The Truth About Epidurals

Mary - posted on 01/19/2012 ( 69 moms have responded )

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I came across this article the other day, and found it rather fascinating:



http://www.slate.com/articles/health_and...



I know that this is a topic that has been debated ad nauseum over the years, but this article had a slant that I found to be rather interesting. It is not an actual study, but rather one mother's conclusions based on all of the research she did into this topic.



"To find answers, I dug into the dozens of studies that doctors have published on epidurals. What I discovered is that there aren’t many clear answers—epidural research has been fraught with methodological problems—but in sum, the concerns voiced by natural birthers are exaggerated."



I didn't find this opinion piece to be overwhelmingly pro-epidural or anti-"natural" childbirth. As an L&D nurse, what really struck a chord with me was her (personal) conclusion that much of what the die-hard non-interventionists state are negative impacts on mother, baby, or the labor process are rather out-dated. Epidurals have really only been widely used for pain relief in labor since the 80's. However, they have changed (and improved) greatly over the years. Many of the "issues" caused by the average labor epidural back in 1995 are, for the most part, not a widespread issue in the epidural of today. I can tell you that from my own personal observations, this is very true. I started in L&D in 1997, and the epidurals given today are vastly different from those administered back when I first started. As the author points out, the amount of both anesthetic and narcotic are significantly decreased from what they once were.



Yet whenever I hear or read any anti-epidural spiels, it seems as if they are still arguing about side-effects and issues of the earlier generation epidurals, without ever acknowledging that many of these things have changed over the years. Concerns that were very true and valid 15 years ago aren't so much anymore, and yet they still pop up in the current debates on this topic.



Thoughts?

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Mary - posted on 01/19/2012

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Perhaps it's comprehension that is the problem, then.



I honestly just don't where to begin in response to you. So many of your statements are erroneous that I would be here all day.



Yes, there really is such a thing as a "small" pelvis. Every single one of us is unique, as is our bone structure. We are not all the same size, and some pelvises are smaller than others (or even oddly shaped), in the same way that some feet, hands, or whatever are smaller than others. With regards to childbirth, what matters is not so much the size alone, but rather the size of the pelvis in proportion to the size of the fetal head. Shape of the pelvis, as well as presentation of the head are huge factors in how hard your body has to work to push a baby out. Sadly, not everyone is physically capable of doing so - epidural or not.



Your completely misunderstood and missed what she was saying about this issue.



As for BP ranges. Just an FYI - 90/60 is actually fairly normal in young, healthy pregnant woman. You actually still have a bit of room to play with there before you or the baby becomes symptomatic. An epidural may transiently lower you pressure, but often it does not. The average anesthesiologist is going to dose more slowly and with less drug to accommodate for this (one of those then vs. now changes that was sort of the point of this article).



As for your statement, " I had a large baby and I didn't need an epidural I pushed it out in 20 min. and what I'm saying is true." ....okay, so what does that prove? I had an epidural with my first and pushed exactly 3 times and she was out. Yay for both of us! Neither of our own anecdotal stories means a damned thing, other than to us individually.



However, this little statement of yours was by far my favorite:



"If women were allowed to move around during labor it would be much less painful and everyone could do it naturally, seriously".



I know you didn't intend for it to be funny, but it did make me laugh. I sooooo wish that it were true. I really, really wish that movement and position changes were a magical potion that could lessen everyone's pain in labor, and aid in getting the baby out. You just don't realize how lucky you were. For the sake of brevity, I'll leave it at this - some women's body's really do have to work harder to push a baby out than others. It is NOT always a question maternal size or even fetal size. It is not even necessarily about one's individual pain tolerance or coping skills. Some of us just require more force than others to push a baby out - and it really is more painful for some of us. And some of us really cannot push that baby out - and not from lack of effort or time. Sometimes, they really just don't fit - or the damage caused by "fitting" is irreparable.



Assuming that just because you did it with ease means that everyone else can only displays a great ignorance of the subject.

Mary - posted on 01/20/2012

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"Also Mary when woman in labor is admited do you actually ask her if you can hook up and IV with fluids and ask her if she is planning on epidural or do you automatically do it? Because to me this is unnecesarry intervention."



Do I ask? Abso-fucking-lutely! To be more specific, I don't even suggest an epidural. When a woman arrives in labor, my exact words are, "What are you plans for pain management in labor?". I word it that way because I do not assume that she wants an epidural, or any other pharmaceutical intervention. I want her to tell me what she wants freely, and without any bias from professional suggestion.



Everything I do I explain prior to doing so. IV's are not automatic, nor required in a healthy young women without risk factors or complications. For years, the hospital I worked at has encouraged women to drink clear liquids throughout labor. We do like to have saline locks in place in the event of an emergency - but they do not need to be hooked up to fluids unless there is indication to do so. If someone refuses IV access - so be it. That doesn't bother me in the least (as long as there are no problems to suggest it is needed). It is your right to do so, and I support your right to bodily integrity. I will explain to you why we do it, or why your particular situation might warrant it. As long as I know that you are fully informed and understand any risks involved (and I feel that there is no potential detrimental effect on your baby - who is my patient as well) - refuse away.



I really am sorry that you have such a negative perception of your birth. However, your assumption that your individual perception of that experience is automatically representative of all hospital births is erroneous. It's as wrong as assuming that just because you got food poisoning from eating a ham sandwich that ALL ham is bad.

Jodi - posted on 01/19/2012

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You agreed to an IV because you didn't want to be rude to the nurse? I'd hardly blame THAT on the medical profession.

Hope - posted on 01/19/2012

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Is not the most important thing that both mother a baby are safe and well at the end of the birthing process.

I have given birth 3 times and each one has been a very different experience. I am grateful for the medical advancements. Let women have the choice and not feel guilty about it.

Amie - posted on 01/19/2012

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Ok here's something I've always wondered. Since it's been brought up medicated births are so bad.



Is there any research to compare how many mothers and babies died because of lack of medical intervention years ago as compared to now --- when our C-secs and interventions are an every day occurence. Does anyone know?



As for epidurals. I did not want one, I never got one. It was that simple - for me. I gave birth to all 4 of mine without anyone sticking a needle in my spine. Which the thought of totally wigs me out. I was lucky enough (yes, lucky) that I was born with a body that could do "as nature intended". I know many women can't, I also know that some women could die because of it.



My husband's cousin is still in recovery because of what happened during her labour and delivery 2 months ago. She had a completely normal pregnancy, no sign of any problems. Until she went into labour, then everything went wrong. If it wasn't for medical interventions, if it wasn't for epidurals and c-secs we would have lost her and the baby. Is her case extreme? Very much so.

I also have friends whose cases are not as extreme but still needed interventions, to ensure their lives, as well as their babies, made it to the other side safely.



I sit firmly in the camp of as natural as you can get it. However, that is for me and me only. I used to be more extreme but as time goes on I'm starting to mellow. I know there are risks associated with epidurals and medicated births. However, there are risks with giving birth period. The only difference is many women have forgotten that.

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MeMe - Raises Her Hand (-_-) (Mommy Of A Toddler And Teen) - posted on 03/04/2012

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After 25 hours the first go and 36 hours the second go, I was taking drugs! My water breaks as soon as I go into labour and the pain is immediate for me. I also had a c-section both times. The first time was an emergency section, I got the epidural at 6 hours, I couldn't do it anymore and I was put to sleep for the section. I was 22 and I was all by myself! The second time, I tried to do a VBAC but after 36 hours it wasn't gonna happen (dilated 3cm's, same as the first time) and the concern of infection to my boy was high. I didn't get the epidural until I went into surgery. I was in hard labour both times I got one. I had no side affects from having an epidural either time. I did have an saline IV both times, so I wouldn't get dehydrated. The worst part was having the catheter for urine. I requested that to be gone within 24 hours. I had to get up and prove I could walk to the washroom first. Hey, if it means getting rid of that thing, no problem! LOL



Next time I will be scheduling a c-section and will have my baby in my arms within 2 hours, forget this 25-36hour noise! LOL



I was not made to deliver babies, I have decided. I was, however, made to carry them. I have AWESOME pregnancies. Never sick. Only problem was the severe GERD. That was scary. I stopped breathing several times while asleep, only to wake up in a huge panic, trying to catch my breath. Nothing that some good ol' prescribed Zantac couldn't fix though, once we knew what the problem was.... ;)



ETA: I denied potocin for my second labour. I had researched a lot and knew it increased the chance of my old scare on my uterus coming open, if my contractions were made to be too strong. Thus putting my and my babies life at risk. I wasn't asked if I wanted poticin the first time....



I feel sooo ripped off though. I really wanted to experience a vaginal birth... :(

Merry - posted on 03/04/2012

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Ok a few things to add, I didn't have an IV at all, I had a line in my hand but it was just used to put antibiotics in due to group b strep. No IV. No perminent cathetor either, they pushed on my bladder and determined when to empty it and justa quick drain I think three times.

Small pelvises exist, babies used to die from it!

And I couldn't feel my contractions one tiny bit. I couldn't move my legs a twinge for 2 hours. And I couldn't walk for 5 hours. Even then I felt wobbly.

Rosie, the only reason I don't like other women having epidurals is the attitude of labor is Hell and no one can or should do it without drugs. It's the mentality tht women are weak and need drs to save us in childbirth. It's the scaring young women into not trusting our bodies to birth our babies. I remember my ultrasound tech literallylaughing at me when I said I was nothing to get an epidural. Her exact words were "hahahahaha ok then haha good luck with that!" it was so condescending. I was 20yrs old, first time mom, and while I mostly felt mad and determined to prove her wrong I also had a fear set in that maybe I couldn't do it.

Oh and my blood pressure is always around 90/58 ish and I've been told many many times it's a wonderful number and just right for me. Not too low.

Merry - posted on 03/04/2012

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I had an epidural and had no perminent damage, I had a weird twinge for a few months in the injection site but other then that I was great!

I do think the epidural aggregated my sons bad heart rate and fetal distress as I was stationary and had to push on my back, but this isn't the epidurals fault,it was mine for not knowing better.

Overall my epidural experience was great and no big complaints, I will still avoid them like the plague but not out of fear, out of determination to birth my way.

Oh and yes, the epidural likely saved me from having a c section.

I was 6 cm at 430am upon admittance, 8cm by noon when they popped my water bag, 6cm right after popping the waters, and 8cm again when I was writhing in agony at 8pm and asked for the epidural. I got a few hours sleep after he epi and by 230am I was at 10cm and by 430am I had my baby.

Now I feel the epidural could have been avoided with a midwife or doula to direct me or if I had known more about labor myself but all things considered it went ok.

As long as epidurals aren't responsible for giving babies low blood sugar..........?

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Having an epi inserted an hour and a half before my beauty arrived saved me from having a c-section.It relaxed me and my doc/nurse told me thats what happened.Thank gosh i gave in as i had a c-section second time around(emergency one to save her life).

So thankful to have been able to experience a natural(vaginal)birth.



However my back was in bits for mths and it was a low dose, i took it to not feel the pain..i was told it was so close to the birth it did not take the full effect.She was worth it all i have to say.

I believe its every moms choice and always make sure to read up on it before the birth, if you want it..get it.

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i can't stand the thought of surgery, and anything that would make it easier for a doctor to force me into it. that's another reason i refused the epidural, lol. it'd have been one step closer to that c-section and i wasn't about to let the doctor bully me into anything (cuz she was that type of doctor but i'm hard-headed, lol)

MeMe - Raises Her Hand (-_-) (Mommy Of A Toddler And Teen) - posted on 03/03/2012

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I had two epidurals and live by it, never a problem. I would and could never ever not use one. My first pregnancy was 25 hours of labour and my 2nd was 36 hours of labour. I am sorry but, if there were no drugs for that long of a haul, I would have passed out! I was still in terrible pain even with the epidural. Needless to say, they both ended in c-sections... :(

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i had a few main reasons for refusing an epidural, and they weren't so much due to concern for the baby as for myself, haha. i'm deathly afraid of large needles and hate sharp, sudden pain. the fact that said sharp sudden pain would be coming from a large needle just sends shivers down my highly reluctant spine. i also have absolutely no trust in nurses with needles of any kind, due to some really bad experiences. and judging from how they blew a vein just trying to get the IV for the pitocin in, i was NOT about to let them jab something into my spinal chord. granted it would have been a "professional" doing it but she was pissed at me because i chickened out and i have no idea how painful she could have made it for me. i also don't want to become paralyzed, as unlikely as it may be.



so i just completely chickened out with my first and will do so with my second and do NOT want anything to do with an epidural. besides, my labor was a breeze and i didn't feel anything anyway.



plus i had to refuse the epidural anyway because my parents kept saying i wouldn't be able to handle giving birth because i wasn't "as strong as" my great grandma, and she "HAD to have hip blocks." proved that shit wrong! very proud of my mostly natural birth (just had the pitocin, nothing else).

Amanda - posted on 03/02/2012

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Some of you are being a little harsh towards those who feel (and rightly so) bullied by the health care professionals during their experience.



During the birth of my first daughter, I truly had a horrible nurse. Being young and not as informed as I should have been, it was a horrible experience. I naively put too much faith in my doc. When I showed up to be induced, the head nurse didn't even want to 'admit' me because i didn't look pregnant enough - WTH? Then finally after much persuasion that yes, I was to be induced due to some high risk issues, they hooked me up to the the meds started.



For a few hours i was fine, no pain, no NOTHING. Then all of a sudden I felt like I was dying. My hubby went to find the nurse who came in and made fun of me for being so wimpy. She said that I did not need anything as the labor would just get worse. Boy was I mad - long story short, my hubby found another nurse who checked me and i was fully dialated. I had missed my window for pain meds and since i was blown off in a majorly rude way, my doc wasn't notified. Then my baby went into fetal distress and nurses were pushing on my belly to get the baby out, ordering blood and such. Do i hate that nurse who called me a baby? You bet I do. Do I hate all nurses? Nope. But what I learned is you know your body and your gut and should follow it. I am glad I did, things could have turned out badly.

Janice - posted on 01/22/2012

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I believe as long as a woman is making an informed decision, then it is her decision. I think the main thing I gathered from the article is that there has not been sufficient enough data to claims one way or the other.

One thing the article does not mention is the risks associated with have a needle/ catheter in your spine. I read a very scary article about a woman dying due to an infection. But I suppose that is a different issue.

Personally I got zero info from my OBGYNs and had to do my own research. In my "What to Expect" book I read about "walking epidurals" and thought "thats what I want, just enough to take the edge off" yet my dr basically said there was no such thing and that epidurals were great and to just get one.

With my daughter I didnt get to choose. She was breech and after a failed EVC I was resigned to the fact I would have a c-section. My c-sec. was easy, no complications, breastfed in recovery, no issues.

Yet, while pregnant with my son I researched VBACs, I wanted to go thru labor. My biggest fear was that if I failed to progress I would have another c-sec and that seemed like failure (pregnant women are so irrational ;)). I was already under the impression that epidurals slow down labor because my friend who was 8cm into a very fast labor was given an epidural to slow her labor (yes the doctors said this) so her truck driver hubby would make it in time. It worked her labor slowed down and hubby made it. Then I found so many articles saying epidurals increased FTP, that I decided to go as long as possible with out one.

When I arrived at the hospital and talked with the anesthesiologist , he informed me that I could get a very small amount meds in my epidural and then they could just up it if wanted. I was soooo happy to hear that. I quietly made it to 7cm when suddenly the pain was terrible and I asked for the epidural but 20 min. later when the anesthesiologist tried to put in the epidural but failed because my contractions were too close together, I was given just a quick shot of meds and then they checked me an I was 10cm. DS heart rate dropped and so they had me push 2x and then pulled him out with forceps. I wonder if I ha asked earlier if my labor wouldn't have progressed so suddenly and maybe forceps could have been avoided but then I also wonder if that 1 time epidural meds shot caused the drop in his heart rate and it was good I didn't get the epidural. IDK



Sorry for the birth story ramble! My point is why was I in the dark about epidural administration until the day I gave birth? I dont know of any woman who was aware that she could have control over how much medication she got in her epidural. I think this info should be more wide spread.

Michelle - posted on 01/22/2012

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I had one for my childs birth and wouldn't change it! I had no side effects and felt great (of course extremely tired) afterwards. My mother-in-law didn't have one (she gave birth a month after me) and she seemed pretty good considering her age and the length of the labor took a toll on her (again apart from being exhausted)

Ania - posted on 01/20/2012

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Thanks for all your words. I honestly thought that I would be stronger in declining things, but my contractions were close apart and painful and at that point I had no energy for fighting with nurse, but I'm ready this time...

Suzie - posted on 01/20/2012

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My nabor a beautiful woman has given birth five times 4 with out an epidural and the last one with the epidural and she would never not have one agin her other 4 were not bad births but she felt like a better mom because of the epidural. i have had an epidural and an entrathical as there was not time for one with my son and the lack of pain during actually got me on my feet faster true i was up walking around with in 30 minutes of having my son and never took anything after. i am a smaller woman and Ania there is such a thing as a smaller pelvis no two weoman are built the same even in bone make up of the body my cousin who is a big girl never had any accedents or injuries had such a small pelvis she had to have a c section and her babys were on 7 lbs. me a smaller woman gave birth to 2 naturley with an epidural and i was up walking and very Active.

Rosie - posted on 01/20/2012

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i don't get why people are so adamant about others not having an epidural. i get why people wouldn't want one for themselves, but who cares what someone else does? and why are they all hell bent on making another person go through excruciating agony? it makes no sense to me. are they so cruel that they would prefer someone else be in pain because they were? it's all very odd to me to have so much invested in the way i give birth (or how someone else does it), to me it's the ending that matters. :)

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Ania -- as the patient, you have the right to refuse any treatment you don't want. Why didn't you just flat out refuse the IV? I know I debated with one of the OBs re: giving me antibiotics in labor. I tested positive for Group B strep. My labor started with my amniotic sac sponteneously breaking (I hadn't had any contractions that day). Because the sac was broken, the doctors wanted to start antibiotics right away. I wanted to wait until at least a few hours (because I didn't know how quickly the labor would progress and if it was over in 5 hours there was no need for antibiotics). I also refused most cervical checks to prevent the introduction of strep bacteria up to my cervix. The doctor discussed it with me, said it was recommended, said I was going against medical advice, but ultimately supported my decision. IMHO I don't think it's really fair to blame a doctor or nurse because you agreed to accept an intervention. They offer, you can accept or decline.

Sherri - posted on 01/20/2012

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@Ania more and more hospitals are all for giving the mother the birth they want. Even 14yrs ago when I had my first I was asked and encouraged to walk around, have a water birth in my own private suite or any other kind of birth I wanted.



I have now delivered all 3 of my kids at this hospital not once did they push any meds what so ever. I have never had an IV (except for #3 because I was induced) or epidural. I will also be delivering #4 there in a few weeks.



However, I find that it is how your OB is that runs the show. He makes ever decision and I have had nothing but positive experiences.

Lady Heather - posted on 01/20/2012

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Yes, you make a scene and yell if someone comes at you with an IV you don't want or need because you aren't having an epidural. You ask to see her superior if she won't listen to you.



Had myself a couple of hospital births and I did have an IV both times. The first time it was because we had a c-section planned and we all assumed she wasn't coming out on her own (breech baby with a bicornuate uterus). But if I had been normal, an IV is not standard issue, especially given that I had a midwife. Second time was a planned c-section so duh. So there's me contributing to those "unnecessary" c-section rates, right? You try sitting there knowing your baby probably can't turn but maybe she will...there's a teeny chance she will, but probably not and you have fast labours so if she doesn't turn things could get really ugly really quick and your husband is out of town a lot and they probably won't have time to get a spinal in you if things go fast and she's breech so you'll probably get general anesthetic and miss the whole thing and your last baby almost fucking died during a brief three hour labour because your contractions are so on top of each other that she doesn't get any oxygen and blah blah blah. This is what was running through my head all the time. It was like panic. My midwife was supportive of my decision to just get the baby out.



So me personally, I don't choose epidurals. I really didn't like that feeling in the c-section. If I was normal and healthy I would never have them. I really didn't find labour that painful anyways. But dude, a lot of us have problems that complicate things. Saying this is rare or that is rare - there are a lot of things that are rare but a lot of rare things add up to not so rare anymore.

Ania - posted on 01/20/2012

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Mary, good to know you and your hospital are progressive that is amazing. You know what is the worst though, that when I went to tour my hospital My questions were answered the way I wanted them to be answered. Nothing was necesarry, no procedures were mandatory and you could deliver however you wanted. My dr was also extremely nice and accomodating. we went over my birth plan and she was fine with everything. That's why I was extremely surprised when i got there and nobody listened...My first labor lasted only 6 hours 3 of those in the hospital. I had it easy all I wanted really was to push in the more upright position, maybe if you , or someone like you took care of me I would not have to have this perception and assumptions. You are right I should not have made comments that assume that every hospital and Land D are the same, but it is so hard not too...

Katherine - posted on 01/20/2012

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@Ania - No I did not have an MRI - I will never have an MRI if I can avoid it!!!



I made my doctor aware of my birth, (my mom was in hard labour for over 36 hours - and I also died due to lack of oxygen - so the fact that I am alive is a mircle, however I WOULD never put myself or my baby into a situation like that) My doctor was aware and said we would watch it come labour time....the on call doctor at the hospital was also made aware.



I was induced at 6:30am.....hooked up to pitocen at 1pm, babies heart rate dropped below 100, sometimes below 90 for several minutes at a time while I was hooked up to pitocen (before epidural), I only dialated to 3-4....stayed there for 6+ hours until babies heart rate drops deemed it was an emergency section.



Do I disagree with how things went? No,

Am I glad I had the medical interventions that were offered? Yes



Do I think I have a small pelvis? yes, or else I would have been able to deliver my baby



Will my next baby be a section? - FOR SURE

Jodi - posted on 01/20/2012

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I would have, yes.



They don't give you an IV here unless there is a specific reason for it. I've also never been asked if I want an epidural. I think perhaps you have had one bad experience and decided to tar everyone with the same brush.

Ania - posted on 01/20/2012

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Jodi...she had job to do and I told her 100 times that I don't want to and this did not convince her, what was I suppose to do make a scene and yell? I was crazy enough because I didn't want an epidural

Ania - posted on 01/20/2012

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IV with fluids for dehydration, you need this idea in order to get epidural.

Shelley - posted on 01/20/2012

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Due to an emergency c-section after 36hrs labor i was given an epidural my side effect is that 4 1/2 yrs later i still have this numb patch about 5cm side to side and up and down from the point it was put in. Its a little weird but it doesn't really bother me.

Had i not had the c section when i did my little girl would be dead. Her little heart beat had stopped completely when they rushed me in for the c-section as the umbilical chord had turned to jelly and detached from her. I am so pleased that there was an option for both pain relief and the c-section as i know i would not have taken my baby girl home with me 2 days later.

I think we should all count ourselves fortunate that we have choices

Tam - posted on 01/19/2012

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I am absolutely fine with epidurals. In fact, I wanted one my first go-round, but genetics didn't let me have the chance. Like my mother before me, I have 'childbearing hips' and a ridiculously fast dilation. To the tune of going from 3 CM to 9.5 CM in the span of thirty minutes. By the time the doc checked me out to see if I was dilated enough for medication, I was already too far progressed. My first childbirth was over in eight hours of active labor, and it was the most intensely painful experience of my life.



Fast forward two years to my daughter's birth. I walked into the hospital at 4 CM and immediately raised hell about 'going fast' and how I needed that anesthesiologist ASAP. I managed to convince them to give me the meds right then, and I bet they were rolling their eyes as they walked out afterward. However, about two hours later of blissfully pain-free contractions, a nurse stuck her head in to check on me. She didn't even intend on checking my cervix until I asked her if I should be feeling a weird pressure 'down there'. She reached down under the blanket and I can still remember the look of shock and panic on her face as she told me the baby was crowning and streaked off to find the doctor.



The epidural sure as hell didn't slow my labor, nor did it drop my blood pressure. My kids were born squalling and healthy.



And I'm one of the people who has a very 'easy' natural birth. As far as I am concerned, the whole experience is terrifying, life-threatening, and utterly exhausting. Any measures I can take to minimize the pain helps with the whole ordeal.



Perhaps I'll be attacked for this viewpoint, but I look at it like any other instance of intense pain - I wouldn't want to get a root canal without anesthesia. When I get dental work done, it's no less valid with or without the medication. I feel the same for epidurals. Regardless of the 'naturalness' of the birth, the end result is generally the same. Being unable to feel the pain with the remarkably small risks is a big, big plus to me.

Ania - posted on 01/19/2012

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Krista, everyone is biased, because everyone was raised differently, obtained different intervention and has different beliefs.

Rebecca, believe me even though I would never want to use epidural if I was in your situation I would probably beg for it too. I'm not saying that no matter what you should not get it, but in my case I really didn't need it and even though I had natural birth and low risk pregnancy I felt like when I got to the hospital everyone wanted to just categorize me and do the same interventions that they do to everyone no matter what. I did not want to be rude to nurse and I was in pain so I agreed to an IV, even though I told her that I'm not planning on getting an epidural. Also I had a back labor, contractions of my uterus were not visible so she assumed without examination or anything that even though I'm in a lot of pain( I told her that on the scale from 1-10 I'm 9) I'm probably 5-6cm dialeted and will need epidural anyway. When I finally sent my husband to get the dr who will check me it turned out I was fully dialated and could push. What my dr promised me was that I will be able to push in a position that I will choose. Guess what I wasn't. They put me flat on my back and I could not breathe at all...even though I pushed only for 20 minutes I almost passed out at the end from the lack of oxygen and baby's HR started dropping too... I didn't sleep on my back the entire last trimester because I could not breathe and they put me flat to push and yelled that I'm not doing it right. Even though it doesn't seem horrible to someone it was pretty traumatizing to me and I still can't get over this treatment. I delivered in New York, in a great Manhattan hospital that is why I was surprised by this backward treatment. After this I decided I'm going to the birthing center where I can choose how to birth and if something happens and I need an intervention the hospital ward is a floor above, but If everything is fine like with the first delivery then I will not go through traumatizing experience again for no reason. I want to have peacful (to me) birthing experience.

Krista - posted on 01/19/2012

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Krista I do not attack Mary's professional integrity, but I noticed that you are attacking me.



No, I am not attacking you. I am not calling you names or saying anything at all about you. You, on the other hand, flat-out told Mary that she was biased -- thereby calling into question the way that she treated and advised the patients with whom she dealt, and thereby questioning her integrity. I am simply asking you to provide proof of your accusation. If you can't, then is it that you just automatically think that ALL medical professionals are biased towards interventions during labour and delivery? Because if that is the case, then would YOU not have a bit of a bias?

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I can say for my experience, my hospital and doctor were extremely anti-intervention. I did not get an IV until I had my epidural. The doctors and midwives worked with me to have a natural birth, even though I was a VBAC with twins. Not every OB is a crazy drug pusher with a knife, Ania.

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Hope, do you have any studies that compare the reasons for morality rates with childbirth? I'm just wondering how much of the change is due to improvements in handwashing (childbirth fever) vs. other improvements.

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Ania, I used to feel the same way you did. Until I had a really, really hard labor. Brutally hard. After 18 hours of contractions every 3 minutes (each contraction lasting 1 1/2 minutes) and 18 hours of vomiting, the pain became intolerable. My epidural was a godsend and a much needed break from the pain. I'm sorry -- no one should have to continue to endure that level of pain if they don't want to. I moved during labor. I used the birthing ball. I rocked. I took a bath. Nothing helped. Not everyone experiences pain in the same way or experiences the same level of pain in labor. Not to mention that if I would have continued to try to do it "naturally" my son would have likely died (since the reason why it was so painful was because he and his twin (16 pounds total worth of baby) flipped at least 3 times during labor and, as a result, his cord was the first thing coming out at the time I was rolled in for an emergency c-section).



I do think epidurals have risks (my back has never been the same & it did slow my labor), but honestly, I'm SO grateful it was available.

Ania - posted on 01/19/2012

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Mary, the article says that epidural slows down labor doesn't it? It also lowers blood pressure doesn't it? that is enough for me to be against it FOR ME. If it is not that scary for most of women than good for them. My interpretetion of research is different that this woman's my conclusion is that epidural is not as safe as birth without it.

Also Mary when woman in labor is admited do you actually ask her if you can hook up and IV with fluids and ask her if she is planning on epidural or do you automatically do it? Because to me this is unnecesarry intervention.

Krista I do not attack Mary's professional integrity, but I noticed that you are attacking me. And what do you mean exactly by saying that I don't have a proof? What proof that I did research?

Hypotension (low blood pressure). 16 studies: 0 – 50%. (Mayberry) Meta-analysis: RR: 74.2 (Leighton*)



o Risks: Can cause decreased oxygen flow to fetus, decreased fetal heart rate.



o Benefits: This side effect is generally considered a risk of epidural, but it may be a benefit in certain cases of maternal hypertension.



· Fever > 38°C or 100.4 °F.



o 4 RCT’s, 6 observational: Without epidural, 0 – 5%. With: 4 – 24%. RR: 1.5 to 70.8 (Table VIII in Lieberman) Meta-analysis: RR 5.6 (Leighton*)



o The rate of fever increased with longer labors, from 5% with labor < 3 h to 28% with labor > 6 h. (Gonen) Typical increase of .07 degrees C per hour of epidural. (Vinson)



o Lieberman et al and Gonen et al found that more than 95% of fever in their term populations occurred in women who had received epidural. Epidural-related fever is generally believed to result from thermoregulatory alterations rather than infection. (Lieberman)



o Secondary effects / risks of fever (from Lieberman):



§ Increased risk of instrumental / c-s: One study showed women with temps > 99.5°F were 3 times as likely to have a c-section (25% vs. 7%) and 3 times more likely to have instrumental delivery (25% vs. 9%)



§ Mom assumed to have infection, treated with antibiotics: 3 times more likely with epidural (20% vs. 6%)



§ Neonatal outcomes: Infants of women with fever were 3 times more likely to have 1 minute Apgars

Krista - posted on 01/19/2012

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Ania, do you have any actual proof upon which you're basing your attack upon Mary's integrity as a medical professional? Because if you do NOT (and we all know you do not), then I would suggest that you consider retracting your words...

Stifler's - posted on 01/19/2012

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My opinion is that pain relief made for childbirth is the best invention ever. I wish I'd not been so scungy and had an epidural in Rocky instead of suffering through birth with no drugs.

Rosie - posted on 01/19/2012

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lol, mary's evil biased plot to make doctors and nurses look good! mwauhahahahhahaha!! i'm tired of people acting like doctors and nurses aren't actual people, and sit around looking for ways to kill us. to make blanket statements like that shows quite a bit of ignorance, and frankly pisses me off that you would attack someone you don't know based upon that ignorance.

Mrs. - posted on 01/19/2012

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I count myself very lucky things have changed epidural wise. I have a lot of scar tissue from catheters in my urethra due to chronic health issues and my docs heavily discouraged natural birth for me (for other scar tissue and pain issues). The main thing that scared me about the epidural was the catheter and the infection/pain after it. However, I worked with all the docs and got them to "wait it out" as far as the cath was concerned, and even then it was to be a quick cath. I did not end up having to have one and it saved me that infection risk. Plus, mine was what they call a walking epidural.



I think it really depends on your docs, hospital and trusting your own experience with your own body (and then communicating that to your nurses and docs) as far as how the epi goes.



Now, I've had a botched spinal tap and know the pain/recovery time that took. However, the care and detail that goes into an epidural was so different from my emergency spinal done by a resident in training....it really can't compare.

Hope - posted on 01/19/2012

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I would like to add on the other end of the scale Afghanistan's maternal death rate is 1575.1 per 100, 000 live births which is the same as the 1800's death rate.

Hope - posted on 01/19/2012

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@Amie in the 1800's the maternal death rate was about 1per 100 live births, in 2008 here in Australia the rate was 5.1 per 100,000 live births and in the USA 16.7 per 100,000. So there has been a dramatic drop in maternal death rate over the past 100+ years.

Mary - posted on 01/19/2012

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Actually, Ania, you might be surprised to learn that I'm not especially pro-intervention. In fact, if you talked to the vast majority of L&D nurses, you would find the bulk of us to be very much against most of them unless they are medically indicated.



What I very much am is against exaggeration and fear-mongering from either side. In fact, I don't believe there even should be "sides" in this. Much like the author of this article, I am in favor of women making " informed decisions based on their goals and priorities." - tempered with an eye what I believe should be the ultimate goal: a healthy mom and baby.



The entire gist of this article was not to be pro-hospital, epidural, or intervention. It was the author's conclusion, that after she did extensive research before deciding on an epidural, that much of the arguments against it are based on exaggeration, out-dated information and misinformation. I happen to whole-heartedly agree with her.



Quite frankly, all of your posts seem to prove that point rather nicely.

Sherri - posted on 01/19/2012

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@Ania a real reason C-Sections are so high is because they don't deliver multiples or breech babies virtually any other way then C-Sections. Also if you have had one C-Section the likely hood is they will require or recommend another for any other subsequent births. These make up a great percentage of C-Sections, not epidurals.

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God, I'm glad to have read that article. I sooo didn't want to opt for an epidural, but induction is a nasty thing and made me change my mind fairly swiftly. I would still try to go without second time around, but knowing that side-effects are not quite as terrifying as I thought is comforting.



Oh, and Ania - my room had the coolest birthing chair ever, we had brought my gym ball along and I was allowed to move around as much as I wanted, it made no difference. And to assume that I simply hadn't mentally prepared myself properly is actually quite insulting.

Ania - posted on 01/19/2012

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Well obviously Mary's point of view is going to be biased towards medicated birth. Almost half of the cases in the hospitals are special, but surprisingly the same. Failure to progress, small pelvis and induction before full term due to a large baby. Do you really believe that 30% of birthing women in this country is in need of c-section?

You can actually educate yourself if you want. Independent research papers (not biased websites or books that also are trying to get their point of view across) says more than with all the respect for Mary and her profession, who works at the same hospital with the same doctors that are used to their routine and need to protect themselves.

Sylvia - posted on 01/19/2012

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That makes sense to me. I personally had a fairly bad experience with epidural anaesthesia (it stopped my already dysfunctional labour cold so that I ended up needing pitocin; I was told I'd be able to feel everything, but in fact I couldn't feel anything), but I acknowledge that some of that was my fault: I could have asked for the epidural to be turned off once I was through transition, but I was too exhausted after 30+ hours of labour to think of asking; I knew we should probably hire a doula, but I put off doing anything about; I could have gone to a midwife for prenatal care, but I let the IVF clinic sign me up with an OB ...



Anyway, although my own experience was not too good, it also wasn't horrible -- I didn't end up having an emergency c-section, baby was fine, I only had a little bit of tearing, etc. Ironically, the epidural *didn't* lower my blood pressure, which was quite high :P And many, many women have epidurals every day, and in most cases everything turns out fine. If there's an L&D issue to be freaked out about, I'd say it's the very high c-section rates we seem to have these days.



That said, if I every have the good fortune to have another baby, I'll be signing up for midwifery care and trying again to go drug-free. But if going drug-free is not working out, I won't feel at all guilty about asking for an epidural.

Ania - posted on 01/19/2012

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Cathy, yes it is my personal experience, extensive research and different stories with epidural and without from women that I know. I believe in exploring and researching and asking questions before we put our bodies in hands of doctors who seem to choose whatever is going to be faster and more convienient for them. Most of the time epidurals are not dangerous, but sometimes they are. It depends what everyone feels is good for them. If you are open to anything and you are perfectly fine with all the unnecesarry interventions during childbirth than it is ok. I am not judging anyone, I'm asking questions and have my point of view on epidural and everything that goes into hospital birth. I state my opinions based on research.

Ania - posted on 01/19/2012

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Good for you Katherine! As long as you are happy with your experience than nobody should comment on that. I am just wondering Did you dr do an MRI to determine your small pelvis? Thats actually the only way before going into labor and it is not 100 percent accurate. How long were you in labor when they decided you are not progressing fast enough due to your "small pelvis" ? By the way if your mom was able to deliver you naturally her pelvis was not too small right? It took her longer that's it. It does not mean that 6lbs baby will just jump out of you.

Katherine - posted on 01/19/2012

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I'm glad I have had not issue with my epidural decision.



I went into the hospital refusing one.....only to be told that I would most likely need a c-section due to so many factors. The one main one being *gasp* a small pelvis and a large baby!!!! (my mom had alot of trouble delivering me NATURAL - no meds at all - I was only 5lbs 8oz.....she was 5'9") My baby was 8lbs12oz......



No issues from the cathetor either......except demanding it be removed as I wanted to pee as soon as I was able to actually move!!



The only "issue" I had is the must have given me to much meds as I was numb....from the neck down.



Once into the operating room "gasp" (small pelivs, big baby, not decending, not dialating more then 3-4cm) they gave me more meds.....it was painfree, (I wanted to feel my child being birth NATURALLY) but I still got my biggest reward!

Ania - posted on 01/19/2012

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90/60 is actually a low blood pressure.120/70 is what is considered normal. Every dr I saw told me that. That is for one. Small pelvises....well I read research on it. It is very rare...There are ligaments and muslces that stretch, pelvis is not an entirely bony structure. I'm happy that my statement about walking and being active in your labor amused you. You should try it next time and see. And large baby or small it doesn't mean anything. Some women's bodies are not able to birth babies only in certain medical situations and those situations are very rare Mary in natural setting and that is the fact

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No such thing as a small pelvis? Really. My best friend had a 5lb 15oz boy and if he had been any bigger.... she would've needed a c-section cuz he wouldn't have come out. He almost didn't come out in the first place..... Nothing happened to cause her to have a small pelvis and she's otherwise an averaged sized 5'4ish" woman. I know another woman who's barely 5' and gave birth naturally w/ no issues to a 9 pounder, but just because you don't believe there are small pelvises doesn't mean it's a fact.

Ania - posted on 01/19/2012

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One statement is enough for me as a con for Epidural Overall it slows down labor and that is a perfect and single excuse for dr to do c-section. It is called - failure to progress. As for the pain...It depends on how ready you are and how you perceive this pain. it is all about mental preparation.

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