The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Epidurals Cause Problems for Mother-Infant Bonding

Research about the effect of epidurals on mother infant bonding:

As a midwife, I work to help women give birth without drugs and without suffering.  Although I think there is a place for epidurals in childbirth, I think we need to be mindful of their effects and work to minimize the harm.  It would be very helpful to have research showing the effects of delaying the administration of epidurals.  In my experience, babies who were exposed to the drugs from an epidural were much less likely to have breastfeeding problems if the epidural had been in place for only two or three hours.  Our maternity care system could do a lot to support bonding and breastfeeding by working to provide other forms of pain relief for early labor and then shift to an epidural for transition and pushing.  We need research that shows the effects of such an approach on endorphin levels and on bonding and breastfeeding.

Adverse Psychological Effects of Epidurals

One-third of the women having an epidural felt ill-at-ease owing to delivery under epidural, both physically and psychologically. The first contacts with the infant are earlier and less disagreeable after epidural analgesia than after general anesthesis, but in the days following the delivery the interactions between mother and baby and the comments the mothers make about their child do not differ markedly whichever form of anaesthesia has been used.^[i] [LMM: these are middle class mothers.]

Murray, et al.^[ii] studied effects of epidural anesthesia on newborns were studied using a sample of babies from mothers having (a) little or no medication during childbirth, (b) epidurals, and (c) epidurals in combination with oxytocin to stimulate labor. The effects of drugs on neonatal behavior were strongest on the first day. By the fifth day, there was evidence of behavioral recovery, but the medicated babies continued to exhibit poor state organization. At 1 month, examiners observed few differences between groups, but unmedicated mothers reported their babies to be more sociable, rewarding, and easy to care for, and these mothers were more responsive to their babies' cries.

^[i] Garel M. Lelong N. Kaminski M. Title Follow-up study of psychological consequences of caesarean childbirth. Early Human Development. 16(2-3):271-82, 1988 Mar.

^[ii] Murray AD. Dolby RM. Nation RL. Thomas DB. Title Effects of epidural anesthesia on newborns and their mothers. Source Child Development. 52(1):71-82, 1981 Mar.

Here are more studies. These are some of my favorites because they're more neurophysiological and provocative in our thinking about the physiological psychology that is disrupted by epidurals. I have more studies about increase in postpartum depression, child abuse, etc., but if you all want to play this game with me, you have to look up studies too. You can use Medline through AOL as easy as I can. Also Psych Database is good for studies on this topic which will not always show on Medline. So I am not your reference librarian, but for every study you can show me, I can show you two others. That's how we play this game.

Importance of psychosocial factors during labor on mothering.

Non-human primate studies have shown that maternal responsiveness develops during pregnancy and is hormonally regulated in accord with recent evidence also from New World monkeys.^[i]

The physical sensation of giving birth may affect the mother's response to her infant by inducing hormonal and neurological changes to make her a better mother. Broad, et al.^[ii] provide a potential neurophysiological basis for the positive effects of a doula on later mothering behavior through the greater incidence of unmedicated birth. In their study of multiparous ewes, intracerebroventricular infusions of corticotrophin releasing factors (CRF) acted centrally to facilitate the induction of maternal behavior only if administered at the same time as vaginocervical stimulation. Changes in CRF messenger RNA (mRNA) were found in the paraventricular nucleus (PVN) and in the bed nucleus of the stria terminalis (BNST), which are brain areas known to be integral in controlling mothering behavior. The spontaneous levels of CRF mRNA are unaltered during pregnancy and lactation, but are significantly increased immediately postpartum in both the PVN and the BNST, indicating the importance of cervicovaginal stimulation during labor (which is blocked by epidural anesthesia) on releasing mothering behavior.

The ewe's ability to selectively recognize her lamb depends upon vaginocervical stimulation to the brain.^[iii] This stimulation then elicits an interest in lamb odors. This process is facilitated by previous maternal experience, meaning that it is easier for a multiparous ewe to bond to her infant than a primiparous ewe. This process is mediated through the neurotransmitters glutamate, GABA, and dopamine.

It is known that oxytocin activates the postpartum onset of rat maternal behavior.^[iv] To the extent that elective cesarean section avoids the labor-induced release of oxytocin, the neurohormonal influences on human mothering could be compromised. In rats oxytocin in the ventral tegmental area (VTA) of the brain and in the medial preoptic area (MPOA) are associated with activation of mothering behavior (along with vasopressin in the MPOA). Pup retrieval after birth and the assumption of a nursing posture over pups after birth is blocked in rats by the infusion of an oxytocin antagonist into the VTA or MPOA or infusions of a vasopressin (V1) antagonist into the MPOA.

Oxytocin secretion is inhibited by opioids^[v] which are commonly administered as pain medication during labor. In rats, both subcutaneous morphine and intracerebroventricular morphine interrupt labor and birth, significantly lengthening labor. Morphine given during labor also inhibits the expression of normal intrapartum maternal behavior. It did not increase the intrapartum mortality of the pups, but did increase pup mortality at 48 hours postpartum and decreased the incidence of normal maternal behavior at 24 hours postpartum. This was in doses insufficient to affect uterine contractions. Noradrenaline depletion in the olfactory bulb of rats induces cannibalism after birth in primiparous mice, without producing anosmia.^[vi] Noradenaline depletion is central to theories of depression. Perhaps violent behavior in depressed mothers functions on a similar mechanism. When animals are noradrenaline depleted experimentally, recognition and bonding to the babies is impaired. After giving birth, sheep and many other animal species bond to their offspring based on the sense of smell.^[vii] Processing of olfactory signals is altered to allow animals to perform this selective recognition. Lamb odors, for example, have little effect on animals before birth. After birth, there is an increase in the number of mitral cells, the principal cells of the olfactory bulb, that respond to lamb odors, which is associated with increased cholinergic and noradrenergic neurotransmitter release. Selective recognition of lambs is accompanied by increased activity of a subset of mitral cells and release of glutamate and GABA from the dendrodendritic synapses between the mitral and granule cells. The relation of the release of each neurotransmitter after birth also suggests an increased efficacy of glutamate-evoked GABA release.

The neurotransmitter GABA (gamma-aminobenzoic acid) plays a role in the process whereby animals bond to their infants.^[viii] Diazepam, an agent which gives rise to enhanced GABAergic activity in the brain, facilitates the acceptance of an baby to whom she has not given birth by a postpartum ewe.

^[i] Maestripieri D, Wallen K. Interest in infants varies with reproductive condition in group-living female pigtail macaques (Macaca ne mestrina). Physiology & Behavior 1995; 57(2): 353-8.

^[ii] Broad KD, Keverne EB, Kendrick KM. Corticotrophin releasing factor mRNA expression in the sheep brain during pregnancy, parturition and lactation and following exogenous progesterone and oestrogen treatment. Brain Research (Molecular Brain Research) 1995 (Apr): 29(2): 310-6.

^[iii] Keverne EB, Levy F, Guevara-Guzman R, Kendrick KM. Influence of birth and maternal experience on olfactory bulb neurotransmitter release. Neuroscience 1993 (Oct); 56(3): 557-65.

^[iv] Pedersen CA, Caldwell JD, Walker C, Ayers G, Mason GA. Oxytocin activates the postpartum onset of rat maternal behavior in the ventral tegmental and medial preoptic areas. Behavioral Neuroscience 1994 (Dec); 108(6): 1163-71.

^[v] Russell JA, Gosden RG, Humphreys EM, Cutting R, Fitzsimons N, Johnston V, Liddle S, Scott S, Stirland JA. Interruption of parturition in rats by morphineL a result of inhibition of oxytocin secretion. Journal of Endocrinology 1989 (Jun); 121(3): 521-36.

^[vi] Calamandrei G, Wilkinson LS, Keverne EB. Olfactory recognition of infants in laboratory mice: role of noradrenergic mechanisms. Physiology & Behavior 1992(Nov); 52(5): 901-7.

^[vii] Kendrick KM, Levy F, Keverne EB. Changes in the sensory processing of olfactory signals induced by birth in sheep. Science 1992 (May 8); 256(5058): 833-6.

^[viii] Ferreira A, Carrau A, Rodas E, Rubianes E, Benech A. Diazepam facilitates acceptance of alient lambs by postparturient ewes. Physiology & Behavior 1992 (Jun); 51(6): 1117-21.