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#31 of 55 Old 12-14-2006, 12:08 AM
 
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Originally Posted by OnTheFence View Post
You know lets actually find out what the percentage of this is? I mean how more likely, because most the people I have known who got epidurals have had vaginal births. Also here is a pretty recent study on the subject that says that epidurals do not lead to more csections.
http://www.bmj.com/cgi/content/full/330/7488/383
I think you will also find that getting an epidural in the early stages of labor MAY increase a chance of surgical birth, but epidurals given later on (after 5-6cm) there really is no difference in outcome.

I think you'll find you've misread this particular study, and it really only finds little difference between recieving an epidural early or late, as has been pointed out. You're not the only one to be mislead by the title of this study, however, and it makes some of it's own conclusions entirely unrelated to what they examined. I think this article sorts out the confusion here well:

http://childbirthconnection.org/arti...k=10005&area=2

That addressed, I feel any birthing woman is entitled to the pain relief she feels is right for her. Everything in birthing (or parenting, or.. life,) is a risk/benefit analysis, and you have to make those for yourself with the information you have available. There's no wrong answer. Epidurals bring risk, obviously (and I would suspect increased c-section rate to be one of them, if very slight, as it overlaps with things like constant EFM,) and the question of whether the benefit is worth the risk is entirely personal. For me, the sense of being strapped down, scrutinized, and imprisoned (ie, physically unable to get up and walk away if I didn't care for how things were progressing,) that made that decision for me. Outside of that, I may have regarded substantial pain relief as being worth other risks like more difficulty breastfeeding, or a spinal headache. For another woman, my concerns would be inconsequential to her, and greater relaxation vs. a higher rate of other intervention might figure more substantially to her. Whatever a thoughtful woman decides is in her best interest is the choice I'm willing to be supportive of.
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#32 of 55 Old 12-14-2006, 12:08 AM
 
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ITA w/ pps re: trusting our bodies, not worrying about # of hours in labor (how is this even calculated? I'm sure it's different for everyone), cm dilated, getting to hospital too early, etc. I did hypnobirthing but felt I found it too late in my pregnancy to switch providers or do homebirthing - which I wish I would have done anyway.
I personally think I was in labor for 24 hrs. during that time I: got an estimate on my car, went to work, went to chiro (lost some mucus plug), back to work, to ob's (asked me if I wanted to schedule induction day after my due date then found I was 2 cm), to lunch, to target, home to pack, to dinner w/ family, to parents' for dessert, then water broke & got to the hospital @ 7 cm 1.5 hrs before dd's birth.
I am somewhat disappointed w/ the expectations here are along the lines of - accept interventions or have an excruciating l & d. what about the possibility of a calm, gentle, maybe even comfortable or PAINLESS birth experience? I know it's possible. why can't we embrace that our bodies were built for birth and can do a perfecly wonderful job @ it?
I also experienced the "rest & be thankful" stage. I knew it was coming b/c my hb instructor told us that if I were to think I couldn't go any longer, then that meant I was almost there. JMO, this is the point when many women opt for the epi & think it gave them a much-needed break. however, as pp said, their body may have done this anyway w/o dangerous drugs, risking prolonged labor, c/s,etc.
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#33 of 55 Old 12-14-2006, 09:36 AM
 
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As to why an epi is given at 7 cm, I'll never know why....you're almost there!!!
I had an epidural when I was 10cm dilated, but it was clear delivery wasn't happening anytime soon. I was exhausted, really felt that I needed to rest, and have no regrets.

As for the original poster's question, here's an interesting article addressing the question of epidurals and c-section rate:

http://www.pubmedcentral.nih.gov/art...?artid=1481670

Apparently, most of the controlled, randomized studies in which no difference in c-section rate was found between those who received epidurals and those who didn't assigned women to the epidural or non-epidural group after they were 4 cm dilated.

According to this article, administering an epidural before the active phase of labor doubles the c-section rate, but administering it later does not.

Sonja , 40, married to DH (42) since 5-29-93, DD born 11-3-2004, DS born 1-18-2007.
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#34 of 55 Old 12-15-2006, 11:11 AM
 
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As to why an epi is given at 7 cm, I'll never know why....you're almost there!!!
I stayed at 9.5 cm for 10 and a half hours, before I finally consented to a c-section!! I was 7 cm 8 hours prior to that. So, at 7 cm, I had 18.5 hours left to labor.

Everything is not black and white. 7 cm is not always close to delivery.
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#35 of 55 Old 12-15-2006, 11:25 AM
 
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with a cesarean rate of nearly(or are we there now?) 30% a majority of those are unecessary. there arent alot of things i can think of that are more violent than cutting someones baby out with no medical reason. while im glad your section was a great experience for you to say you find my account offensive and want me to stop saying it youre showing disrespect from the trauma i went through and the trauma of so many other women. youll find so many people willing to say cesareans are just a bucket of roses, that theyre no big deal even. i just cant do that.
if you have anything more to say to me lets take it to pms.

Mother to Sandrel(oct 2003) and Liesl(mar 2006) and someone new coming February 2013

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#36 of 55 Old 12-15-2006, 11:39 AM
 
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2) Why, oh God, why are so many of the pp writing that " at so and so cm, I had an epi". WHY are you being checked internally???? Any doctor worth their weight will admit that dilation is NOT a measure of progress. All that does is set you on the Friedman Curve (1cm/hr) and if you are not "progressing" according to that standard deviation, then you are labelled "failure to progress" and further interventions (ie) C-sections are pushed!!!!

3) Why are so many of the pp going to the hospital so early???? It doesn't matter how many hours you have been in labor. If it did, I could shock the sh!t out of everyone and say that I was in labor for a MONTH with my last two as I was having prodomenal labor. I was probably walking around at 4-6cm dilated for that time too but that matters a whole pile of beans!!!

What does matter is what emotional signpost you are exhibiting. For crying out loud, stay at home for as long as you can because the sooner you get to the hospital, the sooner interventions and laying on you back happens!!!!
Because we don't know any better and that's what happens when you are in labour in this day and age and you are told to go to the hospital. What you're saying is totally true. Women aren't encouraged that they can do it.

Now I know... if I didn't go to the hospital when I was 1 cm dilated, even though my ctx were 5 mins apart for 3 hrs, I wouldn't have had to spend the night on a triage table. I wouldn't have been denied food and drink and been so exhausted that I asked for an epidural. I wouldn't have spent the rest of my labour laying around on my back. I wouldn't have had my water broken and pitocin administered. Luckily I pushed my baby out on my own and we had a wonderful bf relationship from the start.

It may be hard to believe, but I don't regret the birth I had. I'll definitely be doing it differently this time around though. You live and you learn.

Amanda - wife to DH Kellyjog.gif, Mummers to Trentreading.gif born 03/03/05 Bridgetdust.gif born 08/08/07 and a IT'S A BOY! Kennedy babyboy.gifborn 02/20/11!
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#37 of 55 Old 12-15-2006, 11:46 AM
 
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Originally Posted by OnTheFence View Post
You know lets actually find out what the percentage of this is? I mean how more likely, because most the people I have known who got epidurals have had vaginal births. Also here is a pretty recent study on the subject that says that epidurals do not lead to more csections.

http://www.bmj.com/cgi/content/full/330/7488/383
I'm still reading this thread, but just read this article. Wow. 21% of the women who got epidurals had c-births. That's still well above the WHO recommendations. There was a difference of 3% between the group with epis and the group that thought they got epis, but really didn't (ethical?) But, there's a confidence rating of 5%. So, that means the actual number in that one study is -2 to 8% increase in cesareans with women who get epidurals. An, 8% increase to have a c-birth by taking an epidural? Too much for me!

It's not really opinion but fact that most studies have found that epidurals increase amt of interventions (epi is technically an intervention, too), more assisted pushing and increased rate of c-birth, breastfeeding issues & breathing problem..

But, this is the thing that got me the most. The women in the study who asked for an epidural, some of them got the epidural, the others in the control group got a needle in their back and no pain medication delivered. I would be really upset if in labor I was asked to be part of a study, without reading that I may be denied pain medication when asked. It did make it clear that women were eventually given pain meds if they made a second request though.

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#38 of 55 Old 12-15-2006, 12:17 PM
 
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Originally Posted by cdnmom View Post
2) Why, oh God, why are so many of the pp writing that " at so and so cm, I had an epi". WHY are you being checked internally???? Any doctor worth their weight will admit that dilation is NOT a measure of progress. All that does is set you on the Friedman Curve (1cm/hr) and if you are not "progressing" according to that standard deviation, then you are labelled "failure to progress" and further interventions (ie) C-sections are pushed!!!!
For what it's worth, I actually found it helpful and reassuring to know how many cm dilated I was and how far my baby had descended. Having this information helped me to make the decisions that were right for me during labor.

I wasn't particularly concerned about any increased risk of infection due to internal exams, since my amniotic sac was still intact. And it's not as though my doctor went nuts with the exams -- I think I had two or three in the 10 hours I labored at the hospital. (Which you may think means I went in "too early," but honestly, I don't think there was any way to know at the time that my labor was going to take as long as it did. As I recall, at the time I went to the hospital, my contractions were 3 minutes apart and quite painful; they'd been less than five minutes apart for about 12 hours.)

Different things are right for different people.

Sonja , 40, married to DH (42) since 5-29-93, DD born 11-3-2004, DS born 1-18-2007.
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#39 of 55 Old 12-15-2006, 03:46 PM
 
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As would be expected, this thread veered quickly from the original op's questions. Here are my experiences for your research, OP. I realize they may or may not be the norm.

I was induced with all 5 of my children at 41+ weeks (except one).
I had an epi and pit with all deliveries.
I had EFM with my 1st (done by a midwife, interestingly enough).
I had all of my babies vaginally; a section was never mentioned or brought up.
All of them were 9/10 Apgar (oh wait, one was 10/10).
Their weights were 8 1/2 lbs or over, except the one who was induced early (verrrrrry looooong story).
All had good latch and bf/ed/ing from 9 mos. to 15 mos. (and counting).

I don't have statistics or scientific studies, but this is my personal experience.
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#40 of 55 Old 12-15-2006, 05:17 PM
 
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I beleive that anytime you introduce an intervention whether epidural, fetal monitoring,vag exam ect, you up you chances of a c-sect. The key word is "chances".

It is a case by case situation however we are not always looked at as unique individuals in a bureaucratic environment such as a hospital. Epidurals alone might not cause a particular problem in a prarticular case, but maybe the mama laying on her back with an IV would cause a problem. The epidural drug does enter the baby and what ever problems manifest from that alone is understated.

I very much agree that Epidurals are a tool. Tools can be misused. That doesn't make them intrinisically bad. The same goes for any intervention.

All interventions have a degree of personal interpretation by a medical staff member and that person might be wrong. Second opinions and self education and true informed consent are a must in order to lessen the chance of a c-section.
~Angela~ NAK
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#41 of 55 Old 12-15-2006, 07:46 PM
 
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Originally Posted by alegna View Post
In *general* I would say that the epidural itself makes a c-section more likely AND it begins a cascade of interventions that can also lead to a c-section.

I would say it is almost unheard of for an epidural to prevent a c-section.

-Angela
For most, yes, it can increase the risk of c/s. For me, with my first, I think it helped me deliver vaginally. I had extremely high blood pressure and was not dilating very quickly on pitocin. The epidural dropped my pressure closer to normal and gave me more time.

Tamara: hs'ing Christian mom of five here and five in Heaven. Joyfully awaiting Punkin, coming mid-Sept!
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#42 of 55 Old 12-16-2006, 01:13 AM
 
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But, this is the thing that got me the most. The women in the study who asked for an epidural, some of them got the epidural, the others in the control group got a needle in their back and no pain medication delivered. I would be really upset if in labor I was asked to be part of a study, without reading that I may be denied pain medication when asked. It did make it clear that women were eventually given pain meds if they made a second request though.
All the women in this study recieved epidurals, the timing was simply different, and that was the point under study. One group recieved a spinal, then epidural at next request. The other group was given injections of hydromorphone and an epidural at their third request or a dialation of more than 4cm. Pain relief was denied no one in the study. You're right, that wouldn't have been ethical.
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#43 of 55 Old 12-17-2006, 10:53 AM
 
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What I didn't see mentioned: having an EPI for many hours can cause your temperature to rise considerably. This increases the risk you'll be given unneeded antibiotics (even before baby is born so you can both *profit* from it)
So, after delivery it might take much longer A: until you get to hold your newborn : as they will want to examine him/her closely first and B: to get home , as they might want to keep you there for a few days until they make sure there's no infection (while being there you might be administered more antibiotics, and your child too, just to be on the *safe* side)
I'll try hard avoid this next time, if I can.

Mom to two girls, wife to DH : : : : : :
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#44 of 55 Old 12-18-2006, 03:46 PM
 
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This thread has been temporarily locked due to a possible user agreement violation. The thread will be reviewed and if possible the violations will be addressed and the thread returned for discussion.
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#45 of 55 Old 12-18-2006, 06:18 PM
 
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Please keep the UA in mind when posting. There are some very strong feelings regarding this subject, with good reason. Before you submit your post ask yourself if what you typed is something you'd want to read... if not, likely it would be better to reword your post in a gentler tone. Please remember as well, when relating your experiences use "I" statements and avoid generalizations.

Thanks for your cooperation!
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#46 of 55 Old 12-18-2006, 11:54 PM
 
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Just for interest.....

I actually had a fever BEFORE getting an epidural, and before oxytocin was started. I was put on antibiotics. NOT my first choice, but to me, the risk of passing an infection to my baby (or making myself ill) wasn't a good one!

However, being on antibiotics had no effect on my postpartum experience. They did continue them for an hour or so after the birth, but that was it. I wasn't separated from my son at all. We did stay in the hospital for a few days, but that was because he lost so much weight in the first day, and I requested to stay until my milk came in.


As I said before, I don't think that ANY intervention, least of all an epidural, should ever be taken lightly. But, I don't think anyone here is promoting epidurals as "the way to go" during labour! I think we ALL agree that there are risks to an epidural. But, it is apparent that having an epidural does not necessarily mean that your birth experience goes to pot. Many moms and babies ARE fine after an epidural.

Mom to two amazing boys, C (July 2005) and D (May 2010)

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#47 of 55 Old 12-29-2006, 01:15 AM
 
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I opted out of an epi bc I thought it would up my chances of a c/s, but ended up with a c/s anyway. IMO the person who would be most likely to have an epi (afraid of pain, wants an easy childbirth) would also be more likely to opt for a c/s ("get it over"). Please note I speak mostly of women who go in and demand an epi as soon as they dialate enough to get one bc they want to experience the least amount of labor possible.
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#48 of 55 Old 12-29-2006, 01:41 AM
 
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Originally Posted by pfamilygal
For most, yes, it can increase the risk of c/s. For me, with my first, I think it helped me deliver vaginally. I had extremely high blood pressure and was not dilating very quickly on pitocin. The epidural dropped my pressure closer to normal and gave me more time.
I had a similar situation and I do feel like my epi prevented a c/s.

I was stalled out at 3-4 cm and panicking. My induction had already gone on for over 30 hours, and my water had been broken for around 8 hours. The pitocin had been cranked way up and I was having 20-minute long contractions that I just couldn't get on top of. Add in my high bp, and though the doctor didn't implicitly threaten a c/s, at that point I felt like if I didn't start progressing soon a c/s was a given. In that case I would've had to have the epi or some form of anesthesia anyway, so continuing labor with an epi seemed like the lesser of two evils. Once I got it, I was finally able to rest and relax, allowing my body to do what it needed to do, and I did end up delivering vaginally.

Mama to two crazy boys (8/05 & 9/07) and happy wife to one wonderful hubby.
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#49 of 55 Old 12-29-2006, 03:22 AM
 
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Originally Posted by OnTheFence View Post
You know lets actually find out what the percentage of this is? I mean how more likely, because most the people I have known who got epidurals have had vaginal births. Also here is a pretty recent study on the subject that says that epidurals do not lead to more csections.

http://www.bmj.com/cgi/content/full/330/7488/383

I think you will also find that getting an epidural in the early stages of labor MAY increase a chance of surgical birth, but epidurals given later on (after 5-6cm) there really is no difference in outcome.

The study you quote does not represent reality very well.

First of all, it excludes a whole bunch of women that DO get epidurals:


Quote:
These women were asked if they would like to participate in the trial. Exclusion criteria included non-vertex presentation, scheduled induction of labour, any contraindication to opioid analgesia, and cervical dilation greater than or equal to 4 cm.
The study is also lead by Cynthia Wong, an associate professor of anaesthesiology. That's hardly impartial. She even admits to limitations of the study:

Quote:
However, she acknowledged several limitations to the study, including the fact that different obstetric providers and management styles (including patterns of oxytocin use) may have influenced labour outcomes. In addition, the study was not conducted blind. She considered it unlikely, however, that knowledge of the type of analgesia biased obstetricians’ decisions about mode of delivery.
Unfortunately epis are being pushed as a matter of routine early on, even when the patient does not want one. Also a great majority of these women are receiving pitocin, which the study did not evaluate. It is easier for a nurse to suggest an epidural than offer physical presence and encouragement to help a woman through labor pain. Mine was given at 3 cms, and I consented after about 7 hours of pitocin induced contractions , the realization (or what I thought to be true at the time) that I was not making any progress (I was!) and no encouragement from hospital staff. I went in requesting a natural labor and came out with pitocin augmentation, epidural and ultimately an unneccessary csection for "Failure to progress" So your study doesn't say much for what is happening to a good number of women today.

Mama to my spirited J, and L, my homebirth: baby especially DTaP, MMR (family vax injuries)
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#50 of 55 Old 12-29-2006, 06:00 AM
 
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my friend was in excruciating pain b/c of induction (GBS, AROM @ 38 wks, no labor, fever...so she had to be induced). she stalled at 2-3 cm. 1 hour after the epi her dd was born. she became so relaxed and relieved, she started to dilate agan.

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#51 of 55 Old 12-29-2006, 07:43 PM
 
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I think the number 1 thing that caused my C-section was the fact that the anesthesiologist turned the epidural DOWN. I had back labor with pain so bad I was fantasizing about shooting myself when I was still dilated to 0. I walked around for hours, sat in the hot tub for a while, walked around some more. Nothing helped. The pain was unlike anything I could have imagined. I remembered from my Bradley book that when you think you can't do it anymore, it means you're in transition. Ha! I couldn't do it anymore, and I was still in early labor.

So I got the epidural. The pain went away. I rested. My contractions kept on going and I dilated to 10. They asked if I could feel anything and I said, "I'm doing kegels." I begged him not to turn the epi down ... they didn't care. They turned it down to half strength and the pain went right back up to unbearable. I pushed and screamed at the top of my lungs for three hours. For the last hour of it, the doctor could see my baby's head, and he kept not descending farther. The pain was unimaginable. I think I actually asked for a C-section just to get it over with.

The doctor called the OB in, they agreed the baby was stuck, I signed the forms. They put more anesthetic into my epidural and I went numb from the waist down. I can't describe the relief I felt during my C-section. I didn't care that they were cutting me open, I didn't even care that I had a healthy baby, all I cared about was that the pain went away.

I still wonder how much longer I would have been able to keep pushing if I'd had adequate pain relief. What's the point of turning the epi down so the mother can "feel to push" if feeling the extra pain wears her out and makes her unable to push for as long?
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#52 of 55 Old 12-29-2006, 07:46 PM
 
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In *general* I would say that the epidural itself makes a c-section more likely AND it begins a cascade of interventions that can also lead to a c-section.
What she said.
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#53 of 55 Old 12-29-2006, 07:49 PM
 
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IMO the person who would be most likely to have an epi (afraid of pain, wants an easy childbirth) would also be more likely to opt for a c/s ("get it over").
I wasn't afraid of the pain of labor until I actually felt it. If I'd known what I was in for, I would have been afraid.

I don't think I'm a wimp because I needed the epidural. Labor feels different to different people, and different people experience pain differently. I can't begin to describe how bad the pain was for me, other than to say that I suddenly understood how it was possible to hurt so bad that you'd rather be dead. For months after giving birth, any twinge in my back was enough to start me crying, just from the memory of how much it hurt.
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#54 of 55 Old 12-29-2006, 07:55 PM
 
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I wasn't afraid of the pain of labor until I actually felt it. If I'd known what I was in for, I would have been afraid.
.
This is how I feel now. Before labor, I was all about natural childbirth. Taught it, preached it, saw it every day (I was a L&D nurse, then a CNM). Afterwards--OMG, I thought I would die.

I'm glad you posted this; I thought I was one of the only ones swept away by the intensity of labor.
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#55 of 55 Old 12-29-2006, 11:14 PM
 
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For me, the epi helped me avoid a c. I was in pre-term labor for weeks and weeks and when I was in active labor with my DD, I had been contracting continuously for three days straight. I hadn't slept and was exhausted. Getting the epi allowed me to rest and once I was at 10 cm I had the energy needed to push. I pushed for 50 minutes and had a great delivery. She nursed almost immediately and never had any rooting issues or other after effects. My sister labored for 12 hours, stalled, got her epi and had the baby within the hour. For us, it worked. I will go into this next delivery the same way I did with the first, naturally, and will see how it goes. If I can go without the epi I will, but it was a lifesaver the first time around. I think it really depends on the situation and the circumstances.
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