Effects of epidural anesthesia on newborns and their mothers.

The effects of epidural anesthesia on newborns were studied using a sample of babies from mothers having (a) little or no medication during childbirth (N = 15), (b) epidurals with bupivacaine (N = 20), and (c) epidurals in combination with oxytocin to stimulate labor (N = 20). Outcome measures included assessments of neonatal behavior (Brazelton Scale), mother-baby interaction during feeding, and mothers' perceptions of their babies' behavior during the first month after delivery. Effects of drugs on the 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. The importance of the first encounters with a disorganized baby in shaping maternal expectations and interactive styles was discussed.

Method of delivery and developmental outcome at five years of age.

A controlled follow-up study examined the impact of delivery method on developmental outcome of the child. The modes of delivery investigated were low forceps delivery (188 infants), midcavity forceps delivery (51 infants), forceps rotation with forceps delivery (57 infants), manual rotation with forceps delivery (67 infants), elective caesarean section (101 infants) and spontaneous delivery (control, 207 infants). Breech presentation (100 infants) was separately compared with the vertex presentation groups. Sample selection controlled for complications during pregnancy and low birthweight and was restricted to married English-speaking mothers. The children were assessed at the age of five years on verbal and non-verbal subtests of a standardized intelligence scale, tests of gross motor coordination, and auditory and visual tests. A full paediatric examination was also performed. Breech presentation children performed less well on tests of balance and fine motor coordination and on visual acuity and stereopsis testing than children who presented in the vertex position. No deleterious effect of delivery method was found. In the absence of other complicating events (like a poor antenatal history, prematurity, and a disorganized home environment) delivery complication constitutes an early risk factor which the growing child is able to overcome.