In light of all the epidural talk lately....

[stellarella]

I wanted to clarify the true risks associated with epidurals.

I am not anti-epidural (well I am for myself, but not for everyone else :p) and I do support a womans right to choose.

I do however get very upset and concerned when women are led to believe that epidurals are risk free and safe. Honestly I am quite stunned that what has become such common knowledge amongst health care professionals and birthing mothers alike is now being dismissed.

I do not intend to cause offense with this thread. I do not expect anyone to justify their reasons for choosing one. The reasons are many and varied and they are all valid. All I want to do is share accurate information and prompt women to look further into these risks so that we can all say that we made truly informed decisions.

Here are some of the risks that you will never hear about in a parenting or birth book or any parenting or birth website, and certainly not from any medical profession. I even looked on an Australian Government website and the risks of epidurals were totally glossed over.

As you will see all the statistics/statements on this link have references to research papers/studies which can be looked up if you want further verification.

The author admits that the bias of this article is against epidurals, but that's nothing new seeing as any other article expounding the benefits of epidurals are bias in favour of them.

http://www.healing-arts.org/mehl-madrona/mmepidural.htm

It is not my intention to alarm anyone, only to prompt women to find out the true risks of any choice we make. As I have said before I have also chosen to have an epidural so I am fully aware of the reasons why women choose them :)

Please if you have any other articles to add to this thread then feel free to post them. I will too.

[neostudded]

Thanks, I have saved it and I will look at it when I can cope mentally. (I had one, still feel quite upset about my birth).

[justmum]

Thanks for posting that - it is very informative from the brief read I have had of the article. I hope to get a chance to sit down and have a proper read tomorrow.

[Verdi]

Thanks for the info! _ I actually already knew of all the possible risks from what the article stated.
i actually studied this at nursing school, IMO if i had to take peth or epi i would take epi, but obviously no drugs would be better.

As is said beforei think pain toleration is individual and like you i did epi's for 3 of my births and had a great experience but i knew of the risks.
The key is for women to know of possible risks eventhough they are very slight, then weigh up your pros and cons, personally i would never do peth again i used that for my first child but i believe that it is more potent and a greater level is transfered thru the placenta and it resulted in a sleepy baby eventhough he was born 10 minutes after it being administered
i can't be bothered finding the links but Pethidine is a lot more potent for baby than epi.
I wish i never ever used peth

[neostudded]

Can this thread be a sticky?
It would be very helpful for lots of mothers/mother to be. I know I would have loved to have read this information when I was pregnant with J.:D

I think it is also important to rule out any possible misinformation out there about epidural's.

[stellarella]

Side Effects of Epidurals: Research Data

Author’s note: All of the following data, unless otherwise cited, is collected and summarized from three recent reviews of this topic. This article is intended as a summary of available data. For more complete information, you are encouraged to seek out the original review articles, and to further trace them back to the original studies they review.

http://www.transitiontoparenthood.com/ttp/foreducators/ceinfo/Side%20Effects%202.htm

[shed]

Great post Ella. I think this is the best way for people to be informed. Just give the facts and let them decide for themselves.

I am not anti-epidural either. I am not anti anything, I think the things we have available are miraculous and fantastic. My beef is that they are over-used, that's it. I would love to see some improvement in our system but the first step is to educate our current preggy's (:hugs:) so they go in to the system confident and powerful and come out smiling.

I am anti-epidural for myself because I am scared of the big needle. No medals for me :o

Why can't they invent something decent anyway? Far out.

[QTB]

what a fantastic site!! iv read a bit of it!

iv bookmarked the site and will finish reading it when i get more of a chance.

[stellarella]

Sarah Jane Buckley
http://www.acegraphics.com.au/articles/sarah02.html

[NibbleCurlynBub]

:yes: NO form of chemical pain-relief is risk-free or safe.


We do need to be informed of the risks involved with EVERY choice we have to make.

Well posted, I have noticed people getting a little confused about their information lately, too.

[delirium]

Can I ask if these figures are the same for spinals, or are there more/less issues? With the rise in c/s (me being in that group) I would love to see info on spinals as well. :)

[TaleirasMum]

I honestly always said I would get an epidural as soon as I could but now being so close to my due date I don't think I really want one. I don't have a very large threshold with pain but I'm going to see how I go and test my limits. I have read that the baby is as well in pain coming down so I'm thinking about her as well, she can't get any pain relief and here I am with all this pain relief suggestions.

But I might not being able to handle it in the end so we'll see how it goes when the time comes I guess.

I know it may sound funny, but I sometimes think of animals that give birth to multiple babies. They can't tell us how much pain they are in and don't get any relief at all. Just people staring at them while they're giving birth!! I know that may make me sound like a freak thinking about animals but it puts a bit of light on the situation and makes me feel a little better!! At least my Mum is there holding my hand and my partner. They've got to keep their partners away so they dont eat the babies!! Lol.

[Naboo]

I thought I was going to be an earth mother and have no drugs but my birth had a few other complications and I ended up having an epi and all I can say is..... EPI'S ROCK! I have NO HESITATION having another in my next labour!

[beebs]

Oh my god - that article has totally freaked me out. I had an epi with DS. And I have to say, I have a needle phobia anyway so having a needle in my spine just made me feel disgusting. I really hated it. I felt dizzy and faint and neaseous It didn't work properly anyway. I could still feel half my stomach. So they turned it up really high but its still didn't work except it made everything dead except half my stomach. When they turned it off for the labour part I could still feel the horrid pain and my spine clicking out of place from my prosterior bub. So I had a needle in my spine for nothing:(

I'd be interested to know if that includes spinals as well.

[Sheer Bliss]

I haven't' read the articles - too scared!! The little I know about epi's tells me that I know I don't want one. BUT it would be interesting to see more recent figures to see if 'practice makes perfect' kinda thing? With lots more medically assisted births these days, more epi's/spinals are being performed, so would they be getting better at them? and some of the side-effects from inexperienced people being reduced?

Also would your place of delivery make a difference on that front - a hospy that gives lots of epi's havng more experienced staff have less of the nasty side effects fromt hem not being done properly? Just a thought......I still dont' want one though!

[MummyDaddy]

I thought I was going to be an earth mother and have no drugs but my birth had a few other complications and I ended up having an epi and all I can say is..... EPI'S ROCK! I have NO HESITATION having another in my next labour!

:iagree::iagree::iagree:

[sharonnscotty]

I am a mad sports person.... i have broken bones and waited hours in er rooms..... at first i was all for the EPI but as my pregnany progresses i want as little intervention as possible.... I have relatively low blood pressure to start with and have had a nasty reaction to ani-vomiting drugs given intravenously so I am going to try and go the whole birth with no epi (but then again i will also just wait and see on the day) !!!

Thanks a bunch for the gr8 info :yelclap:

[bada]

Wish I'd read that earlier.

I wanted to do it drug free but the oxytocin enticed me to ask for an epi. It didn't work, nor did the next attempt. I had no idea that there was a chance it wouldn't work (twice even). If I had read about the inadequacies mentioned in the article I may not have been so quick to change my mind on epi's.

I guess I got my drug free birth in the end anyway :rolleyes:

[julietv8]

I didn't have an epi for my first birth and after watching my friend have 6 attempts by 2 doctors to try and get hers in there would be no way in hell I would do it this time! Big scary needles are bad enough without someone trying to jab one in my spine while I labour eek!! I have a "no pointy objects in labour" rule, in that no-one is to come at me with anything sharp while I birth my children.

Just a bit of extra weight on the no-epi side of things for me, thanks Ella.

[tangle]

I've been researching other ways to control the pain such as a labour tens machine and calm birthing because with my last daughter the epidural dropped my blood pressure dropped to 40/20 and all I wanted to do was sleep but the nurse wasn't leaving my side, she wouldn't stop asking me questions about life in general, obviously to keep me conscious, I could have quite happily passed out, I never ever want to go through that again, I'm just glad that my baby survived and so did I.
The epidural with my first daughter didn't cause this reaction, and I don't want to risk it with this baby.

[gasmama]

i agree that medical professionals leave out all the risks of an epiural: but that's because they only have so much time! Do you really wnt your anaesthetist to stand theree and go through every detail when you're screaming in pain? most women just say "I don't care, just put it in!!!" If you knew all the risks of pregnancy there's no way you'd do that either!

I strongly disagree with some of that website's conclusions but specifically about cesar rate and epidurals. This is from the Cochrane Collaboration: research that looks at the results of many many clinical trials involving often thousands of people. You can visit the website at cochrane.org: they have plain english summaries of all their research, but also there are more detailed statements if you are into statistics and the details of the study.http://www2.cochrane.org/reviews/en/subtopics/87.htmland look at 'Pain during labour'
Epidurals for pain relief in labour (nb the italics are mine)


Epidurals are widely used for pain relief in labour. There are various types, but all involve an injection into the lower back. The review of trials showed that epidurals relieve pain better than other types of pain medication, but they can lead to more use of instruments(vacuum, forceps) to assist with the birth. There was no difference in caesarean delivery rates,long-term backache, or effects on the baby soon after birth. However, women who used epidurals were more likely to have a longer second stage of labour, need their labour contractions stimulated, experience very low blood pressure, be unable to move for a period of time after the birth, have problems passing urine, and suffer fever. Further research on reducing the adverse outcomes with epidurals would be helpful.


The more expanded conclusion: Twenty-one studies involving 6664 women were included, all but one study compared epidural analgesia with opiates (me:which means pethidine or morphine-like drugs). For technical reasons, data on women's perception of pain relief in labour could only be included from one study which found epidural analgesia to offer better pain relief than non-epidural analgesia (weighted mean difference (WMD) -2.60, 95% confidence interval (CI) -3.82 to -1.38, 1 trial, 105 women). However, epidural analgesia was associated with an increased risk of instrumental vaginal birth (relative risk (RR) 1.38, 95% CI 1.24 to 1.53, 17 trials, 6162 women). There was no evidence of a significant difference in the risk of caesarean delivery (RR 1.07, 95% CI 0.93 to 1.23, 20 trials, 6534 women), long-term backache (RR 1.00, 95% CI 0.89 to 1.12, 2 trials, 814 women), low neonatal Apgar scores at five minutes (RR 0.70, 95% CI 0.44 to 1.10, 14 trials, 5363 women), and maternal satisfaction with pain relief (RR 1.18 95% CI 0.92 to 1.50, 5 trials, 1940 women). No studies reported on rare but potentially serious adverse effects of epidural analgesia.


There are no Cochrane reviews of Nitrous oxide in labour (that doesn't mean there is no research, btw) but the bad press about nitrous and vomiting was to do with general anaesthesia and nitrous, not labour. Labour makes people nauseous and makes them vomit, not necessarily the gas!:barf:

also



Complementary and alternative therapies for pain management in labour

Acupuncture and hypnosis may help relieve pain during labour, but more research is needed on these and other complementary therapies.
The pain of labour can be intense, with tension, anxiety and fear making it worse. Many women would like to labour without using drugs, and turn to alternatives to manage pain. Many alternative methods are tried in order to help manage pain and include acupuncture, mind-body techniques, massage, reflexology, herbal medicines or homoeopathy, hypnosis and music. We found evidence that acupuncture and hypnosis may help relieve labour pain. There is insufficient evidence about the benefits of music, massage, relaxation, white noise, acupressure, aromatherapy, and no evidence about the effectiveness of massage or other complementary therapies

(More info goes like this: "Fourteen trials were included in the review with data reporting on 1537 women using different modalities of pain management; 1448 women were included in the meta-analysis. Three trials involved acupuncture (n = 496), one audio-analgesia (n = 24), two trials acupressure (n = 172), one aromatherapy (n = 22), five trials hypnosis (n = 729), one trial of massage (n = 60), and relaxation (n = 34). The trials of acupuncture showed a decreased need for pain relief (relative risk (RR) 0.70, 95% confidence interval (CI) 0.49 to 1.00, two trials 288 women). Women taught self-hypnosis had decreased requirements for pharmacological analgesia (RR 0.53, 95% CI 0.36 to 0.79, five trials 749 women) including epidural analgesia (RR 0.30, 95% CI 0.22 to 0.40) and were more satisfied with their pain management in labour compared with controls (RR 2.33, 95% CI 1.15 to 4.71, one trial). No differences were seen for women receiving aromatherapy, or audio analgesia. ")

Ok that's a lot of words, but it really frustrates me:geek: that people confuse their experience with scientific evidence. It really bugs me that so much misinformation is out there with regard to epidurals: the best research in the world tells us that epidurals are NOT associated with a higher risk of cesar- that's research on over 6500 women, not what your sister's hairdresser says! Also 'association does not prove causality": that is, whilst more women who had epidurals have instrumental deliveries, that doesn't prove that it caused them, per se- whilst epidurals are associated with a higher incidence of instrumental delivery. All we can say is that it that an association exists. It may be that women who request epidurals have more painful labours because they are partially obstructed, or because the natural labour fairies cursed them, or the epidural obstructed their Q'i, or something else...



Don't discount anything at this stage. The problem with labour is we'd all like to get through with no pain, no drugs and no side effects, but you can plan for a labour about as well as you can plan for whether it is going to rain next weekend or not; it's basically out of your hands.



Finally, my own experience: two babies, tried natural, in the bath, then gas, then epidurals, one post-epidural headache (the first time- didn't stop me having another).



If you want to know more you can ask your midwife or obstetrician for a referral to see an anaesthetist or anaesthetic clinic (it's uncommon, but the anaesthetist will probably love you for it!):yes:


Good luck and hopefully you won't need a thing!



Ps this was in cochrane too:
TENS (transcutaneous nerve stimulation) for pain relief in labour

TENS is a device which emits low voltage currents which has been used for pain relief in labour. The way that TENS acts to relieve pain is not well understood. The electrical pulses are thought to stimulate nerve pathways in the spinal cord which block the transmission of pain. In labour, the electrodes from the TENS machine are usually attached to the lower back (and women themselves control the electrical currents using a hand-held device) but TENS can also be applied to acupuncture points or directly to the head. The purpose of the review was to see whether TENS is effective in relieving pain in labour. The review includes 19 studies with a total of 1671 women. Fifteen studies examined TENS applied to the back, two to acupuncture points and two to the cranium (head). Results show that pain scores were similar in women using TENS and in control groups. There was some evidence that women using TENS were less likely to rate their pain as severe but results were not consistent. Many women said they would be willing to use TENS again in a future labour. TENS did not seem have an effect on the length of labour, interventions in labour, or the wellbeing of mothers and babies. It is not known whether TENS would help women to manage pain at home in early labour. Although it is not clear that it reduces pain, women should have the choice of using TENS in labour if they think it will be helpful

Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia

Not enough evidence to suggest that stopping an epidural late in labour lowers the risk of instrumental delivery or other unwanted outcomes.
Epidurals are used for pain relief in labour, but they increase the risk of instrumental delivery (vacuum/forceps). Stopping epidurals early aims to allow women to feel the pushing urge and so reduce the chance of having an instrumental birth and possible problems associated with such a birth. There is not enough evidence from the five included trials, involving 462 participants, to show whether stopping an epidural really does lower the risk of instrumental delivery or of any other unwanted outcome. The results show that women whose epidural is stopped report more pain than women whose epidural is continued until the birth of the baby. More research is needed.

Gasmama
mama of 4 angels, Paddy:smiliedance:3yrs and Ollie:baby:11months

[Tam-I-Am]

i agree that medical professionals leave out all the risks of an epiural: but that's because they only have so much time! Do you really wnt your anaesthetist to stand theree and go through every detail when you're screaming in pain? most women just say "I don't care, just put it in!!!" If you knew all the risks of pregnancy there's no way you'd do that either!

It is a medical professional's DUTY to provide all the risks and benefits of a particular treatment regime. Of course when a woman is in labour and not hearing the information - but you know what? I asked an anaesthetist about epidurals when I was pregnant with my first. It was in an antenatal class. He had 2 hours to discuss the true risks and benefits of epidurals. Instead he gave half-truth, and outright lied about some things. He was like an infomercial for epidurals. And at the time, I bought it, had an epidural with my first, and was extremely unwell after the birth of my first child - I truly believe that this was as a direct consequence of the epidural.

If my story were uncommon, I could accept it as a once-off. But rarely do you get somebody who is truly informed who chooses an epidural. Of course it does happen, and more power to them! But EVERY woman should be truly informed about those decisions.

As for keeping us in the dark for our own good or because we wouldn't choose it if we didn't know the risks - what a load of codswallop. Yes, I would still have had babies knowing the full risks of pregnancy - in fact I DID. Many obstetricians and midwives have children. Lots of people who are self-informed about the risks of pregnancy still have children. Informed consent is not some airy fairy concept that only the truly intelligent, or those who have some predisposed criteria have the right to. Every person has the right to informed consent from their carers, and if their carers are not providing information in order for their patients to make an informed decision and give informed consent then they are behaving illegally, not to mention unethically.

[Mum2Mimi]

, IMO if i had to take peth or epi i would take epi, but obviously no drugs would be better.

As is said beforei think pain toleration is individual and like you i did epi's for 3 of my births and had a great experience but i knew of the risks.
The key is for women to know of possible risks eventhough they are very slight, then weigh up your pros and cons, personally i would never do peth again i used that for my first child but i believe that it is more potent and a greater level is transfered thru the placenta and it resulted in a sleepy baby eventhough he was born 10 minutes after it being administered
i can't be bothered finding the links but Pethidine is a lot more potent for baby than epi.
I wish i never ever used peth


:iagree: I would choose an Epi over Peth anyday also and belive that peth is far worse!
I had a bad experience with it, after being given a shot of peth DD heart rate dropped extremly low around 50bpm and it was very scarey, room became flooded with staff preparing me for an Emergency C-sec as a result of the peth,prior to that DD was doing fine.

[One of THOSE mums!]

thanks for passing all this info on. too late for me as i have already had DS.

But I just wanted to say...i agree with an epi before peth.

I was lucky i had an epi and ended up with complications that wouldnt have been avoided.

being pain free gave me the ability to enjoy the experience. even though i ended up having a cs, i attempted a natural birth.

i just want all women to know that the experience is a very personal one. and it doesnt make you any less of a mother if you opt for an epi.

in the end it is the amazing little person you hold in your arms...a gift!