Looking for resources.

[jezebelle]

I understand that this is a natural mothering message board, and that MDC promotes natural childbirth, homebirths, etc.

I see women here discussing the "dangers" of epidurals, the "slippery slope," and their desire to stay away from pitocin. But I don't see any resources for the "why." I don't feel comfortable trusting random websites--I only feel comfortable with studies that back them up. But I don't know how to go about finding reputable sources.

I was wondering if anyone could point me in the direction of a solid website with documented studies to support some of the opinions I've read on here? I'm specifically looking for resources on why pitocin and epidurals are considered "dangerous."

Thank you.

[mambera]

Here's what I get from some PubMed searching. Disclaimer: This is my own search, not systematic by any means and I haven't read the full articles.

Pitocin: While there are some large studies showing significant increases in CS/instrumental delivery with pitocin, the Cochrane Reviews (systematic thorough reviews of the current literature) indicate that, if anything, there is a slight decrease in CS rates with pitocin. (Of course you wonder how many of the women sectioned for failure to progress would have eventually given birth on their own.)

http://www.ncbi.nlm.nih.gov/pubmed/19697814

Ginekol Pol. 2009 Jul;80(7):508-11.
[Obstetric outcomes in oxytocin-related and spontaneous deliveries--analysis of 2198 cases]
[Article in Polish]

Raba G, Baran P.

CONCLUSIONS: (1) Hypokinetic uterine contractions were the most frequent indication for oxytocin administration during labour. (2) Oxytocin administration increases twice the risk of delivery by the caesarean section. (3) Newborns after vaginal oxytocin-related labours scored 7 or below on the Apgar score in the first minute after the birth when compared to the newborns after spontaneous labour. (4) Oxytocin administration during parturition elongates the time of newborns hospitalisation.

http://www.ncbi.nlm.nih.gov/pubmed/15955617

Eur J Obstet Gynecol Reprod Biol. 2006 Jan 1;124(1):37-41. Epub 2005 Jun 13.
Outcomes of labours augmented with oxytocin.
Bugg GJ, Stanley E, Baker PN, Taggart MJ, Johnston TA.

RESULTS: Only 51.1% of women who received augmentation achieved a normal vaginal delivery compared with 76.5% of women who did not need augmentation (RR 0.67; CI 0.63-0.71). Contributory factors to this disparity included a greater number of Caesarean sections (14.4% versus 6.6%; RR 2.18 CI 1.74-2.67), forcep deliveries (12.8% versus 5.3%; RR 2.41 CI 1.93-3.01) and ventouse deliveries (21.7% versus 11.5%; RR 1.89 CI 1.62-2.21) being performed among augmented labours as compared to normal progressive labours.


http://www.ncbi.nlm.nih.gov/pubmed/19370654

Cochrane Database Syst Rev. 2009 Apr 15;(2):CD006794.
Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care.
Wei S, Wo BL, Xu H, Luo ZC, Roy C, Fraser WD.

AUTHORS' CONCLUSIONS: In prevention trials, early intervention with amniotomy and oxytocin appears to be associated with a modest reduction in the rate of caesarean section over standard care.


http://www.ncbi.nlm.nih.gov/pubmed/18843671

Cochrane Database Syst Rev. 2008 Oct 8;(4):CD004907.
Package of care for active management in labour for reducing caesarean section rates in low-risk women.
Brown HC, Paranjothy S, Dowswell T, Thomas J.

Obstet Gynecol. 2009 Jan;113(1):218-20.
AUTHORS' CONCLUSIONS: Active management is associated with small reductions in the CS rate, but it is highly prescriptive and interventional. It is possible that some components of the active management package are more effective than others. Further work is required to determine the acceptability of active management to women in labour.



Epidurals: I have seen many PubMed-listed studies of epidurals and none of them found any change in the CS rate nor any effect on the newborn from an epidural. My personal concern about epidurals is that they may increase vaginal tear rates bc the mother cannot feel what is going on and may 'overpush.' But I actually do not have any literature backup for that and in general I'm not sure why people feel so strongly against them.

[RedOakMomma]

OP, if you look into the back issues of Mothering, you'll probably find several articles (with cited sources) of studies of birthing practices in the US. Many of the ones I've remembered reading talk about induction practices and interventions, then look at the results of those labors (% of c-section, % with complications to mother or child, % of NICU stays, etc.). There have also been some excellent discussions in articles (again, with cited sources) about the lack of statistical difference in outcomes when certain interventions (continuous monitoring, etc.) are used.

You might also want to look into books written about these subjects. The information should be relatively easy to find. I've seen it discussed and quoted in print, on the news, and on the radio, and new studies seem to come out frequently.

[Veritaserum]

Heci Goer is a birth researcher. She has written books such as The Thinking Woman's Guide to a Better Birth and she has a website:

http://www.hencigoer.com/

[*MamaJen*]

That's really great that you're doing real, in-depth research with original studies. I wish every woman got that well informed.
If you hang out in the natural birth world for any length of time, you hear a lot of chatter about "evidence based medicine." The idea is that you want to do the things that the evidence shows to produce good results, and not do the things that produce bad results.
One really good introductory document to read is Evidence based Maternity Care: What it is and What it Can Achieve. Henci Goer is also great for in-depth research.
And of course, while anecdotes aren't facts, I have heard so many mothers who had a hospital birth followed by a homebirth, and would never go back to the hospital unless they had to.
And also, it's not necessarily any one thing in a vacuum, like, just the epidural or just the pitocin. It's the entire philosophy and practice of managed birth that produces bad results, and has pushed the C-section rate to 32 percent.

[soso-lynn]

Here are a few interesting ones;

Jonas W, Johansson LM, Nissen E, et al. Effects of Intrapartum Oxytocin Administration and Epidural Analgesia on the Concentration of Plasma Oxytocin and Prolactin, in Response to Suckling During the Second Day Postpartum. Breastfeed Med. 2009;4(2):71-82.

Thorp JA, Breedlove G. Epidural Analgesia in Labor: An Evaluation of Risks and Benefits. Birth. 2007; 23(2): 63-83.

Gupta JK, Hofmeyr GJ, Smyth RMD. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002006.

As far as the Cochrane Database reviews that show no increase or even decreases in c-section for epidural patients, they are based widely on a study that was done in a hospital with an extremely low c-section rate to begin with and doctors that were explicitely out to reduce the rates of c-sections. It makes a huge difference in how to interpret their data. I don`t have the references at the moment, but you should be able to find the meta-analyses on the Cochrane Database (the latest is from 2005 I believe).

I also believe that medium to long term effects of epidurals are widely under-reported. Many women will develop migraines or have persistent lower back aches for years after their epidurals and will never report it to any doctor. I am not aware of any study that truly looks at the long-term effects other than paralysis and such.

[Beltane]

If you are like me and enjoy reading, I would recommend the books Pushed and Born in the USA. Be sure to counteract these books with some happy birth book though!

[MegBoz]

Originally Posted by *MamaJen*

That's really great that you're doing real, in-depth research with original studies. I wish every woman got that well informed.

ITA & great post (except the CS rate in the US is just over 32%, I believe - 32 point-something.)

Honestly, when I was PG, I didn't know a single person who'd had a natural birth! Not one! I actually said, "Of course I'll get an epidural. I've got nothing to prove?" THANK GOODNESS I got wind of the fact that the CS rate in the US is very high & much higher than other industrialized nations. I reasoned that therefore means we probably have more CS than necessary... and I wanted to make sure I didn't have an unnecessary CS. That lead me to "The Thinking Woman's Guide to a Better Birth" by Henci Goer, which literally changed my life!

While it was published in 1996, it's not too likely that science has since found stuff like pit & epidurals are NOT dangerous, anymore, ya know? (Although, still, I really wish she'd update it.)

If it's hard evidence you're looking for, I think that is your #1 best bet. It's really great how she describes each item in a chapter (CS itself, induction, AROM, pit, epidural, EFM, VBAC, episiotomy, etc.) outlines pros & cons, then in the Appendix lists out the actual studies.

I like "Pushed" & "Born in the USA" as well. The former is well-written & includes personal narratives. The latter is great for credibility!!! i.e. for those who think HB is nuts, I love pointing out that Dr. Marsden Wagner, former head of maternal & child health for WHO, is very pro-HB & vehemently opposed to standard American maternity care practice! But I don't think he's a fabulous writer. (While reading, I was itching to edit that book!)

[AustinMom]

What every mom needs to keep in mind, is that there are "risks" to every intervention. That's why we use them. With am epidural, there are "risks" that you will be temporarily paralyzed from the waist down. That's the most common talked about risk, and that's why women get it. Usually they are not told about the risk of not moving around that causes dystocia in labor and shoulder dystocia at birth, and the increase of tears, need for episiotomy, and extended episiotomy. Not to mention drop in blood pressure, which leads to need for IVs, which has it's risks of over hydration, further lack of movement, and hyperglycemic mom and baby, and then a hypogylcemic baby after he/she is born, leads to further tests on baby, early introduction of formula, poor breastfeeding. Then, there is stalled labor to think about which is Very common usually due to lack of movement, and the fact that it numbs your muscles, so then you are given pit to speed up labor, needing an IV, then you risk a hypersensitivity to the pit, and can lead to uterine rupture (with or without a previous scar) hyper stimulation which can lead to baby heart rate dropping, which can lead to CS. That's just two of the paths an epidural can lead down. There are many many more. But yousee, there are risks to every thing. I say, start with the interventions that are less risky negatively, and have better results. Like hire a Doula, they have shown to lessen the need for epidurals, etc.

You can look at every intervention this way. If I do ___________(like get an epidural, use pit, AROM, etc) it can lead to ____________, and that has it's risks of ________and you'll see there is a huge "tree" of risks that for with many interventions and some are unfavorable. Yes, some complications are rare, but when you think about it, if a procedure carries many of these rare complications, you have to look at what are the chances not of each complication, but of having a complication in general. See what I mean?

Like past people said, it's GREAT you are doing research. GREAT GREAT GREAT. I would also ask you, are you worried that you are going to need them, and want to be fully informed, or are you just curious? The two situations are dealt with differently. If it's curiosity, I'd recommend looking through medical journals online and what your OB has of the risks and complications of them. Henci Goer's book is great, so is Pushed, so is The Birth Partner. It goes through pretty much all the interventions commonly used, and the risks, and how often they work. You'll be very surprised to hear about AROM, and how it only shortens labor by minutes, but carries MANY risks that can change the path of labor very easily. If it's fear/anxiety about not being about to handle the "pain" of birth (not quoting you, just the general public's opinion) or not having effective contractions and needing pit, I'd recommend hiring a Doula, or going to ICAN meetings to get more info. Talk to someone who deals with the physiological side and emotional side of birth, so they can help you better prepare for these two situations.

[Rodeo Mama]

Originally Posted by Veritaserum

Henci Goer is a birth researcher. She has written books such as The Thinking Woman's Guide to a Better Birth and she has a website:

http://www.hencigoer.com/

That's exactly what I was going to suggest. Great book!