Article: Epidurals increase instrumental use by 40%

[BellyBelly]

More help for pain relief births
By KARA PHILLIPS
31 October 2005

PREGNANT women who opt for epidurals are much more likely to need
medical intervention during the birth, research shows.

Those who have the pain-relieving injections have a 40 per cent higher
risk of instruments such as forceps being used, the new international
survey says.

They also are more likely to have a longer second stage of labour,
require drugs to stimulate contractions, experience dangerously low
blood pressure and be unable to move for a time after birth.

The findings come from the Cochrane Review, an independent database,
based on 21 studies into the use of epidurals in labour, involving 6664
women worldwide.

The study found epidurals relieve pain better than other types of
medication but there is a 40 per cent higher risk of needing instruments
to assist birth.

There is no difference in Caesarean delivery rates, long-term backache
or effects on the baby soon after birth compared with other forms of
pain relief.

Adelaide experts say pregnant women should be made aware choosing an
epidural can put them at greater risk of such complications during labour.

Anaesthetist Kym Osborn, at the Women's and Children's Hospital,
however, says those risks are "very small".

He says 41 per cent of women giving birth at the Women's and Children's
hospital choose an epidural, compared with 39 per cent a decade ago. "It
has always been the most popular method," Dr Osborn says. "What is
important is women know their choices - attending anti-natal classes and
speaking with your GP should arm you with the knowledge to make the
choice right for you."

[BellyBelly]

Love the slip there - 'anti-natal' LOL

[Tobily]

There is no difference in Caesarean delivery rates, long-term backache
or effects on the baby soon after birth compared with other forms of
pain relief.

That's interesting - I was always under the impression that epidurals significantly increased your chances of a c/section - and if the article is saying it definitely increases the need for instruments by 40% (presumably because of inability to push effectively?) then you would think that would also reflect in an increased c/s rate especially in comparison to say gas only which doesn't affect your ability to push?? Or am I just reading it wrong

[BellyBelly]

Yeah you do normally have a cascade of interventions, I don't know what basis they worked it out on, but the Cochrane Library is usually very particular so I am not sure there. I guess there are a big number of emergency caesareans going on anyway, they couldn't compare? What I think is most likely that they are referring to is that an instrumental birth is usually the association with an epi, but with an induction I think more likely to have c/section perhaps? I will ask

[Lil_Pearl]

Yeah, epidurals do lead to c-sections, but maybe not DIRECTLY....but what difference does it make, right?

[Tobily]

Geez the more I read on here the more I realise how lucky I was to get through my daughters birth without being wheeled off to theatre....I was induced, had an epi, an 18 hr labour and vac extraction! EEk. The statistics I've seen since then frighten the bejeezus out of me.

Kelly I'd be interested to know what you find out about the c-section stats - I'm in the process of working out my birth plan so it would be handy to know.

[BellyBelly]

An epidural reduces blood pressure, but what they don't tell you is that means less oxygenated blood circulating around at a normal rate. In the contractions that is also less, as the contracting restricts the blood. So if I was a bub, my heartrate would go down and my stresslevels up too There are medications out there for BP, I hate the way doctors use epidurals as a way to control BP... I guess to them its like killing two birds with one stone. Mum relaxed and quiet and managable...

[BellyBelly]

Gosh, did they tell you why they thought it happened?

[christy]

Fletch I have had major problems with my adrenal glands throughout my life, some of the stuff they use for testing the adrenals are out of your system within 24 hours... in animals there are 3 different tests we use to check on the adrenal function so maybe one of them is worse and lasts longer (I'll look it up.... next time I'm at work that is LOL). My BP dropped significantly due to the epidural, but I already have low BP. I have an underactive adrenal gland "sometimes", sometimes it works fine and other times it is a bit slow...

[BellyBelly]

Do you think if you stayed home longer it could have helped? 3cms is classed as early labour (until 4cms) and after this time it is active labour. Early labour can take this long and even longer, which is why I encourage mums to stay home as long as they can to rest, they are more relaxed and are not restricted in terms of where they can go and what they can do - which helps labour progress quicker and they avoid unnecassary intervention from being on the clock. Many women get excited to be having contractions and go in far too early, their labour is still establishing or early but the hospital wont want to wait that long for you to get going. But it is common for dilation to slow or stop once you get in from the anxiety, change of environment and 'white coat syndrome' When a cat has it's kittens for example, it likes to find a dark, quiet place, it knows this is what is conducive to labour. But humans are different and we do things that slow and stop our labours.

[DoulaRelle]

I would totally agree with this article, although it was my request to have the epi, I now wish I hadn't! In the end I had a forceps delivery after my BP was dangerously high and my labour had slowed right down, which meant I had to have the drip up. The Baby was fine, but I was starting to struggle and was getting nowhere after pushing for 2 hours.

[BellyBelly]

The epidural can do that unfortunately - which is why I get soooo confused when some women tell other women to have one as if it's a magic trick!!!

[DoulaRelle]

Yeah I totally agree Kelly, when I gave birth the second time my biggest goal other than a healthy baby was NO epidural. There was no way I was having a forcep delivery again! The recovery after forceps is just horrendous! I never tell people they shouldn't have one, but I do say they don't always work! I finally got all of this out in my de-brief this week. It has been a long time coming, and my main issue was the epi.

[BellyBelly]

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