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Old 01-28-2006, 04:17 PM   #1
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Post Pros and Cons of the Epidural

Potential Benefits of Epidurals

Epidural anesthesia or analgesia provides relief or reduction of labor pain without affecting the mother's mental state. It enables an exhausted mother to relax or sleep during labor and calms the woman who is anxious and tense because of pain. Once an epidural catheter is in place, additional medication can easily be administered as needed, providing prolonged and consistent pain relief.

Some prolonged labors, probably those slowed by anxiety, speed up with an epidural. Anxiety can cause excessive production of the mother's stress hormones such as epinephrine and norepinephrine, which slow contractions. By allowing the mother to rest without pain, the epidural removes her anxiety and her labor progress may improve.2 If not, Pitocin may be administered painlessly. Since epidurals often lower blood pressure, this may benefit some women with pregnancy induced hypertension.3

Epidurals are also useful for cesarean births, making it possible for the mother to remain alert and involved while free from pain. They enable her to avoid general anesthesia, which is considered to carry greater risks.

Epidural narcotics reduce pain without reducing other sensations or muscle function. Women can change positions more easily than with anesthetics. They remain aware of their contractions and often continue to participate; using breathing patterns and other comfort measures. For those women who wish to remain aware of their labors, epidural narcotics are often quite acceptable.

Potential Risks

Epidural blocks carry some risks to the mother, fetus and newborn. Undesired effects tend to be greater with larger doses of medication, a longer interval during which the medication is in effect and immaturity or distress in the fetus.

Undesired effects on the mother:


Inadequate pain relief (up to 10%)4


Rise of the mother's oral and vaginal temperature 5, beginning within one hour after administration of the epidural, which may lead to treatment of the mother and baby for non-existent infection. This effect may be dose-related. This recent finding from England is being investigated in the United States.6


Drop in the mother's blood pressure treated with position changes, oxygen and possible vasopressors (less likely if a bolus of IV fluids is given before the epidural).


Short or long-term postpartum backache from bruising caused by the injection or from ligament strain caused by prolonged time spent in a damaging position or inappropriate movement (for example, extreme passive flexion of the mother's trunk, hips and knees during the second stage, or sudden vigorous movements of the mother) while her muscles are relaxed and her back is numb (up to 19%). Long-term backache is almost twice as likely to occur with an epidural than without.7


Possible unintentional spinal block and resulting spinal headache requiring days of bed rest and a blood patch.


Shivering may be reduced with lower doses, by warming of the anesthetic before administration, or by adding narcotics to the anesthetic.8


Mild to severe itching of the skin (with narcotics)


Retention of urine, requiring a bladder catheter1


Mother feels detached from the process and becomes an observer; others may reduce emotional support. The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.9


Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother).


Rare complications, such as residual numbness or weakness from needle injury to nerves (almost 1 in 10,000)10, delayed respiratory depression with epidural narcotics (up to 12 hours later)8, and brain damage and death (extremely rare)11.

Undesired effects on the labor:



May slow labor, requiring Pitocin; and has been found to increase the chances of a cesarean delivery in primigra****s by two or three times.12


Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20-75%). Delaying pushing until the fetal head is on the perineum reduces the need for forceps. Even though this approach lengthens the second stage, it does not increase the incidence of fetal distress.13
Undesired effects on the fetus:


Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery.


Increased likelihood of newborn septic workup, IV antibiotics and isolation in the nursery if the mother develops an "epidural fever" that causes fetal tachycardia or newborn fever.


If the fetus is already stressed greater amounts of the medication are "trapped" in the fetal circulation, leading to more pronounced newborn effects (see below).

Undesired effects on the newborn:


Short-term (six weeks or less) subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light.4 There are no data on potential long-term effects.


Possible less efficient or less organized initial rooting and suckling behavior. Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies.6


Decreased infant responsiveness may lead to long-term consequences for the parent-infant relationship.14 Parents should be counseled to give their babies time to recover from the birth and medication and should avoid a label of "difficult child" or "incompetent mother."

 
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Old 01-28-2006, 05:04 PM   #2
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girl75 HB User
Re: Pros and Cons of the Epidural

great info.
i am so for epiderals. maybe i am a weenie but i can't stand that pain.
robin

 
Old 01-28-2006, 10:54 PM   #3
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Re: Pros and Cons of the Epidural

I would love to hear from anyone out there who has had an epidural and regretted it. All my friends who have had one felt really good about the decision. One woman didn't have one the first time around and did with the second and said it was a world of difference--all positive.

So if you have had an epidural with any complications or just regret, please post. Thanks.

 
Old 01-28-2006, 11:56 PM   #4
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Re: Pros and Cons of the Epidural

I think I posted somewhere earlier that a good friend of mine hates them. She has three children--with the first the epidural didn't work even after multiple attempts, the second did work, but she ended up being hospitalized a few days later for a severe headache due to improper removal or something, and with the third she just did without. My mom had two without and said it was a positive experience. My sister couldn't stop throwing up--due to epidural or other pain meds or combination...so, I think I'm going to try without unless I start to panic or my labor is dragging on and on.
I've also had friends say they thought the epidural was a lifesaver, so, I guess each woman will have their own experience--it's good to be informed though, thanks Orange.

 
Old 01-29-2006, 07:42 AM   #5
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Re: Pros and Cons of the Epidural

Quote:
Originally Posted by Sallyz
I think I posted somewhere earlier that a good friend of mine hates them. She has three children--with the first the epidural didn't work even after multiple attempts, the second did work, but she ended up being hospitalized a few days later for a severe headache due to improper removal or something, and with the third she just did without. My mom had two without and said it was a positive experience. My sister couldn't stop throwing up--due to epidural or other pain meds or combination...so, I think I'm going to try without unless I start to panic or my labor is dragging on and on.
I've also had friends say they thought the epidural was a lifesaver, so, I guess each woman will have their own experience--it's good to be informed though, thanks Orange.
Just so you know its very common to throw up during labor, I did and that was throwing up alot before they gave me medicine, but my bag had not broke yet and and once they broke it I was fine for a few hours. So dont be surpised if you do without any meds. Im assuming I will either way.
Meg

Last edited by rounsy222; 01-29-2006 at 07:43 AM.

 
Old 01-29-2006, 08:24 AM   #6
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Re: Pros and Cons of the Epidural

Of course you're right. I understand it's normal--this was uncommonly severe though, everyone there was commenting on it. And, from reading a little bit, I doubt it was from the epidural, more than likely it was from one of the oral or IV meds they gave her. It didn't start until that time.
I do have a question for anyone who's had one though--I guess I'm particularly concerned about the baby--I've heard that with an epidural they are drowsy and don't feed as well? Has anyone experienced this?

 
Old 01-29-2006, 11:42 AM   #7
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Re: Pros and Cons of the Epidural

I had three babies- one of which was 9 lbs 13 oz. I had no epidural with him. I didn't like the idea of medication- I had just went through 9 months of wathcing everything Iput in my body and I had some real problems with getting to the homestretch and throwing allof that hard work out the window.

It went fine - about a 8 hour labor from arriving at the hospital.

When I had my second - he was so fast I couldn't have had one if I wanted to.

And by my third I knew I could go it alone and she was my hardest but I did it.
I don't have an issue with people using medication...my issue is that so many people willnot give their bodies a chance to show them what they are capable of. People say "why live with the pain when you don't have to" Becausei it is childbirth.. and all meds pose a risk to you and your child.

I remember after my first sons birth my sister had a baby about a month later. With my son..I nursed him within 5 minutes of delivery , I was on the phone in 10 minutes, I was eating and walking around in an hour. My sister had an epidural, she blacked out during delivery, had a seizure, and a week later still did not feel up to coming to the phone. Related? We never really found out..but she never had any problems goingin and she had 2 births after that without the epidural and they went much better. I didn't want to take the chance.
I think my fear is that ob/gyns push the idea of epidurals because they make for calm, orderly, deliveries and patients. No surprises. Same with inductions. I really think they are 90% of the time only in the best interest of the dr. Some people are ok with that... I think it is again an unnecessary risk.

 
Old 01-29-2006, 06:41 PM   #8
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Re: Pros and Cons of the Epidural

Shelby,
I think you make an excellent point...many women worry and stress about eating the wrong cheese or drinking one diet soda but are very quick to take medication. My point is like you said, many spend a lot of time watching what they put into their bodies but then get to the hospital and take pain medication. I understand under some cir***stances it is necessary and it is a choice every woman has, so I am not attacking anyone.

 
Old 01-30-2006, 07:42 AM   #9
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Re: Pros and Cons of the Epidural

Great info Orange. I think that the more educated mothers become the less intervention that they want. Dr.'s just don't tell you about the risks and side effects. I agree with Shelby, its makes their job easier. I started out this pregnancy thinking that I would get an epidural, but the more I have learned the more I am convinced that I will be going natural. I had my daughter with no drugs, so I hope that I can do it again. I know someone who had an epidural and then couldn't push well enough to deliver. They had to use suction to deliver her baby, and he ended up with brain damage due to it. I am sure that this is very rare, but if anything were to happen, I would never forgive myself.

 
Old 01-30-2006, 08:00 AM   #10
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Re: Pros and Cons of the Epidural

I agree AngelBaby....in the beginning I always thought that I would like to go natural but not opposed to drug intervention i.e. epidural. After reading about the information and such I am NOT willing to take the risk. I don't think it is something to take light no matter how many women claim that they had no problems. It is a drug and it has side effects and the application of how they insert the drug is also a serious matter.

 
Old 01-30-2006, 11:25 AM   #11
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Re: Pros and Cons of the Epidural

But Orange and everyone else keep in mind too that you should be open minded to might happen if things don't go as planned. I was against epidurals with ds and did not want any medication other than gas if necessary. I was induced at 7 days over and ended up with severe unproductive contractions that lasted 10 hours, then I had demerol, which slowed them to every 10 minutes. Then another 10 hours after that I had the oxitocin drip started and within 3 hours was right back to contractions lasting 1-2 minutes every 45 sec-3 minutes...still not very productive. In the end, I gave in and had an epidural after 30 hours of hell. I was exhausted and just couldn't go on. The epidural gave me a break, let me relax and destress somewhat. It was lessened when I reached 10 cm and by the time I went to push it was pretty much gone. I pushed my son with no problems and ended up with a son in stress due to and excessively long delivery, not to the epidural. He's fine now and was fine within days of his birth.
I was so unprepared for labour, for medication for any complications. You have to read up on everything if you want to try natural especially. Make sure you are prepared for everything and I would suggest keeping your mind open to the possiblity that it might not go your way and you may end up with no options but medication.
Oh and by the way, NO ONE but me suggested medication in the hospital I was in...I practically had to beg for it. This time I am using a midwife, avoiding an induction if at all possible and trying to go as natural as possible.
Good luck to everyone!!!!

 
Old 01-30-2006, 12:30 PM   #12
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Re: Pros and Cons of the Epidural

Thanks, I am well aware that things may not go as planned. Obviously if I had to have a section, I would need drugs.

 
Old 01-31-2006, 07:55 AM   #13
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Re: Pros and Cons of the Epidural

Yes, obviously. But I'm not talking about a section and didn't mention that in my post. I am positive that if you asked most women who were induced many of them would have had an epidural or used other medication. Also anyone who has labour for a prolonged length of time would likely agree too. You just get to a point where you can't do it any longer, you are just too tired and stressed.
I wasn't trying to scare anyone or anything and didn't mean to suggest that you weren't aware. I just want to make sure those of you who are doing this for the first time are prepared to keep your mind open to the chance that it might not go as planned.
As I say this though I would also suggest reading as much as you can on how to decrease the stress, pain, and time that you are in labour. I was so naive with ds and really didn't prepare myself at all. This time I am so much more educated and not just from being there but from reading and listening to others.
Good Luck Orange and all of you!!!

 
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