Epidurals

Effect of Epidurals on Labour

I have to present a seminar soon on Epidural pain relief in labour – not my choice, I hasten to add, so has anyone got any juicy references as to the risks and the detrimental side of Epidurals?

I only qualified in Aug 98 and I was stuck with one of talks that you did not really want to present. However we put a twist to ours and also looked at the effects of directed pushing with an epidural (ie the valsalva manoeuvre, you know, “Hold your breath and PUSH, longer longer….take a quick breath and again…..” – I shudder to think! ) as compared to physiological (spontaneous) pushing.

One author who is very interesting was Caldeyro Barcia 1981 – he said that directed pushing leads to declerations and acidosis.

Another article by Thorp et al (1990) “Effects of Epidural Analgesia: Some questions and answers” states that epidurals may increase the rate of c/s etc…. He lists many problems with epidurals ie malpresentation, prolonged first and second stage etc.

Second ref. is also by Thorp (1996) “Epidural analgesia in Labour: Evaluation of risks and benefits”, It is concluded that epidurals should remain a choice for women but they must not hear the pros and cons at the time of labour.


I’m a mature midwifery student… my particular difficulty of the moment lies with epidurals and their effect on normal births.

When discussing pharmocological pain relief in college we are told that women having an epidural for pain relief in labour are ‘more likely’ to have an instrumental birth. Similarly I have heard community midwives in the antenatal period say the same thing to women, that they are ‘more likely’ to have ventouse or forceps to assist their’s baby’s birth if they have an epidural.

In the hospital where I am on delivery suite, there is a new pamphlet on pain relief written for women by anesthetists, which says in black and white that if a woman has an epidural, she is more likely to have a ‘normal delivery’. I spoke very briefly to an anesthetist about this statement, and he said that there is no evidence to support the fact that epidurals increase the likelihood of instrumental delivery in multiparous women and there was only a possible association with epidurals and instrumental delivery in primiparous women. The medical student who was with him agreed wholeheartedly with this.

I have a large number of problems with this:

  1. Statistics for a three month period at the hospital I work in show that multiparous women who start labour spontaneously and have an epidural have a 25-57% chance of having a normal birth. Multiparous women who start labour spontaneously and do not have an epidural have an 88-96% chance of having a normal birth. Surely these statistics like these do point to at least a clear association between epidurals and instrumental deliveries?
  2. If we can’t say statistically that epidurals increase the likelihood of instrumental deliveries, then surely we can’t say they decrease it either?
  3. If medical students are being ‘brought up’ on this sort of reasoning it does not bode at all well for the next generation of doctors.
  4. Does anyone else give a percentage figure when they talk to women about epidurals and instrumental deliveries and if so what, and where do they get the figures from.

Sarah


If you would like to send me the information leaflet, AIMS will do a critique of it and challenge the hospital.

Beverley Lawrence Beech
www.aims.org.uk

PS AIMS never reveals its sources.


Can I suggest that you try a lunchtime session/debate? Ask one of the consultant anaesthetists to discuss the issue and you and your colleagues can put your evidence. Have a vote, then go to whoever (such as your tutors) has input into getting information to women and withdraw the offending document. You will note that I am assuming you will carry the day!

Lesley


From our last 2 years of team stats:

  • 1998 Epidural= 42% chance of a ‘normal’ vaginal delivery, 1999 Epidural= 46% chance
  • If no analgesia, 100% chance of a ‘normal’ vaginal delivery , so what’s different about these women?
  • Entonox only – 1998 81% chance, 1999 98% chance
  • Pethidine – 1998 76% chance, 1999 53% chance

Only 15% of the women we care for use Pethidine and 12% epidurals. We do have small numbers but every time I do the stats I ask myself that question – what’s different? Maybe one day I’ll do some research, but for the life of me I don’t know where you’d start considering all the variables!!

Cate

I can deeply empathize with your frustration! And I am *always* thrilled to hear about student midwives asking these sorts of questions, taking on these issues!

One idea: would it be possible to bring these very stats, from your very own unit, to the doctors in question? They may well of course deny that this “small” sample is relevant to all women getting epidurals, as a whole, but it could be a start, bringing the “facts” about epidurals and deliveries in their very own unit to their attention?

Mind you, I do not expect this simple exercise to make things change overnight, but, as a start?

Laura


Station and cervical dilation at epidural placement in predicting cesarean risk.
AUTHORS: Holt RO; Diehl SJ; Wright JW
AUTHOR AFFILIATION: Coastal Area Health Education Center, and New Hanover
Regional Medical Center, Wilmington, North Carolina 28402-9025, USA.
SOURCE: Obstet Gynecol 1999 Feb;93(2):281-4.
CITATION IDS: PMID: 9932570 UI: 99129350

OBJECTIVE: To compare station and cervical dilation at the time of epidural placement for predicting cesarean delivery risk. METHODS: This prospective cohort study included 275 women in labor with live, singleton fetuses at term in vertex presentations. We excluded women with preeclampsia or previous cesarean deliveries. A multiple logistic regression model evaluated demographic and labor-related variables’ associations with cesarean risk.

RESULTS: Fifty-nine of the 275 patients receiving epidural analgesia (21.5%) were delivered by cesarean, whereas 216 (78.5%) delivered vaginally. Variables that proved to be statistically significant in increasing the likelihood of cesarean were station at time of epidural placement (odds ratio [OR] 5.3; 95% confidence interval [CI] 2.6, 11.0; P < .001) and nulliparity (OR 3.8, 95% CI 1.8, 8.0; P < .001). Cervical dilation at the time of epidural placement was not a statistically significant predictor (OR 1.2, 95% CI 0.9, 1.6; P = .26). Cesareans were performed in 43 of 129 women (33.3%) who received epidurals with the vertex at a -1 station or higher, whereas only 16 of 146 women (11.0%) had cesareans if placement of the epidural was done after the vertex had reached at least a zero station.

CONCLUSION: Station at the time of epidural placement was more accurate predicting cesarean risk than cervical dilation. Placement of the epidural after the fetal vertex has become engaged in the pelvis (at least a zero station) resulted in a substantially lower cesarean risk.


Epidural versus non-epidural analgesia for pain relief in labour

Howell CJ

ABSTRACT

Background: Epidural analgesia is effective in reducing labour pain, but the possible adverse effects are not clear.

Objectives: The objective of this review was to assess the effects of epidural analgesia on pain relief and adverse effects in labour.

Search strategy: The Cochrane Pregnancy and Childbirth Group trials register was searched.

Selection criteria: Randomised trials comparing epidural analgesia with other forms of analgesia not involving regional blockade, or no intervention.

Data collection and analysis: Eligibility and trial quality were assessed by one reviewer. Study authors were contacted for additional information.

Main results: Eleven studies involving 3157 women were included. Epidural analgesia was associated with greater pain relief than non-epidural methods, but also with longer first and second stages of labour, an increased incidence of fetal malposition, and increased use of oxytocin and instrumental vaginal deliveries. With new trial data included, no statistically significant effect on caesarean section rates could be identified.

Reviewers’ conclusions: Epidural analgesia appears to be very effective in reducing pain during labour, although there appear to be some potentially adverse effects. Further research is needed to investigate adverse effects and to evaluate the different techniques used in epidural analgesia.

Citation: Howell CJ. Epidural versus non-epidural analgesia for pain relief in labour (Cochrane Review).

In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.


Epidural treatment for labor lessens woman’s pain, increases complications

Study of 869 women with uncomplicated pregnancies randomized to epidural or IV opiate analgesia. Found that epidural was more effective for pain relief, but increased risk of caesarean section by a factor of between two and four, regardless of the woman’s parity.

(www.swmed.edu/home_pages/news/epidural.htm)


You could also refer the consultant to the MIDIRS ‘Informed Choice’ leaflet on epidural pain relief in labour which cites plenty of research (5 studies including the stuff on the Cochrane Database) which demonstrates that:

epidurals are associated with a threefold increase in the instrumental delivery rate‘ and ‘epidurals are associated with a doubling of the CS rate for dystocia‘.

HOWEVER the same leaflet also cites two studies (both American) that suggest that ‘if the epidural is inserted later in labour there will be less interference with the progress of labour and a higher chance of a normal delivery‘ – although it doesn’t define what ‘later’ means.

The leaflet concludes that one of the questions that remains unanswered is ‘does insertion of the epidural later in labour increase the likelihood of a normal vaginal birth?

I would be interested to know if anyone else has weighed up this evidence and has any more conclusive (or more recent) evidence. The midwife I am working with certainly believes that it reduces the length of the labour, but then we come back to the question … what is so wrong with a longer labour? Aren’t babies meant to come slowly? Another question, I know, and maybe most women want a shorter, pain-free labour?

Clare


Surely these statistics like these do point to at least a clear association between epidurals and instrumental deliveries?

They do suggest there might be an association, and I am certainly no beliver in epidurals helping ‘normal birth’. However, if I was a doctor at your hospital seeking to defend the assertion that epidurals don’t affect the rate of instrumental deliveries, I’d say that this was probably the result of confounding factors.

Women having difficult labours for various reasons – slow dilation, malpresentation, excessive pain – are more likely to request an epidural because they are in greater pain, or more tired, than women having straightforward labours. And they are also more likely to end up with instrumental deliveries. The classic example might be posterior babies. Now, I don’t doubt that this really is a factor in some cases, but what proportion of them?

One way to tell would be, presumably, a large trial looking at women who had booked an epidural *before labour started*, and who got it at the desired stage. But:

a) what would the control group be? Unless you have a population of women who are otherwise comparable, but simply don’t have access to epidurals, it’s going to be difficult to avoid the situation where women with difficult labours opt for epidurals, and
b) you could also argue that perhaps the women who book epidurals before labour starts are those who either have a lower tolerance of labour pain generally, and perhaps this might also affect outcomes in the second stage. For example, these women might not want to have the epidural turned down so that they could push the baby out themselves. Or the women booking epidurals early on might have had more difficult first labours, which influenced their decision, but also increased their risk of instrumental delivery later on.

The combination of anecdotal and statistical evidence that epidurals are associated with an increase in instrumental deliveries seems too strong to ignore, but there are a lot of factors to be separated out.

What about reports that one of the problems with epidurals is the lack of muscle tone in the pelvic floor making it harder for the baby to rotate in order to be born? Does anyone have a reference for this?

Re the Midirs leaflet:

The leaflet concludes that one of the questions that remains unanswered is ‘does insertion of the epidural later in labour increase the likelihood of a normal vaginal birth?’

I assumed this meant does it increase the likelihood of a NVB *relative to* early epidural insertion, not per se. But it sounds like the leaflet that Sarah’s anaesthetists are giving out is claiming that epidurals increase your chances of a normal vaginal birth overall…. bizarre. I would love to know what their control group was!

Angela


The anaesthetist I was speaking to took a similar line, saying that it would be impossible to do a fair randomised controlled trial concerning epidurals and the outcome of labour, firstly because it would be unethical to randomly allocate women, and secondly the results would be inconclusive because it would be impossible to account for all the variables.

I found a reference for epidurals preventing rotation of the baby’s head in Midwifery Practice Core Topics 2 :Mander, R. (1994) Epidural Analgesia, 2 Research Basis. British Journal of Midwifery 6: 259-63. I haven’t actually read it but it says that Mander suggests that epidurals cause ‘relaxation of the pelvic floor (which) prevents rotation of the fetal head, especially in the second stage’.

Sarah


Any anaesthetist who says that it is unethical to undertake a randomised controlled trial of epidurals (or anything else for that matter) because it would be unethical to randomly allocate women, and secondly would be inconclusive because of the variables, clearly has little or no knowledge of randomised controlled trials.

It is unethical NOT to undertake an RCT to establish the affects on the outcome of labour and, just like ultrasound, the doctors are using this excuse to justify their failure properly to evaluate this form of pain control. Furthermore, RCTs are specifically designed in order to deal with the variables!

Where has this man (or women) been for the last ten years?

Beverley Lawrence Beech
www.aims.org.uk


Beverley asked, about the anesthetist who was concerned that a RCT on epidurals would be unethical: “Where has this man (or women) been for the last ten years?”

Answer: Behind our backs, messing about with pointed objects and dangerous substances where we can’t see what is going on.

Rachel


There was a trial in Perth, Western Australia last year on the intrapartum manangement of pain. Primips were recruited in pregnancy and then allocated (if less than 4cm on admission) to epidural or midwifery support. It was called the IMP trial. I am not sure if it has been published yet or not.

Kirsten


Multiparous women who start labour spontaneously and have an epidural have 0% ‘normal’ births. They may have a 25-57% chance of a vaginal delivery. Which makes me question the claim that 88-96% who do not have an epidural have a ‘normal’ birth. Women who have their waters broken artificially, induction or acceleration with drugs, epidural anaesthesia and episiotomy do not have normal births – they have obstetric deliveries, and it is this confusion which blinds women, and midwives, to the reality of birth in the majority of obstetric units. Most women will enter anticipating a normal birth but less than 10% will actually achieve it.

Time and again, AIMS hears women describe their ‘normal’ births as: breaking the waters, setting up a drip because they did not progress, epidural, long periods of electronic fetal monitoring, episiotomy and because they delivered vaginally, and the midwives wrote normal delivery on the notes, the women see their very painful births (often stranded on a bed) as ‘normal’.

We always explain that they did not have a normal birth they had an obstetric delivery, and we really need a concerted campaign to reclaim the definition of ‘normal’. What happens in the majority of our large, centralised, obstetric units is not normal, but it is a common experience.

By AIMS’ definition of normal birth, less than 10% of women under obstetric care achieve a normal birth (and we suspect the figure is far less among primigravidas). The present system of data collection does not easily allow us to identify normal birth, but a fairly accurate assessment can be made.

AIMS has recommended that the statistics are collected in the following form:

  • Artificial Rupture of membranes YES/NO
  • Induction of labour YES/NO
  • Acceleration of labour YES/NO
  • Epidural anaesthesia YES/NO
  • Episiotomy YES/NO

(Note: if the response to any of the above is YES, then the birth should be recorded as an obstetric delivery)

Type of delivery:

Normal birth YES/NO
Obstetric delivery YES/NO

***

Epidurals Versus Water:

Obtain a copy of the MIDIRS Informed Choice leaflet for professionals. It gives the research evidence for the following statements:

Epidurals are associated with:

  • a doubling of the caesarean section rates for dystocia;
  • a threefold increase in the instrumental delivery rate;
  • a rise in maternal temperature (You may recall that paediatricians were expressing concern about the temperature of the water where women wanted a water birth on the grounds that a high water temperature could cause brain damage to the babies -interestingly they have made not comment at all about epidurals which cause a rise in maternal temperature to a fever level! A level which could not be achieved by immersion in water!)

Beverley Lawrence Beech
www.aims.org.uk


It is worth checking the Cochrane library on this subject. Epidural analgesia and birth outcome formed the basis of my recent PhD, and the extensive literature review I carried out demonstrated a clear association between epidural analgesia and instrumental birth in primiparous women (although the effect is not clear in multiparous women).

The most recent RCT on the subject reports no association with LSCS, but a close reading of the text indicates that the link with instrumental vaginal birth remains. The abstract, however, may mislead a reader into thinking that there is no such association.

Soo


I am a first year student midwife (also mature)and can honestly say that I have only seen one vaginal birth with an epidural since starting my course. Prior to starting this course I worked as a nursing auxiliary on a labour ward and attended a phenomenal amount of instumental births. The majority of the women involved had an epidural in situ.

My problem is that the midwives I have observed and worked with do not seem to stress to the women the downsides of epidural. In fact I have found myself in total dismay at some midwives who continually ask labouring women if they want an epidural. I have also found myself feeling extremely proud of the women who stick to their guns and profusely refuse an epidural.

Amanda


I have found myself in total dismay at some midwives who continually ask labouring women if they want an epidural.

This is sooo true! Why? Because unless a midwife has worked through all her own feelings about pain and labour – has complete confidence in the female body’s ability to give birth – and, above all, has the communication skills, practical knowledge and self confidence necessary to support a woman in strong labour, an epidural seems the easiest way out – for everybody concerned.

As for me, after a 10 year gap, I just can’t cope with all those forms and tubes and wires and drugs and obs and hassle. I’d rather carry the woman on my back around the car park, if it helped her cope in labour – than organise an epidural.

Hannah


I was a mature student, but now qualified. I had an epidural with my first daughter 10 years ago, it was a really heavy block – was topped up hourly between 10am and 9pm, felt ‘something down there’ around 9:20 pm, midwife said it couldn’t be baby as I’d not long been examined. However, did look under the sheet and told the medical student to get her gloves on – had a baby 2 pushes later!! Only had perineal/vaginal lacerations, one of which required 2 small sutures. However, I didn’t particularly enjoy the experience of augmentation and being continuously monitored – which led to 2x fetal blood samples being done.

I always give full explaination of epidurals – and state the higher incidence of instrumental delivery/augmentation. Some women, with OP labours, desperately need one, and on these occasions I have tried everything else.

Sometimes women I have looked after have coped really well (even with OP – occiput posterior- labour)- I have gone off shift and returned next morning to find the midwife who took over care recommended epidural – and she had it within the hour. I have also heard midwives speaking at the nursing station – basically saying it’s going to be a long shift with a woman making ‘heavy weather’ of labour – you know that within the hour that woman will have an epidural!

Of all the women that I have taken over care for, where an epidural is sited, I have rarely seen an ‘SVD’ – usually ventouse. Recently I’ve seen failed ventouse – forceps, and a failed ventouse – LUSCS – this baby was quite large, and there was difficulty delivering the shoulders at C/S, and as I recall, the epidural had never been fully effective.

You have to wonder if an operative delivery is more obvious because that is what led to the epidural in the first place – a difficult and prolonged labour which then required augmenting (another side-effect of epidural). But does the epidural mask the outcome (ie obstructed labour) in these cases?

Cheryl

Mobile Epidurals

Low-Dose Mobile Epidurals associated with fewer complications of labour

Effect of low-dose mobile versus traditional epidural techniques on mode of delivery, The Lancet, 7 July 2001
http://www.thelancet.com/journal/vol358/iss9275/artid/16821

The Lancet Editorial Commentary on the study


I have been encouraging women who had had ‘mobile’ epidurals into hands and knees position – or what ever they found comfortable, until there was a case where a woman sustained an injury through not being able to FEEL if she had got a limb into an awkward position or not. There followed a memo (from the anaesthetists? can’t recall) which forbade us to encourage alternative positions for this reason.

Yet another reason to avoid epidural, if you ask me. But some women prefer them, so one has to work around them.

Terri


If a woman has a ‘mobile’ epidural in situ and is no longer allowed to adopt any position she chooses (or is advised), what is the point of having a ‘mobile’ epidural? Does anyone know of any research into the long-term effects of mobile epidurals?

Beverley Lawrence Beech
www.aims.org.uk


No, but because I’m in mega cynical mode and there is this new group of epidural fixated individuals called obstertic anaethetists I think we can all guarantee that any research out there will be pro-mobile epidural and state that there are no long term problems, the same way the research says that back pain isn’t a problem!!!!!

Cate


My personal POV on mobile epidurals……..

After training at a centre that pioneered mobile epidurals the whole concept is open for debate. Yes a woman may be mobile for one or two “top-ups” but as the epidural medication builds up (in most cases) the woman is soon immobile and resting in bed unable to support her weight in any position she may want to try. To my knowledge a mobile epidural has the same problems as a standard epidural.

Robyn


I have rarely seen any woman who is truly mobile after one of these so-called ‘mobile’ epidurals. The only benefit I can see is that the woman is able to retain some use in her legs and lower body which allows some limited movement. This may have implications in avoiding pressure sores developing during a long labour ( a whole other issue in itself) and it may also be easier for her to change positions albeit in a very limited way. I think the term “mobile” in relation to these epidurals is misleading and should be abandoned by health professionals because there are as many problems associated with these as with the conventional epidural.


Effect on the Baby?

Changes in Foetal Heart Rate Patterns

PerinatalMedizin Vol: 10, Issue: 4, pp. 113 – 117, August 26, 1999
Title: Changes in fetal heart rate patterns during epidural anaesthesia 
Authors: Korebrits, C.a; Kuhn dos Santos, J. F.a; Brückner, J.b; Dudenhausen, J. W.a

Abstract (English):

Objective: Continuous lumbar epidural anaesthesia is commonly used for analgetic treatment during labour and delivery, It is still a matter of controversy whether epidural anaesthesia has direct or indirect side effects on the fetus. It has been reported that local anaesthetics can cause changes in the fetal heart rate patterns in the sense of direct myocardial side effects. The objective of this study was therefore to carry out a precise cardiotocogram (CTG) evaluation before and after the insertion of an epidural anaesthesia needle.

Methods: A total of 88 patients who had received epidural anaesthesia during labour were included in the study. The epidural anaesthesia was performed with bupivacaine in a lateral position. The CTGs of these patients were examined retrospectively. Thirty-minute periods of the CTG before and after insertion of the epidural needle were compared according to the following criteria: basal frequency, oscillation amplitude, accelerations and decelerations. In addition, maternal heart rate and blood pressure before and after the epidural were evaluated and compared.

Results: After the insertion of the epidural needle a change in the oscillation amplitude and an increase in variable and late decelerations was observed. There were no significant changes in the other CTG criteria and no changes in maternal heart rate and blood pressure.

Conclusions: No maternal parameters such as a fall in blood pressure can be made responsible for the changes in fetal heart rate patterns after insertion of the epidural needle. These findings raise the possibility that changes in the fetal CTG might be due to direct cardiotoxic side effects of the local anaesthetic.


Neonatal Sepsis

Pediatrics 1997 Mar;99(3):415-9 1: Pediatrics 1997 Mar;99(3):415-9
Epidural analgesia, intrapartum fever, and neonatal sepsis evaluation. 
Lieberman E, Lang JM, Frigoletto F Jr, Richardson DK, Ringer SA, Cohen A
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

OBJECTIVE: Although several studies have documented an increase in maternal temperature associated with use of epidural analgesia during labor, none have investigated the impact of epidural use on the rate of intrapartum fever or the consequences for the fetus and newborn of this elevated maternal temperature. This study evaluates the impact of epidural analgesia use during labor on the rate of intrapartum fever and the performance of neonatal sepsis evaluations and treatment with antibiotics.

METHODS: We studied 1657 nulliparous women with term pregnancies and singleton vertex fetuses who were afebrile at admission for delivery. The rates of maternal intrapartum fever >100.4 degrees F, neonatal sepsis evaluation, and neonatal antibiotic treatment according to use of epidural analgesia during labor were determined. Rate ratios and 95% confidence intervals (CI) were calculated. Multiple logistic regression was used to examine associations while controlling for confounding factors.

RESULTS: Intrapartum fever >100.4 degrees F occurred in 14.5% of women receiving an epidural but only 1.0% of women not receiving an epidural (adjusted odds ratio (OR) = 14.5, 95% CI = 6.3, 33.2). Without epidural, the rate of fever remained low regardless of length of labor; with epidural, the rate of fever increased from 7% for labors < or = 6 hours to 36% for labors >18 hours. Neonates whose mothers received epidurals were more often evaluated for sepsis (34.0% vs 9.8%; adjusted OR = 4.3, 95% CI = 3.2, 5.9) and treated with antibiotics (15.4% vs 3.8%; adjusted OR = 3.9, 95% CI = 2.1, 6.1). Although 63% of women received epidurals, 96.2% of intrapartum fevers, 85.6% of neonatal sepsis evaluations, and 87.5% of neonatal antibiotic treatment occurred in the epidural group.

CONCLUSIONS: Use of epidural analgesia during labor is strongly associated with the occurrence of maternal intrapartum fever, neonatal sepsis evaluations, and neonatal antibiotic treatment.

PMID: 9041298, UI: 97193713


Intrapartum Death

Does anyone have any experience of a baby dying or showing a suboptimal CTG trace during or immediately following the insertion of an epidural or spinal? Does everyone monitor the baby’s heart during the epidural/spinal procedure?

I have had a situation where the baby was apparently healthy before the epidural and dead when we listened afterwards. A friend knows of two such situations and one where the CTG was ominous.

D, Midwife


I’ve always noticed that the baby reacts to epidural analgesia. Usually I note a quiet or sleep trace following insertion of an epidural. It has never gone beyond this unless there were prior problems and usually I find that the trace improves after 30 mins or so.

Where I’ve used top-ups the situation re-occurs with each top-up, but not with continuous infusion – presumably because the baby adjusts to a constant rate of the drug.

Jade


Epidural paralyzed women get news

A TV show called EXTRA (www.extratv.com) featured women paralysed after epidurals:

It started talking about how most of us assume childbirth will be safe and few of us expect to leave the hospital anything but healthy with a healthy baby. But to these women who were paralysed it was not to be the same ever again……! One woman was paralysed and confined to a wheel chair- the other was actually one of those who had the epidural go up and cause respiratory arrest and spinal cord damage. She is brain damaged and now her children care for her rather than the other way around. Very very sad stuff.

Details of another case from the show on the web (dated) March 10th, 1997, copied below:

morgaine

Monday March 10th, 1997

Epidural Nightmare

Any mother can tell you that nothing compares with childbirth pains. That’s why 90% of expectant moms use epidurals during their delivery. But the procedure can be risky…with the possibility of paralyzation!

During the procedure, an epidural needle is inserted near the base of the spine. The needle then injects anesthetic to kill the pain of childbirth. But if an epidural is done incorrectly, vital nerves can be damaged…which is what happened to Kathryn Erickson, who used to love to dance and waterski. But now she has problems just getting up the stairs.

Kathryn knew something was wrong…she’d been through an epidural before, and it didn’t feel right. Her son Shane was born healthy, but soon afterwards nurses began to notice Kathryn’s blood pressure was running low. She couldn’t even walk herself out of the hospital when it came time to leave.

For 7 months, wheelchairs and therapy were her life. Kathryn still has problems moving her left leg, walking is difficult, and she’s often in pain. She’s suing the anesthesiologist…who she believes damaged the nerves in her spine.

Doctor Wayne Kleinman is an anesthesiologist at Tarzana hospital near L.A., and administers epidurals to women in labor. He says problems with epidurals are rare, but admits that the procedure can be scary.

As for the Ericksons, three years after Shane’s birth they are still trying to prove the epidural was to blame. And Kathryn is still trying to adjust to life with limitations: “I miss my old self a lot. It’s kind of almost like getting old overnight.”

There are other alternatives to epidurals. A general anesthesia can be administered with an IV…or a painkiller can be injected into the birth canal. You should consult your doctor for the best option.


Links to other sources of information:

The Epidural Express: Real Reasons Not to Jump On Board by Nancy Griffin
The history and practicalities of epidurals, and a discussion of side-effects for mother and baby, with references. Suggestions for other ways of managing pain.

Medical Risks of Epidural Anesthesia During Childbirth, by distinguished doctor-midwife couple Lewis and Morgaine Mehl-Madrona – a comprehensive and well-referenced paper.
(www.healing-arts.org/mehl-madrona/mmepidural.htm)

Epidurals – Dead from the Waist Down? by Beverley Lawrence Beech, of AIMS
(www.aims.org.uk/jnlspr98b.htm)

All About Epidurals, by Sarah Buckley, in the Compleat Mother
(www.compleatmother.com/epidural.htm)

PRO/CON Clinical Forum: Labor & Epidural Analgesia – Debate between an anesthiologist and two obstetricians, about effect of epidurals on labour.
(www.soap.org/archives/epilabor.htm)

Common and Not So Common Complications of Epidural Anesthesia by Eveline Faure, MD
(http://dacc.bsd.uchicago.edu/library/articles/complications.html)

Epidural Photo Sequence – shows insertion of epidural catheter.
(http://doyle.ibme.utoronto.ca/Epidural/epidural.htm)

Epidurals – recent findings re maternal fever and neonatal sepsis. From Anesthesiology by Paul Ting.
(http://anesthesiology.about.com/health/anesthesiology/library/weekly/aa091597.htm)

Effect of low-dose mobile versus traditional epidural techniques on mode of delivery, The Lancet, 7 July 2001
http://www.thelancet.com/journal/vol358/iss9275/artid/16821


AH updated 7 July 2001

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