Opinions please! Epidural & C section… - Mothering Forums

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Old 12-13-2006, 12:34 AM - Thread Starter
 
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Just working to further educate myself & want the well respected opinions of the MDC mommas.:

So, what do you think...
Does an epi “send” you closer to a C/S?
Does it help prevent a C/S?
Or does it have no affect on the outcome?
Or is it just a case by case basis?

Of course this is not a poll, I want to hear more than answers to those questions if you have them.

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Old 12-13-2006, 01:02 AM
 
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I can't comment about the affects of an epidural on labor as I have only birthed at home but my understanding is that it will slow labor due to the infusing of fluids into the blood stream.

However, I can make comment regarding its' effect on the fetus. As the epidural is given in the spinal column, the mother experiences localized effects from the narcotics. Unfortunately for the baby, these drugs pass through the placenta and are circulated causing a "systemic effect" meaning that it affects all of their systems.

One notable side effect is depressed breathing in the baby, as a result, the hospital will insist on electronic fetal monitoring of the baby. As EFM will show the natural heart rate fluctuations of the baby as contractions come and go, this is sometimes interpreted as "fetal distress". In combination with the side effect of the narcotic on the baby and the EFM, there is a higher incidence of C-sections as a result of epidurals.

Just an interesting FYI, the babys' immature liver cannot metabolize these narcotics as readily as the mothers liver. As a result, these drugs take a long time- sometimes days-to be cleared from the baby's body. These narcotics can interfere with the natural rooting that infants do for breastfeeding.
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Old 12-13-2006, 01:23 AM
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Actually, it take 4-6 weeks for the drugs to clear through the liver.

I've heard that epis can sometimes help a stalled labor and thus avoid a c/s. But yeah, most of the time it seems they cascade and this can cause a section.
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Old 12-13-2006, 01:27 AM
 
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If you choose an epidural it is more likely your birth with result in cesarean delivery.

~Marie : Mom to DS(11), DS(10), DD(8), DD(4), DD(2), & Happily Married to DH 12 yrs.!
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Old 12-13-2006, 01:36 AM
 
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I had an epidural after 49 hours of labour, because I was too exhausted to go on without any sleep.

When I got the epidural, I was barely 4 cm dilated, and had been on oxytocin for 7 hours.

After a few hours of napping, I went from 4 cm to 9 cm in less than an hour. I slept a bit more, and 5 hours after getting the epidural, I pushed my baby boy out, all by myself.

BUT, I do think that in MOST cases, they can lead to a c-section. I personally think that epidurals should ONLY be used in cases of maternal exhaustion, where a c-section is imminent if the mother is unable to get any rest. Many women get an epidural VERY early on in labour, and that only slows things down....

Neither my son nor I had any negative effects from the epidural. He nursed like a pro right from the start, and I was walking around 2 hours after giving birth. I also did feel him come out, which was AMAZING.

I have no desire to test fate and have another, though. I am really hoping NOT to be in that position again, and plan to use Hypnobirthing so that even if I do find myself in a very long labour, I will be able to relax enough to still be able to cope.

In my situation, I think that the epidural prevented a c-section, but that is VERY rare.

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Old 12-13-2006, 01:39 AM
 
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Originally Posted by chantelle7 View Post
Just working to further educate myself & want the well respected opinions of the MDC mommas.:

So, what do you think...
Does an epi “send” you closer to a C/S?
Does it help prevent a C/S?
Or does it have no affect on the outcome?
Or is it just a case by case basis?

Of course this is not a poll, I want to hear more than answers to those questions if you have them.

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
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Old 12-13-2006, 01:47 AM - Thread Starter
 
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BTW, I didn't have an epi with DD & don't want/plan on one with baby that's due.
The story behind why I'm looking for opinions on the epi/section is too long & involved for me to post. My circle of friends is just starting to have kids & this is a constant subject, that's why I'm asking. I've already explained all the stuff about baby having it in their system, possible BF issues, etc. The C section is a new one & I (purely guessing here) imagine an epi would send you "closer" to having a C, if you can't feel how would you know when to push, KWIM? Seems that would just naturally (no pun intended) lead to other complications.

Just wanted to clarify a bit about my posting here. Carry on

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Old 12-13-2006, 01:54 AM
 
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I had an epidural after 14 hours of labour. It really helped me out so that I could rest. After I got it I was able to relax more and it helped me dialate faster. Since after 14 hours I was only at 3cm. After about 5 hours I was able to push out my 9lb 9oz son! Not all us can handle labour the same. I went into it wanting a totally natural birth, but ended up with the epidural and it really helped me focus better.

From my understanding if you get an epidural too early it could slow down your labour and *might* end up with a c-sect.
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Old 12-13-2006, 02:00 AM
 
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"Studies consistently show that c-section is 2-3 times more likely with epidural. One study showed that risk was 26% if epidural at 4 cm, 33% at 3 cm, 50% if epidural given at 2 cm dilation."

http://www.transitiontoparenthood.co...epiduralfx.htm

That said, I had the epi with my first at 4cm and had a vaginal delivery. All told I was on the epi for about 6 hours, total labor was 36 hrs. I didn't have a problem pushing, actually pushing was the easiest part, only 20 minutes. I did have to be told when to push since I didn't feel the contractions and I ended up with a 2nd degree tear (I told dr not to cut me). We also failed at breastfeeding, it could have been due to the epi, my dd was a very sleepy baby. But I just don't know. Obviously this time I hope to avoid unneccessary interventions and go natural. I notice you're due in Jan, me too Here's some more links I found helpful:

How to avoid an unneccesary c-section:
http://www.childbirth.org/section/avoid.html

Fetal monitoring:
http://www.mymidwife.org/momstobe/monitoring.cfm
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Old 12-13-2006, 02:26 AM
 
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I had an epi with my first. I'm going epi-free this time. But not because of any interventions.

I went in to the hospital around 7:30 pm. Took a nap. Got epi around midnight, dilated to approx 7 cm. Took a nap. Woke up around 12:40 am. Started pushing. DD was born at 1:21 am.

I had a short, intervention-free birth. Granted, my mother was there to assure I had no unneccessary interventions (she had two natural births and both times they wanted to csec and she ripped the docs a new one about at least letting her TRY)... but it didn't lengthen my labor, which was relatively short. No episiotomy, no tearing, no csec.

We did have issues breastfeeding, but that was more due to latch issues and lack of support/knowledge. Once again, going a different route this time. DD wasn't sleepy at ALL... she was always wide awake all the time.

But I see myself as more of an exception to the rule type of deal.
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Old 12-13-2006, 02:55 AM
 
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If you choose an epidural it is more likely your birth with result in cesarean delivery.
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.
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Old 12-13-2006, 03:02 AM
 
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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.

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

-Angela
Actually, had my aunt not had one she would have had a csection. The epidural actually bought her more time, allowing her to relax, and cervix to open after PROM.

I imagine women with prolong labors who become extremely exhausted with the pain, gladly welcome an epidural than want to go to the OR. Which sometimes happen when moms in labor get tense and tired in labor.
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Old 12-13-2006, 03:08 AM
 
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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
This study doesn't compare women with an epidural to women labouring without pain relief, though...it compares women given an epi on their first request for pain meds, to women given other painkillers on their first request and an epi on their second.

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Old 12-13-2006, 04:15 AM
 
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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 wish I could find the link but the study I quoted above was mentioned on another website, and when the epi was given after 5cm there was no difference in the c-section rate. Now I have no idea how large the study was or if there were any other problems with it.

Another thing is if the woman already has the epi and needs to have an emergency c-section, it can be useful because she doesn't have to be put under general anethesia.
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Old 12-13-2006, 04:36 AM
 
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black and white version
Does an epi “send” you closer to a C/S? yes
Does it help prevent a C/S? no
Or does it have no affect on the outcome? anytime you mess with yourself youre asking for problems "if it aint broke dont fix it"
Or is it just a case by case basis? people will tell you that to make you feel better about it after the fact


shades of grey version:
Does an epi “send” you closer to a C/S? in some cases an epidural has been known to cause problems that will make a doctor want to cut you open.
Does it help prevent a C/S? in some rare cases ive heard people claim that epidurals calmed them down enough to relax and give birth
Or does it have no affect on the outcome? anytime you alter the natural progression of things it effects the outcome.
Or is it just a case by case basis? everyone has to decide for themselves what risks theyre comfortable taking.

quick googling:
http://www.kimjames.net/epidural_ris...de_effects.htm
http://www.healing-arts.org/mehl-madrona/mmepidural.htm
http://www.gentlebirth.org/archives/epirisks.html
http://en.wikipedia.org/wiki/Epidural

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Old 12-13-2006, 04:42 AM
 
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I imagine women with prolong labors who become extremely exhausted with the pain, gladly welcome an epidural than want to go to the OR. Which sometimes happen when moms in labor get tense and tired in labor.
after 2 days of active labor with a posterior baby(all back labor) being up the whole time and exhausted i still didnt want an epidural.
saying women would rather have an epidural than go to the OR is like saying women would rather be violently attacked than fatally wounded, id rather they both not happen.

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Old 12-13-2006, 06:49 AM
 
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after 2 days of active labor with a posterior baby(all back labor) being up the whole time and exhausted i still didnt want an epidural.
saying women would rather have an epidural than go to the OR is like saying women would rather be violently attacked than fatally wounded, id rather they both not happen.
Well I would much rather have an epi than a c-section if those were my choices. JMO I think there's a huge difference between getting the epi and having a section. I remember thinking after delivering my dd, after everything in my birth plan flew out the window, at least I didn't have a c-section, I was so thankful for that. I've had minor surgery before (laparoscopy) and couldn't walk for a week. I don't even want to think about what major surgery would be like, plus trying to take care of a baby and be successful at bf'ing while recovering. My recovery after a vaginal delivery was easy, even though I had a 2nd degree tear I was walking around an hour later, 2 days later I wasn't feeling any pain, just minor discomfort when sitting.

The problem is that I don't have a crystal ball to tell me whether getting the epi will help me avoid surgery or whether the epi will leave me paralyzed or with some other terrible fate. My reasons for not wanting to get the epi this time are because of the risks for both myself and the baby. If they had a medication without risks I would gladly take it (obviously this is hypothetical). I have no desire to be in excruciating pain. Although I don't have anything else to compare it to, I don't feel that the lack of pain in itself made me enjoy the birth of my daughter any less. It was being flat on my back, tied up to machines, and having no control over what happened to us that made my birth experience less than ideal. Missing out on holding her in those first few moments because they had to suction meconium since the meds they pumped in me most likely made her go into distress. Given the choice of going through that again, terrified that my baby wouldn't make it because the monitors were showing she was in distress and everything else I mentioned, or dealing with the pain of childbirth, I would gladly take the pain. But if those other things weren't an issue, I would be getting something for the pain from the get go.
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Old 12-13-2006, 01:23 PM
 
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I am against epis in general-- like the pps I think they lead to more c/s, harder time bfing, etc. but I do think there are a few cases where it's the lesser of the two evils (the other being c/s)-- as mentioned if mom is stuck and c/s is the next step, it may relax her enough to get the rest of the way. But that's already been mentioned and should be used with great care. But....

Has anyone considered:
An epidural may be extremely helpful (not saying "necessary") for the woman who has experienced sexual abuse and is having trouble relaxing/dilating due to the intense feelings/sensations that she is having. The epi may help distance her from her memories (even if it's just cellular memory) enough to relax & dilate. Imagine if you've been raped, or otherwise violated-- the intesity of birth could be too much to handle, especially if you haven't dealt with your feelings yet.

sorry, we're getting OT

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Old 12-13-2006, 01:54 PM
 
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I think epi's affect labor in different ways depending on how many cm you're dilated, how long you've been in labor,etc. I think that in almost all cases you are definitely safer without one though. I don't think there is any argument that the drugs go to the baby no matter what. But I think being educated about epidurals can DEFINITELY help you if you ended up with one. I wanted to birth naturally but after 35 hours of labor ended up with an epi anyway. I KNOW that being informed saved me from a c/s or an assisted delivery. The baby was having a hard time and the staff (because I had an epi) thought I couldn't push effectively... I knew that epis can work against you when pushing so I knew to have them turn down the meds before it was time to push and that I would really have to give it my all becuase otherwise they might decide to intervene. They were breaking out the forceps after only 40 min of pushing and I was like "oh no you don't!" and tripled my efforts... dd was born 5 minutes later. Being ready to try to counteract the epi's effect, I feel, saved me from assisted delivery.

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Old 12-13-2006, 01:56 PM
 
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The baby was having a hard time and the staff (because I had an epi) thought I couldn't push effectively... .
funny how all of the sudden they'll use that fact to convince you that you need help delivering but they don't warn women of that fact BEFORE they get the epidural.

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Old 12-13-2006, 03:04 PM
 
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It might be appropriate to include the role of Pitocin in this discussion, because I think that Pit contractions are difficult to tolerate, which leads to an epidural.

But why the Pit in the first place?

How many mamas and babies laboring in hospitals aren't ripe yet?.....TONS....so labor is forced to progress with Pitocin.

Sometimes when inductions/augmentations fail, a cesarean is indicated ("failure to progress")....But maybe we can cite a group of women who, thanks to epidural pain relief, are able to continue tolerating Pitocin contractions and thus avoid a c-sec.

the 80% of women who get epidurals + the 66% of women who have a vaginal birth will mean that MOST women with epidurals DO have vaginal births, right? is that decent math?
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Old 12-13-2006, 06:03 PM
 
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I had an epidural. It was pulled out, to let me labor some without it, in the thinking that perhaps it was slowing labor. I labored longer, then I had the epidural replaced. So, I got 2 epidurals.

I did end up with Pitocin and a c-section. I also had a very alert baby, complete rooming-in of my baby, and an easy breastfeeding relationship.

Everything isn't always black and white. I really feel in my heart that my baby was not coming out of me in the normal way.
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Old 12-13-2006, 07:25 PM
 
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OK, maybe I'm just in a pissy mood but there are a couple of things that need to be cleared up.

1) An intervention free birth does not mean a vaginal birth. Intervention free means no pictocin, no epi, no internals, no EFM, no IV, no C/S. Having an epi means that there was an intervention.

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!!!!

To prove my point, with my dd#2 born 3 months ago, 10 minutes before she was born, my contractions were 5-8 minutes apart, irregular and only 45-50 sec long. HOWEVER, this is the big HOWEVER, I was telling my husband, that I can't go on anymore, my legs were shaking and I was burping up lunch. Rationally, I said "I can't be in transition, my contractions are close enough or long enough...but physically, guess what....I waaasss!!!!
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Old 12-13-2006, 07:32 PM
 
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OK, maybe I'm just in a pissy mood but there are a couple of things that need to be cleared up.

1) An intervention free birth does not mean a vaginal birth. Intervention free means no pictocin, no epi, no internals, no EFM, no IV, no C/S. Having an epi means that there was an intervention.

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!!!!

To prove my point, with my dd#2 born 3 months ago, 10 minutes before she was born, my contractions were 5-8 minutes apart, irregular and only 45-50 sec long. HOWEVER, this is the big HOWEVER, I was telling my husband, that I can't go on anymore, my legs were shaking and I was burping up lunch. Rationally, I said "I can't be in transition, my contractions are close enough or long enough...but physically, guess what....I waaasss!!!!

I can only speak for myself but I didn't know about the risk internal exams carried when I had my dd. So that's how I know I was so many cm dialated when I had the epi.

Same for going to the hospital early. But then again I was induced so I was at the hospital from the start. Obviously hindsight is 20/20. I know a lot more now then I did back then about inductions, epidurals and other interventions. This time I hope to get to the hospital right around the time I feel the urge to push.
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Old 12-13-2006, 07:41 PM
 
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I'm pretty sure I've mentioned before; I went into labor during my grandfather-in-law's wake. I made it through the first wake and dinner before I made the decision to go to the hospital. I was having regular steady contractions and felt my labor progressing quite quickly, so I went in. I wanted to rest myself for the birth and take a nap or two, get out of the uncomfortable formal clothing I was in... all of this contributing to the decision to go to the hospital. Had I not gone in when I did, I wouldn't have gotten to rest as my body told me I needed to.

I know how dilated I was when I had my epi because they only checked me twice. I went from 3 cm to 7 in roughly 2 hours, and my contractions were getting stronger. I was told my labor was progressing too quickly for a "first timer", to which I replied that that was just tough because the baby was coming within an hour. I had my epi, took a 15 minute nap, and woke up to push.

I had a very pleasurable, memorable birth experience, but had I not gone in when I had, I know I simply would have been too physically exhausted to push. I needed that rest and napping that at that point, only the hospital could provide me. I needed to get myself away from the death and heartbreak I was surrounded by and be in my comfortable, peaceful birthing room with music playing and DH snoozing next to me. And that was my decision, one which I'm particularly pleased with, and refuse to feel bad, ignorant, stupid or mistaken about, despite who agrees with it or not.
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Old 12-13-2006, 07:54 PM
 
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Originally Posted by Redifer View Post
I know how dilated I was when I had my epi because they only checked me twice. I went from 3 cm to 7 in roughly 2 hours, and my contractions were getting stronger. I was told my labor was progressing too quickly for a "first timer", to which I replied that that was just tough because the baby was coming within an hour. I had my epi, took a 15 minute nap, and woke up to push.
I think this detail from your story is interesting...I doula'd a woman who started to fall asleep before the pushing stage, the "rest and be thankful" phase of labor:

from http://www.birthingnaturally.net/birth/pushing.html
Quote:
Once you have hit transition, you will soon be upon the time when contractions spread out again. They generally move to about five minutes apart but they may stop completely. Many women experience what is known as a “rest and be thankful” stage. This occurs because once the baby passes through the cervix, the uterus may need to “catch up” to be snug against the baby, because the contractions will only move the baby when the uterus is snug against the baby.
I think it's interesting that intellectually, you knew you would need an oppertunity to rest from labor, before doing the work of pushing your baby out.

I wanted to share with the group that this wisdom is also shared by the body, too...though
Quote:
But this stage, although common, is largely unknown in the hospital, where it is rarely given time to occur naturally.
from http://www.birthpsychology.com/messages/push/push.html

Sometimes we might think that only drugs can offer salvation from the rigors of labor--but sometimes it is our own bodies that will provide the comfort.
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Old 12-13-2006, 08:22 PM
 
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As to why an epi is given at 7 cm, I'll never know why....you're almost there!!!
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Old 12-13-2006, 11:01 PM
 
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Does an epi “send” you closer to a C/S?
Does it help prevent a C/S?
Or does it have no affect on the outcome?
Or is it just a case by case basis?

All I can offer is my own anecdotal information, but I had 3 full-term deliveries, epidurals with all 3, and all were vaginal deliveries. With my oldest dd, I was actually begging for a C/S during labor (I had only researched very mainstream info at that time, never heard of MDC) and my OB was very emphatic that C/S should only be used in an emergent situation when vaginal birth was absolutely not possible (the mother or baby was in inherent risk). She personally has a very low C/S rate, I believe, compared to the other OBs in the practice. At no point in any of my labors/delivery was C/S mentioned by any hospital staff members. My 2nd dd had cord involvement (cord was trapped between her head and my pubic bone), and my ds was having decels that were not recovering (cord was wrapped, we discovered during birth). But she never mentioned C/S. I don't think that my epi's prevented C/S, either, because I think my body would have delivered my babies regardless- if I were somewhere that I couldnt' have gotten an epi, my babies would still have come out vaginally, I believe, just with a lot more pain. I do think that the epidurals, in each case (even though I had a very severe complication with my last one) helped me to relax and be more aware of my birth experience and I did enjoy the experiences a lot more after the epidurals kicked in. And I had very alert, great nursing babies with great Apgars, too. But that was a personal preference, not everyone feels that the pain relief gained by an epidural is a desirable outcome, kwim?

In my case, the epidurals didn't lead to C/S, but I do believe that, generally speaking, once you start interfearing with the natural birth process, you *generally* increase the chance that you will encounter more un-natural events, including C/S. A friend's DIL had a baby last week- water broke at home, no ctx, they started pitocin, baby's heartrate was irregular- bad recovery after decels, epidural at 1cm because mom couldn't tolerate the pitocin-induced ctx, 12 hrs with no dilation, C/S due to failure to progress and "big" baby. He was 7.5lbs and she's not a small woman : So in that case, I'd absolutely say that interventions including the epidural at 1cm (which prevented mom from walking, squatting, etc. to get ctx strong and regular, and help with dilation) caused her C/S. Not cut and dry, guaranteed black and white in every case, but generally speaking, I believe that interventions can lead to C/S.

Half-marathon running Mommy to 3 spunky girls and 1 sweet boy. Spending my days and nights where my kids need me most- at home with them!!

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Old 12-13-2006, 11:39 PM
 
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I'd say case by case basis. I have heard of women who say it helped them relax when labor stalled. Great if that works for them. Problem is you don't always know if it's going to help or hinder (more likely to hinder I think). In my 1st labor, I got an epi after about 16 hours of posterior labor, thinking it might help me get past 6cm. It didn't. I found out later that epi's with a posterior baby is not a good idea. (hospital birth for posterior baby is not a good idea either!) Ended in a c/s for FTP. I think hospitals really push epi's for their own convenience (laboring moms who have epi's are easier to deal with).
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Old 12-13-2006, 11:50 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


Ditto
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