If you go to a message board that concerns itself with natural childbirth…or any message board about birth in general, chances are you will find a post where a woman asks about whether or not she should get an epidural or why she should refuse and epidural and go “all natural.” The on-line community will offer many opinions. One of which, is the idea that an epidural (or pain relief in general) will interfere with your ability to bond with your infant.
Open up the definitive textbook on anesthesia for obstetrics, Chestnut, and you won’t find the topic even mentioned. Is it that we don’t think bonding is important? Nope! Bonding with your children is really important…isn’t that the reason why most of us have them in the first place? So that we can have a relationship with them? The lack of information on bonding and epidural pain relief is due to one of two things, either there is no evidence for or against, or the evidence is so new that it hasn’t made its way into the texts yet.
I went to pubmed.gov which is a free database of medical literature and did a few searches. First, I searched for the MeSH terms “epidural analgesia” and “labour, obstetric” and “object attachment.” The latter is what came up when I searched “bonding,” rather than the kind of bonding that is concerned with amalgams and prosthetic limb parts and cement. Number of hits: 0.
Then I searched the MeSH terms, “epidural analgesia” and “object attachment.” Number of hits: 1.
Unfortunately this article is in french and I’m not bilingual. It’s also from 1989 and was published in a journal that stopped publishing after 1995. The abstract suggests there is no link between “bonding” and labour epidural pain relief, but you can’t draw any conclusions from an abstract…especially not one from an article that’s 22 years old, that may not have been published in a peer-reviewed journal and was certainly not published in a top-tier journal. For those of you who don’t know how publishing medical research works, it generally goes like this:
write article…submit to a journal (generally the one with the biggest impact factor in your field, or a top-tier journal)…
get rejected
make changes to article, submit to a second tier journal.
get rejected
try again.
get rejected
try again
get rejected
submit to a non-peer reviewed journal
get rejected
submit to a journal that takes a “fee” for publishing you…
get published.
Okay, that was a little snarky. But today, only the best papers, the ones with the best methodology, where the trial was registered before it began recruiting so the authors can’t do anything funny like change the outcome measures halfway through, with robust statistical methods and well thought out conclusions get published in reasonably well read peer-reviewed journals.
So should I pursue a paper written 22 years ago, in another language, in a journal that doesn’t exist today to answer my question? Nope. I guarantee the methodology won’t be up to today’s standard and the answer to the question will still be a resounding, “who knows?”
I next searched the non-MeSH terms “epidural” and “bonding” and got a slew of 14 articles which you can view here. Only one is a clinical trial, this article by Cohen and Woods. Unfortunately, it compared epidural vs IV morphine after C/S in women, all of which had an epidural catheter in place. I want to compare a group of women who had epidurals during labour for analgesia with a group of women who gave birth without an epidural. No such clinical trial exists…I searched and searched in Pubmed using multiple combinations of the following key words: labour, birth, epidural, bonding, object attachment maternal-infant attachment and natural childbirth. There isn’t even a retrospective study.
Can it be that no one has researched this?
Indeed, it can.
I can find lots of opinions but no evidence.
So how did this all start? apparently with Michael Odent, a retired physician, and a key figure in the natural birth movement. Btw, he also thought that fathers shouldn’t be present during birth. He was (is?) a big proponent of the idea that the pain of labour releases hormones and endorphins that allow bonding to occur between mother and infant…a woman who takes pain control, he believes, interferes with this natural hormonal process and bonding may not occur to the same extent or as easily. You can read all about Dr Odent’s beliefs on his website, WombEcology. Its kooky entertaining reading.
Opinion became a rumor, and the rumor became a “fact” and I kid you not, every message board having anything to do with birth has a heated exchange on this topic somewhere in its archives…probably more than one.
What would have to be true for the whole “epidurals interfere with mother-infant bonding” story to be true? Well, for starters, wouldn’t your relationship with your child would have to be determined based on those first few moments in the delivery room? You and your baby would have to be like a momma-duck and duckling or like Jacob Black and Renesmee in the Twilight series. Isn’t the thought that so much depends on such a short moment a horrible thought?
The birth of your child is one day in the life you are going to lead with that child…maybe 2 or 3 days if things really take a long time to get going with your labour versus years of developing a relationship with your child. We bond by caring for another person and by spending time with them. If the whole thing was really hormonally determined, then how could parents bond with their adopted child? How could dad bond? How could the grandparents? What about the parents of premies or of babies that need a lot of special interventions or surgeries just after birth? Can you really say that your bond with your baby after a “natural childbirth” is better than theirs? Isn’t focusing on the birth and not the ongoing parent-child relationship is just like focusing on the wedding instead of the marriage?
And if you look at your newborn and he or she seems to be a stranger, well, maybe that’s because you are strangers to each other. You’ve just met! But this isn’t bad…its amazing to meet this little person and get to know them. When my son was born, I had no idea who he was…but every day I get to find out. I’ve learned how he likes to be held, what his face looks like just before he dissolves into howls, and recently, what makes him giggle and squeal with joy. Every day we belong a little bit more to each other.
Conclusions:
There is no evidence regarding any link between epidural pain relief during labour and maternal-infant attachment/ bonding because no studies have been done.
theadequatemother 
Great blog…keep up the good work!
Great post. I’ve had three labours, one with an epidural, two without. Until I stumbled across the internet natural birth community the concept of ‘bonding’ with my children had never occurred to me. I grew them, I gave birth to them, I love them, I take care of them, I get to know them. I am still not entirely sure what is meant by ‘bonding’ in the first moments of life as the holy grail of natural child birth. I am aware that some women due to post partum depression or other issues may have difficulty developing a bond with their child over a longer period of time, but always believed this was the exception rather than the rule.
I worry that by merely raising the spectre of not bonding with your baby immediately and that being a Really Big Problem, natural birth advocates are putting undue pressure on women.
I agree – undue pressure and completely unrealistic. I think it is much more common to stare at your wrinkled, red, screaming newborn and feel some mixture of wonder, horror, love and fear. Its a very confusing time. For the majority of women, I think its more usual to grow into that relationship more gradually as opposed to the lightning bolt. Higher expectations probably lead to feelings of inadequacy. I think a good analogy would be our romantic relationships. How many of us had love at first sight vs growing together over time and shared experiences?
It makes me wonder, is there much research on “bonding” at all? Do researchers know how it’s “supposed” to work, physiologically? If we knew what physiological processes were supposed to take place, to complete this overall process of bonding, then it might be possible to identify interruptions to those processes. Or is there research on the specific hormones released during birth, and what their (guessed-at, I’m sure) purposes are? That would be interesting to see.
Interesting questions! Its completely out of my field. I there are tons of research studies on bonding (or object attachement) – 10341 in pubmed. 278 of those are clinical trials on everything from mother-infant bonding to couple’s therapy. I don’t think we know how its “supposed” to work, physiologically. In general, our understanding of neuroscience is pretty primitive. We don’t know how brains acquire language, store memories…we don’t understand depression. The list of things we don’t understand is massive compared with what little we do understand. While researchers can pinpoint some of the neurotransmitters involved in falling in love and see what areas of the brain get triggered under different circumstances with functional MRIs and PET scans, we still have no idea how things actually work.
Maybe in our lifetime? I certainly hope so cos this stuff is fascinating!
All this layperson can offer is her own story, which is that after the blessed, blessed relief of an epidural from the horrors of labor pain, that allowed her to rest through the next 6-7 hours of labor and did indeed allow her to push through an entire 15 minute second stage, even though NICU had to deal with the newborn infant who was in distress for about half an hour and no skin to skin was available, 16 years later we have one of the closest relationships I’ve yet seen among any parent and child I know. I think people should chill out about that first five minutes – the next five years are a LOT more important.
Very interesting post! Thank you for digging into the scientific evidence (or discovering the lack thereof in this case) to help dispel one of the myths associated with surgically/medically assisted birth. After requiring an epidural during delivery myself, I was very concerned about being bonded with my little one because of all the “facts” I had heard about the negative impacts of epidurals. Like a new mom really needs one more thing to worry about while recovering!! But here I am months later with my baby, happy and healthy – and completely bonded.
I have this article in front of me: Jonas et al, 2008, from Arch Womens Mental Health; Influence of oxytocin or epidural analgesia on personality profile in breastfeeding women: a comparative study. It’s not randomised and it is small but it does have a few interesting things to say about this topic.
Hi Miranda,
I’ve read it…seems like a lot of speculation to me, no hard evidence. My position is that when you are dealing with issues bonding and personality scales, you’d really have to make sure that the subjects in each of the comparison groups were similar…and that means randomization and a large enough n.
What did you think about this article, what do you think it shows?
Personally I find it a bit creepy to think my personality can be altered by my physiology, but as an LC it makes sense that the hormonal changes of lactation do more than just help us feel relaxed and cuddly. We are mammal after all and a lot of our previous survival would have depended on instinct and being programmed to respond to infants in certain ways. With no real rationale at all I requested a spinal with both my Caesars.
Thank you. Just found your site. I ended up with a scheduled c-section due to complications. So of course I had an epidural with that. To be honest, it was great – not what I was expecting from listening to many of my more granola friends before the birth. I had a fantastic anesthesiologist who told me in a play-by-play what was going on and what they were doing (DH can’t take blood). She was a voice of calm as they took out my baby and then did minor surgery to remove cysts. I think the epidural allowed me to focus on my son instead of the pain!
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Fuck the natural childbirth, fuck the pain, I surely consider this thing to be a great mistake on the nature’s part. WHY does it have to be so painful? Ok, bonding and stuff… but why does the bonding have to be created THROUGH PAIN?! Wouldn’t it be nicer to develop a bonding through joy and pleasure? We’re naturally attached to smth that gives us pleasurable sensations and try to avoid all that is associated with pain, right? This is simply illogical for me. Also, which is even more illogical is to believe that the bonding actually OCCURS through pain. Oh Really? Love is a spiritual thing, emotional, psychological – not physical! Otherwise no man ever would love their children, since they do not suffer during birth. All in all, I still consider the childbirth pain to be a great nonsense that has been ever created by nature. And all the people who support this theory of “good” pain, please keep your bullshit to yourself.