightly increase the risk of birth defects if used during the first two months of pregnancy. Also, using it for a long time or in high doses near the expected delivery date may harm the unborn baby. To lessen the risk, use the smallest effective dose for the shortest possible time. Tell the doctor right away if you notice any symptoms in your newborn baby such as slow/shallow breathing, irritability, abnormal/persistent crying, vomiting, or diarrhea."

"This drug passes into breast milk and is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.”


This concludes the highlights I pulled out from the drug inserts.  I encourage you to click on the links and read the whole insert for yourself.  Going in with all the information may help you make the right decision for your family.  

I want to re-iterate that our perspective (Krystyna & Bruss) is that drugs are a tool, to be used wisely and at the optimal time, i.e., when the benefits outweigh the risks.  If you are going to use any of these as a tool, then educate yourselves on dosage.  You can ask questions like, "Is mom going to get the suggested dose all at once or over a time period?"  "What can we do if she needs more than the suggested dose?"  "Are there any other options?"

We have had students use an epidural as a tool after a prolonged and/or especially painful labor.  The epidural provided the rest and/or relief they needed, and some of them went on to have a quick progression to second stage and a vaginal birth.  Their births are no less "Bradley" than our mothers who had epidural-free births.  All the couples used their communication skills to make the Healthy Mom, Healthy Baby choice for their family.  

It all boils down to the same question, "Which choice is right for our family in the unique instance of our birth?"  When you choose with a Healthy Mom, Healthy Baby filter, you can help clarify which choice works for you.

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.



Categories: Avoiding harmful substances, Epidural, Information Center, Informed Consent, Toxins, pesticides, chemicals and pregnancy, Warning Labels

Post a Comment

Oops!

Oops, you forgot something.

Oops!

The words you entered did not match the given text. Please try again.

16 Comments

Reply moncler jackets
4:36 PM on March 16, 2022 
I and my pals happened to be looking at the best procedures on your web site and quickly got a terrible feeling I never expressed respect to the blog owner for those strategies. Most of the young boys became certainly very interested to read through them and have in reality been making the most of those things. I appreciate you for really being indeed considerate and then for utilizing certain notable subjects millions of individuals are really wanting to understand about. My very own sincere apologies for not expressing appreciation to sooner.
moncler jackets http://www.monclerjackets.us.org
Reply golden goose outlet
4:37 PM on March 16, 2022 
I must voice my love for your generosity in support of persons that must have help with in this concept. Your real dedication to passing the solution all around became certainly powerful and have all the time permitted ladies just like me to achieve their aims. Your new useful key points indicates so much to me and even more to my mates. Many thanks; from everyone of us.
golden goose outlet http://www.goldengooseshoes.us.org
Reply kevin durant shoes
4:37 PM on March 16, 2022 
I together with my buddies have already been going through the nice tips and hints on the blog and then suddenly I had a terrible feeling I had not thanked the web blog owner for those tips. Those guys had been absolutely passionate to learn them and have now very much been enjoying those things. Appreciate your genuinely indeed accommodating and also for settling on variety of superb issues most people are really needing to learn about. My sincere apologies for not saying thanks to earlier.
kevin durant shoes http://www.kd12.us.com
Reply kd12
4:37 PM on March 16, 2022 
I wish to voice my gratitude for your generosity in support of women who absolutely need assistance with this field. Your personal commitment to passing the solution all over had become pretty interesting and have usually enabled most people much like me to arrive at their ambitions. Your new helpful advice signifies a lot a person like me and additionally to my fellow workers. Thanks a lot; from each one of us.
kd12 http://www.kd12.org
Reply a bathing ape
4:38 PM on March 16, 2022 
I want to express my thanks to the writer just for rescuing me from this type of instance. Right after looking throughout the world wide web and meeting views that were not pleasant, I believed my life was done. Being alive minus the approaches to the difficulties you have fixed by way of your entire guide is a serious case, as well as those that could have badly damaged my career if I hadn't come across the blog. Your actual natural talent and kindness in dealing with all things was important. I don't know what I would have done if I had not come upon such a step like this. I can also now look ahead to my future. Thanks a lot so much for this specialized and result oriented guide. I will not think twice to endorse your site to anyone who needs and wants assistance about this subject.
a bathing ape http://www.bape-clothing.us
Reply stephen curry shoes
4:38 PM on March 16, 2022 
I in addition to my guys happened to be digesting the good guides from your site while unexpectedly I had a terrible suspicion I had not thanked the website owner for those secrets. All the people are actually as a result very interested to see them and have simply been using those things. We appreciate you turning out to be really thoughtful and also for deciding on this kind of excellent themes millions of individuals are really eager to learn about. My sincere regret for not expressing appreciation to sooner.
stephen curry shoes http://www.stephcurryshoes.com
Reply golden goose outlet
4:38 PM on March 16, 2022 
I needed to put you a bit of word in order to thank you as before regarding the incredible ideas you've provided on this website. This has been generous of people like you to offer openly precisely what a lot of people might have offered for an ebook to help make some bucks for themselves, primarily now that you could possibly have tried it in the event you desired. These smart ideas additionally worked as the fantastic way to recognize that some people have the same keenness really like my very own to find out a whole lot more on the subject of this matter. Certainly there are millions of more fun moments in the future for folks who start reading your website.
golden goose outlet http://www.goldengooseoutletstore.com
Reply birkin bag
4:38 PM on March 16, 2022 
I want to show my thanks to this writer just for rescuing me from such a scenario. Just after surfing through the internet and coming across advice which were not productive, I assumed my life was done. Living without the approaches to the problems you've solved by way of your entire site is a serious case, as well as ones which might have negatively damaged my career if I hadn't come across your web blog. That natural talent and kindness in handling all areas was valuable. I am not sure what I would've done if I had not discovered such a subject like this. It's possible to at this time relish my future. Thanks a lot so much for this specialized and effective guide. I will not think twice to suggest the website to any individual who should get assistance on this topic.
birkin bag http://www.hermesbirkinbags.us.com
Reply nike kyrie 7
4:38 PM on March 16, 2022 
I and my buddies came analyzing the great recommendations found on the blog while suddenly I had a terrible feeling I never expressed respect to the web site owner for those strategies. The women are already absolutely happy to read them and now have absolutely been enjoying those things. Many thanks for being very kind and also for getting varieties of brilliant resources most people are really desirous to understand about. Our own sincere regret for not saying thanks to you earlier.
nike kyrie 7 http://www.kyrie-7.com
Reply kd 13
4:39 PM on March 16, 2022 
I happen to be commenting to make you be aware of of the amazing encounter my wife's daughter found checking your site. She figured out a good number of details, including what it is like to possess an incredible coaching style to make many people completely know precisely various very confusing topics. You really surpassed our own desires. I appreciate you for displaying those invaluable, healthy, edifying and as well as fun thoughts on this topic to Emily.
kd 13 http://www.kd13shoes.us
Reply birkin bag
5:33 AM on March 22, 2022 
Thanks for your entire efforts on this web page. Debby delights in getting into investigations and it's really obvious why. We learn all about the compelling mode you deliver effective tricks by means of this website and as well as inspire response from other individuals about this subject matter while our own simple princess is undoubtedly learning a great deal. Enjoy the remaining portion of the new year. You are always performing a fantastic job.
birkin bag http://www.birkinbag.us.com
Reply yeezys
5:34 AM on March 22, 2022 
I simply had to thank you very much again. I'm not certain what I might have done in the absence of those tricks discussed by you relating to my field. It previously was a real frightening case for me personally, however , encountering a new well-written approach you resolved that made me to jump for contentment. I am happy for this advice and even expect you realize what a powerful job you are providing training the others with the aid of your website. Most likely you've never come across any of us.
yeezys http://www.yeezy-shoes.us.org
Reply kawhi leonard shoes
5:35 AM on March 22, 2022 
My spouse and i were very ecstatic that Michael could deal with his homework from the ideas he had from your very own web page. It is now and again perplexing to just always be giving out guidance others may have been trying to sell. And we also understand we have the website owner to appreciate for this. Those explanations you've made, the easy blog navigation, the friendships you will aid to promote - it's most astonishing, and it is making our son and the family know that the concept is exciting, and that's really indispensable. Thank you for the whole thing!
kawhi leonard shoes http://www.kawhileonardshoes.us
Reply jordan 1
5:36 AM on March 22, 2022 
Thank you so much for providing individuals with such a remarkable opportunity to discover important secrets from this website. It is usually so pleasing and also full of amusement for me personally and my office colleagues to visit your web site at least 3 times in a week to read the fresh guides you have. And definitely, I am also at all times motivated for the wonderful points you give. Some two ideas in this post are rather the simplest I've ever had.
jordan 1 http://www.jordan1shoes.us
Reply supreme clothing
5:37 AM on March 22, 2022 
Thank you a lot for providing individuals with remarkably spectacular opportunity to read in detail from this web site. It is often very excellent and as well , stuffed with a great time for me personally and my office fellow workers to visit your website really thrice in 7 days to read through the newest issues you will have. And of course, I'm just actually impressed with your special opinions you give. Certain 2 ideas on this page are indeed the most efficient I have had.
supreme clothing http://www.supremesoutlet.us.com
Reply curry shoes
5:37 AM on March 22, 2022 
I enjoy you because of all of your effort on this blog. Gloria take interest in carrying out investigations and it is easy to see why. A number of us hear all regarding the compelling mode you make rewarding steps on the web site and therefore attract contribution from some others on this concern while my daughter has been discovering so much. Have fun with the remaining portion of the year. You're performing a terrific job.
curry shoes http://www.curry8shoes.us