Fentanyl -- More about Fentanyl

Last year I posted about epidural and how babies are non-consenting research subjects. Today I received a comment on that post and wanted to share it here. Otherwise, you might miss it. It gives me the opportunity to revisit that information.

Link to the post:
http://hospitalbirthdebate.blogspot.com/2007/01/babies-are-non-consenting-research.html

And today's comment:

Anonymous said...

I am a terminal ovarian cancer patient and my doctor prescribed a fentanyl patch for the extreme pain I suffer. It has provided excellent relief and I don't believe that it has damaged my mental or physical health in any way. However, I have read that it is not short-term, acute pain, so I would agree that it doesn't belong in obstetrics. However, I think you're going overboard to classify it as a street drug. There are people who misuse just about anything in an attempt to get high. Should we ban house paint and spray cans so teens can't "huff" them? Same with fentanyl. There's more to life than giving birth. This drug has brought much comfort for people who suffer chronic pain.

11:26 AM

Thank you for your post, Anonymous. There are not words to express how sorry I am to know that you are terminally ill. I wish you the best. I am sure the fentanyl patch is most helpful to you. This is the appropriate use of fentanyl. Labor and birth is not.

I shared an article about a young man who died from a fentanyl and heroine overdose in my post last year. The article says that over a hundred people have died from that combination of drugs. Clearly, I am not the one to classify it as a street drug. Whether it is or not isn't the point. What is happening to babies who are born under the influence of narcotics and synthetic opiods is the point. In addition to it being known as a dangerous drug on the street, the US Defense Department classified fentanyl as a potential chemical warfare drug. They were considering it as a chemical to use to subdue crowds but decided against it after the tragic loss of many lives in the Chech Republic, I think it was., where fentanyl was responsible for many deaths when used to subdue crowds.

Why would anyone even consider administering this to a laboring woman and baby? For any reason? The reason it is used at all was to counter the effects of bupivicaine which was known to be dangerous.

Fentanyl is a synthetic opiod. The drugs -- a cocktail of drugs at the discretion of the individual anestheseologist -- are administered directly into the spine of a woman. It doesn't just numb her from the waist down -- it gets into her system. She is impaired. Her baby gets the drug and is impaired. This doesn't begin to compare with the valid use of the drug for pain for an adult, with a patch. The blood brain barrier of the newborn doesn't develop for weeks according to some research out of the University of Arizona. Unfortunately, I can't find it right now. Basically, the astrocytes that will eventually make the blood brain barrier don't develop for awhile.

Prior to the great marketing campaign in obstetrics that convinced women that epidural is safe, we knew that babies were affected by the drug that is still used in epidural -- bupivicaine. I can tell you, as can many women, we were not "numb from the waist down." We were drug impaired. Babies were limp, unresponsive, and hard to waken. My daughter could not be wakened. So, now, a decade later, thanks to fentanyl... thanks to fentanyl!?!??! ... those effects are minimized. All babies from the beginning of obstetrics have uninformed, non-consenting research subjects. Now epidural is promoted as so "safe" and so "normal" that women who want to NOT have epidural are now seen as the weirdos by women who are happy to go in, lay down, spread before strangers, and turn their bodies over to the medical conveyor belt. They are happy to be numb, unable to feel their bodies, their babies, or to even move to allow their baby more room to birth from their bodies. Pitiful. Talk about "peer pressure".

Bupvicaine and fentanyl, neither one, were ever shown to be safe before using in labor and birth. Never shown to be safe for the baby. Experimentation on women and babies in recent years in obstetrics has been to find the dosage of bupivicaine that does provides the best "maternal satisfaction." The harm to the baby during birth and for his life time is not anyone's consideration.

The research by the early 90's was clear about the detrimental effects for both. Rather than discontinue it's use, experimentation on women and babies continued. The main point of my posts is that fentanyl is used by obstetricians without ANY research to show that it was safe for the baby or mother before doing so. There is a huge difference between a fentanyl patch for a adult in pain, and a catheter in your spine allowing the drug directly into your nervous system. HUGE DIFFERENCE. An adult can choose to use it. A baby can not choose. They are dependent upon to ensure their safety and wellbeing during labor and birth. A woman who would never consider during sanctioned (prescription) or street drugs, and is admonished if she does, is given full permission to use harmful drug during this most important event. It is done without his consent and against his will. Does the human baby not have the right to labor and be born without drug? With a mother is not impaired.

bupivicaine and fentanyl to find the best amount of fentanyl to COUNTER the dangerous effects of bupivicaine. These effects have been known since late 80's and early 90's. Rather than ending the use of the bupivicaine researchers continue to study the effects on HUMANS ... human newborns.

I am sorry, I don't think we can compare the adult experience/need for pain relief with fentanyl with what is right and just for the human newborn. The "off-label" use of fentanyl in obstetrics, on laboring and birthing women and babies can not be justified. I am speaking out on behalf of the babies who cannot speak for themselves. I am outraged at the medical profession for such criminal violation of woman and babies and for violating the position they hold. They are to protect and "do no harm." I am sad that women are so incapable of trusting their own body to birth their baby and instead trust the propaganda that epidural is perfectly safe. I am outraged that they believe that the use of narcotics is dangerous and the potential for addiction applies to everyone else but them.

What kind of society is this that promotes that a woman laboring and giving birth "under the influence" is ok? Natural? Normal?

I was born by saddle block and have done intensive trauma therapy to heal it. I have given birth "under the influence" of drugs several times -- one against my will and permission, and one by choice as my ex-medical student, later to be obstetrician husband convinced me it was perfectly safe. I was thirty-seven, supposedly in the high risk category and "didn't need to go through all of that." Wasn't he sweet? That was in 1994. Ten years later I found the extensive research showing how dangerous it was for me and for my daughter. He didn't read the research. He had trusted his teachers who pass on their medical rituals.

I know how hard it is to process the violation of a birth where things were done to me, against my will. I know what is it like to feel violated and feel raped .... to not remember twenty hours and who did what to me. All because of drugs I never said yes to. I know how hard it is to have chosen to induce and use epidural and then to learn how lied to I was. In both cases I know how painful and how freeing it is to recognize and deal with the impact on myself and baby. I know the power to heal that comes from seeing that my baby experienced their birth, whether I was violated or made the decision that resulted in their wounding.

We can acknowledge that women and babies are affected by birth ... drugs, interventions, rough handling, strangers, invasions ... because now we have techniques to help us heal and integrate the early, traumatic experiences. We don't have to remain ignorant, in denial, continuing to harm babies.

Hollywood Images of Birth

From a very interesting blog, Feminist Mormon Housewives at http://www.feministmormonhousewives.org/?p=1462#comment-291738

The poster wondered about how common the Hollywood birth images are actually are in real life. That is one topic that neither Heather nor I have written on. One hundred forty some people responded. Here's mine:

The images we see of childbirth on television, Hollywood style, are like everything else on television …. designed to numb us, entertain us, and sell us. Rarely, does a woman go from not much happening to full transition, at the worst possible time … or most timely for entertainment. Like other forms of violence that humans watch mindlessly for hours every day, modern birth in the hospital is crammed into brains as the “normal” way, the safe way … they are selling epidural and the control of women’s bodies, minds, and souls just like they are selling the newest car, line of clothes, improved mop, and sexy shampoo. Like violence, like the sexual images our children are exposed to, the message of the horrible pain, the need for a crew of medical people pushing, probing, and coaching … all keeps us hyper aroused, over-stimulated and numbed — all at the same time. Our children hear shampoo commercials of orgasmic sounds, see women sprawled and wiggling in bras .. selling everything from cars to microwavable rice. And, they are expected to abstain — with images of sexual relationships everywhere … and, since society doesn’t question or confront this, it’s zero surprising that the images of birth — meant to draw women to the hospital where it is very lucrative — are indoctrinating our society. The walking wounded and numb make good, compliant women, consumers.

Thanks for this topic … it is one I haven’t written about on my blog … but will.

www.hospitalbirthdebate.blogspot.com

Comment by janel — November 29, 2007 @ 12:43 am

I couldn’t read all of the messages, but I did pick up on one vein of thought and posted a summary of what I wrote so extensively on last year ….

With all due respect to Janet’s husband, an anesthesiologist, apparently, I would like to ask him if he might be someone who could answer my challenge —

Throughout the history of modern birth, starting with morphine, twightlight sleep, ether and including Scopalamine, Demerol, Cytotec, and now epidural, these drugs have all been used on laboring babies and women with ZERO research to show their safety. ALL of them have been shown to be damaging and dangerous and were stopped because of the consequences … after use on millions of babies and women. Twenty years ago the choice drug was Demerol … and it is rarely used because of the impact on the baby. Since then epidural has increased in spite of the research in the late 80’s and early 90’s that shows it is dangerous. The drug, bupuvicaine that made it dangerous was counteracted by using fentanyl, an opiod … ALSO NEVER shown safe for laboring babies, but known to be extremely dangerous for adults. Mothers are encouraged and supported to give birth UNDER THE INFLUENCE OF NARCOTICS?? What a horrible contradiction. Yes, I have given birth under the influence of epidural. We are not just numb from our waist down — we are altered, drug-impaired while birthing our baby. And, this is considered normal. In the early 2000’s one study took 120 pregnant women and divided them into ten groups and each was given a different dose of fentanyl to see which dosage works best to counter the effects of narcotics. !?!?!? These babies and women are UNinformed and NON consenting subjects in a research study …. animals get better consideration. Women and babies (some who grow up to be men born “under the influence” of drugs) are one long research study. Psychology, medicine, human development, addiction studies. prevention, and treatment, and the myriad of other social and health issues, etc totally ignore the impact of birth on the lifetime of the human and certainly doesn’t consider that drug use and the resulting disruptions so well known, and the trauma form a foundation for life.

For a long time I have been looking for someone in the obstetric or anesthesiology field to give me ONE study that proves that ANY drug used EVER in modern medical birth was shown to be SAFE prior to USING on BABIES and WOMEN.

Doctors, nurses, and women will all … out of their own guilt, not imposed by others … resist the truth that drugs affect the baby ….because when we have chosen that or had it imposed upon us, or learned it was “fine” and “safe”, we face a huge journey.

There is a whole new field of understanding fetal and newborn learning, consciousness, and healing of whatever happens — whether it was truly lifesaving technology or doctor-induced for doctor convenience and malpractice avoidance (my ex is an OB), or by maternal choice. Ultimately, humanity has to begin to see that birth IS THE BABY’S experience of coming from somewhere into this physical life — and that the baby does not go to “OFF” during labor and birth. We know that the fetus is learning, responding in relationship with the mother and the environment … hearing, tasting, sensing, developing. And, we know that the newborn IMMEDIATELY is negotiating with a new environment during major physiological transition, and is interacting … LEARNING … It is clear that something very serious is amiss in medicine about the importance of labor and birth and how babies are also experiencing, responding, learning. All bundled together, that is results in memory. Prenatally, postnatally, and during labor and birth. The baby is experiencing everything. It is his or her birth. We can’t deny it away. Birth can’t just be about the mother’s need for pain relief or convenience, or the doctor’s needs.

Again, with all due respect and sincere wish for a real dialogue about what is really happening to babies in birth, I share my passion here.

Thanks.
Janel

I hope sometime soon, someone who is trained in anesthesiology will respond to my request for ONE research study that shows ANY of the drugs EVER used were studied BEFORE using on babies and women. The question is basically ignored by those promoting banning homebirth, and the wrong promotion of it as safe so that more women than not, now in 2007, will see it as perfectly safe. Drugs at birth is a collective consciousness that allows the cycle of dependency and drug addiction we see to be perpetuated. THAT could be a hypothesis for someone to study -- as it has never been studied. EVEN in addiction studies, with 80% of the present population born under the influence of drugs, IMPAIRED, with impaired mothers, the use of UNRESEARCHED drugs at birth has NEVER been studied as a causal or related factor.

The use of narcotics in labor and birth (while discouraged and even warred against in every other aspect of life) is disguised at giving women freedom from pain in birth … with no regard for her baby’s lifelong consequences of being born while they both are impaired “under the influence” of narcotics. In ANY other situation in life, a woman would be chastised and judged for being impaired while doing something so important, and she’d be seen as harming her child if she is impaired.

In this bi-polar society in seems daunting for anyone, especially medically trained people to see that even when they are using a substance for the right reasons, to facilitate the birth so that either or both mother and baby will survive, it STILL has consequences. Refusal to see that and to engage in ways of supporting the baby afterwards create this growing belief -- a monster that everyone ignores and denies -- that babies are unaffected by what we do, what they experience, what they have circulating in their body, and that their systems must work and struggle to adjust because of drugs and disruptions.

The research in the late eighties and 90’s were very clear about what the physiological response to epidural was for the mother and baby. This does not change just because they added ANOTHER harmful, unresearched drug to counteract (fentanyl). It doesn’t change because we deny it with the belief that women’s rights to pain relief, doctor’s time schedules, and convenience are as important, if not more, than the rights of a human baby to be born free of harmful, addictive chemicals.

It seems to me that the lack of any research and the ongoing research ON babies and mothers to find the right dosages with least complications, and the obstetric shop-talk sharing how to’s is outrageous.

Using Cyotec in the first place was done on women and babies without study and it was done between doctors and residents, in online chats, and general “shopt-talk” fashion. Dosages, complications, and responses was figured out like how we teach our young people to prepare, stuff, and cook a turkey. AND, meanwhile, simultaneously, THEN they began to research it …. THOSE who have it in their interest to continue using it. Same with epidural anesthesia …

YEAH, I AM blue in the face ....

I met a local anesthesiologist recently ... our conversation started over the war. It was a week after my son went to Kabul and I was working at being numb. He started giving me all sorts of things to send my son to read ... including something about the Heroin War, or something. I started to share my perspective that our violence and addiction starts in the primal period ... as I shared my oft cited research where 120 babies received different doses of bipuvicaine and fentanyl to determine the best dose combination, this new acquaintance smiled .... I said, "What, you are a doctor?" He, who is as crazed about the war and heroin use as I am about making birth safe for the baby by creating science-based protocols and using drugs and interventions only when needed, was shocked when I suggested that he and his colleagues have created the drug addiction crisis and asked how is it that any of you would be able to consider what it is that you have done to so many humans? I said it would take a spiritual crisis and awakening ... and our society does not support that. Anyone in any sort of emotional, psychological, or spiritual crisis is "diagnosed" and pumped with drugs that cause a myriad of other issues. We see it on television, in the advertisements .... around and around we go.

Progress in the "war on drugs", the "war on crime", the "war on gangs", the "war on violence", the "war on poverty", the "war on cancer" will happen ONLY when we start bringing babies into this world in an aware, safe, gentle, connected, drug-FREE, violence-FREE way. (Medical birth is violent).

We can conceive, gestate, labor and birth, and care for our infants with awareness, protection, gentleness, our time and touch EVEN when or ESPECIALLY when medical intervention ARE necessary. What is wrong with this world of obstetrics that promotes all or nothing ... either their way or no way.... zero compromise so that woman blindly follow, or live their lives damaged in silent rage and illness, unable to connect with their children in the way that both their mind and souls strive for and miss over and over and over.

Oh, my ....

The Numbing of America -- Epidural research from before 1990

I have posted this before, and I'll keep doing it to show that epidural anesthesia is used predominately in 2007 when the research TWENTY YEARS prior clearly shows that epidural is not safe for normal, routine use. None of the drugs EVER used in obstetric care have been shown to be SAFE BEFORE using on the birthing baby. We have over TWENTY YEARS of research on epidural drugs that continues to show that it is not safe. TWENTY years of ancedotal evidence to SUPPORT the scientific claims. TWENTY YEARS of research on women and babies who are NON-informed and NON-consenting research subjects. Animals in scientific research are protected more than human babies.

I have asked Dr. Amy Tutuer for almost a year now to provide ONE piece of research that shows that the drugs in epidural anesthesia were EVER researched and shown to be safe BEFORE USING and before the thirty years of non-informed research (use on women and babies) began, AND, to provide ONE piece of research that shows that the HUMAN BABY has no long term effects from being born "under the influence" of narcotics and resulting interventions. (as the incidence of drug addiction of narcotics increases and WAR on DRUGS marches on in the US.)

It's time for America to DETOX.

Source: http://www.fensende.com/Users/swnymph/Epidural.html

Epidurals substantially increase the incidence of oxytocin augmentation, instrumental delivery, and bladder catheterization. (21 studies cited)

Saunders, NJ, et al. "Oxytocin infusion ... primiparous women using epidural..." BMJ 1989;299:1423-1426 Diro, M. and Beydoun, S. "Segmental epidural analgesia in labor: a matched control study". J Nat Med Assoc 1985;78(1):569-573.
Chestnut, DH, et al. "The influence of continuous epidural bupivacaine analgesia on the second stage of labor and method of delivery in nulliparous women". Anesthesiology 1987;66:774-780.
Kaminski, HM, Stafl, A, and Aiman, J. "The effect of epidural analgesia on the frequency of instrumental obstetric delivery". Obstet Gynecol 1987;69(5):770-773.
Philipsen, T and Jensen, NH. "Epidural block or parenteral pethidine as analgesic in labour; a randomized study concerning progress in labour and instrumental deliveries". Eur J Obstet Gynecol Reprod Biol 1989;30:27:33.
Gribble, RK and Meier, PR. "Effect of epidural analgesia on the primary cesarean rate". Obstet Gynecol 1991;78(2):231-234.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol 1993;169(4):851-858. Nel, JT. "Clinical effects of epidural block during labor. A prospective study". S Afr Med J 1985;68(6):371-374.
Yancy, MK et al. "Maternal and neonatal effects of outlet forceps delivery compared with spontaneous vaginal delivery in term pregnancies". Obstet Gynecol 1991;78(4):646-650.
Stavrou, C, Hofmeyer, GJ, and Boezaart, AP. "Prolonged fetal bradycardia during epidural analgesia". S Afr Med J 1990;77:66-68.
Eddleston, JM, et al. "Comparison of the maternal and fetal effects associated with intermittent or continuous infusion of extradural analgesia". Br J Anaesth 1992;69:154-158.
Bogod, DG, Rosen, M, and Rees, GAD. "Extradural infusion of 0.125% bupivacaine at 10 Ml H-1 to women during labour". Br J Anaesth 1987;59(3):325-330.
Smedstad, KG and Morison, DH. "A comparative study of continuous and intermittent epidural analgesia for labour and delivery". Can J Anaesth 1988;35(3):234-241.
Chestnut, DH et al. "Continuous infusion epidural analgesia during labor: A randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine". Anesthesiol 1988;68:754-759.

In first-time mothers, epidurals substantially increase the cesarean rate for dystocia. This effect may depend on mamangement. (12 studies cited)

Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol 1993;169(4):851-858.
Diro, M. and Beydoun, S. "Segmental epidural analgesia in labor: a matched control study". J Nat Med Assoc 1985;78(1):569-573.
Chestnut, DH, et al. "The influence of continuous epidural bupivacaine analgesia on the second stage of labor and method of delivery in nulliparous women". Anesthesiology 1987;66:774-780.
Thorpe, JA et al. "The effect of continous epidural analgesia on cesarean section for dystocia in nulliparous women". Am J Obstet Gynecol 1989;161(3):670-675.
Philipsen, T and Jensen, NH. "Epidural block or parenteral pethidine as analgesic in labour; a randomized study concerning progress in labour and instrumental deliveries". Eur J Obstet Gynecol Reprod Biol 1989;30:27:33.
Gribble, RK and Meier, PR. "Effect of epidural analgesia on the primary cesarean rate". Obstet Gynecol 1991;78(2):231-234.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410. Abboud, TK et al. "Continuous infusion epidural analgesia in parturients receiving bupivacaine, chloroprocaine, or lidocaine - maternal, fetal, and neonatal effects". Anesth Analg 1984;63:421-428.
Stavrou C, et al. "Prolonged fetal bradycardia during epidural analgesia". S Afr Med J 1990;77:66-68. Smedstad, KG and Morison, DH. "A comparative study of continuous and intermittent epidural analgesia for labour and delivery". Can J Anaesth 1988;35(3):234-241.
Epidurals decrease the probability that a posterior or transverse baby will rotate. Oxytocin does not help. (7 studies)
Saunders, NJ, et al. "Oxytocin infusion during second stage of labour in primiparous women using epidural analgesia: a randomised double blind placebo controlled trial". BMJ 1989;299:1423-1426.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Kaminski, HM, Stafl, A, and Aiman, J. "The effect of epidural analgesia on the frequency of instrumental obstetric delivery". Obstet Gynecol 1987;69(5): 770-773.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol 1993;169(4):851-858.

Having an epidural at 5cm dilation or more eliminates both excess posterior/transverse and excess cesarean for dystocia. (2 studies)
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol 1993;169(4):851-858.

Epidurals may not relieve any pain or may not relieve all pain. (3 studies)
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol 1993;169(4):851-858.
Eddleston, JM et al. "Comparison of the maternal and fetal effects associated with intermittent or continuous infusion of extradural analgesia". Br J Anaesth 1992;69:154-158.
Crawford, JS. "Some maternal complications of epidural analgesia for labour". Anesthesia 1985;40(12):1219-1225.

Innovations in procedure - lower dosages, continuous infusion, adding a narcotic - have not decreased epidural related problems. (13 studies)
Naulty, JS. "Continuous infusions of local anesthetics and narcotics for epidural analgesia in the management of labor". (this is a literature review) Int. Anes. Clin. 1990;28(1):17-24.
Diro, M. and Beydoun, S. "Segmental epidural analgesia in labor: a matched control study". J Nat Med Assoc 1985;78(1):569-573.
Chestnut, DH, et al. "The influence of continuous epidural bupivacaine analgesia on the second stage of labor and method of delivery in nulliparous women". Anesthesiology 1987;66:774-780.
Thorpe, JA et al. "The effect of continous epidural analgesia on cesarean section for dystocia in nulliparous women". Am J Obstet Gynecol 1989;161(3):670-675.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia: risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol 1993;169(4):851-858.
Abboud, TK et al. "Continuous infusion epidural analgesia in parturients receiving bupivacaine, chloroprocaine, or lidocaine - maternal, fetal, and neonatal effects". Anesth Analg 1984;63:421-428. Eddleston, JM, et al. "Comparison of the maternal and fetal effects associated with intermittent or continuous infusion of extradural analgesia". Br J Anaesth 1992;69:154-158.
Bogod, DG, Rosen, M, and Rees, GAD. "Extradural infusion of 0.125% bupivacaine at 10 Ml H-1 to women during labour". Br J Anaesth 1987;59(3):325-330.
Smedstad, KG and Morison, DH. "A comparative study of continuous and intermittent epidural analgesia for labour and delivery". Can J Anaesth 1988;35(3):234-241.
Chestnut, DH et al. "Continuous infusion epidural analgesia during labor: A randomized, double-blind comparison of 0.0625% bupivacaine/0.0002% fentanyl versus 0.125% bupivacaine". Anesthesiol 1988;68:754-759.
McLean, BY, Rottman, RL, and Kotelko, DM. "Failure of multiple test doses and techniques to detect intravascular migration of an epidural catheter". Anesth Analg 1992;74(3):454-456.

Delaying pushing until the head has descended to the perineum increases the chances of spontaneous birth. (a time delay of 1 hour is not really delaying - it needs to be a positional not timed thing...) Evidence is divided as to whether letting the epidural wear off before pushing increases spontaneous delivery. (4 studies)
Maternal complications of epidurals include:

Uitvlugt, A. "Managing complications of Epidural Analgesia" International Anesthesia Clin. 1990;28(1):11-16]
Maternal hypotension(5 studies). This reduces uteroplacental blood supply and can cause fetal distress. (8 studies)

Convulsions (4 studies)
Respiratory paralysis (3 studies).
Cardiac Arrest (6 studies)
Allergic Shock (2 studies)

Maternal nerve injury due to needle injury, poor positioning, forceps injury, infection, hematoma, or subarachnoid injection of chloroprocaine. The last three usually cause permanent injury. (9 studies)
Spinal headache (3 studies)
Increased maternal core temperature. (2 studies)
Temporary urinary incontinence. (1 study)
Long-term backache (weeks to years), headache, migranes, numbness, or tingling. (2 studies)
Serious complications occur despite proper procedure and precautions. The epinephrine test dose can cause complications. (12 studies)
Epidural anesthetics "get" to the baby. (5 studies)

Epidurals do not protect the fetus from distress. In fact, they cause abnormal fetal heart rate, sometimes severe, which may occur with or independant of maternal blood pressure (11% - 43% depending on the study and type of medication used - the 43% was found with Bupivacaine, the most common drug for epidural.) (15 studies)
Stavrou C, et al. "Prolonged fetal bradycardia during epidural analgesia" S Afr Med J 1990;77:66-68
Epidurals may cause neonatal jaundice. (2 studies)
Clark, DA & Landaw, SA. "Bupivacaine alters red blood cell ... jaundice associated with maternal anesthesia" Pediatr. Res. 1985; 19(4):341-343]
Epidurals may cause adverse neonatal behavioral and physical effects. (these are both direct effects and indirect effects from the increased rate of labor complications and interventions.) The importance of this is debated. (4 studies)
Epidural anesthesia may relieve hypertension, but hypertensive women are at particular risk of epidural-induced hypotension, which reduces placental blood supply. (2 studies)

Ancedotal story about epidural disappears

An interesting post appeared and then disappeared on another blog today. Hmmmm. It was very much of interest to me as I just posted about CNM in Canada being certified to administer epidural. Have I mentioned lately that epidural anesthesia has never been shown to be SAFE for the birthing baby's brain? Nor, for the mother? In fact, it's been shown over and over and over to be detrimental physically to the mother and baby. Logical and science tell us it is detrimental emotionally, psychologically, and spiritually to the baby and in particular, in the mother-baby relationship.

Here's the post that later got removed by the doctor on her blog.

It's from an online acquaintance whose wife gave birth on Monday:

Water breaks Sunday at 11:55. We go to hospital at 2:30am. Contractions get bad about 2 pm. The give her an epidural. Babies heart rate drops, they get it going by shoving their hand up and tickling babies head. 1 hr later babies heart rate goes into the low 60s, should be 120-150. The can't get it to stay up. Rush in for emergency C-Section.


I get scrubbed up, go in sit on the stool beside her, she's crying, she's scared. They start cutting, she says it feel wrong (she's numb from the shoulders down from the epidural). They cut some more...the epidural didn't freeze her inside. She's screaming (blood curtling scream) in pain, then it gets even worse, she's sobbing now (too much pain to scream as they cut and dig through her abdomen). By the time the anesthesioligist gives her more drugs it's been 5 minutes and the baby is out, they're starting to put her back together.


Baby is fine, has a slice on her cheek from the scalpel and a cut in her head.

THERE'S THAT LINE THAT I HAVE POINTED OUT IN BIRTH STORIES TO RESEARCH!! "Baby is fine" --- and goes on "slice on her cheek and cut in her head." Are people really so clueless about the experience of the fully present and FEELING baby? The baby is a real person -- they feel pain even more acutely than we do. We have developed coping skills for pain. Lord o' mercy. The human baby who has never felt anything but soft touch and comfort is gripped by an adult hand and pushed and pulled and is sliced and diced during the most significant experience of her life -- that could be gentle and quiet and loving -- and "baby is fine?" #($&#(* ($#(*&&_@*#&!!! Once you REALLY get how fully sentient a baby is that phrase will make your blood boil too. AND, this -- "Women are only numb from the waist" and "baby doesn't remember." Sure. Everyone in the room is NUMB. The effect never wears off on a cellular level. Mother and baby are IMPAIRED --- JUST LIKE ANYONE ON NARCOTICS IS IMPAIRED. SIMPLE TRUTH.

They say they think the babies cord was being crushed...we find out later from a student nurse they gave her too much epidural (shoulders down should have been waist down) and that's what caused the heart problems.  

JANEL: LABORING AND BIRTH WOMEN AND BABIES ARE UNINFORMED, NON-CONSENTING SUBJECTS IN ONE LONG RESEARCH PROJECT. 

They then forget to give her a morphine shot 3 times, and then have to verify she's supposed to get it after being told in front of us. So no pain drugs for 4hrs...today they stop giving her pain medication at 8am without telling her (she's taking other pills so doesn't know they've stopped). 7pm the pain starts hard. Their excuse "you didn't ask for more".


Do I have statistics on how often this sort of thing happens? No. Do I care what the frequency is? No. If it happens to even one woman, it's one damn time too many. This woman will be traumatized, possibly for life, because she consented to an intervention which is, according to Amy, harmless.


THE WOMAN WILL BE TRAUMATIZED FOR LIFE? WHAT ABOUT THE BABY??? THEIR RELATIONSHIP IS FOREVER TRAUMATIZED --- and unless they engage in a therapeutic process to specifically deal with the BABY'S perceptions and needs they will have a relationship that will directly reflect this experience. Baby and mother were BOTH UNDER THE INFLUENCE OF NARCOTICS when the most basic, fundamental experience that defines their relationship took place. It doesn't just happen so dramatically to one dyad--- it happens every day, in 80% of all US births. It's about the MOTHER'S 'right to pain relief" and "maternal satisfaction" propaganda by the medical establishment that women fall prey to. It's keeps women numb, compliant, and coming back to the medicals for most of their mothering years. It leads statistically to csection and the only winner there is the physician and his Queen (the hospital -- doctors are the "worker bees" that bring in the honey).

How long are women (and their partners) going to swallow this BS -- and continue to put themselves and their babies in harms way? (Ever wonder where this meconium type statement came from? Swallowing feces when someone else is doing or saying something outrageous?)

Babies are non-consenting research subjects

What are the long-term consequences of this? A look at just a couple of peer-reviewed scientific research about epidural anesthesia will point out a major flaw in "scientific research" about the safety of epidural --- but first,


Murder Charged in Heroin-Fentanyl Overdose After Police Chief's Son Dies August 29, 2006

The overdose death of an Illinois police chief's son has led to murder charges being filed against the man who sold a deadly mix of heroin and Fentanyl to the teen, the New York Times reported Aug. 25.

The 35-year-old dealer, Corey Crump, faces up to 30 years in prison in connection with the death of Joseph Krecker, 17, the son of Franklin Park Deputy Chief Jack Krecker. The teen overdosed in June.

The heroin-fentanyl mix has killed hundreds of people across the country, but this is the first case where murder charges have been filed in connection with an overdose.

"With this announcement comes the bittersweet reality that members of our own family can be vulnerable to the evils of gangs, guns and drugs," said Chicago police superintendent Philip J. Cline.

My deepest sympathy to this family on the loss of their son and so tragically. With deepest regard and heartfelt respect for them, I use their story to introduce and conclude regarding the health and social problems of using fentanyl in labor and birth.

Fentanyl is an opiod. It is considered a dangerous street drug and a potential chemical weapon by the Pentagon (previous post). The biological effects of the fentanyls are indistinguishable from those of heroin, with the exception that the fentanyls may be hundreds of times more potent. Fentanyls are most commonly used by intravenous administration, but like heroin, they may also be smoked or snorted. http://www.streetdrugs.org/fentanyl.htm. Aaaand, it is used in epidurals for laboring and birthing babies.


The number one flaw of the obstetric, peer-reviewed literature, is that the drugs were never shown to be safe for birthing human beings EVEN THOUGH the detrimental effects on adults are clear. Fentanyl in epidural anesthesia is considered "safe" after years of using on non-consenting, non-informed babies (and their moms). And, now as many as 85% of births are "under the influence" of epidural anesthesia. The drugs used in epidurals are known to be dangerous to adults and were never shown to be safe for the birthing brain. Yes, I say it everyday here -- sometimes multiple times. Drugs used in labor and birth were never shown to be safe for birthing baby. None. Ever. I am outraged that the antecdotal pseudo-scientific research that exists was done on birthing women and babies. In the late 80's it was clear that epidural was dangerous for mother and baby, and the research since has been done on NON-CONSENTING, UNINFORMED HUMAN BABIES. It's an outrage, I tell you. Here are just two examples:

Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. Jaishri Bogra, Namita Arora, and Pratima Srivastava,BMC Anesthesiol. 2005; 5: 5.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1159169

In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section.
Researchers -- in their research -- actually acknowledge the detrimental effects of epidural and are researching for dosage on live babies and women. We are to believe any of the research that the obstetric field dishes us? I gave birth twice in a teaching hospital - one a planned induction with epidural. Were we research subjects? Must not be, no one ever followed up to see how we did in the long term. HA! It's appalling.

Methods: Study was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 μg intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain.

The year is 2005. HOW IS THIS “SCIENTIFIC STUDY” APPROVED AND ACCEPTABLE TREATMENT OF THE HUMAN NEWBORN??? One hundred twenty babies randomly placed in groups to receive different drugs. Drugs that were never, ever shown to be safe for a baby. Lord o'f mercy -- do the people in charge of the "War on Drugs", drug prevention, drug treatment, and child psychology know this?!?! Being in all of those fields, I can tell you, NO, they don't.

Researchers concluded, Spinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod) on bupivacaine (a local anesthetic) in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.

Complications in dosage and other factors such as hunger, dehydration, size, etc. is consistent with what the researchers at University of Pennsylvania found in adults (previous post). So serious is this opiod that it is considered a chemical weapon by the US Pentagon -- and yet, it is used routinely at birth. Someone needs to regulate obstetrics and this research. It is criminal to administer opiods to non-consenting babies in research - drugs known to be be fatal if administered in too high a dose and that doses must be customized,
http://www.sunshine-project.org/publications/pr/pr110203.html. Oh, my!! A baby who used fentanyl (and possibly drugs for later ADHD, etc) or whose mother was born using fentanyl or used during her life could react to fentanyl later? And, that includes legal and illicit use. How many babies have died or become addicts because of being born "under the influence?"
So sadly, we now have young adults dying from overdosing of the drug fentanyl. Again, from the tragic story above, The heroin-fentanyl mix has killed hundreds of people across the country, but this is the first case where murder charges have been filed in connection with an overdose. I wonder if those who have died from the heroin-fentanyl combo (and those who suffer, but don't die and live life struggling as addicts) were born "under the influence" of fentanyl - maybe even those who were early subjects of this peer-reviewed "scientific research" to find a cocktail that achieves "maternal satisfaction" aka "control of women." The issue of women "under the influence" and the impact of this on attachment and life-long mothering is another topic.

Bupivacaine versus bupivacaine plus fentanyl for epidural analgesia: effect on maternal satisfaction. J D Murphy, K Henderson, M I Bowden, M Lewis, and G M Cooper, Department of Anaesthetics, Birmingham Maternity Hospital, Queen Elizabeth Medical Centre. BMJ. 1991 March 9; 302(6776): 564–567.

OBJECTIVE--To compare a combination of epidural fentanyl and bupivacaine with bupivacaine alone for epidural analgesia in labour and to evaluate factors in addition to analgesia that may influence maternal satisfaction.

"Maternal satisfaction" is the objective!?! with a drug like fentanyl?? while the field promoted controversy about home and water birth?!? Perhaps this “scientific” approach to studying the drugs used in epidural anesthesia – focused on maternal satisfaction – give us some clues as to how this culture approval for these dangerous drugs has evolved into “maternal request” and “informed consent” lingo and an epidemic addiction problem in the US. This research was done in 1991 when the literature was clearly showing the detrimental effects to mother and baby. It is a lie that this is about maternal satisfaction. Epidural was and is promoted by appealing to the suffering of the laboring woman; but, it is about money and controlling women. (See my January 6th post, "Anesthetized women look so vulnerable.")

The addition of fentanyl to bupivacaine reduced the requirement for local anaesthetic (-33 mg, -55 to -15, p less than 0.001) without compromising analgesia. No adverse effects in neonates were attributed to the use of fentanyl.

Oddly, many of these “scientific” studies of drug use during labor use statements such as this -- “No adverse effects in neonates were attributed to the use of fentanyl” even when this was not the focus of the study, variables not accounted for, but reported on nonetheless. How the newborn was assessed, therefore, is not part of the “scientific study” and there are no "hard numbers" to support this claim. It is inappropriate reporting. There rarely is an adequate, non-objective, research-based method for assessment of the newborn -- for the baby is considered a product of birth, not a participant, and certainly is not considered to be experiencing the single most profound experience his brain will have.
Was the APGAR used? The APGAR was designed to evaluate babies born under the influence of ether in the forties! and has never been normed or updated. The Brazelton Newborn Assessment Scale is considered the "gold standard" for newborn assessment. Nor, has it or any assessment for evaluating newborns been normed on NON-DRUGGED babies. How could they? Estimates are that eighty to 95% of babies born in the US are born under the influence of drugs. Think about that – the assessments for evaluating babies at birth have been normed on drug-impaired babies. We do not know what our human potential is and those in the medical field do not know, objectively or subjectively, what a normal functioning, non-impaired baby "looks like."

So much for winning the "War on Drugs," the “Just Say NO” campaign, and the DARE program.

The study concludes, The already high maternal satisfaction from conventional epidural analgesia can be improved; epidural fentanyl may be combined with bupivacaine to reduce operative deliveries and confer other advantages that may increase maternal satisfaction. Further investigations should be performed to determine the exact mechanisms of these findings and, in particular, to develop a safe method of delivering such analgesia to women.

MORE studies using drugs shown to be detrimental to babies DONE ON BABIES in order to find safer mechanisms and dosages and combinations -- for maternal satisfaction? Nooooo! No more drugging our babies to find the "exact mechanism" and to "develop a safe method of delivering such analgesia to women." You've shown it is NOT safe. STOP PROMOTING it as safe. Does this make anyone else as nuts as it does me??? What women would not pursue other satisfying non-drug methods of pain relief (water, self-hypnosis, prelabor body work, movement in labor, etc) if she only knew the truth?
Is anyone else starting to look with new eyes at the heroin, crack, meth, cocaine problem in our society? The painful struggle of recovery from these drugs is successful for 15% of addicts. And, maybe addiction can be prevented by drug-free prenatal development and labor and birth. Anyone else wondering about the rising incidence of asthma, autism, allergies, ADHD? Educational and behavioral problems? Family, marital, and parent-child problems?

Speaking of the War on Drugs, it was reported in multiple sources in September that production of opium is up 59% in Afghanistan and that "last year, about 450 tons of heroin was consumed worldwide, 90% of it from Afghanistan, according to the U.N." http://www.usatoday.com/news/world/2006-09-02-afghanistant-opium_x.htm. And ,they say America's war in Iraq is about oil supplies!!

According to Bob Curley, in Mission Accomplished in War on Drugs? August 4, 2006, Adolescent use of illicit drugs has declined over the past 20 years, while use of heroin has remained stable, if stubbornly so. Everyone has agreed for the past 20 or 30 years that the only real improvements will come from demand reduction, not supply reduction," said Dogoloff, a former U.S. drug czar. Interestingly, this is the same time period that epidural anesthesia with bupivacaine and fentanyl (opiates) has been increasingly popular to the point of being "standard protocol" in virtually every hospital. And now women and men claim they had "natural birth and the epidural was great." Natural now means "vaginal" to many - drugs are so accepted as normal in birth and for every ailment.

Seems to me we could stop the DEMAND for opium by not birthing our babies "under the influence" of opium. In the early nineties a cutting-edge program "Parenting for the Drug-Free Years" out of the University of Washington (that I was trained to present) was based on enhancing the parent-child relationship in order to extend the "first time drug usage" of the child. It was known the later the first time usage, the less likely a person would become an addict. Opium at birth --- who woulda thought? How many parents and children are struggling to understand what is happening in their lives while the world ignores the beginning of life and the early drugging as the root source?

Humans will look back on this time in history and shake their heads in disbelief at what humans did to their babies. I already did that in regards to my induced and epidural labor and birth of my own baby. Thankfully, there are new understandings of the brain and healing technologies for birth trauma. And, there is forgiveness of self and others, and there can be a collective effort to make birth safe for babies coming in now.

Again, my deepest sympathy to the family of Joseph Kreckler.