"It's all about a healthy baby and a happy mommy."

"The drugs don't cross over the placenta and don't affect your baby."

"A lot of times [an epidural] can help with pushing... "

"When you're in a lot of pain, you're not in control, and that's when you do a lot of tearing."

When a Hollywood glam TV doctor issues the above snippets of advice, we're supposed to sit up and take note, right? Well, according to the producers of the popular television talk show The Doctors, this seems to be the case.

Recently, I had the chance to view this show segment on epidural analgesia. Considering the recent series of blog posts by Michael Klein, MD, in which the pros, cons and realities of epidural analgesia were discussed, I feel compelled to weigh in on this "right for prime time" depiction of a doctor informing a pregnant woman about epidural labor pain relief.

In fact, two - not one - doctors were featured on the episode about epidural analgesia, accompanied by a near-term pregnant woman propped on an examination table (in the middle of a tv film studio) under the guise of receiving valuable medical advice prior to her up-coming delivery. During the four minute, thirty-six second segment, the anesthesiologist demonstrated the technique of epidural catheter placement on a mannequin while the show host, Dr. Lisa Masterson, commentated. Surrounding the mocked procedure, Dr. Masterson offered the pieces of advice included above.

Sadly, the sweeping generalizations made by the two physicians on stage created the regrettable error, so common of the mainstream media, of sensationalizing the realities associated with the childbirth process. And in so doing, these doctors used their authoritative knowledge - in sound-bite-sized pieces - to under-inform a pregnant woman (along with the studio audience and presumably thousands of viewers across America) with their joint assertion that epidurals are nothing short of a God-send to (wo)man kind. (Supported by Masterson's claim that women in other parts of the world who don't have access to epidurals are collectively "dying" to get them. In fact, women in other parts of the world where epidurals are unavailable are more likely to be dying from HIV/AIDS, malnutrition and malaria rather than worrying about analgesics in labor.)

But I digress.

In Dr. Masterson's preamble to the piece, she explained, "Today, we're showing you what you need to know before getting an epidural." The assumption, of course, is that every pregnant woman watching the show would in fact go on to receive an epidural during her labor and birth, and that in the following four and a half minutes, all important questions would be answered regarding the topic of choice.

Unfortunately, everything that a woman needs to know about epidural analgesia wasn't addressed. (See Dr. Klein's series of posts for more information on what a woman needs to know about how epidurals affect the course of labor and birth.)

The anesthesiologist's claim that "The drugs don't cross over the placenta," can be firmly debated as true or false (largely dependent upon the type of epidural administered), but to suggest that epidurals "don't affect your baby" is flat-out wrong. In fact, we know that epidural analgesia affects the baby - fetal heart rate decelerations following epidural placement confirm this time and time again. And if those decels eventually lead to a cesarean section... then most certainly the baby is affected in the process. For starters, numerous studies have shown babies born by cesarean section vs. vaginal birth have a higher likelihood of suffering numerous breathing problems including pulmonary hypertension and the need for exogenous oxygen supplementation.[1] Sarah Buckley, MD, devotes an entire chapter (7) in Gentle Birth, Gentle Mothering: A Doctor's Guide to Natural Childbirth and Gentle Early Parenting Choices to the impact epidural analgesia has on the labor and birth process itself, as well as on the mother and fetus/infant. With numerous sources pointing to the neurobehavioral alterations experienced by babies born in the presence of epidural analgesia, Dr. Buckley certainly does not dismiss these side effects. [2]

When contemplating how epidurals do or don't affect the Second Stage of labor in terms of risk for perineal tearing, the evidence is also contrary to Dr. Masterson's claim that a woman is ' less likely to tear when an epidural is in place.' Truth be told, when a woman cannot feel the intensity of her pushing efforts, she is much more likely to suffer a perineal tear - along with being more likely to experience an instrumental delivery which also carries a higher risk of tearing.[3]

Interestingly, Dr. Ma - the anesthesiologist on the show - briefly delved into the role of catecholamines (stress hormones) in labor - claiming that without an epidural, the mother's body produces too large an amount of catecholamines which, when passed through the placenta can harm the baby. Other experts in the field, of course, tell us that catecholamines released in labor have a very necessary and functional purpose - particularly in the Second Stage of labor - facilitating the final movements of the fetus and imminently assist the birth process.[4]

Concluding the television show segment, the pregnant woman (finally given the opportunity to ask a single question) summarizes what she's heard in the preceding minutes:

"So, an epidural is actually good for the baby?"
Doctor Masterson's emphatic reply: "YES."

The debate over the pros and cons of epidurals aside, I find it regrettable that a healthcare provider would take the professionalism out of her profession by reducing what should be a lengthy, clinically bi-partisan conversation about a significant medical technology and turning it into a minuet of misinformation and false conclusions. Any pregnant woman - whether a guest on a talk show or not - should be told the truth, and nothing but the truth, about the benefits and risks of medical procedures... especially when they are deemed optional.

Posted By: Kimmelin Hull, PA, LCCE

[1] Buckley, Sarah MD Gentle Birth, Gentle Mothering : A Doctor's Guide to Natural Childbirth and Gentle Early Parenting Choices p 197 (Celestial Arts, Berkeley CA,2009) www.sarahbuckley.com

[2] Buckley, Sarah MD Gentle Birth, Gentle Mothering : A Doctor's Guide to Natural Childbirth and Gentle Early Parenting Choices p 197 (Celestial Arts, Berkeley CA,2009) www.sarahbuckley.com

[3] Lothian, Judith PhD The Official Lamaze Guide p154, 241-2(New York, NY Meadowbrook Press 2005, 2010)

[4] Odent, Michel MD Birth and Breastfeeding: Discovering the Needs of Women During Pregnancy and Breastfeeding (East Sussex, UK Clarview Books 2003)

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