BBC: Epidurals protect against pelvic floor damage

[Pirogi]

http://www.bbc.co.uk/news/health-11071881

[rhiOrion]

somebody tell that to my pelvic floor

[rparker]

If I'm reading that article correctly, the main reason epidurals are associated with a lowered risk of pelvic floor floor damage is because their use dramatically increases the number of c-sections and vacuum assisted deliveries. It also looked like their use increased the risk of pelvic floor damage if the attending hcp used forceps instead of a vacuum.

The article tried to gloss over this, but the actual information it cited basically suggested that a decrease in the use of forceps is the big reason epidurals are "better" in this sense since women who have had an epidural are less likely to effectively push out a baby on their own. Rising c-section rates and the use of epidural anesthesia (vs general) seemed to also play a pretty big role since the article stated that over a third of the women with epidurals had c-sections. It didn't state this either way, but it's probably safe to assume that very few of the women who experienced pelvic floor damage by "not having an epidural" had c-sections... I guess they might have had general anesthesia crash c-sections, but it seems unlikely that that would account for a significant number of the "non epidural" group.

So basically, having an unassisted or forceps assisted vaginal delivery--with or without an epidural--increases your chance of pelvic floor damage. Having an epidural decreases your chance of having an unassisted vaginal delivery and almost no one uses forceps anymore so therefore having an epidural decreases your risk of pelvic floor damage. Having a c-section is the best way to protect your pelvic floor but even that isn't guaranteed since women who don't have children also experience pelvic floor damage. Lame.

[kittywitty]

Last I read c-section is negligibly effective against pelvic floor issues and it's more of a pregnancy issue. And that having an episiotomy (which is more likely with epidural) really increases your risk of prolapse.

I also thought that precipitous birth increases your chances-would make sense that they didn't have an epidural in that case, thus skewing the results since there wouldn't have been time for one.

Either way, it's a load of horse manure. I have pelvic floor issues and more problems from the 8 years of back pain from a poorly done epidural that thankfully didn't land me with a c-section and tripled mortality rate.

[MegBoz]

Weird, because I thought it was pretty well established that epidurals led to more overall tears & more high-degree tears. So that runs rather counter to existing science

The team from the Nepean Clinical School of Medicine in Sydney followedup 367 women who gave birth between 2005 and 2008.

Over a third had undergone either a planned or emergency Caesarean section, and there were no cases of muscle damage or tearing among these women.

Of those who had delivered their baby vaginally, about 13% were found to have some damage."

Ahhh - there you have it! Small sample size.

So 367 * 34% had CS = 124.78

So round up to 125 for total CS and that leaves 242 vaginal births remaining

242 * 13% = 31.46 women had "some damage."

So they're comparing a sample size of only 31 women who did have vaginal births & damage. That's very small. WAY TOO SMALL to be statistically significant.

The length of labour was key: a long period of pushing was strongly associated with injury.

Again, that makes these results sound 'off' somehow since epidurals are well known to lengthen labor overall & lengthen 2nd stage. So if epidurals are associated with longer 2nd stages & longer second stages are associated with injury, it seems strange to say epidurals truly have a statistically significant association with FEWER pelvic floor injuries!

Of course, that's not to say that if A=B and B=C then A=C. I know medical science doesn't work that way, but it still seems unlikely to be accurate results.

The researchers, led by Dr Clara Shek, speculated there may be two reasons for this. Firstly, women who have epidurals tend to be told when to push as they can no longer feel contractions This means the potential damage from premature or over-pushing is reduced.

I knew this was going to make me angry eventually! Again, I thought it was pretty well established that "coached" & "Purple pushing" not only has the tendency to deprive the baby of oxygen more than mama-directed pushing naturally would, but it leads to worse tears.

This seems like a classic case of the medical field getting all excited at finding data that appears to confirm what they already believe - that medically managed birth is superior.

The beginning of the article has a sub-head that includes, "a study of nearly 400 women suggests." Referring to 367 as "nearly 400" is quite a stretch. & the REAL STUDY IS OF DAMAGE (i.e. of those who DID have damage, was it worse with or without epidural?) THAT is the question. & as calculated above, only 31 had damage. Really, this is a study of 31 women.

[Pirogi]

Originally Posted by rparker

If I'm reading that article correctly, the main reason epidurals are associated with a lowered risk of pelvic floor floor damage is because their use dramatically increases the number of c-sections and vacuum assisted deliveries. It also looked like their use increased the risk of pelvic floor damage if the attending hcp used forceps instead of a vacuum.

The article tried to gloss over this, but the actual information it cited basically suggested that a decrease in the use of forceps is the big reason epidurals are "better" in this sense since women who have had an epidural are less likely to effectively push out a baby on their own. Rising c-section rates and the use of epidural anesthesia (vs general) seemed to also play a pretty big role since the article stated that over a third of the women with epidurals had c-sections. It didn't state this either way, but it's probably safe to assume that very few of the women who experienced pelvic floor damage by "not having an epidural" had c-sections... I guess they might have had general anesthesia crash c-sections, but it seems unlikely that that would account for a significant number of the "non epidural" group.

So basically, having an unassisted or forceps assisted vaginal delivery--with or without an epidural--increases your chance of pelvic floor damage. Having an epidural decreases your chance of having an unassisted vaginal delivery and almost no one uses forceps anymore so therefore having an epidural decreases your risk of pelvic floor damage. Having a c-section is the best way to protect your pelvic floor but even that isn't guaranteed since women who don't have children also experience pelvic floor damage. Lame.

The way I read it, they removed those who had c-sections from the analysis. They only looked at vaginal deliveries. Their data showed the likelihood of pelvic floor damage in a vaginal delivery was highest in forceps-assisted, then spontaneous/unassisted, then vacuum-assisted.

Over a third had undergone either a planned or emergency Caesarean section, and there were no cases of muscle damage or tearing among these women.

Of those who had delivered their baby vaginally, about 13% were found to have some damage.

The risk of muscle tearing was slightly lower among those whose birth had been assisted with a ventouse - a suction cup which fits on the baby's head -than those who did not have an assisted delivery.

But the use of forceps did push up the risk of damage, with a third of these births resulting in muscle injury.

Their data also showed that a longer pushing phase was highly associated with pelvic floor damage. I wonder if the women self-selected for epidurals. It may be that those who were less likely to have an epidural were also less likely to accept c-section, therefore having a longer pushing phase. Those who accepted epidural may have been more likely to accept a c-section, thereby removing them from the data set.

I also wonder if they controlled for movement during labor. It is widely known that lithotomy and reclined sitting positions are the worst for opening the pelvis. If these women were not allowed to push in any position, then their pushing phases were likely longer.

Of course, I didn't access the actual study, and the sample size was only 367 women.

Originally Posted by kittywitty

Either way, it's a load of horse manure.

I agree. I was just in the mood to discuss crap.

[Galatea]

Breaking news:

Women's bodies are defective! But don't worry - modern medicine will fix them.

P.S. My pelvic floor is just fine with my spontaneous non-medicated pushing... one time I shocked a midwife with how strong my PC muscles are!

[tireesix]

I have a rubbish pelvic floor thanks to EDS. Suffered a prolapse on my third. However, I knew before I ever had children that my pelvic floor was weak.

I have to wonder though whether todays lifestyles contributes more to poor pelvic floors etc rather than child birth??????

I don't know, the study seems to small and somewhat off to me too.