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Honest question: Why no drugs/pain relief? - Page 6

post #101 of 151
if you are making an informed choice and consent to the use of drugs, then i'm not understanding why you would feel guilty about that choice regardless of what others say to you?


Quote:
Originally Posted by DeeEast
My only problem is the fact that, personally, I feel that women are pressured into a drug-free delivery and made to feel guilty if they ask for pain-relief. That offends me. When a woman is in that much pain then no one has the right to make anyone feel less of a woman for asking for pain relief.
post #102 of 151
Quote:
Originally Posted by DeeEast
There are risks with "natural" delivery and the same with pain relief.
Quote:
Originally Posted by huggerwocky
Scientifically speaking that is not true. They are not the same but others are added by pain relief.Totally agenda free.
There is one particular risk that comes to mind that is ADDED to the normal risks of a natural (med-free) delivery as a DIRECT RESULT of choosing to go med-free.

That is, if a woman who opts for no meds during vaginal birth ends up needing a crash section, she often has to be put under a general anesthetic instead of the less risky epidural anesthetic that could likely have been used had it been in place when the emergency occurred.

Is this a reason to justify epidural placement 'just in case' an emergency arises? The answer to that question lies in what particular risk factors a woman has that might make it more likely than not that she'd need an emergency section to begin with.

But it IS something that can end up increasing mom's overall risk during delivery based on her initial choice to go drug free during labor.

Is it common? No, I'd guess not. However, serious anesthetic complications from epidural and/or spinal placement aren't common either. It's just another thing to consider.
post #103 of 151
Quote:
Originally Posted by wifeandmom
There is one particular risk that comes to mind that is ADDED to the normal risks of a natural (med-free) delivery as a DIRECT RESULT of choosing to go med-free.

That is, if a woman who opts for no meds during vaginal birth ends up needing a crash section, she often has to be put under a general anesthetic instead of the less risky epidural anesthetic that could likely have been used had it been in place when the emergency occurred.

Is this a reason to justify epidural placement 'just in case' an emergency arises? The answer to that question lies in what particular risk factors a woman has that might make it more likely than not that she'd need an emergency section to begin with.

But it IS something that can end up increasing mom's overall risk during delivery based on her initial choice to go drug free during labor.

Is it common? No, I'd guess not. However, serious anesthetic complications from epidural and/or spinal placement aren't common either. It's just another thing to consider.
The risks of general anesthetic, in my educated opinion, are MUCH lower than the risks of ADDING meds and epis to natural childbirth. So the "benefit" of an epi placement "just in case" are actually nullified by the risks of meds/epis that multiply the c/s rate.
post #104 of 151
Yeah, having an epi increases your chances of needing a c/s.
post #105 of 151
These are my reasons why:

1. I don't ever want my children to take drugs, why give them drugs now? A little pain on my part is well worth it for a beautiful drug free baby.

2. My baby doesn't have a choice, but I do. So I choose not to for my baby's sake.

3. Its healthier for both me and baby on many levels.

4. I'm not comfortable with the risks vs. potential benefits that might be gained.

5. Having had 2 natural unmedicated births, I can't ever see myself going to the other side.

6. I birth at a birth center, and pain medication isn't an option.
post #106 of 151
Quote:
That is, if a woman who opts for no meds during vaginal birth ends up needing a crash section, she often has to be put under a general anesthetic instead of the less risky epidural anesthetic that could likely have been used had it been in place when the emergency occurred.

Is this a reason to justify epidural placement 'just in case' an emergency arises? The answer to that question lies in what particular risk factors a woman has that might make it more likely than not that she'd need an emergency section to begin with.
No, especially when 20% of the time the epidural fails to work sufficiently for c-section so getting the epidural isn't full proof (by far).
post #107 of 151
Quote:
Originally Posted by erin_brycesmom
No, especially when 20% of the time the epidural fails to work sufficiently for c-section so getting the epidural isn't full proof (by far).
Without an epidural in place already, there is a 100% chance of mom needing general anesthesia for a true crash c-section. The risks of general anesthesia are greater than that of an epidural, something that is clearly documented time and again, *especially* in a pregnant woman.

As I stated very clearly earlier, this is still not a reason to advocate routine epidural placement for 'just in case' purposes, unless mom is at a higher than average risk of needing a crash c-section to begin with. Even in those particular cases, I can see how mom might be willing to take the risk of needing a general anesthetic to avoid the associated risks of an epidural if she doesn't want the epidural.

I was merely responding to the assertation that NOT having an epidural NEVER presents increased risks to the woman who chooses to forego an epidural because that simply is not truein all circumstances.
post #108 of 151
Quote:
Originally Posted by CookieMonsterMommy
Yeah, having an epi increases your chances of needing a c/s.
Recent research has shown this to be false. Even with epidural placement prior to 4cm (or 'active' labor), the c-section rates were found to be statistically no different than with placement at a later point in labor OR with no epidural at all.

I believe there *is* still some question among professionals as to whether or not it slows the average labor down if given too soon, but it has most assuredly been shown to NOT increase the c-section rate overall.
post #109 of 151
Quote:
Originally Posted by Kidzaplenty
The risks of general anesthetic, in my educated opinion, are MUCH lower than the risks of ADDING meds and epis to natural childbirth. So the "benefit" of an epi placement "just in case" are actually nullified by the risks of meds/epis that multiply the c/s rate.
Recent research has clearly shown that having an epi does NOT increase the c-section rate, HOWEVER, there *are* additional risks that are present with epidural placement that are *not* present in an unmedicated delivery.

So, I can see that perhaps the risk of needing a general anesthetic (which increases mom's risk of death to a much greater degree than epidural) would be low enough to 'negate' the risks associated with routine epidural placement (BP issues, maternal fever, etc).

Also, again, I never stated that placing epidurals 'just in case' was a good idea, only that by choosing NOT to have one in place, mom was then at a higher risk of needing a general anesthetic should an emergency arise, and it is something to be considered in the overall decision making process.

Here's an example that comes to mind:

Mom goes into labor, labors at home for hours with no real problems or issues. Membranes rupture and it is noted that there is severe meconium staining in the fluid. Warning bells are hopefully going off at this point, nothing to panic over for sure, but something to definitely be aware of.

Fast forward a few hours. Baby is now showing decels when heart rate is checked during/immediately after a contraction. At some point, decision is made to transport to hospital.

Off mom goes with meconium stained fluid and non-reassuring heart rate during contractions. Gets to hospital where things are still under control at this point, but going downhill with discussion of c-section if dilation/delivery doesn't occur very soon.

Baby continues to show more and more signs of distress, to the point of necessitating a section.

So, if it were *me*, and I was at the point of transfer from homebirth to hospital cause my baby was in that much trouble, I'd ask for an epidural when I got there *knowing* that I wouldn't have gone to the hospital in the first place without cause for serious concern.

Does that make sense? If it's bad enough to warrant ditching the homebirth plan, it's bad enough to warrant getting that epidural 'just in case', cause 'just in case' just became a whole lot more likely than not.
post #110 of 151
Quote:
Originally Posted by wifeandmom
Recent research has clearly shown that having an epi does NOT increase the c-section rate, HOWEVER, there *are* additional risks that are present with epidural placement that are *not* present in an unmedicated delivery.
Do you have a link to that research? With an overall rate of almost 30%, I'm not sure that I find "recent" research on this subject very reassuring.

I've had general anesthesia once, and a spinal twice. Except for the fact that I wanted dh to be able to see his children being "born", I'd have opted for the general all three times (if they'd have allowed it) - risks and all. Recovering from a general sucks - it really, really, really sucks - but I'd rather go through that than the experience of having the spinal placed. I've had no complications (unless this persistent backache is related, but I'll never know one way or the other), but the experience alone was horrible.
post #111 of 151
Quote:
Originally Posted by Storm Bride
Do you have a link to that research? With an overall rate of almost 30%, I'm not sure that I find "recent" research on this subject very reassuring.

I've had general anesthesia once, and a spinal twice. Except for the fact that I wanted dh to be able to see his children being "born", I'd have opted for the general all three times (if they'd have allowed it) - risks and all. Recovering from a general sucks - it really, really, really sucks - but I'd rather go through that than the experience of having the spinal placed. I've had no complications (unless this persistent backache is related, but I'll never know one way or the other), but the experience alone was horrible.
Sure, it'll be tonight before I can pull it up. I may also have to locate DH's password to get into the anesthesia journals online, but it's out there. DH has only been out of school for 3 years, so this whole topic was HOT HOT HOT when he was doing his research classes and such.
post #112 of 151
Quote:
Originally Posted by Storm Bride
I'd have opted for the general all three times (if they'd have allowed it) - risks and all. Recovering from a general sucks - it really, really, really sucks - but I'd rather go through that than the experience of having the spinal placed.
There is a very good reason they don't allow women as a general rule to choose general anesthesia instead of a spinal, assuming of course a spinal is possible.

Your risk of dying is truly that much greater compared to a spinal, so from the anesthesia provider's perspective, they'd much rather you dislike the process of getting a spinal and be alive at the end of the day vs. you preferring the process of being knocked out and dead at the end of the day.

The risks really ARE that much greater. I've never met an anesthetist that didn't HATE having to put a very pregnant mom under a general. It's just too risky if there is any other way.
post #113 of 151
From a quick Google, then I really MUST go run some errands:

http://www.nichd.nih.gov/new/releases/epidural.cfm

From that particular study, here's what made the overall study design very unique and interesting:

Quote:
The researchers began by examining the labor records from the Tripler Army Medical Center. In late 1993, the U.S. Department of Defense required that epidural analgesia be made available to women in labor at military medical centers. As a result, the rate at which first time mothers received epidural analgesia at the medical center increased from 1 percent to 84 percent. During that time, there were no major staffing changes at the hospital and no change in delivery procedures.

"This unique natural experiment offers an ideal opportunity to study the impact of epidural analgesia on the course of labor and delivery," the researchers wrote.
The overall results:

Quote:
The researchers found that there was no difference in the rate of Cesarean section between the before and after groups. Nor was there a difference in the incidence of difficult vaginal births requiring forceps or vacuum instruments. On average, however, the women in the after group experienced an increase in labor duration of 25 minutes as compared to the before group. The increase in labor duration was confined to the second stage of labor, from the time when the woman's cervix is completely dilated until the baby is actively expelled from the birth canal. The length of the first stage of labor, during which the cervix dilates, did not differ between the two groups.
And one more:

http://www.asahq.org/news/asanews21605.htm
post #114 of 151
Quote:
Originally Posted by wifeandmom
There is a very good reason they don't allow women as a general rule to choose general anesthesia instead of a spinal, assuming of course a spinal is possible.

Your risk of dying is truly that much greater compared to a spinal, so from the anesthesia provider's perspective, they'd much rather you dislike the process of getting a spinal and be alive at the end of the day vs. you preferring the process of being knocked out and dead at the end of the day.

The risks really ARE that much greater. I've never met an anesthetist that didn't HATE having to put a very pregnant mom under a general. It's just too risky if there is any other way.
I'm aware of the risks. I'd still have opted for a general anesthetic. At least that way, if I did survive, I wouldn't be plagued with nightmares. That's okay, though - the anesthetist has a clean conscience, and we all know that the mom's quality of life after the baby arrives doesn't even factor in.

And, caling it my "dislike" of a spinal is dismissive, inaccurate and somewhat condescending. It's not "dislike" - it's sheer, unmitigated terror. I find c-sections absolutely terrifying and the spinal is equally terrifying, if not more so. The fact that anesthetists call the shots in OR is just one more thing to hate about the whole process. (The last one managed to make it even worse by unexpectedly clamping an oxygen mask to my face.)

The thing is - I'm not concerned about whether the anesthetist hates to put me under...I'm concerned about whether I hate being put under - or hate being punctured. (They also didn't seem too concerned with putting me under general because I was on the verge of delivering a frank breech...and screaming "no". Funny how much concern about general anesthesia and pregnant women was being shown that day.)
post #115 of 151
I'd really like to see these studies. It's not the epidural itself that increases c-section rates -- it's the related interventions. Epidurals tend to slow labor, and sometimes pitocin is used to speed it up, and EFM is used to monitor how the baby responds to this. Both are linked with higher c-section rates. I don't know how these military hospitals operate, but if they tend to use synthetic augmentation and EFM for everyone, logically that's going to help level the rates between the groups.

Quote:
The two groups also differed in the timing of when their infants required assistance from medical instruments. The need for use of forceps or vacuum extraction to assist the baby through the birth canal appeared later in the after group than in the before group. Dr. Zhang explained that, in the before group, these extraction procedures were more often used when the baby was higher up in the birth canal. For the after group, the procedures were used when the baby was much farther along in the birth canal.
Why would this be?
post #116 of 151
I have not read all the studies or info that was just posted. But I have to think that IF the c/s rate does not increase due to meds and epis then it has to be that they are overly inflated already. C/S should be only about 1 in 10, not the high percentages that are "standard" today in our "medically managed" births.
post #117 of 151
Quote:
Originally Posted by Storm Bride
I'm aware of the risks. I'd still have opted for a general anesthetic. At least that way, if I did survive, I wouldn't be plagued with nightmares. That's okay, though - the anesthetist has a clean conscience, and we all know that the mom's quality of life after the baby arrives doesn't even factor in.

And, caling it my "dislike" of a spinal is dismissive, inaccurate and somewhat condescending. It's not "dislike" - it's sheer, unmitigated terror. I find c-sections absolutely terrifying and the spinal is equally terrifying, if not more so. The fact that anesthetists call the shots in OR is just one more thing to hate about the whole process. (The last one managed to make it even worse by unexpectedly clamping an oxygen mask to my face.)

The thing is - I'm not concerned about whether the anesthetist hates to put me under...I'm concerned about whether I hate being put under - or hate being punctured. (They also didn't seem too concerned with putting me under general because I was on the verge of delivering a frank breech...and screaming "no". Funny how much concern about general anesthesia and pregnant women was being shown that day.)
I see all the time how unethical it is for doctor's to agree to do medically unnecessary c-sections just because mom wants one for whatever reason. I see it said that this should be illegal, doctors who agree to do it should lose their license, etc etc etc. I see where medical decisions during childbirth should be strictly based on NEED, as in ONLY do a section when it is MEDICALLY NECESSARY, because it's what's best, safest, unnecessary procedures cost more money, etc etc etc. Do you agree with this sentiment? That a woman should NOT be allowed the luxury of 'choosing' a medically unnecessary c-section for whatever reasons she may have?


If you know anything about my beliefs surrounding childbirth, the bottom line for ME personally is that YOU, the mother, should be able to call the shots regarding which risks YOU feel most comfortable with. That belief doesn't go over so well here sometimes, and I'm ok with that.

If YOU are ok with the increased risk of death for yourself by *choosing* to have a medically *unnecessary* general anesthetic used instead of the safer alternative, AND you are willing to sign a consent form releasing whomever puts you to sleep of any and all responsibility for your choice, then I can see you choosing a general if it's that big of a deal to you.

You know the risks. You accept the risks. It really should be up to you if you feel like the increased risk of complications and death are 'worth it' for whatever reason you may have. I *do* believe the anesthesia provider in question should have some sort of protection from lawsuit should YOUR choice result in less than a positive outcome (of course they should still be responsible if they are incompetent, just not responsible if one of the known risks of GA actually affects you since it was your choice to begin with).

I also wonder if this would be one of those cases where people felt like you should be responsible for the additional costs associated with general anesthesia since it is clearly not medically necessary, it would be strictly for maternal preference. I see that argument for elective c-sections, you know....'fine, have a section if you want, but you can pay for it too' type thinking. I personally disagree with that sentiment, but it seems it would fit here as well.

Your argument sounds a lot like what I went through for a medically 'unnecessary' c-section with my first pg. We went round and round, with me insisting that I completely understood the risks associated with my choice, and while I certainly expected them to do a competent job during surgery, I also understood that sometimes things happen during a section that simply cannot be controlled (i.e. I could hemmorhage and need a hysterectomy).

Now, if they'd gone in there just hacking me to pieces and were clearly incompetent, you better believe I'd have sued them. But if I ended up with any of the myriad of complications that are KNOWN to be associated with c-section, well...that was my choice, and I accepted full responsibility for that choice.

If you felt the same way about the increased risk of GA with no real medical necessity, I would think ultimately it should be up to you to take on those risks.

I will say you'll have a hard time finding an anesthetist to agree with you, much like I found it *very* difficult to find an OB who agreed with me. And it sucked. I won in the end, but it was after a very long, very bitter, very distressing fight. A fight that was worth it, one that I'd fight again in a heartbeat, but distressing nonetheless.
post #118 of 151
Quote:
Originally Posted by fourlittlebirds
I don't know how these military hospitals operate, but if they tend to use synthetic augmentation and EFM for everyone, logically that's going to help level the rates between the groups.



Continuous EFM is standard of care at Tripler (where the first study took place). Pitocin is started as if it's candy, and it's *incredibly* unusual for a mother to labor and deliver *without* pitocin. I know this personally.

So, I'd say the use of EFM and Pit can be pretty much assumed for virtually all cases in both sets of women (the no-epi group and the epi group).

The c-section rates didn't significantly change between the two groups, which led to the conclusion that the use of epidural didn't increase the c-section rate. Seems like a logical conclusion to me given the parameters of the study.

Now, it IS quite likely that using pit, EFM, and especially using BOTH, could very well be upping the c-section rate overall. But when you introduce the epidural to the equation, the c-section rate did not change statistically speaking.

And the assertation earlier in this thread was that epidurals, not EFM and/or Pit use, increased the risk of c-section. THAT is what this particular study simply did not find a correlation for.
post #119 of 151
Yeah, so I'll get an epidural just in case I need a crash section?

Do you know how rare a CRASH c-section is? Seriously. Even in emergent and urgent c-sections, they almost always have time to place a spinal.

I've seen them have to use general TWICE in my life, and you know what one of the reasons was? Because the doctor placing her epidural placed it too high (very short woman) and with a bit too much of a loading dose and paralyzed her diaphragm. She needed the general because she couldn't breathe and was thrashing all over the OR table. They knocked her out and put a breathing tube down her throat. Score one for preventive therapy, huh?

Getting an epidural in case you'll need a stat section? What a warped and sad view of birth.

Please look into who funded those studies...

Off to post at Baby Center or Parenting or whatever those other boards are.....
post #120 of 151
Quote:
Originally Posted by fourlittlebirds
Quote:
The two groups also differed in the timing of when their infants required assistance from medical instruments. The need for use of forceps or vacuum extraction to assist the baby through the birth canal appeared later in the after group than in the before group. Dr. Zhang explained that, in the before group, these extraction procedures were more often used when the baby was higher up in the birth canal. For the after group, the procedures were used when the baby was much farther along in the birth canal.

Why would this be?
That is an interesting difference. First, there was no significant difference in the number of babies that required instrumental delivery between the groups, only a difference in WHEN instrumental delivery was used during the delivery process.

One guess, although it is purely a guess, is that so-called 'mid-forceps' deliveries (which is what I'm assuming they mean when they say instruments were used when baby was higher in the birth canal) are generally frowned upon these days. Perhaps 15 years ago in the 'before/no-epi' group, mid-forceps deliveries were used more often overall?

I do know that by 2002 at Tripler, mid-forceps deliveries were truly a very last resort, ONLY used if crash c-section was not possible for whatever reason, simply based on research findings that say a crash section is safer overall when compared to a mid-forceps delivery. At what point this policy came into practice, however, I do not know.

Another thought is that an epi is going to naturally relax the pelvic floor in lots of women, so the baby might descend properly at first, but get 'stuck' closer to the end of delivery. Of course, this doesn't really explain why just as many babies were needing instrumental delivery in the no-epi group, only they were requiring assistance higher up in the birth canal.
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