I didn’t want an epidural.
I wanted a natural childbirth.
But I was having a baby—my first—in a hospital in Atlanta, Georgia, where nearly every laboring mother got an epidural.
What’s an epidural?
An epidural is regional anesthesia that blocks the nerve impulses from the lower spine.
The goal of an epidural is to give pain relief without blocking all feeling.
Some two thirds of American women giving birth in the hospital—probably much more—get an epidural.
In some hospitals epidural rates are as high as 90 percent.
Tick Tock goes the hospital clock
The medical clock started ticking the moment you are admitted into the hospital.
That’s how it works in hospitals in America.
What is best for you and your baby becomes irrelevant.
Your birth plan becomes irrelevant.
(You can have it taped up on your door and the walls of the birthing room, like we did. The labor and delivery nurses won’t bother to read it. And if they do, they’ll likely laugh about it in the staff room.)
Doctors and the hospital staff, often dictated by hospital policy, which is in turn dictated by insurance reimbursement, have a timeline and a woman’s body is expected to follow it.
If your body doesn’t comply, they start intervening with synthetic hormones, anesthesia, and other “miracles” of modern medicine.
That’s what happened to me.
I was told by a doctor I had never seen before, the only male in the practice, that I was “being selfish” for wanting a natural childbirth.
First came the epidural, administered by an anesthesiologist who threaded a catheter through a needle that he had placed in my back.
Then came the Pitocin, to “speed up” my labor. Administered via an IV drip.
As if labor is a race. And I was falling behind.
Here’s what doctors don’t tell you when they tout the virtues of epidurals:
Epidural Anesthesia Contains Opioids.
Epidurals contain a combination of drugs: An anesthesia like bupivacaine, chloroprocaine, or lidocaine.
And an opioid narcotic like fentanyl, morphine, or sufentanil.
An opioid. Heroin is an opioid. So is fentanyl.
I’ve spent the last two years researching and writing a book on addiction, which is considered one of the most pressing health crises of all time. During that time, there’s been a huge amount of media attention to the DANGERS of fentanyl. Everyone agrees: no baby should be exposed to fentanyl. Ever.
CNN’s Sanjay Gupta, M.D., calls fentanyl lethal.
We heard from the new head of the CDC that fentanyl almost killed his son.
We know that fentanyl is 50 to 100 times more potent than morphine.
Yet we give fentanyl to laboring women without telling them? And thereby make sure their babies are exposed to fentanyl?
Let me run that by you again: In America today we are injecting up to 90 percent of laboring women with an opioid that goes directly into their spinal column that has the potential to cross the placenta and get into the baby’s bloodstream.
Is this wise?
Is there any reason that a thinking person would say, “Sure, dope my baby up with fentanyl?”
Your doctor tells you epidural anesthesia is “safe.”
Yet you’re reading about the addiction crisis in America.
The fentanyl overdoses.
Might there be a connection between doping a baby with narcotics during birth and the opioid crisis?
Shrug your shoulders and say, no way. The dosing is too small. It’s not a big deal.
But the safety of giving fentanyl to a newborn has never been studied.
The FDA does not recommend babies be exposed to fentanyl or fentanyl use during labor and delivery
In fact, we are told by the FDA that it is absolutely not safe to give fentanyl to a pregnant woman.
Here’s what the FDA document actually says:
Labor and Delivery: There are insufficient data to support the use of fentanyl in labor and delivery. Therefore, such use is not recommended.
Being exposed to fentanyl is being exposed to a highly addictive synthetic drug
Opioids are a highly addictive and very dangerous synthetic drugs. Why would we ever give them to a baby?
If your doctor gave you an epidural, your baby was most likely exposed to opioids. My baby was exposed to fentanyl.
I was bullied into getting an epidural by an insensitive doctor. With the full collusion and support of a hospital that put profits over people, as nearly every hospital in America does.
My firstborn was exposed to fentanyl without my knowledge or consent. I had no idea that synthetic opioids were a main ingredient in epidurals.
Early childhood exposures and early childhood trauma both play a seminal role in adult addiction.
A 2015 study by a team of researchers at Columbia University found that the use of epidurals was associated with measurable changes in the volume of a newborn’s brain.
You want a baby with a healthy body and a healthy brain who grows up free from addictions.
You need to understand that the most scientific, healthiest birth is the one with the fewest interventions.
If you’ve already had a baby and you had an epidural, like I did, don’t waste time feeling guilty or self-critical.
If you’re trying to conceive, newly pregnant, or having a baby soon, now you know what I wish I had known.
There are many less dangerous, gentler, and more empowering techniques for managing labor pain. I’ll write a post about them soon.
Don’t get an epidural.
Instead, educate yourself about opioid and other addictions, and spread the word to other expectant moms and dads about the dangers of epidurals.
If you or a loved one is struggling with addiction, you are not alone. We are here to help. Read more about fentanyl use during childbirth in The Addiction Spectrum: A Compassionate, Holistic Approach to Recovery (HarperOne).
Colton Arrant says
This article couldn’t be further from the truth and has little to no scientific merit. If you’d done your homework, you’d realize that epidural opiates are highly lipophilic and very little leaves the epidural space. The concentration is also very low. What does make it out is metabolized and virtually none makes it to the baby. The FDA recommends not giving it IV which is a totally different story. By combining opiates with local anesthetics you need less of each because the effects are synergistic. Thanks to misinformation presented by you and others I have to constantly correct these false narratives with patients daily as an anesthesiologist.
Jennifer Margulis, Ph.D. says
Thank you for sharing your thoughts, Dr. Arrant. I hope that further research shows that you are correct in your assessment of epidurals but at this point there are more unknowns than knowns in this debate, which is why we are having this conversation. The fact is that longterm safety studies of epidural anesthesia on health outcomes, brain development, and addiction have not been conducted. At least none that I am aware of. If you know of any such studies, please share them here. I find the science on short-term outcomes concerning, as is patient testimony and the experience of mothers I have interviewed. As well as my own experience birthing with and without an epidural. I know you administer epidurals often, perhaps daily, but I am wondering how many of your patients who were born to mothers given epidurals you have followed into adulthood and assessed for addiction and substance abuse? And how many mothers to whom you have given epidurals have come back to talk to you? As a woman given an epidural, I can tell you firsthand that my leg was numb for nearly two weeks, and I also ended up with bleeding, painful hemorrhoids. A close friend had a spinal headache so severe she could not lift her baby. She describes being in the most excruciating pain she has ever experience. But the doctors who administered these epidurals were never informed of this. What’s more, we know that from research conducted on 80,000 women that less than 3 percent will experience complications. That sounds like a “low risk,” but the numbers tell a different story. At least two million women get epidurals in this country, probably much more. Which means that 60,000 new moms are experiencing complications (which is more than the entire population of Greenland.) This problem is easier to quantify than the possibility of lasting consequences to a baby, which, I agree with you, is speculative at this point. You are not disagreeing that the baby is exposed to some amount of fentanyl–in tiny concentrations– but the question remains what, if any, are the longterm effects of that exposure? Fentanyl is a good drug for epidurals, according to anesthesiologist Gregory A. Smith, M.D. (who I also interviewed for this article and whose words are included in the book), because it’s very potent and very fast-acting. He has done thousands of epidurals but no longer recommends them and urges women to find alternatives to manage labor pain. Louana George, who worked as a labor and delivery nurse and then practiced as a homebirth midwife for over 30 years and who also has attended over 1,000 births, found that babies born to women who had had epidurals were often too sleepy to nurse, couldn’t seem to coordinate their suck, and often did not even reach for the breast. She told me: “The difference between the epidural babies and the natural birth babies was striking.” We can say the science shows that they are safe for the baby but that is very much an open question. As you know, a small study in Sweden found that infants born to mothers who had been given pudendal blocks had trouble breastfeeding, higher body temperatures, and more crying: https://www.ncbi.nlm.nih.gov/pubmed/11264622. Another study from researchers at Wichita State showed that epidurals interfered with sucking reflexes: “Labor pain relief medications diminish early suckling but are not associated with duration of breastfeeding through 6 weeks postpartum.” Louana George agrees with you on one point: “Since fentanyl is lipophilic [which means it binds to lipids] it is a drug that can be sequestered in the neonatal brain, which explains prolonged depressed neurobehavioral and breastfeeding behavior in the newborn.” I’m glad we’re having this conversation. If you made it this far, thanks for reading.
I find it interesting that you blame your postpartum bleeding and hemorrhoids on the epidural. Can you explain the reasoning behind that?
Also, why were you “forced” to have the epidural? Since you have based your article on anecdotal experience more than evidence-based research I am going to say “in my experience” (which is with 10s of 1000s of laboring women), none of them have ever been forced to have an epidural for labor. While it is true that 80-87% of women in the United States choose an epidural for labor analgesia (national statistic readily available) it is not a medical necessity so therefore it is elective. I am sorry you had a bad experience but I am more concerned with the inflammatory wording of your article. I cannot imagine a situation where your epidural was placed without your consent and if so, that was an agregious situation. Could you please explain the circumstance?
Colton Arrant says
I have taken a few days to gather the most recent and comprehensive literature on the subjects that have been discussed in your writings. Below are a few of the most recent articles and what they have to say on the subject. My reply is quite lengthy as it encompasses many topics, not just the subject of fentanyl.
If you read only one article, please read this one published in Anesthesiology in July of 2018
Here is what the newest literature has to say concerning epidurals and breastfeeding
1. This is a systemic review (a study that takes all data on the subject with similar criteria and tries to pool data for power)
It found 12 studies that show a negative impact on breastfeeding, 10 that show no impact, and 1 with a positive impact.
2. Here are to large randomized control trials (along with systemic reviews, the best for establishing correlation). It found there was no difference in breast feeding success at 6 weeks in women with and without epidurals at 6 weeks post partum in doses up to 2 mcg/mL (the standard fentanyl dose).
3. Another RCT published this year with 1200 patients. Breastfeeding was success was correlated with having a labor epidural, however when it was controlled for by previous success there was no difference. So success with breastfeeding was tied to prior success rather than epidural anesthesia.
4. Editorial published in 2017 by Dr. Chesnut. He is the leading authroity in obstetric anesthesia and his textbook is the “Bible” of obstetric anesthesia had this to say on the subject.
5.Here is an Italian randomized control trial that shows there is no difference in the onset of lactation.
At best you can say the it’s controversial and needs further study, but many large and more recent studies have shown no effect.
On the topic of risks with epidural placement
I always cover all of these risks prior to epidural placement and a patient signs a written form that also notifies the patients of these risks.
Common: Nausea and vomiting (this happens very often without epidurals), itching, mild hypotension, mild back tenderness at the site( not long term back pain. this is from poor posture and lax joints during the third trimester).
Rare and serious: Epidural hematoma, epidural abscess, spinal headache, paresthesias, nerve palsy.
Hypotension is prevented by prior administration of IV fluids and may need to be temporized by phenylephrine. Neither of these interventions has a negative impact on the mother or fetus. Hypotension can easily be avoided by decreasing the initial dose and concentration of local anesthetic. Nausea and vomiting can be safely treated and is treated in women without epidurals. itching is mild and can be eliminated by removing opiates from the epidural infusion.
Spinal headaches are a known risk. It is provider dependent. the risk is about 1 in 100. Personally I’ve had 3 dural punctures in the past to years out of over 1,000. It all three cases it was from patient movement during placement. 1 developed a headache and it was treated with a blood patch and resolved. There are no long term issues with this and it can be managed conservatively and resolves in less than 1 week in most and almost 2 weeks in all. It can be debilitating in the short term and often a blood patch is performed if symptoms persist more than 2 to 3 days with failure of conservative measures.
Epidural hematomas are extremely rare the literature shows less than 5 to 6 per 1 million epidurals. Typically these occur in patients on oral thinners, receiving heparin, have low or dysfunctional platelets, or have a coagulation abnormality. Reviewing the patients medical history and lab data virtually eliminate this risk in labor epidurals. Personally, I have only seen this once. It was in a lady with a complex congenital heart defect who was on postpartum and it was thought she had a pulmonary embolism. She received Lovenox, a blood thinner, and had a hematoma develop with weakness. She underwent surgery and symptoms resolved.
Epidural abscesses are just as rare. Good hygiene and sterile technique can easily prevent this occurrence.
Prolonged numbness or wekaness. About 1 in 5,000. This is not caused by the epidural. Rather, it is a result of stretching of the nerves during prolong pushing or keeping a patient in a position for prolonged periods of time. The patients symptoms are masked by the epidural. this can be an isolated patch of numbness or weakness in the movement of the hip, knee, or foot. typically symptoms improve in days to weeks and rarely last longer than six months.
Anesthesiology 2006; 105:394–9. Incidence of Epidural Hematoma, Infection, and Neurologic Injury in Obstetric Patients with Epidural Analgesia/Anesthesia Wilhelm Ruppen, M.D.,* Sheena Derry, M.A.,† Henry McQuay, D.M.,‡ R. Andrew Moore, D.Sc
Epidurals and labor time
The most recent review which I have sent (the very first article published this month in Anesthesiology) shows at most it prolongs 1st stage by 30 min and 2nd stage by 15. Some studies show it actually reduces labor times. This all has to do with measuring methods and how actively managed the patients are by their nurses, mid wives, and obstetricians.
“Maybe it’s time, in this era of recognition of the problems with addictions, to look at what could be influencing the onset of addictive behavior,” George says. “Maybe it starts with the epidural.”
There is absolutely no evidence to support this statement. To suggest infants become addicted from epidural opiates is far fetched. The women who receive the fentanyl in their epidurals are not becoming opiate addicts themselves. Over prescribing opiates in the community, prior substance abuse, genetics, and easy accessibility along with and many other factors are to blame for this. Pushing the idea that an epidural can cause opiate addiction is a scare tactic to prevent women from getting an epidural.
Epidural labor analgesia does not affect the incidence of cesarean delivery, instrumented vaginal delivery for dystocia, or new-onset long-term back pain.
American Journal of Obstetrics and Gynecology Volume 186, Issue 5, May 2002, Pages S69-S77 American Journal of Obstetrics and Gynecology The Nature and Management of Labor Pain: Peer-Reviewed Papers from an Evidence-Based Symposium
The effects of epidural analgesia on labor, maternal, and neonatal outcomes: A systematic review
Nothing was mentioned about the benefits of epidurals which include, but are not limited to:
-Superior form of pain control with improved patient satisfaction
-Safer than IV meds (I routinely hear mother say they don’t want an epidural, because they don’t want to harm their baby. Yet they will take Stadol, an IV narcotic which does affect the baby, without concern)
-Superior control of HTN in pre-eclamptic patients.
-Safer for C sections than general anesthesia, and should be placed in patients early at high risk for this (Morbid obesity, TOLAC, cardiac issues, etc.) to avoid complications in the event of emergent c section.
-Greater success rates for cephalic versions
-Reduced postpartum depression
-Some studies show a decrease in labor time.
-Opiates reduce local anesthetic doses and which improves motor function and ability to push and quicker time to normal sensation and strength postpartum
-Improves patient tolerance to remove retained placental products, allows patients to undergo D & C without additional anesthesia, can be used for hysterectomy in the event of placenta accreta. All of which I have used them for personally.
Thanks for your time and interest in the subjects. Overall I think we both want the best outcomes for patients and their newborns and it is important to know the data and present this information to those considering an epidural. I really enjoy what I do and find great satisfaction in providing care to the laboring women in my hospitals.
Amber Sims says
Wow, I am grateful to have read more about an intervention I chose to thankfully avoid during the birth of our daughter. There are so many concerns about epidurals that are not clear and only raise serious doubts about this *very common* practice–yikes!!
Why not have a midwife instead of a OBGYN?? I had a midwife and delivered in a hospital 2x. You have a PhD but got bullied into a epidural ?? How about doing your research about what kind of birth you want and what medical professional and facility can provide you the experience you want ?
Jennifer Margulis, Ph.D. says
We started our care with hospital midwives, Elen. They were even more conservative and shaming than the doctors in the practice so we actually switched to the doctors (falsely) believing we would get gentler prenatal and postnatal care. The doctor who attended the birth was the only doctor I had not met with during the course of prenatal “care.” The medical practice we went to was determined by our insurance. As was the hospital. At the time I was a graduate student. I actually found out my Ph.D. thesis was approved two weeks after my daughter was born. And, yes, I was highly educated and got bullied anyway.
Anita Butler says
I was a birth doula for over ten years before I shifted my focus to lactation and postpartum care, and fertility.
The absolute WORST case of bullying I ever witnessed – by FAR – was of a 43-year old first time mom who was a career RN. The doctor’s comments and behavior were shocking. I left there trembling because of what I witnessed – and yes, I followed up with a letter to the chief of obstetrics at the hospital as well as the California Medical Association. When I encouraged my client to also write, she said, “I just want to forget about it.”
Aaaand that’s what all too often is the case.
Do you know if this would also include spinals for cesareans? I didn’t have an epidural with my eldest, but they did use spinal anesthesia and he had a lot of trouble breastfeeding & seemed very out of it for a long time; nothing like my home birthed babies.
Jennifer Margulis, Ph.D. says
Skyla–The combination of drugs differs, depending on a number of factors. You can request your child’s hospital records and ask the anesthesiologist to find out what combination of drugs you were given.
This article might help: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD012134/full
“The practice of regional anaesthesia for caesarean section is commonplace today in developed countries like the USA and the UK, and is gradually increasing in developing countries (Jenkins 2003; Afolabi 2012). It involves the use of epidural or spinal anaesthesia, which allows consciousness during the operation (Michie 1988; Rollins 2012). Spinal anaesthesia is preferred over epidural anaesthesia for elective caesarean and emergency caesarean procedures, due to the relative ease of administration, reduced systemic toxicity, faster onset of action and start of the operation (Wagner 2000; Jenkins 2003; Rollins 2012). Spinal anaesthesia, also known as a spinal or subarachnoid block, involves an injection of local anaesthetic drugs into the spinal space containing cerebrospinal fluid and surrounding nerves that supply the abdomen and uterus using a spinal needle (Michie 1988). Spinal block is administered at L3 to L4 level of the subarachnoid space, thus allowing independent control of respiratory function (Casey 2000). Administration of spinal anaesthesia induces a blockade of neuronal signals supplying the abdomen and uterus at level T6 to T10 (Michie 1988; Ankcorn 1993). In the subarachnoid space, the distribution of drugs used for spinal blockade is affected by the inherent characteristics of the anaesthetic, the patient, spinal fluid, and the injection technique of the anaesthetist (Gogarten 2003; Grant 2011). Numerous local anaesthetic drugs are used as the principal means of producing surgical anaesthetic effect and their actions can be further enhanced by the addition of opioids or adrenergic agonists with many potential advantages (Cousins 1998).
“Drugs used for spinal anaesthesia in caesarean section are mainly local anaesthetics of either the amide or ester class, based on the link existent between the amine and aromatic arms (Becker 2006). The aromatic arm accounts for lipid-solubility, which in turn determines its potency, that is, the more lipid soluble the drug, the faster the time of onset and the greater its ability to penetrate through nerve sheaths with consequent increase in potency (Becker 2006). Also, the ability to bind plasma proteins is an indicator of the duration of action of the drug. Local anaesthetics such as bupivacaine, ropivacaine, levobupivacaine, chloroprocaine, lidocaine, and tetracaine have been used for caesarean operations, in combination usually with opioids such as fentanyl or its derivatives, or morphine (Gogarten 2003; Rollins 2012).”
I had home birth (with no pain medication used) and the worse hemorrhoids I’ve ever heard of. Don’t know if hemorrhoids can be blamed on anesthesia. Just by pushing and straining the rectum can saúde hemorrhoids. ?♀️ I find your article interesting but it’s just not backed up by any research. My mother had anesthesia for all 3 of her births and my sisters and I don’t even drink alcohol, let alone use of any opiates. It could be all a big coincidence.
I had an epidural with my first. I wanted to try natural, but I was being induced and couldn’t bear the pain. I was still in significant pain after the epidural. The anesthesiologist (who looked like Chong, bandana and all) said, “You’ll be feeling good in no time.” Then, as he was injecting the drug into the line said, “This is the equivalent to China White on the street.” Very soon after my blood pressure was something like 52/23, the OB was on the verge of a losing it. I had a nurse new to the hospital – and not very good – and she had left my IV run dry. The OB squeezed two bags of fluid into me as fast as he could then went out in the hall and ripped someone a new one. I always thought the blood pressure problem was due to the lack of fluids. The epidural was stopped and I ended up delivering with no pain relief anyway. This was more than 13 years ago.
I just found out today that China White is fentanyl. Honestly, I wouldn’t have known any better even if they told me what it was back then. I was out of mind with pain and I trusted my OB implicitly.
And now I sit here wondering if the fentanyl has anything to do with my not being able to breastfeed, my child’s breathing problems as an infant, the continuing speech difficulties, the emotional problems, the autoimmune disease . . . Any suggestions on where to start looking for information?
As an aside, I had a different anesthesiologist with my second child and he left a three – four inch diameter wound because he couldn’t get the epidural in. Every try was during a contraction. After I screamed at him, he jammed it in and left me in agony with pain shooting through my hip and leg for an hour because it wasn’t in the right place. I asked for something in my IV until that guy got himself together, he tried again between contractions and got it right away. But I still have intermittent pain in my hip/leg and where the wound was more than ten years later.
Hindsight is 20/20. But if fentanyl hurt my child, I’d like to know.
Josh Voeller says
Our son was delivered lifeless and pale white due to direct Fentanyl exposure. His APGAR score was 0. He was resusitated with cold mechanical precision by a pair of ambivalent nurses. My son was breech so a cesarian was necessary but my wife had entered labor before the spinal block could be set. The anesthesiologist tried twice to set the block but couldn’t due to her movements during contractions. Rather than informing us of his intentions and giving her a chance to hold still he simply flooded her with Fentanyl intravenously, delivering this incredibly powerful drug directly to my 7 pound son.
Only time will tell what the long-term effects will be. The anesthesiologist simply didn’t give a damn. To anyone reading this please inform yourself as much as possible beforehand, many doctors in this 21st century medical machine will not.