Rayna Degree Starling CCCE,CD(DONA), BDT(DONA), CLC May 28,2018 A birth plan has several components, its informational for the practitioners on the birthing team. It’s a plan the mother and partner have to refer back to during the birthing process. The birth plan is a general roadmap that you create describing your birth wishes. One of the components in the birth plan is pain management. The epidural is an anesthesia it’s a regional anesthetic, which means it only affects a portion of the body and allows the woman to be awake and alert. It numbs pain sensations in the lower abdomen, back, and perineum. The problems occur when the laboring woman has an epidural in place, it affects the normal physiology of labor, in turn the labor process will change. Last, because of the changes the effects of breastfeeding the newborn has an effect as well. An epidural can cause the labor to slow down and make contractions weaker. If this occurs another procedure is needed, one which is Pitocin a synthetic form of oxytocin a natural hormone, to help speed up labor once the epidural slow contractions down. The use of pitocin can have many risks, during labor. Second, effects of an epidural can make the newborn baby have side effects as well, right after delivery, which derives for the effects on the mother (Buckley 2009). Epidural and Hormones: The interference of natural hormones by receiving an epidural can change the process of labor and birth, the effects on the process has risk of slowing down and weaken contractions. Which can lead to other medical procedures, that can affect the process of labor, and maternal health Epidural interference of natural hormones are; oxytocin (a hormone that causes increased contractions of the uterus during labor and stimulates the ejection of milk into the ducts of the breast), prostaglandin (Alpha hormone that promote uterine contractions), and CAs (adrenaline is the main hormone secreted by the adrenal medulla, and noradrenaline is the main neurotransmitter of the sympathetic nerves in the cardiovascular system. known as CAs) Maternal side effects from an epidural: First, the drop-in blood pressure, which can affect the baby blood supply in utero, inability to pass urine, itching of the skin, shivering, nausea, and vomiting. Although some of the effects such as shivering, nausea, and vomiting can occur during labor naturally, but the effects of the epidural make the effects higher. The effects of an epidural can make the baby have difficulties with breastfeeding right after delivery. Last, latching on to the breast for the first time can be a challenge, and with a baby who was born to a mom with an epidural at times makes it more of a challenge to breastfeed. The studies show evidence a relationship between epidural analgesia and adverse effects on the newborn (Gomez,”et al”,2014). The relationship between the two depends on the options available to relive pain during labor. Meaning which options of epidural, the mother use. The mother who have receive an epidural after baby born, and do not have baby skin to skin immediately after birth the mother report not having” enough milk” (Buckley, 2009, pg. 13). The studies show evidence a relationship between epidural analgesia and adverse effects on the newborn (Gomez,”et al”,2014). The relationship between the two depends on the options available to relive pain during labor. Meaning which options of epidural, the mother use. The epidural can cause effects in the fatal heart rate(FHR), which can cause baby to lack blood and oxygen, but often these effects can change with the position of the mother. Some cases other medication may be required. Furthermore, maternal fever during labor can show signs of infection(sepsis). If baby is born to a mother who has a fever, and develop an infection, the mother and baby will be separated for further testing and administration of antibiotics. The medication opiates that’s use in the epidural do have a well-recognized negative effect on early breastfeeding behavior (Buckley, 2009 pg.7). The mother who have receive an epidural, after baby born, and do not have baby skin to skin immediately after birth reports less milk on the 4th or 5th day postpartum. When the laboring woman has an epidural in place, it affects the normal physiology of labor, in turn the labor process will change. Last, because of the changes and the effects of an epidural and added medical procures, will make breastfeeding the newborn right after birth more difficulty. K. Alexander, viewpoint argues that, “Epidurals have been proven safe as a method of managing the pains of labor and delivery” (Alexander 2009). The author felt the relief of an epidural stop the torture of pain, and she was able to enjoy the process of delivering and meeting her daughter. K. Alexander author use her own birth story, and several findings from cited resources. K. Alexander author “Notes women should not be discouraged or ashamed to request them during childbirth.” (Alexander 2009). K. Alexander, author research information says, that placing an epidural before 4 to 5 centimeters (dilation of the cervix-the mouth of the uterus), which considered to be ready for an epidural show no difference then receive an epidural before 4 centimeters. Timing of placing an epidural does have a higher risk of cesarean delivery. “Several retrospective studies have shown an increase risk of cesarean delivery in nulliparous women (that has not given birth) in whom epidural analgesia was administered before cervical dilatation of 4 cm or 5 cm” (journals.lww.com). In conclusion, there are poor studies on recent randomized controlled trials. (Buckley 2005) The medication opiates that’s use in the epidural do have a well-recognized negative effect on early breastfeeding behavior (Buckley 2005). I would use the following cited resource of my findings to rebut the counterargument. The risk of receiving an epidural will make changes in the hormones, also knowing the models of care that promote, support, and understanding the principles and practice of natural and undisturbed birth (Buckley 2005). Last, the interference of hormones by receiving an epidural can change the process of labor and birth. One of the components in the birth plan is pain management. Choosing an epidural as pain management can have an adverse reaction to the process of labor and affect the success of breastfeeding.