Fen's Ende Software
I have been sent a review copy of a new video tape. The authors
knew that given my natural childbirth perspective they might get
a mixed review, and here it is... The title is "Permission to be
pain free - understanding labor epidurals" from the Duke University
Health System. The information is presented by anesthesiologists.
The video starts well, discussing natural birth in a positive light
and letting women know that preparation for childbirth through good
classes is a good way to learn to reduce pain. It also includes
a very good discussion and graphic presentation of how an epidural
is administered and how it is different from a spinal block and
a walking epidural.
The only problem I have with this video is that the references
presented and the answers given to questions asked about the
safety of epidurals are always in comparison to narcotic drugs
used in labor. Yes, the epidural is the safest form of medical
pain relief for labor. Yes, compared to narcotics, the epidural
does not seem to slow labor much or increase the risk of cesarean.
However, compared to natural birth we might see a different picture.
The problem is that nobody is including an unmedicated control
group in their studies. I hereby challenge the obstetric anesthesiology
community to design and run studies that compare the medicated births
of all types to natural births. By natural, please be sure that I
mean births that did not involve pitocin.
For more information or to order this video, you can call
1-888-809-4484, but first check your local HMO library or medical
library. As a tool in the childbirth classroom, this could be a
useful addition as long as you include some healthy discussion.
Newsgroups: misc.kids.pregnancy
Since it happens behind you, I couldn't see, but basically, they stick a big ol' needle in your back. The needle is used to put a catheter in place. The drug is injected into the catheter. The tube is taped in place so you can move without dislodging it. I don't know if you can lie on your back, but you wouldn't want to anyway. (Not good for your labor.) There are two ways of doing the epidural. With a continuous infusion it lasts until they turn it off. (I don't know how long it takes to wear off once they stop.) Mine was a one shot deal. (Repeated once.) Each time, the significant relief lasted about 2 hours, then gradually began to wear off. (The first time it wore off, I got another dose. The second time it was almost time to push anyway, so it was allowed to wear off completely so I could push easily.)
I did not find the procedure painful. They give you a local anestetic (basically a shot of novacaine) before putting the catheter in your back, so all you feel is the initial needle prick. I know that some people find it very painful though.
Newsgroups: misc.kids.pregnancy
I had an epidural with my first pregnancy. It is funny, my childbirth educator had three children and experienced both types of delivery, natural and epidural. Of course, we were all pushing her for information (we were scared to death, all of us were first timers) and pinned her down as to her advice on what to do. She hesitated, but said, "I think you might want an epidural with your first baby, then since the second one comes sooner, you might want to try it natural." We also had a woman have her baby early and come into our last class to see us (she had actually had it the night before) and her first words were, "Take the epidural!" Well, I'm no fool! When I got to 6 cm and thought I'd scream if the pain got any harder I said shoot me up!
What happens is this: The anesthesiologist has you sit up and bend over so he/she can look at your back. Mine gave me a numbing shot first. It felt like a small sting. No big deal. The only thing I felt after that was some pressure, when he put the epidural needle in. You do have to be absoutely still when the needle goes in. He taped it flat on my back and hooked me up to the machine. I felt nothing. It was recommended that I stay on my side. The pain vanished and gave me some much needed relief. I was in labor for 24 hours so I was really tired. The only negative thing I can say about it is that I should've had it turned off sooner. I felt SOOOO good that I couldn't feel to push correctly. Since I'd been in labor so long, the doctor used the vacuum to help me out.
My daughter was born healthy and beautiful. My legs never felt numb or anything, the pain was just gone. No headache or anything either. With my next pregnancy, I decided I was "tough" so I tried natural childbirth. I got stuck at 8 cm and thought I was going to lose my mind. Believe me, those pains you feel at 5 or 6 cm. are NOTHING compared to the ones at 8 or 9! The doctor thought I'd be stuck for a while and gave me a shot of demerol right into my vein. (so it would be gone by the time the baby came). Well, Steven was crowning within 5 minutes! The shot had apparently relaxed me and he just came sliding out! That was not good. He was blue and not breathing (the demerol had affected him, depressed his system) and he had to be resusitated. He was and is fine, but had a hematoma (a blood filled bruise) on the side of his head for a month from coming out of the birth canal so fast. He was lop-sided. I'm trying for my third child. After having experienced both ways, I'm definitely going for the epidural again. I respond strongly to drugs anyway (I'm very sensitive) so I'm going to ask for just enough of an epidural to take most of the edge off, either that or turn it off a lot sooner. The thought of getting "stuck" again isn't appealing! Everyone's different, I've had friends have their babies in 3 hours naturally with no problem, but for me, the epidural is the way to go!
Jamie
Newsgroups: misc.kids.pregnancy
Well, I had decided not to have pain medication during my induced labor(pitocin and mag sulfate due to toxemia) until after 6 hours, I couldn't take it any more. I begged for that anesthesiologist to come back and give me some relief! So an hour later (an eternity!) he showed up and made my husband leave while he did the procedure. I wasn't happy that hubby got kicked out, but it was policy at my hospital. I was out of it with the pain, but here is what I remember: He gave me a local anesthetic so that I wouldn't feel the epidural going in. I couldn't see anything he was doing because it was all happening to my back. He put some kind of template on my back and told me it was very important for me not to move so I concentrated on not moving while the pain of the contractions was horrendous. I felt some pushing in my back, it was in, the med flowed and I could relax again and began to feel a helluva lot better-you can lay on your back since only a flexible tube carrying the medicine comes out from your back. They put in a catheter, but you don't feel it either. Taking out the epidural was easy as well, since it only took a few seconds-I was surprised. After all the fear I had from reading about migraines and my giving myself a hard time about wimping out to get the medicine, I was sincerely glad that I did it. I had a miserable birthing experience (babies to the NICU, didn't see them for a couple of days because I kept fainting) and found the epidural, ironically, to be one of the few things that went right.
There are two main types of epidurals: bolus (single shot that can be repeated) and continuous. Which one that is used depends on many factors, including the doctors.
First thing they do is give you an IV and then give you 2 liters of fluid (to try and help with the decreased bp, this also can slow labor because it increases the blood volume and decreases the concentration of oxytocin in your blood). You then lie on your side, curled into a ball. They clean up with betadine (usually cold), numb your back (personally, it only numbed the skin and wasn't worth it for me), then they actually take a large needle and use it to insert a catheter in your epidural space. You are then given a test dose to see if you'll have any reactions, then either a bolus or continuous epidural.
For the most part you are confined to your back or side from thereon out.
Yes, you HAVE to have an IV. How long the anesthesia lasts is dependant upon the type, the drug, etc. Continuous obviously lasts longer and can be refilled before the medication runs out.
You will lie on your back or propped on your side afterwards, it won't hurt it. The catheter is very fine and small.
My epidural hurt immensely. I had good pain relief, but the administration was the most painful thing I have ever felt. Everyone is different here. I guess the worst thing is the backaches that I still have after 4 years.
Robin Elise Seibert, ICCE, CD, NACA
Ms. Goer has written medical pamphlets and magazine articles for 10 years, and is an ASPO (Lamaze) certified childbirth educator and labor support person (doula). She has read through the literature, given overviews and abstracts as well as the citations for those who wish to read the original research. She starts out with a section on how to understand the statistics and read the literature with an eye to a well-designed study. The amount of work in this book could only be appreciated by seeing it - I have included only a few of her citations and this is only one of many topics covered... This book was written for birth professionals, but a consumer-oriented version is coming soon (est. early 1999).
Here is the summary from the section on epidurals:
Epidurals substantially increase the incidence of oxytocin augmentation, instrumental delivery, and bladder catheterization. (21 studies cited) [Saunders, NJ, et al. "Oxytocin infusion ... primiparous women using epidural..." BMJ 1989;299:1423-1426]
In first-time mothers, epidurals substantially increase the cesarean rate for dystocia. (12 studies cited) [Thorp, JA, et al. "The effect of intrapartum epidural ..." Am J Ob Gyn, 1993;169(4):851-858]
Epidurals decrease the probability that a posterior or transverse baby will rotate. Oxytocin does not help. (7 studies)
Having an epidural at 5cm dilation or more eliminates both excess posterior/transverse and excess cesarean for dystocia. (2 studies)
Epidurals may not relieve any pain or may not relieve all pain. (3 studies)
Innovations in procedure - lower dosages, continuous infusion, adding a narcotic - have not decreased epidural related problems. (13 studies) [Naulty, JS. "Continuous infusions of local ..." (this is a literature review) Int. Anes. Clin. 1990;28(1):17-24]
Delaying pushing until the head has descended to the perineum increases the chances of spontaneous birth. (a time delay of 1 hour is not really delaying - it needs to be a positional not timed thing...) Evidence is divided as to whether letting the epidural wear off before pushing increases spontaneous delivery. (4 studies)
Maternal complications of epidurals include: [Uitvlugt, A. "Managing complications of Epidural Analgesia" International Anesthesia Clin. 1990;28(1):11-16]
Serious complications occur despite proper procedure and precautions. The epinephrine test dose can cause complications. (12 studies)
Epidural anesthetics "get" to the baby. (5 studies)
Epidurals do not protect the fetus from distress. In fact, they cause abnormal fetal heart rate, sometimes severe, which may occur with or independant of maternal blood pressure (11% - 43% depending on the study and type of medication used - the 43% was found with Bupivacaine, the most common drug for epidural.) (15 studies) [Stavrou C, et al. "Prolonged fetal bradycardia during epidural analgesia" S Afr Med J 1990;77:66-68]
Epidurals may cause neonatal jaundice. (2 studies) [Clark, DA & Landaw, SA. "Bupivacaine alters red blood cell ... jaundice associated with maternal anesthesia" Pediatr. Res. 1985; 19(4):341-343]
Epidurals may cause adverse neonatal behavioral and physical effects. (these are both direct effects and indirect effects from the increased rate of labor complications and interventions.) The importance of this is debated. (4 studies)
Epidural anesthesia may relieve hypertension, but hypertensive women are at particular risk of epidural-induced hypotension, which reduces placental blood supply. (2 studies)
In my childbirth classes, I always say that in the cases of women who have been in labor for days and are exhausted, epidural may allow them the rest they need to avoid operative delivery. Also, women who are tense to the point of fighting their contractions may benefit from the artificial relaxation of an epidural - these women are usually those who have taken inadequate classes (but not always!)...
I teach the Bradley Method, and we have an overall 86% unmedicated rate. This is not because we use scare tactics or only superwomen come to our classes! The techniques we use allow the majority of women to work with their bodies to keep the pain to a level they can handle! I believe that any good childbirth educator teaching any reasonable method can achieve the same result provided that they make no promises that a particular breathing pattern WILL remove all the pain (reasonable expectations), and that the class comes away feeling confident that if they wish to avoid drugs in a normal labor and delivery that they have the strength to do it.
Notice I said "normal" labor and delivery - I mean that any intervention may make the pain too much to take, interventions such as induction of labor, being forced to lie down, and being disturbed too often (such as for vaginal exams...).
Epidural anesthesia does seem to be the safest for both mother and baby if you have to have something, such as for a c-section! It is wonderful that in the case where a c-section is really necessary, that we have a way for the mother to be awake for the birth of her baby. She can participate as fully as possible in the birth if she has an epidural rather than general anesthesia!
Things that can help you avoid drugs in labor: a trained labor assistant (doula), hiring a midwife instead of an OB for low-risk women, researching the safest place to have your baby (the best area hospital, a birth center, or home - individuals need different things!), and being involved enough in your own health care to read everything you can about the process of pregnancy and birth!
Sure, get information from the net, and from classes, but read books written by a variety of sources, and follow the medical literature as much as you can!
-Sabrina
Sometime ago, there was a discussion about epidurals in this news group. Somebody gave me a rough time because I criticized the use of epidurals, but I could not remember the exact citations of my studies. They accused me of creating an "unnecessary panic."
Well, here is the info.
This comes from "A Good Birth, A Safe Birth" by Diana Korte and Roberta Scaer.
"Here is what we do know about epidurals from the obstetrical literature:
- For nearly all women, they obliterate the sensations of labor and delivery. Occasionally the block is incomplete.
- Continuous electronic fetal monitoring is almost always used.
- An IV must be used.
- The woman must stay in bed, losing her ability to be active and limiting the positions she may assume.
- Pitocin is frequently given at the same time for slowed labors.
- They can lower the woman's blood pressure and put the woman and infant at risk.
- The relaxation of the woman's pelvic muscles that epidurals bring may prevent those muscles from assisting in the usual rotation of the fetus as it moves to a normal birth position.
- The urge and ability to push may be reduced or extinguished.
- They more than double the use of instrument delivery and more than triple the use of midforceps delivery because the baby has not rotated normally or the mother cannot push. (Kaminski, et al, "Obstetrics and Gynecology 69:770 [1987])
- The increase the cesarean liklihood due to "failure to progress" in women giving birth for the first time at least two to threefold; cesareans are at least 6 times more common for failure to progress in women giving birth for the 1st time if the epidural is given before 5 cm of dilation and the woman's dilation is slower than average (Thorp, et al, presentation at 1989 "Birth" journal conferance).
- Failure to progress is the most common reason for a 1st-time cesarean.
- Persistent, chronic backache is significantly greater among women who have epidurals during labor (MacArthur et al, "British Medical Journal" 301:9-12 [1990]).
- Serious, nonfatal complications (cardiac arrest, spinal damage, toxic reactions, and prolonged severe headache) associated with epidural anesthesia occur in the range of 1 per 10,000 deliveries (Scott and Hibbard, "British Journal of Anesthesiology 64:537-41[1990]).
- Narcotics are now being given at the same time to strengthen its effect.
- Narcotics are known to cause breathing problems in infants when given within several hours of birth.
- All drugs cross the placenta and affect the baby.
- When the cord is cut, the infant is left with trace amounts of any drugs that were being given to the mother at the time of birth.
- The infant's immature organs must detoxify the drugs.
- The infant's immature brain can be affected by his mother's drug use during labor and delivery.
------- End of quote.
They go on to admit that they do NOT know for sure the short and long-term effects of epidurals on the infant. But they quote several interviews with delivery nurses who are sure that the babies look woozier and do not suck as well when epidurals are used.
They also quote a few studies on the effects of drugs during pregnancy. Most notably...
"Working with Sarah Broman, a psychologist at the National Institutes of Health, Brackbill analyzed data from a study of 53,000 women who gave birth at 12 different teaching hospitals between 1959 and 1966. Broman and Brackbill studied the data on the 3500 women in the project who were the healthiest and who had the most uncomplicated pregnancies, labors, and deliveries, trying to rule out the possibility that any results showing damage to babies would be due to complicated pregnancies or deliveries. In this select, healthy group, they found that obstetrical drugs affect the children's behavior through at least 7 years of age. Among the older children whose mothers had received drugs during labor and delivery, there were lower reading and spelling scores, and lower scores on a visual-monitor test."
The book cites many other instances where it definitely looks possible that epidurals can cause brain damage. So, to the guy who accused me of "creating an irresponsible panic", read up. It's not conclusive, but it *might* be true, and it isn't just from idle yammering.
This book also includes a very good discussion of the economic corruption that prompts hospitals to promote epidurals. They discover that unless they do a lot of them, they can't afford to keep their anesthesiologists on staff. They also make money doing them. One case cited interviews with nurses who were sharply criticized if they even informed patients of the potential risks of epidurals, including one nurse who was fired for this. It is UNTRUE that epidural anesthesia does not cross the placenta to the baby, an oft-touted belief that I have seen in pamphlets and on this net. It is not even clear that its effects are any less than any of the common pain-killing narcotics given during birth.
My one critism is your reprinting of the data from (I believe) "A Good Birth a Safe Birth" that found a connection between labor medication and learning disabilities. That study looked at children born in the late '50's and early '60's. At that time medication was FAR heavier than today. Women were routinely heavily doped during early labor, and drugged into total unconciousness during delivery. The spinals that were routinely given almost ALWAYS required forceps delivery. Things today are very different, with drugs being used in much lower dosages and most women able to push during their epidurals. If there is, in fact a connection, it is almost certainly dose related, and the risks from modern medications VERY slight.
My sister had an epidural in her first labor (expensive female OB, big NYC private hospital, unproductive labor for 12 hours (probably prodromal in light of her subsequent labors), amniotomy, pitocin, and something in the demoral family). She had a strong reaction to the epidural. Her blood pressure plummeted and she stopped breathing. They literally tore the baby out -- she couldn't have sex for six months.
With her next two babies she went to a midwifery practice and stayed home until in full-blown labor. No medication, minimal tearing, no problems.
I know lots of women who have had blissfully pain-free births thanks to epidurals ("I wanted to name my baby after the anesthesiologist"). I always interpret this as meaning that they gambled and won.
Informally, as a La Leche League leader I have found that a very high percentage of moms who've had epidurals have very sleepy hard to nurse newborns and this seems to last up to 4 weeks. There is just not enough hard research on it!!! Also, I wonder what makes a woman wish to be unable to FEEL, as in numbing one from the total experience.
I am unable to speak for La Leche League Int. but at the '94 Texas LLL conference research into epidurals was mentioned as the #2 need as far as unknown effects, first only AIDS & breastfeeding.
The whole idea of numbing oneself is that these women and I have met MANY is that they plan on getting an epidural as early in labor as possible and not feel a thing and a catheter is yucky but that is the ONLY side effect of epidural. Drs and nurses will swear up and down that an epidural is 100% safe and has no side effects and is not a drug in that it won't reach the baby. My question is why do so many women not want to be in charge of their bodies/births/ babies' health???Ina May Gaskin speaks of an epidural epidemic, and women here really buy into it.
My last baby was born at home and weighed 10# 6oz and let me tell you that was incredible agony and I didn't think I could make it either. But I did (4th baby and 10 hrs of intense pain including 4 hours at 8cm with a swollen cervix, baby had 15 and 1/4 " head!)and now I know I can do anything!
My experience with an epidural was very positive. It did slow down labor, however, requiring the use of pitocin. Once the the pitocin was administered, labor went quite quickly. The epidural did not inhibit the baby's progress down the birth canal. When it came time to push, I could definitely feel enough to push, and could move my legs (although they were numb.) I really don't feel like I missed out on the birth experience; in fact, I think it made it more positive. Rather than focusing on the pain, I could focus on the arrival of my new daughter.
To my knowledge, neither the baby nor I suffered any adverse effects. She was a vigorous nurser from the start, and not drowsy at all.
I was on bedrest for the last 2 months of my pregnancy, so was unable to complete natural childbirth classes, as we had hoped. My labor was induced with pit, but I went for 24 hours without dilating more than 2 cms. At that time I began to experience severe back labor. It was determined that the baby was posterior. After several hours of increasing severity - I could no longer stand the pain and relented to an epidural.
Once fully dilated, I pushed for 5 hours!!! The baby did not turn - and I had to be taken to the O.R. and prepped for a C-section. At the last second he was delivered via forceps and all was fine. I must say that I had nominal discomfort once the epidural was administered. But what happened as a result could probably have been prevented if I had not had the epidural.
I went home 24 hours later. That evening I became incontinent of urine. This continued into the next morning and I contacted my doctor. I had to have a foley catheter inserted for 4 days. Apparently all the pushing (all 5 hours worth) had taken its' toll on my bladder muscles. I am certain I could not have lasted 5 hours without the epidural. I would have felt what my body was telling me and relented earlier. But because I was not in pain - I continued to try to push, push, push, hoping the baby would turn. The result was one exhausted new mom walking around the house with a new baby in one arm and a foley bag in the other. Not a pleasant sight.
My son was induced after 8 days late. No fetal distress but a sonogram indicated dangerously little amniotic fluid. So they induced and monitored him carefully.
I didn't respond immediately to the pitocin, but when I did, all hell broke loose. Labor progressed very quickly (6 hours from onset of first contraction until my son was delivered). I handled the first 3 hours fine, but then I hurt bad. I didn't think I could possibly be in transition because I had been in labor for such a short time. I was afraid to ask for an epidural because I was sure I was only 2 cm dialated and they would say it was too early. I felt like I was being a whimp - crapping out after only 3 hours. But finally I had to ask for help. When they check I had gone from 0 - 5+ in those 3 hours and he OKed the epidural.
Getting the epidural was essentially painless - just a little stick, no big deal. But it took much longer to kick in that I expected. The anesthesiologist had to return 3 times to inject more goop into the catheter - I was just getting no relief at all. He said that tall women often take more goop and longer to get relief - something about more Cerebral/Spinal fluid in a longer spine. 1 hour later I finally was getting enough relief that I was semi-sane. My OB appears and wants to check my progress and I snapped at him, told him it had only been an hour, I was only 5 cm an hour ago, and he was to leave me alone and let me get a nap. He checked me anyway. 10cm - time to push and I am finally getting numb. So 5 - 10 in the hour that I was waiting for the epidural to take effect.
This sorta sucked. I got no relief for the transition, but now it was time to push and I was as numb as a doornob. The labor nurse said that lots of women have a hard time pushing when they are numb and they may have to wait the 2 hours for the epidural to wear off before I could really push the baby out. Apparently this is why they try to time the epidural to relieve the end of the labor but to have worn off by the time you need to push.
Great labor nurse. She explained how to push and I just had to do it blind. But I could. She let me know when I was being effective and when I wasn't. David was watching the monitor (for both the baby's heartbeat and the peak of the contraction) so he could help me with the timing and we did great. It still took 2 hours of pushing. (This was my first baby). By the end of it, I was starting to feel the contractions, but didn't feel any pain in the perineum. I was glad for the relief, even if it came late.
Most importantly, Paul was perfect. Screaming like hell as they clamped his cord and just an active little kid. He kept kicking the nurse who was trying to get his footprint.
I had no negative aftereffects. I didn't feel groggy from the epidural or anything else. We had no problems at all nursing.
All in all, I have no complaints about the epidural. Wish it could have taken effect earlier. Im glad I could push in spite of it. If my next labor is really painful and I feel like I could use some help, you can be sure I'll ask for an epidural.
After induced labour (2 weeks late, prostaglandin gel, waters broken followed some hours later by pitocin drip), I found the pain too much to cope with and I was tensing up too much for the contractions to be productive. I received a low-dosage, continuous feed epidural which, within 1.5 hours, reduced the pain to nil. This lasted about four hours after which the epidural needle slipped out and the pain returned in full force. It took about 2.5 hours of the labour from hell before they realised what had happened. They reinserted the needle and the epidural took effect again shortly before the baby got into distress and a vacuum extraction ensued. I spent the next eight days in hospital with repeated UTIs, but I don't know whether that was due to the size of the baby, the swift extraction or the epidural.
After all that, what will I do next time? I'll try to go with a natural labour - I'll be much more proactive against intervention / induction, but if I feel I can't cope, I'll have an epidural again.
My wife had a bad epidural experience. We went to the hospital after Peg had been in labor at home for about 6 hours. They did an ultrasound, and the baby was transverse breech. They said she needed an emergency C-section, which we agreed to, even though it was the LAST thing we could have imagined. They took her away to prep her. I met her in the operating room, and asked her how she felt. She said it was really wierd not feeling anything. The baby was born, and I went out with him while they stitched Peg up.
Eli was not nursing well at all, but he also had an infection from inhaling meconium and was in NICU for a week, so we cannot directly attribute his lack of nursing on the epidural.
Peg, on the other hand, was not feeling well the next day. She had one of those push-button medication devices for the pain. She said the C-section hurt, but she had a really bad headache. The next day, the headache was worse. By the next day, she couldn't have any bright lights, and had a severe headache. The nurses and doctors said she was just upset because the baby was in NICU, and sent her home. We came back to the hospital the next day because Peg now had literally blinding headaches, and went into convulsions and vomited in NICU. Another doctor came in, asked a few questions, and they realized she had a dural tear from the needle. They performed a blood patch, gave her an IV, kept her a day, and she was fine. We now know better.
Ask the chiropractic mailing list about the dangers of epidurals. You will be amazed how many people have long term effects from them.
I have had about 10 women in my Bradley classes who have had their epidurals go up and need some help with respiratory efforts and heart also. They certainly wanted to do natural childbirth next time around.
Deb Phillips Arkansas Licensed Midwife
My positive experience with epidurals:
I had epidurals with the delivery of both of my children. Both times, I was grateful to have the epidural, since it made it possible for me to endure the labor with minimal pain (I actually slept for 6 hours the first time; second time it wasn't even that long :-) and save my strength for the hard job -- pushing!!
My children did not have any negative side effects from the drugs, nor did I. Both children were healthy when born; good apgars, crying, etc. and to this day they don't show any signs of brain damage either. They've been developmentally normal (not geniuses but not delayed either) and happy, sociable, healthy kids. The only side effect I noticed the second time around was that I was cold, but that wasn't a problem. And both baby and I had good stable, steady heartbeats the whole time; no fetal distress.
I did encounter an administrative hassle at the hospital in both cases -- they didn't have enough anesthesiologists on hand either time, so there was a delay in getting the epidural when I wanted it (I waited as long as I could, just to minimize the amount of time/drugs) -- about 1 hour longer than I wanted. But once it was in, what relief!! As I mentioned, I was able to relax and sleep.
In both cases, pitocin was used to counteract the slowdown in labor due to the epidural. No problem, it didn't hurt me! :-) I had a fairly long labor the first time -- about 10 hours. And delivery took 2-1/2 hours; just as I started getting tired, my daughter decided to come out. With my second, labor was about 4-1/2 hours and delivery was 9 minutes (!!!!). So I don't feel the epidural had any effect on my birthing process (good or bad). When it came time for delivery, the anesthesiologist cut back the amount of the epidural drug, so I could feel the pushing and how it was affecting me and my baby.
If I were to get pregnant again, I'd do it the same way.
My attitude going in was wait and see: I'd prefer no medication, but I realize that I am generally a wimp when it comes to pain, and looking at the alternatives, epidurals are safer and have fewer side effects.
I was induced (overdue, degrading placenta), so some of the side issues (I.V., fetal monitoring, pitocin, staying in bed) were already a fact of my delivery. Having started the induction 5pm the night before, and having gotten little chance to sleep, and having slept poorly when sleeping, I was very tired by the time my labor started progressing (2pm). The epidural at 4:30pm (and 3+cm) was wonderful. It was an ideal administration; I could feel my legs (and move one leg well, and the other slightly), I could feel my perenium (sp?), and I could feel the peaks of my contractions under my ribs. Being able to rest, and be aware of what was happening was wonderful. Although I had been dealing with the contractions, it took all of my concentration, and I barely noticed other people in the room before the epidural. With the epidural I could pay more attention to what was happening because all of my attention was not focused on dealing with the pain. I had no ill after effects, and the urinary catheter was not nearly as bad as I had imagined. Several people had advised me ahead of time that there was no need to be a martyr, and there are no brownie points for pain. I agree.
Having written this, it sounds appologetic, which is not my intent. The
epidural was
I had an epidural for Beans. I would not have wanted to face a
c-section without one! For a cesearian delivery, an epidural is
greatly preferable to general anesthesia. I had no bad side effects;
Beans had no difficulty nursing, and was not jaundiced. her apgars
were 7 and 9, typical of a Cesearian birth.
In the longer version, I'd say that my labor probably was delayed by
the epidural. The dilation slowed, but then continued after they gave
me Pitocin. In the end, I was 10 centimeters but her head simply
couldn't come down. Once I had the c-section, the doctor said that had
she known how big the baby's head was, she would have not let me labor
so long. She had completely undersestimated Sabina's head size. I
guess I'd have to say that the epidural made the 24 hour labor
bearable, and I was very glad to havr had the c-section with epidural
as opposed to general anesthesia.
I hear what you're saying about the research being negative. If we
lived in an ideal world, we would have no anesthesia during labor and
delivery, no episiotomies necessary, no one would drink coffee during
her pregnancy, you name it. But sometimes difficult labor and
deliveries happen, and for me the epidural was a necessary evil. I
would guess the literature finds epidurals to be better for the baby
than general anesthesia.
I had a terrible childbirth class (can you tell??) . All it did was
tell us we were weakwilled and didn't care about our babies if we
considered anesthesia. The possibility of c-scetions was barely
addressed.
*The following is my response to a request for clarification...
(from the person who sent me email)
As always, this is a risk benefit analysis; there is a lower tollerance
of side effects in drugs for minor illnesses as compared to drugs for
major illnesses. Alternatives to epidurals are more dangerous...
Although I had prepared for a drug-free birth using the Bradley method,
my son turned during early labor and became stuck in the transverse breech
position. This necessitated a cesarian section. With an epidural came
other nasty things I had hoped to avoid, such as IV, urinary catheter,
continuous fetal monitoring, and confinement to bed. At first the epidural
"took" on only one side, so the nurses kept turning me to try to get it to
work on the other side. There were hot spots where the epidural didn't
work at all, and I could feel some of the cutting. Later it took several
hours for the numbness to wear off because they had given me a lot of
medication. My baby had to go to the special care nursery for some oxygen
(not related to the epidural), and I couldn't see him until I got out of
the recovery room. I feel that the epidural and its effects were the
worst part of the entire experience and would never choose to have one
unless there was no other way.
A couple comments from my epidural experience:
* I went through Lamaze with the intention of having a natural
childbirth, but my waters ruptured long before contractions started and
the contractions that finally occurred were very weak. Because the
doctors felt that the baby had not completely descended (this was only
2 weeks before due date, but there was still some ballottement going
on) they felt it would be dangerous for me to be in positions other
than flat on my back. That let out most of the labor-inducing stuff I'd
learned in Lamaze.
My doctors were very sympathetic to my trying to do it without
medication and we agreed together to let my body work for itself for a
certain number of hours, at which point it would be necessary to speed
things up to avoid the risk of infection.
I got to that point with 0 contractions. At that point I agreed to
induce, and the induced contractions really hurt, especially since my
waters had broken already.
I ended up asking for an epidural--which DID NOT WORK. I had complete
relief from pain for 15 minutes, then something went wrong. The
anesthesiologist attempted 2 boluses, neither took. So I got through
the induced labor on my own, fully dilated, at which point they checked
the baby's head and found an extreme disproportion between him and me
Because the epidural hadn't worked, I went through a Caesarean with
general anesthesia. Not a pleasant experience.
My oldest was born after about 16 TOTAL hours of labor (from first pain
I felt til he was here) I had one injection of demoral early in my
labor to make my contractions more efficient (at about 7 hours into
labor) nothing after that. The pain was excurciating but not to the
point that I was screaming at people and out of control. Although my
husband is lucky he doesn't wear any jewelry or he would have a
premanent dent in his fingers from me squeezing them so hard :) I
pushed for 30 minutes and our son was born APGARs were great and he had
no trouble nursing at all.
My second was born after about 12 hours of labor, when I was dialated
to 8cm my doctor and labor nurse determined she was breech. A quick
sono. confirmed she was a frank breech and we decided to do a
C-section for safety sake. So I had the epidural, although there were
no side effects for either of us, she also had high APGAR's and nursed
very well, the little piggy that she was :). However, although I had
no problems with the epidural, I would not have another one, just
because I COULDN'T feel anything, and I disliked that more than the
pain.
My third was a VBAC born after 7 hours of labor (from first pain I felt
til she was born). No drugs of ANY kind, about 4 pushes, no tears and
no episiotomy. She also had very high APGAR's and was a good nurser.
I am expecting my 4th and the only reason that I can see I would have
an epidural would be if I have to have a C-section, and then I would
only allow MY doctor to administer it.
I know that this has gotten very wordy but with so much discussion
about the pros and cons, I thought I would relate my thoughts since I
have been down both roads.
My labor was induced when Maura was 3 1/2 weeks late and the sono came
back with danger signs. Immediately I was stuck in bed with IVs for
pitocin and glucose. After 24 hours, I *finally* started getting
contractions.
By 30 hours, I was dilated 3 cm. I had been in bed the whole time
[other than walks to the bathroom] and had no food. The contractions
were so bad, I could barely stand them, and was screaming [normally I'm
not a vocal person]. After much agony, I went against my original plans
and requested an epidural.
The epidural took the edge off the contractions. It did *NOT* stop the
pain, even after several boosters. There was one breakthrough pain spot
in my right side which never stopped causing intense agony. However,
the use of the epidural made it possible for the doctor to increase the
pitocin dose a bit, and within 4 hours of the epidural starting, I was
pushing.
I did *not* have any difficulty pushing, and only had to push for 20
minutes total. No grogginess, no headaches, no fetal distress from the
epidural [all the distress she was in had started before the epidural
was put in].
When/if I have another child, I'm still planning to try to avoid the
epidural if possible, but IMO, it's worth having the epidural in order
to be able to have a vaginal delivery.
I had planned on no drugs, but I knew since I had never been through
labor and delivery before I should keep an open mind. I generally have
a pretty high tolerance for pain, though, so I thought I would be able
to handle it. And, mostly, I was able to -- up until about 4 cm :)
My labor had started at 1:30 am on a Saturday, and most of the day the
contractions were manageable. About 6 pm they started to get
"uncomfortable" and by 9:00 I was on the phone to the hospital telling
them I WAS coming in, even though the contractions were still pretty
irregular (anywhere from 4-7 minutes apart). When I was examined I was
at about 4 cm, and was told to walk around for an hour. When I got back
I told the labor nurse immediately that I'd be interested in an
epidural. We had to wait for the doctor to examine me; he estimated me
to be at 6 cm and OK'd the epidural plus something IV in the meantime
to relax me (mostly it made me sleepy between contractions).
The anesthesiologist had just begun an epidural with another patient,
and was required to wait with her for 30 minutes after it was
administered. It seemed as though it took him forever to get there.
Then he asked me to sit up and bend over a bed tray (those things they
serve the hospital meals on) while he performed the epidural. It was a
difficult task, since I seemed to be having one long contraction at
this point. He asked me to let him know when I wasn't having one, and I
just told him to go ahead because I couldn't tell where one ended and
the next one started.
It took about 20 minutes; I'm not sure why. My labor nurse started to
become a little concerned because the external monitor slipped when I
sat up and she hadn't been able to get a fetal heart rate the whole
time. Once I laid back down Katy's heartrate kept decelerating during
contractions (probably because the cord had slipped down beside her and
was being compressed).
After that, things happened pretty quickly. I think I probably was
close to 10 cm by the time the anesthesiologist came to administer the
epidural, because it took no time afterwards for Katy to be born. I
wish I would have had the presence of mind to ask for another check
right before he did it, because if I had known I was that close I
probably would have been able to forego it.
So, here we are, getting ready to deliver Katy, and he keeps checking
to see if the epidural has taken effect (brushing wet cotton balls on
my thighs, asking if I feel it, etc.) -- of all the tests he did, I
felt everyone. As far as I can remember, I never lost any sensation
anywhere (except in the perineum because of a pudendal block they did
for the episiotomy).
The following day I had a nasty headache, but it was a hot, fairly
humid day and I'm prone to sinus headaches, so I attributed it to
either the weather or to tension in my shoulders from the pushing. I
tried to tough it out and, in retrospect, maybe should have asked for
some medication to help. But we went home on Monday with instructions
to call if the headache didn't get any better. It didn't. I literally
was flat on my back in bed except for feeding Katy and going to the
bathroom. When I did go back on Tuesday, they performed what's called a
"blood patch," where they take blood from your arm and put it into the
epidural space to replace any spinal fluid that leaked. It helped
immediately, so I'm sure that's what the headache was from.
The one thing for which I am grateful concerning the whole experience
is that I KNOW I can make it all the way through labor (and maybe
delivery) at least without an epidural, since I essentially did it
before. I hope next time I can be a little more aware of what's going
on with my body so I can tell how close I am. I'm still not averse to
trying some other pain relief (i.e., TENS) but I'm positive I don't
want another epidural.
For me, the epidural was fabulous, wonderful and now that I'm pregnant
a second time, I'm definately going to ask for it again.
I thought I'd relate my epidural story of my firstborn. I had the most
wonderful birth experience. I was very concerned about the pain of
labor, and requested an epidural. It was administered, and my beautiful
new year's baby was born a few hours later. It was a beautiful,
painfree birth for everyone involved, and I have no birthing horror
stories to relate (I can't tell you how many "I laid there for hours in
agony" stories I had to suffer through during pregancy). Not so for me!
My daughter was born alert and happy, and I believe the lack of pain
induced trauma in her mother resulted in a happy birth experience for
her.
What I am doing here is taking the section titled "Research" above
and filling in all the studies published after 1983 - where in the
above section I only cited one example (at most) of the many citations
available for each topic. Some references are used to illustrate
several topics, so they will be repeated and the number of studies
is smaller than it may seem by looking at the size of this list.
I plan to add a literature update soon.
Epidurals substantially increase the incidence of oxytocin augmentation,
instrumental delivery, and bladder catheterization. (21 studies cited)
In first-time mothers, epidurals substantially increase the cesarean
rate for dystocia. This effect may depend on mamangement. (12 studies cited)
Epidurals decrease the probability that a posterior or transverse baby
will rotate. Oxytocin does not help. (7 studies)
Having an epidural at 5cm dilation or more eliminates both excess
posterior/transverse and excess cesarean for dystocia. (2 studies)
Epidurals may not relieve any pain or may not relieve all pain. (3 studies)
Innovations in procedure - lower dosages, continuous infusion, adding
a narcotic - have not decreased epidural related problems. (13 studies)
Delaying pushing until the head has descended to the perineum increases
the chances of spontaneous birth. (a time delay of 1 hour is not really
delaying - it needs to be a positional not timed thing...) Evidence is
divided as to whether letting the epidural wear off before pushing
increases spontaneous delivery. (4 studies)
Maternal complications of epidurals include:
[Uitvlugt, A. "Managing complications of Epidural Analgesia"
International Anesthesia Clin. 1990;28(1):11-16]
Serious complications occur despite proper procedure and precautions.
The epinephrine test dose can cause complications. (12 studies)
Epidural anesthetics "get" to the baby. (5 studies)
Epidurals do not protect the fetus from distress. In fact, they cause
abnormal fetal heart rate, sometimes severe, which may occur with or
independant of maternal blood pressure (11% - 43% depending on the
study and type of medication used - the 43% was found with Bupivacaine,
the most common drug for epidural.) (15 studies)
Stavrou C, et al. "Prolonged fetal bradycardia during epidural analgesia"
S Afr Med J 1990;77:66-68
Epidurals may cause neonatal jaundice. (2 studies)
[Clark, DA & Landaw, SA. "Bupivacaine alters red blood cell ...
jaundice associated with maternal anesthesia" Pediatr. Res. 1985;
19(4):341-343]
Epidurals may cause adverse neonatal behavioral and physical effects.
(these are both direct effects and indirect effects from the increased
rate of labor complications and interventions.) The importance of this
is debated. (4 studies)
Epidural anesthesia may relieve hypertension, but hypertensive women
are at particular risk of epidural-induced hypotension, which reduces
placental blood supply. (2 studies)
> I have looked back in Henci's book, and there is indeed some
> incidence information. The studies (which I only have the
> abstracts from, but which Henci believes are well-done, ie.
> that they used adequate controls, enough subjects, and reasonable
> methods) do not agree as to the incidence of side-effects...
>
> One study found life-threatening but non-fatal complications in 1 of
> 14,000 cases and serious complications in 1 of 5,000 (1990). Another
> found life threatening complications in 1 of 3,000 cases (1985).
> I can only assume that there have been some advances in the use
> of epidurals in that 5 years, or that one hospital had better
> anesthesiologists than the other - you are right, it really does
> vary by doctor!
> Henci points out that drugs have been taken off the market when
> the serious complications/adverse reactions are in the 1/1000
> to 1/30,000 range, yet epidural is touted as perfectly safe.
> Anyway, I really want people to do lots of reading, and THINK
> before they decide. I also want women to decide in labor what they
> can handle, not before! (I know you did that!)
I think that a balanced presentation is important here so that people
really think about the options ahead of time instead of dismissing the use
of any drugs outright.
My water broke at 10AM at home. I called the Doctor, my husband and my
mother and went to the hospital at 10:30AM. I had no contractions up
to this point and was put on Pitocin. By 3PM I had reached my pain
threshold and asked for an epidural only to be told that I had not
progressed enough. The pain of contractions was extremely intense. I
had curled myself into a tight ball, closed my eyes, couldn't bear to
have anyone touch me and did everything I could to block out all
external stimuli. Finally, at 5PM I got the epidural. I became a real
person again. I could unbend my body, hold my husband's hand, have
conversations. I could rather enjoy this event. I watched the monitor
for the baby's heart-beat and my contractions. At 11PM, epidural was
allowed to wear off and when it came time to push, I had NO problem
identifying when a contraction was starting and how to push. I pushed
for two hours but unfortunately, Katherine was facing forward instead
of spineward. I had to have a C-section because she was stuck and in
distress by this time. Luckily, I already had an epidural so they just
upped the dosage.
References
Saunders, NJ, et al. "Oxytocin infusion ... primiparous women using
epidural..." BMJ 1989;299:1423-1426
Diro, M. and Beydoun, S. "Segmental epidural analgesia in labor: a
matched control study". J Nat Med Assoc 1985;78(1):569-573.
Chestnut, DH, et al. "The influence of continuous epidural bupivacaine
analgesia on the second stage of labor and method of delivery in
nulliparous women". Anesthesiology 1987;66:774-780.
Kaminski, HM, Stafl, A, and Aiman, J. "The effect of epidural analgesia
on the frequency of instrumental obstetric delivery". Obstet Gynecol 1987;69(5):770-773.
Philipsen, T and Jensen, NH. "Epidural block or parenteral pethidine as
analgesic in labour; a randomized study concerning progress in labour
and instrumental deliveries". Eur J Obstet Gynecol Reprod Biol 1989;30:27:33.
Gribble, RK and Meier, PR. "Effect of epidural analgesia on the primary
cesarean rate". Obstet Gynecol 1991;78(2):231-234.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia:
risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous
labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol
1993;169(4):851-858.
Nel, JT. "Clinical effects of epidural block during labor. A prospective
study". S Afr Med J 1985;68(6):371-374.
Yancy, MK et al. "Maternal and neonatal effects of outlet forceps
delivery compared with spontaneous vaginal delivery in term pregnancies".
Obstet Gynecol 1991;78(4):646-650.
Stavrou, C, Hofmeyer, GJ, and Boezaart, AP. "Prolonged fetal bradycardia
during epidural analgesia". S Afr Med J 1990;77:66-68.
Eddleston, JM, et al. "Comparison of the maternal and fetal effects
associated with intermittent or continuous infusion of extradural
analgesia". Br J Anaesth 1992;69:154-158.
Bogod, DG, Rosen, M, and Rees, GAD. "Extradural infusion of 0.125%
bupivacaine at 10 Ml H-1 to women during labour". Br J Anaesth
1987;59(3):325-330.
Smedstad, KG and Morison, DH. "A comparative study of continuous and
intermittent epidural analgesia for labour and delivery". Can J Anaesth
1988;35(3):234-241.
Chestnut, DH et al. "Continuous infusion epidural analgesia during labor:
A randomized, double-blind comparison of 0.0625% bupivacaine/0.0002%
fentanyl versus 0.125% bupivacaine". Anesthesiol 1988;68:754-759.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous
labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol
1993;169(4):851-858.
Diro, M. and Beydoun, S. "Segmental epidural analgesia in labor: a
matched control study". J Nat Med Assoc 1985;78(1):569-573.
Chestnut, DH, et al. "The influence of continuous epidural bupivacaine
analgesia on the second stage of labor and method of delivery in
nulliparous women". Anesthesiology 1987;66:774-780.
Thorpe, JA et al. "The effect of continous epidural analgesia on
cesarean section for dystocia in nulliparous women". Am J Obstet
Gynecol 1989;161(3):670-675.
Philipsen, T and Jensen, NH. "Epidural block or parenteral pethidine as
analgesic in labour; a randomized study concerning progress in labour
and instrumental deliveries". Eur J Obstet Gynecol Reprod Biol 1989;30:27:33.
Gribble, RK and Meier, PR. "Effect of epidural analgesia on the primary
cesarean rate". Obstet Gynecol 1991;78(2):231-234.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia:
risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Abboud, TK et al. "Continuous infusion epidural analgesia in
parturients receiving bupivacaine, chloroprocaine, or lidocaine - maternal,
fetal, and neonatal effects". Anesth Analg 1984;63:421-428.
Stavrou C, et al. "Prolonged fetal bradycardia during epidural analgesia".
S Afr Med J 1990;77:66-68.
Smedstad, KG and Morison, DH. "A comparative study of continuous and
intermittent epidural analgesia for labour and delivery". Can J Anaesth
1988;35(3):234-241.
Saunders, NJ, et al. "Oxytocin infusion during second stage of labour
in primiparous women using epidural analgesia: a randomised double blind
placebo controlled trial". BMJ 1989;299:1423-1426.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia:
risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Kaminski, HM, Stafl, A, and Aiman, J. "The effect of epidural analgesia
on the frequency of instrumental obstetric delivery". Obstet Gynecol 1987;69(5):
770-773.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous
labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol
1993;169(4):851-858.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia:
risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous
labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol
1993;169(4):851-858.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous
labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol
1993;169(4):851-858.
Eddleston, JM et al. "Comparison of the maternal and fetal effects
associated with intermittent or continuous infusion of extradural
analgesia". Br J Anaesth 1992;69:154-158.
Crawford, JS. "Some maternal complications of epidural analgesia for
labour". Anesthesia 1985;40(12):1219-1225.
Naulty, JS. "Continuous infusions of local anesthetics and narcotics
for epidural analgesia in the management of labor". (this is a literature
review) Int. Anes. Clin. 1990;28(1):17-24.
Diro, M. and Beydoun, S. "Segmental epidural analgesia in labor: a
matched control study". J Nat Med Assoc 1985;78(1):569-573.
Chestnut, DH, et al. "The influence of continuous epidural bupivacaine
analgesia on the second stage of labor and method of delivery in
nulliparous women". Anesthesiology 1987;66:774-780.
Thorpe, JA et al. "The effect of continous epidural analgesia on
cesarean section for dystocia in nulliparous women". Am J Obstet
Gynecol 1989;161(3):670-675.
Thorpe, JA et al. "Epidural analgesia and cesarean section for dystocia:
risk factors in nulliparas". Am J Perinatol 1991;8(6):402-410.
Thorpe, JA et al. "The effect of intrapartum epidural analgesia on nulliparous
labor: a randomized, controlled, prospective trial". Am J Obstet Gynecol
1993;169(4):851-858.
Abboud, TK et al. "Continuous infusion epidural analgesia in
parturients receiving bupivacaine, chloroprocaine, or lidocaine - maternal,
fetal, and neonatal effects". Anesth Analg 1984;63:421-428.
Eddleston, JM, et al. "Comparison of the maternal and fetal effects
associated with intermittent or continuous infusion of extradural
analgesia". Br J Anaesth 1992;69:154-158.
Bogod, DG, Rosen, M, and Rees, GAD. "Extradural infusion of 0.125%
bupivacaine at 10 Ml H-1 to women during labour". Br J Anaesth
1987;59(3):325-330.
Smedstad, KG and Morison, DH. "A comparative study of continuous and
intermittent epidural analgesia for labour and delivery". Can J Anaesth
1988;35(3):234-241.
Chestnut, DH et al. "Continuous infusion epidural analgesia during labor:
A randomized, double-blind comparison of 0.0625% bupivacaine/0.0002%
fentanyl versus 0.125% bupivacaine". Anesthesiol 1988;68:754-759.
McLean, BY, Rottman, RL, and Kotelko, DM. "Failure of multiple test doses
and techniques to detect intravascular migration of an epidural catheter".
Anesth Analg 1992;74(3):454-456.
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