epidural question

[groovyjem]

good morning all

we was at our antenatal class last night and the lady was explaining that one in two people who have the epidural then have to go on to have help delivering there baby i.e either with forceps or ventouse.

am just wondering for the ladies who have had epidural in previous pregnancies how true this is ? and what was your experience would you recommend epidural or not ?

thank you xx

 

[cupcake0406]

I have seen many epidurals during labour and whilst I would say that epidural definitely increases the risk of instrumental delivery I would also say that in my experience it is definitely not 1:2. I'm not for or against epidurals but you could end up with instrumental delivery for maternal exhaustion due to pushing without one, so I wouldn't worry if you feel you need one xx

 

[Emerald87]

I had the epi and went on to have an unassisted birth. But it was VERY close - the doctors were rushing in with forceps just as I got her out myself. However it wasn't the epidural to blame - it was my big baby that got stuck for 3 hours -_-

Do your research. Try reputable sites and talk to your doctors and midwives. They're the best source of information because they've seen things first hand.

Personally, I would wait until you're in the birthing room to decide. I was induced and it was intense. I could have done it without the epi but I had already been in full-blown labour for 8 hours and they couldn't tell me how much longer it'd be, so I opted for it. You might feel that you can handle the pain at the time or maybe not. Be open with things. Have a birthing guide rather than a plan. Things change and the whole point of labour is to have a healthy and happy baby at the end.

Good luck!

 

[Mum2BKW]

My understanding is that epidurals can numb you to different extents - sometimes you can't feel anything at all and sometimes you can feel the contractions or even a lower intensity pain.

I imagine that if you are completely numb it would be very hard to push, I know they will tell you when you push but not being able to feel your own body must make it tricky - how would you know if you are pushing with the right muscles? Or how hard you are pushing? So I could understand that leading to more interventions.

But if you have a lower dose epi then it wouldn't be such an issue.

I've not had one myself, I'm waiting to see what happens as this is my first baby. If I do have one I will ask for he the lowest dose.

 

[alicecooper]

I've had epidurals for all 3 labours.

The only one that required ventouse and forceps was the second one, and that had nothing to do with the epidural, it was because the cord was around his neck.

 

[special_kala]

I had a epidural first time round. Nearly 3 hours of pushing and prepped for a csection. Thankfully after a very rough examination by a doctor i felt enough to push her out.

My non epi birth was far better for me and baby.

 

[summer rain]

In the experience of women I know it's actually more like 3 in 4 xx

 

[CatherineK]

Sorry but that statistic is bull. First of all, as you know, it's more common in the US to get them. I probably know 100+ women who've had them and told me their story, and only a very small handful needed assistance...and that was normally because of a beech baby, small pelvis, or cord issue. I've give labor with and without, and both were different, but good, experiences.

 

[groovyjem]

thank you all for your replies

this is my first too and am defo going in with open mind, as you ladies say we never know how things may go and just take it as it comes and if needed at least by posting this thread i have a better idea of the experience someone has actually gone thro so thank you for sharing.

i never realised you can have different doses of the epidural defo something to discuss and ask midwife at our next app. xx

 

[sophie22]

I didn't but it was very close! That statistic is very wrong though

 

[Mum2BKW]

i never realised you can have different doses of the epidural defo something to discuss and ask midwife at our next app. xx

Yes I believe these days they give you a button that you can use to 'top yourself up' so it's much more under your own control than it used to be. I'm not sure if they do that everywhere, best check with your midwife as you said.

 

[DLA]

Would love to see where they got that statistic! I'd bet all the money in my bank account that it's wrong. I had an epi and pushed the baby out without any assistance in 20 minutes....

The strength of the epi has a lot to do with it. While I couldn't feel most the pain, I could still feel when I needed to push.

ETA Just thought of this. The day I was in labor I was so nervous about a forceps or vacuum delivery so I told my OBGYN how nervous I was and he laughed and said he almost never has to do that... (and I'm pretty sure more than not, most the women choose epis).

Just about all my friends and family have had epis too and not one had an assisted delivery so already that statistic is not proving to be accurate in my experience..

 

[solitaire89]

I'm not sure about the stats (they do seem a little out to me), but an epidural is linked to an increased chance of vaginal instrumental birth (i.e. a birth assisted with forceps/ventouse). The NHS should tell you this, which is what they've done. I've lifted the following from the NICE guidelines for Intrapartum Care (care for women in labour) which the NHS should follow:

1.5 Pain relief in labour: regional analgesia
Information about regional analgesia
1.5.1 Before choosing epidural analgesia, women should be informed about the risks
and benefits, and the implications for their labour.
1.5.2 This information about choosing epidural analgesia should include the
following:
It is only available in obstetric units.
It provides more effective pain relief than opioids.
It is associated with a longer second stage of labour and an increased chance of
vaginal instrumental birth.
It is not associated with long-term backache.
It is not associated with a longer first stage of labour or an increased chance of
caesarean birth.
It will be accompanied by a more intensive level of monitoring and intravenous
access.
Modern epidural solutions contain opioids and, whatever the route of administration,
all opioids cross the placenta and in larger doses (greater than 100 micrograms in
total) may cause short-term respiratory depression in the baby and make the baby
drowsy.

FWIW - I didn't have the epi, so can't comment on that experience, but I did have a pain free and drug free labour and birth, and can say that I don't trust the NHS's stance on "alternative" therapies being ineffective!!

 

[DLA]

Here is a randomized medical study done involving 160 patients comparing epidurals to no epidurals.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299112/

Results:

There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group.

ETA The main focus of this study was to see if epis prolonged labor but they also recorded the incidence of assisted delivery. Very interesting!

 

[solitaire89]

That is an interesting study - I shall have a proper read later. Thought this was misleading though:

Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

Which basically reads that the labour does slow down unless you give large quantites of drugs to maintain the rate. Is it a poorly worded summary though, or is it that the NHS use UK studies to support their statements?

 

[DLA]

That is an interesting study - I shall have a proper read later. Thought this was misleading though:

Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

Which basically reads that the labour does slow down unless you give large quantites of drugs to maintain the rate. Is it a poorly worded summary though, or is it that the NHS use UK studies to support their statements?

Have no idea about the NHS. I would hope they use updated studies to support their statements but I know there's a ton of misinformation out there even among medical professionals sometimes (over here as well). I just thought the outcome was interesting because there wasn't a higher rate of assisted delivery like a lot of people (including me) worry about with epis.

 

[tristansmum]

That is an interesting study - I shall have a proper read later. Thought this was misleading though:

Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

Which basically reads that the labour does slow down unless you give large quantites of drugs to maintain the rate. Is it a poorly worded summary though, or is it that the NHS use UK studies to support their statements?

Have no idea about the NHS. I would hope they use updated studies to support their statements but I know there's a ton of misinformation out there even among medical professionals sometimes (over here as well). I just thought the outcome was interesting because there wasn't a higher rate of assisted delivery like a lot of people (including me) worry about with epis.

Y
So I could be totally wrong here but from what I read on here and see on us birth shows a lot of labours are induced and so use the drip. Also seems slot of ladies have epidurals over there so maybe that's why the obgyns say it doesn't increase labour or increase the use of assisted birth???? I think the orginal statistic is wrong but I recently read my hospitals own statistic and forceps/vagina were used more in births with epidurals. My two close friends who had epis for their births had forceps.

 

[solitaire89]

Have no idea about the NHS. I would hope they use updated studies to support their statements but I know there's a ton of misinformation out there even among medical professionals sometimes (over here as well). I just thought the outcome was interesting because there wasn't a higher rate of assisted delivery like a lot of people (including me) worry about with epis.

I would hope so too... But quite frankly, as I said, I take everything they say with a pinch of salt - they say that hypnotherapy is ineffective and in my case (as well as many others) that is most certainly not the case. For my part, I didn't rely on what the NHS said - I looked at studies for myself and then went from there.

I agree about the worries of each method of pain relief, and it's compounded by the fact that different professionals tell you different things, amd different studies say different things. It's why I started looking further afield for pain relief options. Contrary to popular belief, I'm not a nut that shuns pain relief because I want to "feel the pain"!

Have just looked at the guideline and it was updated Oct 2012, so they obviously are updated.

 

[solitaire89]

So I could be totally wrong here but from what I read on here and see on us birth shows a lot of labours are induced and so use the drip. Also seems slot of ladies have epidurals over there so maybe that's why the obgyns say it doesn't increase labour or increase the use of assisted birth???? I think the orginal statistic is wrong but I recently read my hospitals own statistic and forceps/vagina were used more in births with epidurals. My two close friends who had epis for their births had forceps.

You've done exactly what I was going to suggest - get your hospital's stats up!

I understand that induction is more common in the US, but I also understand that augmentation of labour is common there too (the use of pitocin) - to the point of being standard practice, so the length of labour is not the "natural" length of labour in the first place but much shorter.

 

[DLA]

I see my OB today and I am curious to see if oxytocin administration is standard when you get the epi. As far as I know I didn't require any type of induction medications, as I was firmly against them and really didn't need them luckily. However, it seems oxytocin might be administered as part the epi. This I am curious about!