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.