Women in Control of Epidural During Labor Use 30% Less Anesthesia


Epidurals have become the “drug of choice” in maternity wards across the United States. As of 1997, “nearly two-thirds of all women who give birth in hospitals with high-volume obstetric units had an epidural during labor. In many hospitals, epidural analgesia is routine and is provided to more than 90 percent of all women who are in labor in that hospital.” Yet epidurals are not without potential risks for both mother and baby, which is part of the reason the findings from a new study on laboring women are so promising.

new study reports laboring women given control over their epidural anesthesia resulted in a 30 percent reduction of the amount of anesthesia used and were “basically as comfortable” as women on a continuous dose. Researchers also report a trend toward fewer deliveries that required instrument assistance, such as forceps, in the patient-controlled group.

Dr. Peter Benstein, a professor of clinical obstetrics and gynecology and women’s health at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, said:

“My personal belief is that epidurals tend to slow labor down. So, if you can get away with less medication with patient-controlled analgesia, I think it’s a wonderful thing.”

“And, it’s not a surprise to me that women used less anesthesia. If you can titrate your own medication, you’re probably not going to give yourself a lot. An anesthesiologist will tend to give you a little bit more because they want to make sure there’s no pain.”

The author of the study is Dr. Michael Haydon, a perinatologist at Long Beach Memorial Medical Center in California.

Generally, epidural anesthesia is given on a continuous basis, according to Haydon. But patient-controlled devices that can control delivery of the anesthesia are widely available, he added. Patients are given a button to push when they feel they need more medication. The devices are programmed to only provide a specific amount of medication for specific time periods to ensure that people don’t give themselves too much.

The study randomly selected first-time mothers for one of three groups: “the standard dose given as a continuous infusion; a continuous infusion with an additional patient-controlled option; and patient-controlled anesthesia only.” The first group used an average of 74.9 mg of anesthesia during labor. The second group used an average of 95.9 mg, while the patient-controlled group used the least anesthesia of all, an average of 52.8 mg, according to the study.

Women in the patient-controlled group did report slightly higher pain scores when they got to the pushing part of the delivery, but also reported being satisfied with their pain relief overall.

Women’s Views On News says:

This is good news because epidurals, despite having made labor more bearable for scores of women, have their pitfalls: they can lead to prolonged labor and an increase in vacuum and forceps deliveries. They can also result in more C-sections, which is far from ideal.

Rebecca on Babble writes:

Less meds with the same level of relief? What’s not to like here? A lower dose of medication with adequate pain management would benefit both moms and babies. I find this study so exciting because it opens up new possibilities for women as active participants, not just passive patients, in hospital births. It’s ideas like these that may help us progress toward a hospital birth model that takes into account the needs of both babies and the mothers who give birth to them.

Laura Nelson at Think Baby writes about the study’s findings and how they might impact maternity care in the United Kingdom.

Patient-controlled epidural analgesia is currently only available in one-fifth of hospitals in the UK due to the expensive costs of the equipment needed. Experts are now looking into whether the positive effects outweigh the costs.??“The technique reduces the need for anaesthetic which in turn reduces the need for forceps delivery – and it gives women a feeling of control. The question is whether the small clinical advantages are enough to justify the cost of new equipment and staff training,” Dr Elizabeth McGrady, a honorary clinical lecturer in anaesthetics at Glasgow University said to the BBC.

Personally I’m all for empowering women to be, as Rebecca said, “active participants” in hospital births. Although I did not have an epidural with either my daughter’s hospital birth or my son’s home birth, there was a point during my induced labor with my daughter that an option like this would have appealed to me (had I not had complications including low platelets that prevented me from getting an epidural anyway). I hope this study leads to hospitals adopting patient-controlled epidurals as standard practice for women who choose to have epidurals.

Related links:

  • Over at Women’s Health and Pregnancy, there’s an informative post with diagrams and pictures about how an epidural is given, as well as the pros and the cons.
  • At Anticipation and Beyond, there’s another informative post about the dangers of epidurals. The author writes, “This blog isn’t to insult those who have made this choice, but to increase your knowledge, so you can make informed choices for the future.”

Photo credit: Women Health and Pregnancy

Cross-posted at BlogHer

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Birth plan? Doula? Natural birth? Not here you don’t.

A sign posted at the Aspen OB/GYN Women’s Center in Provo, Utah has many women up in arms. What’s so offensive? Read for yourself.

The sign reads as follows:

Because the Physicians at Aspen Women’s Center care about the quality of their patient’s deliveries and are very concerned about the welfare and health of your unborn child, we will not participate in a “Birth Contract”, a Doulah Assisted, or a Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care.

I first learned of this sign from Naomi, the Denver Doula, who posted it on Facebook. Being a doula (which is misspelled on the sign) herself, she took a particular interest in it. When she called the Center and inquired with the receptionist as to why the sign was posted she was told, “in case there is an emergency we don’t want anyone to get in the way of the doctor doing what he has to do.”

Annie from PhD in Parenting was inspired by the sign to write How Not To Have a Natural Birth and believes the center might as well have said:

Because Physicians at Aspen Women’s Center care only about doing things their own way and making as much money as possible from unnecessary birth interventions, even if it poses greater risks to the welfare and health your baby, we will not participate in a “Birth Contract”, a doula-assisted, or a Bradley Method delivery. For all patients who have done any research into having the safest birth possible, please notify the nurse so that we can transfer you to a facility that cares less about control and money.

Annie added, “I guess we can at least credit them with warning women in advance. Many hospitals with the same attitude don’t have a sign hanging out front.”

Amber responded, “I always thought the big ‘trust birth’ poster in my midwives office was a little cheesy. Now that I’ve seen the alternative, I think it’s truly marvelous. Really.”

Miriam Zoila Pérez of Radical Doula wrote a post called Signs You Don’t Want to See at Your OB-GYN’s Office. She believes the sign could be translated to say:

We don’t care at all what you want as a parent, or a person in labor. We want a patient who will sit quiet and do what we say–no matter what. Oh and if you have a partner you want involved, tough. Your desires don’t matter.

Miriam adds, “They should change the name of the center to the ‘Unborn Children Center’ since they don’t seem to care too much about the women involved.”

A commenter named Janna responded saying, “That’s what bothered me most about this hateful little sign–not once is the “welfare and health” of the MOTHER mentioned, just the “welfare and health” of the “unborn child” and the “quality” of the “deliveries.” Who would want to give birth in a place where they’re the lowest priority on their caregiver’s list? I hope women in this area have other options and the opportunity to have safe, healthy, supportive births.”

Does no doula, Bradley Method birth or birth “contract” equal no women’s rights?

Summer who writes at Wired for Noise says signs like this one and stories like the lack of choice with regard to our reproductive health and doctors’ personal “birth plans” make her sometimes think Doctors Hate Women.

What does it say when women have to escape, have to run away in order to do something as normal as give birth? What does it say when women are treated like children, talked down to, insulted, lied to, and handed letters telling them what the god-head doctor will allow or not allow. When all you want to do is give birth and you’re doctor is more concerned with telling you to sit down and shut up, what is that if not hatred?

I have to agree with Annie that at least some doctors are upfront with what they will and won’t “allow” as part of their practice. Kudos to them for being honest. Hopefully that will allow women to look for another care provider while she’s still early in her pregnancy.

Rest assured if the OB/GYN I had at my daughter’s birth would have given me a piece of paper with her “rules” or had a sign posted like that at the Aspen Women’s Clinic, I would have found another care provider pronto. Instead, however, she paid me lip service and acted like she cared about my birth plan (though she didn’t act very well and that should have been a big clue for me) and said we could “try” Hypnobirthing, etc. However, when push came to shove (no pun intended), it was her way or the highway. I had my healthy baby girl at the end of it and for that I am truly thankful, but I also got a lot more than I bargained for (and not in a good way). Then again it was that experience lead me to pursue a home birth for my second child and become a home birth advocate.

Although I admire the Aspen Women’s Center’s honesty, I find it truly offensive that they imply that if a woman wants a doula, natural birth, or has a birth plan, she is not concerned with the welfare and health of her baby (so much more personal than “unborn child” don’t you think?) or is even putting her baby’s life at risk. Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily. And how exactly is choosing a Bradley birth not good for the health or welfare of the baby? “Bradley® classes teach families how to have natural births. The techniques are simple and effective. They are based on information about how the human body works during labor. Couples are taught how they can work with their bodies to reduce pain and make their labors more efficient.” What about a birth plan or “contract?” Is that harmful to the “unborn child?” The American Pregnancy Association suggests, “Creating a birth plan can help you have a more positive birth experience.”

There are other things I find offensive as well, like Janna mentioned above, the mother does not seem to be included in the equation at all. Is there any concern for her “welfare and health?”

Who’s time money welfare are they really concerned with? I’ll let you draw your own conclusions. I’ve obviously already drawn mine.

Cross-posted on BlogHer.

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One year later – Julian’s (footling breech) home birth story

NaBloPoMo – Day 28

It’s been just over a year since my baby boy made his amazing entrance into the world, and yet, I never posted his birth story on my blog. So here it is one year later – in it’s full, unedited (LONG) glory (altered only to change the midwives’ names to first initial) – for your reading pleasure. :) I think you birth junkies out there will especially enjoy it. :)

Julian - 1 1/2 hours old - 11/23/06

Julian Emerson’s birth story

Recorded on Nov. 29 and Dec. 11, 2006

My labor began around 1:30 a.m. Thursday, Nov. 23, 2006, (41 weeks to the day) when I woke up to a real contraction, not the typical toning contractions I’d been having for the past several months. This was the night after I went in for some serious acupuncture (with electronic stimulation) at the acupuncture college to bring on labor. I was excited when I had another and yet another contraction and it started to sink in that I was in early labor.

I mentioned that I thought I was in early labor to Jody when he came to bed around 2 a.m. He got me my HypnoBirthing Rainbow Relaxation c.d. sometime during the night and I listened to it with my headphones on to help me stay focused and relaxed. I went through most of the night sleeping in between contractions. When I did have one, I breathed through it and reflected on something I’d read on a Mothering.com message board. One mama said that each time she had a contraction, she thought of her body giving the baby a big hug. That thought made me smile when I read it and so I focused on all the hugs my body was giving my baby for the last time while he was in utero.

I woke up a bit before 9 a.m. on Thanksgiving Day (Nov. 23). Jody and Ava were still sleeping. I continued to have contractions though they weren’t really regularly spaced. I decided to go have some breakfast and watch TV. I had some yogurt, peanut butter toast and Pregnancy Tea and watched a bit of the Macy’s Thanksgiving Parade while I breathed through contractions. I found the TV to be a bit distracting so I turned it off and mostly lay on the couch. When I got up and moved around, my contractions picked up, but while I laid on the couch, they slowed down a bit. I was feeling pretty tired so I decided that hanging out on the couch was a good thing for now, to save up my energy for when I really needed it.

I called K, my midwife, around 10 a.m. and told her that I was in labor and what was going on with me. She said to check in every few hours – like around 1 p.m. – and let her know how I was doing. She also said she would probably come by to check on me later in the day and take my blood pressure and draw my blood so she could make sure that all was going well with me and there were no signs of HELLP syndrome (which I developed when in labor with Ava). In the meantime, she said I should go eat a big breakfast.

Jody came downstairs (and Ava soon after) and made eggs, turkey bacon and toast. I didn’t feel much like eating, but it tasted good and I slowly ate it all.

After breakfast and watching some of the parade on TV with Ava, I was still feeling really tired, so I decided to go back up to the bedroom and take a nap. That was around noon.

Before I went to sleep, I briefly talked to my sister Carrie on the phone and told her I was in early labor, but I had no idea if the baby would be born that day or when. I just wanted to give her a heads-up since she was planning on being here during the labor (once we needed her) and birth to watch Ava.

Again, I slept between contractions while I napped, but somewhere in that hour or so that I lay in bed, my contractions shifted significantly. They started to get very intense and I had to start vocalizing (or moaning) to get through them. I called out to Jody and told him that things were getting really intense and right around then the phone rang and Jody answered it. It was K (midwife) saying she was on her way by to see how things were going with me. Jody mentioned that it was good she was coming because I had just said that things were getting intense. (I later figured out that I must have been in “transition” during that time.)

I don’t recall if I asked Jody to apply counter-pressure to my back around that time or if he just instinctively did it, but it helped a lot to relieve the back labor I was experiencing.

K arrived around 1:10 p.m. She took my blood pressure, which was normal. (She never got a chance to draw my blood, but it turned out not to matter.) Then I had another contraction which I vocalized through and told her that it really hurt. She wanted to check me then to see how dilated I was. I was thinking that I hoped I was at least 5 cm dilated so that I could get into the birthing pool (which hadn’t been set up yet) or this was going to be a very, very long labor. I can’t remember if she said I was fully dilated when she checked me (though she later told me that I was complete), but she commented that the head was still really high. She felt around a bit more and then excused herself. (I found out later that that was when she discovered what she was feeling was limbs and that the baby was now breech. She excused herself so she could call A, the assisting midwife, and tell her to get to my house ASAP.)

K came back in the room and whispered to Jody that she had felt feet while she was checking my dilation. He didn’t quite realize what that meant at the time. At some point he said something aloud about the baby’s feet, which I heard and replied “feet??” (although I don’t remember this). And K said yes, the baby is breech, which I remember. I didn’t have any weird reaction to this news. I thought I remembered reading stories of babies being born vaginally in the breech position in “Ina May’s Guide to Childbirth,” so I knew it could be done. I wasn’t fearful at all. It was all just very matter of fact in my mind – the baby is breech and I’m going to have to get him out.

Somewhere in there, Jody called Carrie (three times) to come to the house. The last time he talked to her, she said she would be here in 20 minutes, but Jody said at the rate things were going that might be too late. So in the meantime, Ava hung out with me, K and Jody in the bedroom. She never seemed scared or worried for me and I think it helped a LOT that we had watched birth videos and read the “Welcome With Love” book (about a home birth) many times in preparation for the birth. In the book they mention that sometimes moms have to yell and scream and make a lot of noise when babies are born and I am thankful that it said that since I ended up making a LOT of noise myself – something I didn’t expect because I never got vocal while giving birth to Ava. At one point, K asked Ava if she could go downstairs and get her purse for her. Ava did it without missing a beat. She was a great helper.

Anyway, I think it was after K left the room to call A that I felt the first urge to push. It was a completely involuntary urge and I yelled out, “I need to push!” I remember K yelling back to go with whatever my body was telling me to do. I think it was on the next contraction or the one after that that my water broke, all over the bed. I had not planned on giving birth in bed, and because things had progressed so quickly at the end, we hadn’t even put a waterproof cover down. I remember thinking, “Oh no! I’m soaking our new mattress!” (Our mattress was only six months old. Thankfully, it cleaned up and dried out nicely.)

The baby’s feet were born first without too much pushing on my part. Jody left the room during that time and I yelled to K, “Where is he going?!” furious because he was no longer applying counter-pressure to my back. She said, “He’s getting the camera.” And I yelled, “I don’t care about pictures!” He did snap a few of the baby’s feet coming out, but only one turned out because K’s hand was in the way of the others.

Jody called the professional photographer we hired to photograph the birth around the time I started pushing, but got her voicemail. By the time she called back, the baby had been born. (We opted to have her take family pictures a few weeks later instead.)

Carrie arrived after his feet were born and took Ava downstairs since things were very intense in the bedroom.

After his feet and legs came out, K said I needed to move to the end of the bed, so that gravity would be on our side. I said, “No” emphatically, not wanting to move a muscle. K said I *had* to move, so she and Jody picked me up and scooted me to the foot of the bed. She then told Jody that we needed to get into a supported squat position, so he held me under my arms while I began to bear down with everything I had.

I started out pushing with contractions, but it didn’t take long for K to say she wanted me to push whether I was having a contraction or not. I’ve heard enough birth stories to know this meant that I needed to get the baby out ASAP, so I pushed and pushed, taking breaks just long enough to catch my breath.

While his body was being born, A (the assisting midwife) arrived.

I don’t remember birthing him as being painful per se, but it was really, really intense work. I vocalized through every push and couldn’t imagine doing it without making noise. I think I opened my eyes once and then closed them again so I could focus on pushing. I also remember moving my right hand to the top of my belly. It helped me feel more connected with the baby and the job we both were working on.

Once his body was born (but his head still inside me), at K’s urging I pushed with everything I had to get his head to come out. I remember wondering if I was pushing enough or if I would be able to do it, but his head emerged with one really hard push.

Minutes after Julian’s breech home birth - 11/23/06Mommy and daddy look at Julian - 11/23/06Our son, Julian Emerson, fully entered the world at 2:14 p.m. Thursday, Nov. 23, 2006, after about 13 hours of labor, only one of which was really intense, and about 45 minutes of pushing. It was approximately 1 hour after K had arrived to our house.

It turned out that Julian’s umbilical cord was wrapped around his neck three times. It is for that reason, my midwife and I believe, that he ended up turning into a breech position in the days or hours before he was born. It was as if he “knew” he couldn’t safely be born head-down with the cord as it was, so he flipped to a safer position – in an act of self-preservation.

Also, I later learned that his right arm was tucked back behind his head and K had to reach inside me and pull it down so that he could be born without damaging it or getting stuck. She also reached in while his feet were being born to make sure they both came out together and one didn’t get wedged in.

Jody and Ava cut Julian’s umbilical cord - 11/23/06Julian scored a measly 3 on his first Apgar, then an 8 on the second one done 5 minutes later. A gave him a few puffs of air mouth-to-mouth to help get him breathing, while they encouraged us to talk to our baby. It didn’t take long for him to start breathing, and in the meantime, he was still getting oxygen from the umbilical cord that was left attached to the placenta until it stopped pulsing. Jody and Ava cut the umbilical cord together a little over an hour after he was born.

Julian weighed in at 9 lbs., 8 oz., was 22 inches long, and had a 15 inch head. What a big boy!

After the intensity of that birth and such a large baby, I ended up with only a first-degree tear, requiring four stitches. Not bad at all.

Amy and Julian after breech home birth - 11/23/06Giving birth to a baby in the breech position felt so different from birthing a head-down baby (as Ava was). With Ava, once her head was out, it felt like the rest of her just slid right out. With Julian, I felt like I had to work for every ounce of him to be born – saving the hardest part – his head – for last.

It was an amazing, incredible and very intense experience, but, if you ask me, it could not have turned out more perfectly. We have so much to be thankful for. We have a healthy baby boy and I had a great home birth with our amazing midwife. It is a Thanksgiving Day our family will never forget!

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Related Post:
How we made the decision to have a home birth in the first place: Planning for a home birth

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