Weighing the Pros and Cons of the Epidural by Penny Simkin The epidural block has been used increasingly over the past 50 years. Childbirth educators across the country are finding that more and more women plan--even demand--an epidural in order to avoid labor pain. Why the popularity? Are there any significant disadvantages to epidurals? Are they safe enough for routine use? What Is an Epidural? Epidural anesthesia or analgesia refers to total or partial loss of sensation in the trunk between the fundus and the pubis or lower. An anesthetic agent (such as Marcaine, Lidocaine or Carbocaine), a narcotic (such as Demerol, Morphine, or Fentanyl), or a combination of the two, is injected in the lower back in the epidural space between lumbar vertebrae two and five (L-2 and L-5). Some use the terms anesthesia and analgesia to refer to the agents used: anesthetic agents or analgesics (narcotics). Anesthetic agents numb the area; epidural narcotics, if used alone, diminish but do not completely eliminate labor pain. Others use the terms to describe the amount of pain relief. Anesthesia, as with a standard epidural, is the total loss of the sensations of labor. Analgesia, as with a light epidural is the partial loss. Epidural narcotics are being used for labor in some centers, but are presently less available than the anesthetics.1 Today, epidural narcotics are more often used for post-cesarean pain; a single dose administered in the delivery room provides approximately 24 hours of pain relief. The cost of an epidural, including the anesthesiologist and hospital fees, ranges between $700 and $1,200. Risk Versus Benefit There is almost always a trade-off when medications and interventions are used during labor. Each woman must know and consider the potential benefits and risks and apply them to her own circumstances. When the mother is managing her pain well and progress is normal, the risks of an epidural outweigh the benefits. If, however, she is exhausted, in extreme pain or requires painful interventions, the benefits may outweigh the risks. Potential Benefits of Epidurals Epidural anesthesia or analgesia provides relief or reduction of labor pain without affecting the mother's mental state. It enables an exhausted mother to relax or sleep during labor and calms the woman who is anxious and tense because of pain. Once an epidural catheter is in place, additional medication can easily be administered as needed, providing prolonged and consistent pain relief. Some prolonged labors, probably those slowed by anxiety, speed up with an epidural. Anxiety can cause excessive production of the mother's stress hormones such as epinephrine and norepinephrine, which slow contractions. By allowing the mother to rest without pain, the epidural removes her anxiety and her labor progress may improve.2 If not, Pitocin may be administered painlessly. Since epidurals often lower blood pressure, this may benefit some women with pregnancy induced hypertension.3 Epidurals are also useful for cesarean births, making it possible for the mother to remain alert and involved while free from pain. They enable her to avoid general anesthesia, which is considered to carry greater risks. Epidural narcotics reduce pain without reducing other sensations or muscle function. Women can change positions more easily than with anesthetics. They remain aware of their contractions and often continue to participate; using breathing patterns and other comfort measures. For those women who wish to remain aware of their labors, epidural narcotics are often quite acceptable. Potential Risks Epidural blocks carry some risks to the mother, fetus and newborn. Undesired effects tend to be greater with larger doses of medication, a longer interval during which the medication is in effect and immaturity or distress in the fetus. Undesired effects on the mother: Inadequate pain relief (up to 10%)4 Rise of the mother's oral and vaginal temperature 5, beginning within one hour after administration of the epidural, which may lead to treatment of the mother and baby for non-existent infection. This effect may be dose-related. This recent finding from England is being investigated in the United States.6 Drop in the mother's blood pressure treated with position changes, oxygen and possible vasopressors (less likely if a bolus of IV fluids is given before the epidural). Short or long-term postpartum backache from bruising caused by the injection or from ligament strain caused by prolonged time spent in a damaging position or inappropriate movement (for example, extreme passive flexion of the mother's trunk, hips and knees during the second stage, or sudden vigorous movements of the mother) while her muscles are relaxed and her back is numb (up to 19%). Long-term backache is almost twice as likely to occur with an epidural than without.7 Possible unintentional spinal block and resulting spinal headache requiring days of bed rest and a blood patch. Shivering may be reduced with lower doses, by warming of the anesthetic before administration, or by adding narcotics to the anesthetic.8 Mild to severe itching of the skin (with narcotics) Retention of urine, requiring a bladder catheter1 Mother feels detached from the process and becomes an observer; others may reduce emotional support. The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.9 Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother). Rare complications, such as residual numbness or weakness from needle injury to nerves (almost 1 in 10,000)10, delayed respiratory depression with epidural narcotics (up to 12 hours later)8, and brain damage and death (extremely rare)11. ADVERTISEMENT Undesired effects on the labor: May slow labor, requiring Pitocin; and has been found to increase the chances of a cesarean delivery in primigravidas by two or three times.12 Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20- 75%). Delaying pushing until the fetal head is on the perineum reduces the need for forceps. Even though this approach lengthens the second stage, it does not increase the incidence of fetal distress.13 Undesired effects on the fetus: Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery. Increased likelihood of newborn septic workup, IV antibiotics and isolation in the nursery if the mother develops an "epidural fever" that causes fetal tachycardia or newborn fever. If the fetus is already stressed greater amounts of the medication are "trapped" in the fetal circulation, leading to more pronounced newborn effects (see below). Undesired effects on the newborn: Short-term (six weeks or less) subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light.4 There are no data on potential long-term effects. Possible less efficient or less organized initial rooting and suckling behavior. Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies.6 Decreased infant responsiveness may lead to long- term consequences for the parent-infant relationship.14 Parents should be counseled to give their babies time to recover from the birth and medication and should avoid a label of "difficult child" or "incompetent mother." Conclusion The childbirth educator's duty is to inform, not to talk women into or out of using an epidural. Many women will choose an epidural, when well informed of benefits, risks and alternatives; others will choose to avoid it if their labor allows. When women are well informed, they will consider the information, along with other factors - such as their fears, self-perceptions, their goals for their birth experiences, their support system - and make the most suitable decision. This article has been reproduce with permission of Penny Simkin. Penny Simkin, a physical therapist specializing in childbirth education and labor support in Seattle, Washington, is the author of The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth and co-author of Pregnancy, Childbirth and the Newborn: A Complete Guide for Expectant Parents. www.storknet.com

Nobody really know the cause of morning sickness, but it is suggested to be caused by all the new hormones that are circulating through your body. Its tends to be worse in the morning , hence its name, but can occur at anytime during the day or night. It usually begins around the 6th week of pregnancy and continues through the beginning of your second trimester. While the nausea is obnoxious, you can thank of it as a good sign! This means the placenta is developing well! Vomiting is normal, however excessive vomiting can be caused by Hyperemesis gravidarum, which is harmful to both you and your baby. If you aren't sure what is a little and what is A LOT, please contact your medical proffessional. Here are some helpful hints to keep that sickness under control: 1.Keep saltines next to your bed. Eat a couple in the morning BEFORE rising. 2.Drink ginger tea when you start feeling nauseas. 3.drink small amounts of liquids throughout the day to stay hydrated! 4. Avoid spicy foods 5. Avoid eating right before bedtime or naps

Quick, Easy Solutions to Rash-Free Diapering By Susy Goins <....> Preserving the perfection So your baby has a rash What if your angel bum still develops a diaper rash? How radical is this: If you have breast milk handy, apply that to your baby’s bum. My daughter had a rash that cleared up in a day with breast milk. Making your own ointments is easy and not as labor intensive as you might think. Many of the ingredients can be found in better grocery stores or health food stores. This recipe was given to me through an e-mail list by a fabulous toiletry maker by the name of Shucky, aka Sylvia LaReverend: Calendula-Comfrey Diaper Ointment 1 lb. coconut oil (in the oil aisle; do try to buy the organic kind) 2 good handfuls calendula petals (health food section; don’t let the per pound price put you off; the petals are not heavy) Comfrey leaves (don’t use on a pregnant woman) Melt the coconut oil in a stainless steel pan. Add the herbs. Cook the herbs on low heat for about 30 minutes; the petals should be crispy, not burnt. Filter the ointment into jars. Use as needed. Try an oatmeal bath. Grind up oatmeal in your coffee grinder for a pleasant soak in the tub. Another way to get the benefits of oatmeal without the mess is to put some regular oatmeal (not baby oatmeal) in a small cotton bag and let it soak in the tub with your baby. Squeeze water through it every so often. Ointments and balms Try olive oil or shea butter on your baby’s bum. These are thicker emollients. Olive oil is readily available in any store; buy the higher grade virgin oil to get the most benefit. Shea butter can be found in the health food section with other body butters like cocoa and mango. You don’t have to use the zinc oxide ointments on your baby’s bum. Yes, they do create a barrier, but they also dry into a powdery residue and can make cloth diapers smell like fish. Petroleum also makes a good barrier, but it is comedogenic (clogs pores). Natural wipes solutions You can make your own baby wipes to help in your campaign against Ugly Baby Butt, too. A wet cloth is basic -- almost too easy, huh? Here are a few recipes for wipes you can try: Wipies One 3 cups of water 1/8 cup olive oil 4-6 drops tea tree oil 6-8 drops lavender oil Combine these in a sealable container and shake vigorously; add 1 tablespoon of your favorite baby wash or soap, and mix with a spoon until combined. Baby Wipes Solution Add 2 drops of tea tree essential oil or lavender essential oil to 1-2 cups of distilled water. Anti-Fungal Baby Wipes 1/2 cup distilled water 1/4 cup vinegar 1/4 cup aloe vera gel 1 Tablespoon calendula oil (Remember the coconut oil recipe a few paragraphs back? That would work here.) 1 drop lavender essential oil 1 drop tea tree essential oil Use a glass jar with a tight fitting lid. Pour in all the ingredients, cover the jar and shake to blend. Place your wipes in a container, and pour on enough solution to moisten them. Store any extra solution in the fridge. It should stay fresh for a long time, especially if you use distilled water. The vinegar and essential oils discourage yeast growth, which means you shouldn't have too much trouble with these wipes getting moldy. If your baby has a really red, raw diaper rash, you might not want to use these wipes because the vinegar may cause a burning sensation. The wipes themselves Recycled paper towels Those flannel baby blankets and burp rags old, soft towels, too embarrassing to keep out anymore, etc From Naturalfamilyonline.com

Pelvic floor (Kegel) exercises during and after pregnancy The pelvic floor is a "hammock" of muscles, attached to the pelvic girdle, that hold the pelvic organs in place. Pelvic floor, or Kegel, exercises strengthen your lower pelvic muscles. This helps prevent a long period of pushing during labor.Start doing daily Kegel exercises while you are pregnant, and continue doing them after childbirth. During pregnancy and delivery, the pelvic floor can become stretched and weakened, commonly causing urine control problems (urinary incontinence) for months to years after childbirth. A weakened pelvic floor can also allow one or more pelvic organs to sag, as in the case of uterine prolapse. Doing regular Kegel exercises helps prevent urine control problems (incontinence) after childbirth. From: www.health.yahoo.com/topic/pregnancy/resources/art icle/healthwise/tn9219