Damage to central nervous system during childbirth?

May 9, 2013 3:35 AM

How does Bupivacain effect the body and can the effects be reversed?

6 months ago I gave birth to a beautiful baby boy but something went wrong during the birth and I haven’t felt the same since. I was given quite a high dose of Bupivacaine during labour (even the nurse seemed unsure when it was prescribed) and I think this might have had something to do with what’s happened to me.

Since the birth I have been experiencing a number of significant symptoms: mild amnesia, cognitive slowing/changes, flat affect (in comparison with my former really vibrant personality), not able to sleep or if I do it’s barely at all. As a result of this I have been getting quite depressed which means that every doctor I have seen has put it down to post natal depression and when I insist it’s more than that they tell me I also have psychosis. It has to be more than post natal depression as I knew there was something wrong from the very beginning and I absolutely love being with my baby, I have no worries about looking after him and I have all the support I could possibly need and more. My gut tells me I suffered an accidental overdose of medications that act on the central nervous system - not enough to be fatal, but enough to injure my brain.

It seems no sleeping tablet can help me get any rest at night and the anti-depressants the doctors have prescribed aren’t making me feel any better even though I have had many different ones. I refused to take the anti-psychotic tablets as they make me feel incredibly sick (even with anti-sickness tablets) which means I struggle to look after my baby. This normally wouldn’t be a problem as my mum is with me most of the time and could help except I have now be admitted into a mother and baby unit so that they can monitor me taking the tablets and I also have to look after my little one pretty much all by myself (the staff which are there to help are trying to encourage me to do it by myself, unfortunately I think they are used to dealing with people with post natal depression and think my problem is dealing with my baby)

I feel like I’m on a downward spiral and there doesn’t seem to be a light at the end of the tunnel. I have had an MRI scan to see if there is any obvious damage to my brain but unfortunately nothing showed up. I’m sure things would look a little brighter if I could get some sleep but I don’t think it would cure the underlying problem.

What I would really like to know is - does anyone have any experience of anything like this stemming from childbirth or Bupivacaine? Does anyone actually believe that there could be something wrong other than post natal depression or psychosis? Could there be damage to my central nervous system or part of my brain? And most importantly, does anyone have any idea of how I can get back to my old self?

posted by anon81 to Health & Fitness (19 answers total)

I was given quite a high dose of Bupivacaine

How do you know it was 'quite a high dose'?
posted by empath at 4:17 AM on May 9, 2013 [2 favorites]

Firstly congratulations on your new baby. I'm sorry you've been having a difficult time.

This suggested that anxiety/depression can be a side effect of Bupivacaine.

This seems to show that insomnia can be a result but its for Bupivacaine liposome.

Do you know exactly what type you were prescribed? Also, it seems that whether it was administered by injection or not has a bearing on the likelihood/type of side effects.

I generally feel your gut instinct is correct, so if you feel it was an overdose and you know that your symptoms don't fit with post-natal depression (such as your ability to bond with your baby) then I would continue to argue your case that they need to get to the real reason for your symptoms. You know your own body.

Here is a link to a patients' advocate site which can give advice if you think there may have been an issue with the care your received.

Good luck.
posted by billiebee at 4:20 AM on May 9, 2013

Have you reviewed your medical records? And have you done so with another doctor? Just telling them what you think happened isn't good enough.

Secondly, being admitted to a mother-baby ward isn't a first resort. Psychosis and depression after birth can disguise themselves in ways that can be difficult to determine. I'm not saying you are wrong, but you would need to review your records as a first course of action.

And you had a baby six months ago. A lot of what you describe is normal had-a-baby-six-months ago stuff.

I'd also like to propose that you may not be wrong. But that alo your current care providers may not be wrong, either. In other words, you could have PPD and have had an adverse reaction to that med.

No one here can tell you for sure what happened, but please continue to be honest with your care providers about your concerns. Contact patient relations as well. And continue what appear to be good communications with your family.

I genuinely wish you and your little one the best.
posted by zizzle at 4:59 AM on May 9, 2013 [6 favorites]

quite a high dose of Bupivacaine during labour (even the nurse seemed unsure when it was prescribed)

I would think your first order of business would be to find out exactly how much the dose was. Make sure the recorded dose is consistent across your records.

the anti-depressants the doctors have prescribed aren’t making me feel any better even though I have had many different ones.

It's only been 6 months; you observed, then reported symptoms, then got tested etc., and then would first have been prescribed anti-depressants just a few months ago. That's a very short time to have "many different ones." ADs take a while to become effective, up to a month or more. Regardless of the origin of your depressive symptoms (PPD, side effect of meds), give your prescribed treatment(s) a chance to work before giving up on them.
posted by headnsouth at 5:15 AM on May 9, 2013 [7 favorites]

headnsouth makes a good point about ADs taking a while to work. And if they're not the right ones for you, they can cause some of the symptoms you describe.

I was prescribed an SSRI antidepressant years ago, and it gave me almost all of the symptoms you describe. I changed to a tricyclic AD, which after some time settling in, gave me my functional self back and changed my life.

I know you developed these symptoms before you took ADs, but could it be possible that this was a natural fall-out from the birth and the drugs you needed at the time, then the ADs you were on either contributed or didn't help, and trying "many different ones" too quickly has sent you on a mental rollercoaster? Going onto and coming off ADs should be done very gradually. I'd be worrying about the standard of care you're receiving if you're just cycling through them.

Anyway this is just a theory. I'm inclined to say listen to your gut too, and the suggestions about going through your medical records with a doctor are excellent.
posted by greenish at 5:32 AM on May 9, 2013 [1 favorite]

This is not to nitpick, but those "anxiety/depression" symptoms described in the drug reference links are generally referring to a much shorter window of time around the injection. In other words, not necessarily long-term side effects, six months out. Not to say that it's outside of the realm of possibility, but...

Post partum depression and psychosis are very real things and don't necessarily have anything to do with whether or not you feel like you are having trouble caring for your baby, so the depression/fog/exhaustion/insomnia/flat affect are not at all beyond the realm of PPD. Sometimes if it looks like a duck, quacks like a duck...

If it were me, as a nurse and as a mom, I'd be worried about either severe PPD or something else neurological going on, but the Bupivacaine would not necessarily be my first concern.
posted by takoukla at 6:14 AM on May 9, 2013 [13 favorites]

Off the top of my head, I would wonder if anyone has checked your thyroid? It's a common issue post-partum and could be playing into these symptoms . . .
posted by MeiraV at 6:17 AM on May 9, 2013 [1 favorite]

"It has to be more than post natal depression as I knew there was something wrong from the very beginning and I absolutely love being with my baby"

That's not true. Postpartum depression can start right away, and often it does not involve any negative feelings about the baby. It looks like it explains all of your symptoms and it is very common.

I'm no doctor, but the near-death drug overdose resulting in permanent brain damage theory is not the only way to explain or make sense of what is going on.

Definitely get a second opinion. If the dosage was really outrageous, a competent unbiased doctor would tell you. In that case you could look into medical malpractice lawsuits and stuff, and the competent unbiased doctor could get you evaluated for brain damage etc.

If a competent unbiased doctor does not think your theory makes sense, maybe listen to them?
posted by steinwald at 6:18 AM on May 9, 2013 [8 favorites]

You need sleep. Full stop. Amnesia, cognitive dysfunction, flat affect are all effects of insomnia - sleep is so radically important for correct brain function and you're not getting it. It's really hard to see how important this is when it's so out of reach, I know. But you need to get it back, and the best way to tackle it is to throw everything you've got at treating the presenting problems.

On postpartum insomnia: 'It's no longer just about sleep. It's about her body betraying her, it's about defeat, and it's about the shutdown of her system. ... most postpartum women who present with insomnia are not just having sleep problems, even if that is the only one they identify. Experts claim that most postpartum women who cannot sleep when their babies sleep are also suffering from symptoms of depression and anxiety that are contributing to their sleep disturbance. With acute anxiety, sleep can become the object of their obsession: What if I don't sleep again tonight? I can't go one more night without sleep. How will I function with no sleep? How can my husband sleep through the night like this? If I go another night without sleeping I know I'll really go crazy.

So it's not just about sleep. You will find that when the depression and anxiety is treated, the sleep generally improves.' (adapted in the linked article from Therapy and the Postpartum Woman, Karen Kleiman, Routledge, 2009)

Your situation sounds terrifying, and I want to really say that clearly: from what you're describing, your experience is that you aren't getting good, respectful, effective care for your postpartum mental health, and your healthcare providers may or may not have a good understanding of postnatal depression. They may be structurally misogynist and dismissive (especially since you've been labelled with psychosis without a full explanation: this is so, so common, and I'm really sorry). I'm particularly scared for you going into inpatient care and not being able to feel supported and understood, because this is a recipe for mental health hell, and actively works against recovery.

You need advocacy and help from anywhere you can get it - where are you located? Your current situation is disabling and you need someone who can guide you through this and also make you feel heard and understood - patient advocacy services, PPD/PND support networks, mental health service user advocacy. I've got all of my fingers crossed that your family are supportive - your mum should be able to help you liaise with people and get through this, and through treatment.

I promise you will get back to your old self. Absolute promise. Postnatal illness comes in so many different forms, it is real and serious, and it is treatable, and you deserve that treatment and for it to be good and effective. My heart's with you.
posted by lokta at 6:40 AM on May 9, 2013 [6 favorites]

The most common explanation for what you are describing would be non-medication induced post-partum depression. I don't know if that's what you have going on, but as someone who diagnoses mental disorders, I would not assume that the medication during childbirth was to blame.
posted by OmieWise at 7:41 AM on May 9, 2013 [2 favorites]

Do you mean that you got the bupivicaine in your epidural? I assume you do, because bupivicaine is a local anesthetic, like lidocaine or novocaine. Depression and insomnia are not common side effects of epidurals.

IANYD, and I cannot say whether your symptoms could definitively be related to bupivicaine or not, but there is usually a fairly easy way to gauge how strong your epidural was. Now, the old way of doing the epidural was to dose the anesthetic really high, which made it more effective, but also had a higher risk of side effects and makes it very difficult for a woman to move or feel enough to push during labor. The more modern way to do it is to dose the anesthetic pretty low, which some people call a "walking epidural" because you are more likely to be able to move and feel things with it.

I personally had a fairly high dose epidural, everything from my hips down was completely numb and I found it very difficult to move my legs. I could not feel the contractions at all, at least until about 6 hours later when the medication started wearing off and they asked me if I wanted the epidural "topped up". So... How well did your epidural work? How numb were you? That will give you an idea of how high a dose of the medication you got. The dosing of the anesthetic in the epidural is a pretty standard thing,I would be surprised if you got a very different dose than what other people get.
posted by treehorn+bunny at 8:14 AM on May 9, 2013 [2 favorites]

Does anyone actually believe that there could be something wrong other than post natal depression or psychosis?

After having read about Bupivacaine: no. IANAD, but.

I have had an MRI scan to see if there is any obvious damage to my brain but unfortunately nothing showed up.

"Unfortunately"! But it sounds like cause for celebration? Of course it didn't offer an answer and you're hoping for an answer -- but "no brain injury" is a good part of the answer, no?

I have now be admitted into a mother and baby unit so that they can monitor me taking the tablets...I think they are used to dealing with people with post natal depression and think my problem is dealing with my baby

This sounds like perhaps less than ideal care. Do you have a psychiatrist you are speaking with regularly? If your mother is able to care for you at home and you are primarily interacting with nurses and otherwise being left alone in an environment where the care providers are dismissive... Hmm. How much can your mother do -- not leave you alone? Take you to daily appointments? Maybe you should have a talk with whomever is co-ordinating your care with your mother present to hash out whether or not you'd be better at home. Ask what sorts of supports the hospital could provide you and your mother for outpatient care.

I’m sure things would look a little brighter if I could get some sleep

Yes. While you're in hospital, try to make use of it by being insistent about that. There are people who can care for your baby so insist on sleeping medications that will actually get you good night's sleep. I think you will do well to accept that you have some standard post-partum problems -- you may have other ones, but leave that aside for now -- and you should prioritize treating the known issues for now.
posted by kmennie at 8:21 AM on May 9, 2013 [1 favorite]

Also re: lokta's comment, we don't know that the OP has been labeled with psychosis without a full explanation. The nature of psychosis is such that people can have delusions (fixed false beliefs) that induce paranoia. I am not saying her concern about brain damage from a medication overdose is definitely an example of this, but we are only hearing one side of the story here,and she may be getting excellent medical care, it is difficult to judge.

Also the reason for being admitted to the mother and baby unit is because of not taking antipsychotic medications and presumably having continued serious symptoms. Mothers and babies have been shown to do better when kept together than separated, it doesn't mean they think the problem is taking care of the baby.
posted by treehorn+bunny at 8:28 AM on May 9, 2013 [6 favorites]

My son is 9 months old and it wasn't until about a month ago that I started to feel like a real person again.

I would describe my labor as typically intense but it did take four attempts for them to place the epidural, and when they finally did get it placed, they put it in a blood vessel and had to take it out and place it one last time. I was contracting like mad all during the process, bearing down, trying with all my might to keep from moving, and, on top of that, I had been shaking uncontrollably practically since they began administering the Pitocin. I squeezed my husband so hard with each contraction I'm surprised his head didn't pop right off there in the delivery room.

After all of that, my husband wasn't allowed to stay with us in the semi-private hospital room overnight. I couldn't sleep all night because I was just so amazed by the little son sleeping peacefully in the crook of my neck and, as the night gave way to morning, I realized that I couldn't move my head to either side without pain. Turns out I had a spinal headache from leaking spinal fluid from the epidural ordeal.

Why tell you all of this? Well, because when I left the hospital, I felt really sort of brutalized and let down. My son was beautiful and perfect and I was overwhelmed by the depth of my feeling for him, but I was also seriously deflated. Over the next few weeks there were days when I got literally four hours of non-contiguous rest per twenty-four hour period. My baby cried sometimes for 8 hours a day and fed literally every hour and a half around the clock. I cried a lot, too, and, at times, as described by lokta above, eventually became desperate around the issue of sleep. I won't lie - my marriage suffered a good deal because I was angry at my husband for 1.) being able to fall asleep easily and 2.) not having to breastfeed five times a night and then umpty-dozen more times during the day. Honestly, the first four months of being a mother were a kind of exquisite misery. Never, not once, did I experience anger toward my son or fear for his safety. If anything, caring for him was the single thing that gave me any kind of pleasure at all.

Then, I started getting my period back and I realized that on top of the post-partum mental health issues I was experiencing, my hormones were even more rat-fracked than I'd thought. And I'm a person who goes to therapy the way some people stop by Pinkberry after work.

I'm not a doctor. I don't know from Bupivacain. But I can tell you that you're going through something that is impossible to understand as you are going through it. There is no easy roadmap, either, because every woman's post-partum experience is different. The alchemy of everything that's going on inside of you is a mystery that only you have intimate familiarity with. But you must prepare yourself, too, for the possibility that what is happening inside of you, though it makes you feel crazy and damaged, is normal in a very perverse way. I know it doesn't seem possible. It is. And I say this as someone who has come through the worst of it and has the perspective that accompanies that. Yes, you may have been hurt by this drug. But it is possible that you're suffering because of what's happening inside you. To that end, and in closing, a few questions and suggestions:

- Does your baby sleep through the night? If you're still up even only once a night for a feeding, you're not getting good sleep. Now would be a good time, if you haven't already, to pump a bottle and insist that your husband do at least one feeding overnight.

- Are you your baby's primary caregiver? If so, get a sitter twice a week for a couple of hours each time. Go get your hair washed. Go to the gym. Get a cup of tea and take a two hour walk. It's necessary for to get away from your baby sometimes.

- Do you eat full meals while you're with your son? Make sure you're eating a full breakfast and lunch along with your son, and eating enough extra calories to support breastfeeding.

Lastly, it might help you to print out this question and show it to your mum. You say you're with her a lot; it might help her help you if she understood what's going on inside of you most of the time.

I wish you peace and continued joy from your baby. You can get better. It just may take more time than you think it should.
posted by TryTheTilapia at 8:43 AM on May 9, 2013 [6 favorites]

I’m sure things would look a little brighter if I could get some sleep but I don’t think it would cure the underlying problem.

I actually think it might. Don't underestimate how badly sleep deprivation can mess with your mind. If I were you, I would make good, uninterrupted sleep the absolute very top priority, and see how much that helps. Everything else flows from getting enough good sleep.
posted by rabbitrabbit at 8:58 AM on May 9, 2013 [2 favorites]

I had terrible problems after the birth of my first child that were caused by PPD and (crushing) sleep deprivation. I have known other mothers with PPD, in some cases severe enough to require extensive in-hospital treatment. I am not a doctor, I am not a psychiatrist or a psychologist, I am not a care professional of any kind, but I want to emphasize as strongly as possible that what you are describing looks very, very much like what I and my friends have been through.

I had to go to a psychiatric emergency room with my baby because I was beginning to seriously believe that the only way I would get any sleep would be to hurt myself or my baby so that I could get admitted to a psych ward. I say this not to illustrate that I was going through what you're going through now, but to underline the seriousness of what I was experiencing.

I believed it could not possibly be PPD because my baby was over a year old; I was wrong. I thought it for sure wasn't PPD because I loved her fiercely and passionately and had from the moment they put her on my chest, but I was wrong. I thought it absolutely was not PPD because I wasn't DEPRESSED, I was CRAZY -- I couldn't think, I couldn't plan, I couldn't even be. I was wrong. It was PPD, amplified by a baby who nursed every 2 hours around the clock until she was 14 months old.

You sound angry and scared, and I don't blame you in the slightest. I just. . . I don't know. But when I read your question, I immediately was like "Oh, I know what that is, that's PPD." If it's at all possible, give PPD treatment a chance, because really, everything you're describing sounds so familiar.
posted by KathrynT at 9:11 AM on May 9, 2013 [6 favorites]

I always appreciate treehorn+bunny's doc's thoughts and now she's a mom too so, awesome dual perspective right there.

Also, just one last thought, as another mom. My first kid pregnancy and postpartum (even after emergency c section) were a breeze. I thought, if this is what it's like, I'll have ten kids! My second, I was ten months out post partum, I couldn't stand my husband or our marriage, I would do all te things others described above - lie awake as aninsomniac, dreading that the sun would come up in X number of hours, knowing that I shouldn't even bother trying to close my eyes because I'd wake up with my similarly insomniac baby in an hour. I would sit at the kitchen table frozen and trying to make sense of doing basic stuff like dishes and laundry and making breakfast for myself and the kids.

My husband would ask me if I needed to see a doctor, was I depressed? And I was sure I was just so so so tired but I didn't need help. At about a year post partum, finally my fog started to clear and I started getting a few more hours of sleep a night and I looked back and I wondered why I didn't take the help my husband was offering. I'm a very stubborn person and not always so receptive to advice, so there's that part too, but mostly I just didn't see how easy it was to feel like there was nothing I could do about the spot I was in and I didn't need anyone's help. Looking back, If my best friend was in the situation I was in and I saw it, I would have personally made the appointment and driven her to the doc's to get evaluated for PPD. But of course it's always harder to see when you're in the thick of it.

I only say this to say that diagnoses of PPD and PPP aren't any evaluation of how capable you are as a parent or your fortitude as a person, it's a brain/chemical/hormonal thing and just like all sorts of other things that need medical help, there is nothing to be ashamed of if you have it. Again, this is not to say that this is absolutely what's going on with you right now, but if it is, please don't feel as if you need to justify what's going on with you right now as something that went wrong during your labor or whatever. Lots and lots of women go through the same exact stuff you are, give and take other symptoms, and it's very common.
posted by takoukla at 10:30 AM on May 9, 2013 [3 favorites]

OP, like everyone else who's commented here, I believe that your epidural medication is not responsible for your symptoms now. Central nervous system damage is vanishingly unlikely when bupivacaine, even at high doses, is injected into the epidural space; it is possible, but by no means definite, if bupivacaine is accidentally injected directly into the bloodstream.

Had you accidentally received a large dose of bupivacaine in your bloodstream during labor, you would have had immediate, unmistakable symptoms--ringing in your ears, a very fast heartbeat, dangerously low blood pressure, a metallic taste in your mouth, and possibly a loss of consciousness or at least the sense that you were about to pass out (tunnel vision, etc.). If the misplaced injection wasn't corrected immediately, it would have resulted in a catastrophic intrapartum event that would likely have required admission to an ICU for cardiac monitoring, antidysrhythmic drugs, and a lipid infusion.

It doesn't sound like your epidural was placed inappropriately, and even if you got a larger dose of medicine than is normal, it was delivered to the right place and you had a complete return to normal sensory and motor capability before you were discharged. Your body processed and excreted the bupivacaine a long time ago.

It is 100% possible to experience postpartum depression, and even postpartum psychosis, without feeling depressed or psychotic in a way that you recognize as depression or psychosis. It manifests in a lot of different ways, and I think, like everyone else, that prioritizing sleep (and forgetting about bupivacaine) will give you the most relief.

treehorn+bunny wrote: How well did your epidural work? How numb were you? That will give you an idea of how high a dose of the medication you got.

With the utmost respect for your education, training, and experience, I have to say this is incorrect.

In my hospital, every woman gets exactly the same medication in their epidural, in the same concentration, delivered at the same rate. Totally standard: 14 mL an hour of 0.01% ropivicaine in a 250 mL bag.

Some women develop a profound motor block along with their sensory block--can't even wiggle their toes, forget about bending the knees. Some women get a great sensory block with almost no associated motor block, and can easily lift their hips off the bed. Most women are somewhere in between. There is no way to tell what the dose is based on how numb someone is.
posted by jesourie at 2:20 PM on May 9, 2013 [4 favorites]

The dose cannot be precisely judged from the patient's response, it is not a linear correlation, because different people react to medications differently. However, in general, women receiving a higher concentration of anesthetic will get a denser block/are more likely to get a motor block. I am sorry if my response was unclear.
posted by treehorn+bunny at 8:38 AM on May 11, 2013 [1 favorite]