amen

the following is an excerpt from my friends blog, you can read the rest here, and please do...






"What facts do I wish I were armed with?
Let's start with the fact that I didn't have the true facts.
The risks associated with the medicines in epidurals have been completely minimized by most health care providers, and women have been flat out told that the drugs DON'T cross the placenta.

I won't share the thousands of anecdotal stories of sleepy babies born under the use of these drugs, or the recorded stories of maternal injury and death resulting from the use of these drugs, OR the cascade of interventions that can occur after using these drugs. I'm just going to post a few startling statements from the FDA itself.

First off, 2 medications are given simultaneously via the epidural.
One medication is a local anesthetic, and one is an opioid.

Common local anesthethics include lidocaine (Xylocaine), ropivicaine (Naropin) or bupivicaine.
One of these is used in combination with an opioid such as Fentanyl.

Here are a few official statements regarding the use of Fentanyl, Bupivacaine, and Naropin (emphasis mine):

Bupivacaine
(pregnancy class C)

Local anesthetics rapidly cross the placenta, and when used for epidural, caudal, or pudendal block anesthesia, can cause varying degrees of maternal, fetal, and neonatal toxicity. (See Pharmacokinetics in CLINICAL PHARMACOLOGY.) The incidence and degree of toxicity depend upon the procedure performed, the type, and amount of drug used, and the technique of drug administration. Adverse reactions in the parturient, fetus, and neonate involve alterations of the central nervous system, peripheral vascular tone, and cardiac function.
Maternal hypotension has resulted from regional anesthesia. Local anesthetics produce vasodilation by blocking sympathetic nerves. Elevating the patient’s legs and positioning her on her left side will help prevent decreases in blood pressure. The fetal heart rate also should be monitored continuously and electronic fetal monitoring is highly advisable.
Epidural, caudal, or pudendal anesthesia may alter the forces of parturition through changes in uterine contractility or maternal expulsive efforts. Epidural anesthesia has been reported to prolong the second stage of labor by removing the parturient’s reflex urge to bear down or by interfering with motor function. The use of obstetrical anesthesia may increase the need for forceps assistance.
The use of some local anesthetic drug products during labor and delivery may be followed by diminished muscle strength and tone for the first day or two of life. This has not been reported with Bupivacaine.
It is extremely important to avoid aortocaval compression by the gravid uterus during administration of regional block to parturients. To do this, the patient must be maintained in the left lateral decubitus position or a blanket roll or sandbag may be placed beneath the right hip and gravid uterus displaced to the left.




Naropin
(pregnancy class B)

Local anesthetics, including ropivacaine, rapidly cross the placenta, and when used for epidural block can cause varying degrees of maternal, fetal and neonatal toxicity (see CLINICAL PHARMACOLOGY and PHARMACOKINETICS). The incidence and degree of toxicity depend upon the procedure performed, the type and amount of drug used, and the technique of drug administration.
Adverse reactions in the parturient, fetus and neonate involve alterations of the central nervous system, peripheral vascular tone and cardiac function.
Maternal hypotension has resulted from regional anesthesia with Naropin for obstetrical pain relief.
Local anesthetics produce vasodilation by blocking sympathetic nerves. Elevating the patient's legs and positioning her on her left side will help prevent decreases in blood pressure. The fetal heart rate also should be monitored continuously, and electronic fetal monitoring is highly advisable.
Epidural anesthesia has been reported to prolong the second stage of labor by removing the patient's reflex urge to bear down or by interfering with motor function. Spontaneous vertex delivery occurred more frequently in patients receiving Naropin than in those receiving bupivacaine.




Fentanyl
(pregnancy class C)

Fentanyl readily passes across the placenta to the fetus; therefore, Fentanyl transdermal system is not recommended for analgesia during labor and delivery."