Dr. Sarah Buckley: Epidurals – Risks and Benefits

by Julia Hall | Apr 25, 2017 | Clinical, Prenatal

In Babymoon’s 5-week Lamaze series, we discuss at length the six “Healthy Birth Practices” that have been linked to better outcomes for moms and babies. One of these healthy birth practices is to avoid unnecessary interventions.

But how does one determine when an intervention is necessary or unnecessary? We recommend using your BRAIN – examining the Benefits, Risks, and Alternatives to an intervention, and then asking yourself what your Intuition says and what happens if we do Nothing (right Now).

In the first of series of her blogs on her web site, Sarah Buckley begins to examine the benefits and risks of an epidural and shares some of the research surrounding this common intervention. Buckley, a physician who also authored Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices, says:

“Obviously, the main benefit of an epidural is the very effective pain relief that most women experience. Because of this effective analgesia, epidurals also reduce stress, and stress hormones, in labour. This can be beneficial when women are experiencing very high levels of stress and pain, which can slow labour progress.”

To understand some of the risks or side effects of an epidural, we first must understand oxytocin. As we discuss in our Lamaze series, the hormone oxytocin – also known as the “love hormone” – is a key player in the process of labor and birth.

Childbirth Connection explains:

“Receptor cells that allow your body to respond to oxytocin increase gradually in pregnancy and then increase a lot during labor. Oxytocin stimulates powerful contractions that help to thin and open (dilate) the cervix, move the baby down and out of the birth canal, push out the placenta, and limit bleeding at the site of the placenta.”

Buckley explains that within the oxytocin “positive feedback cycle” (as illustrated in the diagram), uterine sensations lead to oxytocin release which contributes to stronger contractions, more sensations, and more oxytocin. The cycle continues and helps baby to be born quickly and easily. Oxytocin also activates reward and pleasure centers in the brain.

When epidural analgesia is introduced into the equation during labor, there are no longer sensations to trigger oxytocin release, and therefore levels will decline.

Buckely will explore the consequences of a lack of oxytocin in Part 2 of her series, coming soon.

Read all of Part 1

Why We Don’t Know Much About Medications for Pregnant Moms

by Julia Hall | Feb 21, 2017 | Clinical, Prenatal

Have you ever wondered why many medications aren’t studied in pregnant women?  Have you noticed that even most over-the-counter medications or supplements carry the warning to “consult with your provider” before using in pregnancy?  Did you know that up to 95% of late-stage clinical trials still exclude pregnant women AND is estimated that over 50% of pregnant women take some kind of medication?  A recent study calls for change!

Commentary by Mallory Locklear:

But for most medications, we have no idea how they work in pregnant women because we’ve never studied it. And with such little information, some pregnant women choose to err on the side of caution, which could mean suffering through pain, discontinuing antidepressants, and putting themselves at risk of disease.
There are a few reasons for this. First, there’s the fear of harming the fetus. In the 1950s the drug thalidomide was prescribed to pregnant women as a way to treat morning sickness. But after thousands of babies were born with limb deformities, it became clear that medications taken by a pregnant woman posed a risk to the fetus she carried.

This was further emphasized by diethylstilbestrol, a drug once thought to prevent miscarriages and later found to cause vaginal tumors in females exposed to it in the womb. Pregnant women and even women of childbearing age were then explicitly excluded from clinical trials for some time. Once the underrepresentation of women in clinical trials was recognized as a problem and including them in trials became a priority in the 1990s, it was strongly suggested that they either use contraception or abstain from sex while taking part in trials. Currently, up to 95 percent of late-stage clinical trials still explicitly exclude pregnant women.
Other reasons are more financially-based. “The market for pregnant women is much smaller than the general market,” says Costantine. This means drug companies don’t want to take a risk on a smaller slice of the market, especially when there are no regulations in place to protect them from legal action if something went wrong.
If a woman needs a medication while pregnant or was already using one prior to pregnancy, her doctor has to anticipate and measure any potential changes in its therapeutic effect. “For some drugs you follow the concentration in the blood and adjust the doses accordingly,” says Costantine.

Read the entire article…

8 bizarre pregnancy dreams and what they really mean

by Julia Hall | Jan 30, 2017 | Clinical, Prenatal

Have you wondered what those crazy pregnancy dreams mean? I had several vivid dreams during my pregnancy with my second son (sorry, Robert!) and would have loved to use this article to decipher what I was sorting out in dreamland.