Somebody in my prepared childbirth class asked about the a statement she read that after you take pain medication or get an epidural you don't produce endorphins anymore. I have been wondering about that myself, where can I find some more information about that fact, to support it. And what exactly produces endorphins. You know that class activity where you get a couple to slowdance and the rest of the class states what activities produce endorphins (touch, movement, encouraging words, etc.) where can I find support, evidence for that theory.
Erica By: Erica

Hi,

Production of NATURAL oxytocin directly increases production of endorphins, making mom relax which further increases oxytocin production.  This is an essential feedback mechanism which makes labor more productive.  This info is in The Birth Partner by Penny Simkin and the official Lamaze guide.  Thus, an epidural can help her relax by reducing the pain.  It's the pitocin that interferes with endorphin production because it is not the natural hormone.

Jane

Does the newborn also get the effect of endorphins after birth? I've been looking for research on this, and can't seem to find any.

According to Dr. Sarah Buckley in Gentle Birth, Gentle Mothering, (c) 2005, p 119, the baby secretes beta-endorphins during labor from its own pituitary and from the placenta and hormone levels in the placenta are even higher than in the mother's bloodstream at birth. She cites:

Facchinetti F, et al. Fetal intermediate lobe is stimulated by parturition. Am J Obstet Gynecol 1989;161:1267-70.

Facchinetti F, et al. Changes in beta-endorphin in fetal membranes and placenta in normal and pathological pregnancies. Acta Obstet Gynecol Scand 1990;69:3-7.

Jevremovic M, et al. [The opioid peptide, beta-endorphin, in spontaneous vaginal delivery and cesarean section]. Srp Arh Celok Lek 1991;119:271-4.

-- Henci

I know I'm replying years later, but.... My understanding is that administration of edpidurals often slows contractions, leading to administration of pitocin. If pitocin is a concern, then an epidural could, indirectly, increase the likelihood of interference with endorphin production.

Childbirth is a complex process with many interdependent components. Changing one parameter can have many direct or indirect results down the line, in a domino effect.

--Diana McCleery

No problem with posting years later. The issue is certainly still current! Yes, among its other defects, epidurals increase the use of oxytocin. According to a systematic review (an analysis of all the relevant research in a structured manner) of the randomized controlled trials (RCTs) (participants are assigned by chance to one form of treatment or another) of epidurals vs. other forms of pain relief, women are 20% more likely to be given oxytocin if they have an epidural. That percentage is actually probably much greater because results are analyzed according to assignment group ("intent to treat"), not according to what treatment the individual had. The strength of an RCT is that by assigning participants to groups by chance, you get rid of some potential sources of bias. For example, women experiencing slow, difficult labors that require oxytocin to make contractions stronger are more likely to want epidurals. If you analyze according to actual treatment, you remove that strength. Analysis by "intent to treat" generally works well because in most RCTs, all but a small percentage of participants get their assigned treatment. However, in, I think, all but one of the epidural RCTs, substantial percentages of women assigned to the "no epidural" group decided they wanted an epidural. For this reason, analyzing according to "intent to treat" inflates the number of women in the "no epidural" group who had oxytocin to strengthen their labors.

-- Henci

Anim-Somuah M, Smyth R, Howell C, et al. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev 2005(4):CD000331.