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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Booby Traps Set Up Breastfeeding Moms for Failure

Many mothers start out with the best of intentions when it comes to breastfeeding. Health experts agree that “breast is best” and the benefits of breastfeeding for both the baby and the mother are numerous. Yet while a lot of people give lip service to the importance of breastfeeding, there isn’t a lot of support for women once they make the decision to breastfeed. In fact, our society offers very little support to breastfeeding moms and often sabotages breastfeeding altogether.

How many times have you heard about a mom being told to cover up her nursing child on an airplane or at an amusement park or at a store or at a restaurant or even asked to leave or had the police called on her? How many times have you seen formula ads in parenting magazines and on television? How many times have you read a magazine article giving incorrect breastfeeding advice (or should I say formula advice) or heard of a well-intentioned pediatrician giving parenting advice that compromises the breastfeeding relationship? Has a can of unwanted infant formula ever mysteriously appeared at your doorstep?

The examples above all have one thing in common – they are Breastfeeding Booby Traps. Best For Babes (a non-profit that believes “ALL moms deserve to make an informed feeding decision and to be cheered on, coached and celebrated without pressure, judgment or guilt, whether they breastfeed for 2 days, 2 months 2 years, or not at all”) describes Breastfeeding Booby Traps asthe cultural and institutional barriers that prevent moms from achieving their personal breastfeeding goals.”

Some Booby Traps include:

  • sending moms home from the hospital with a “gift bag” of formula,
  • having family and/or friends who are uncomfortable with you nursing and ask when you are going to give the baby a bottle,
  • or having a pediatrician who is unable to answer your questions about breastfeeding.

This post is not to debate breastfeeding vs. formula-feeding. Parents have the right to decide how to feed their baby. But they also have the right to be presented with factual information and the right to not have their feeding decisions undermined. Best For Babes is working to help accomplish that.

Here are some more Booby Traps that have set the blogosphere abuzz.

Amber from Speak Her Truth wrote Marketing and Breastfeeding, Who Hasn’t Been Duped? and said she is not going “to join in on this back and forth bashing of breastfeeding vs formula feeding mothers.”

As long as we fight amongst ourselves on this one symptom we cannot unite against the disease. The disease of markets that profit solely on the belief that our bodies are not good enough, not good enough to be sexually attractive, not good enough to give birth and not good enough to nourish our babies afterwards. A simple statement that could bring down this entire empire of insecurity: “Not only are we good enough, we are better just the way we are.”

Maya from Musings of a Marfan Mom wrote about Babble’s partnership with Similac – in which Similac sponsors Babble’s Breastfeeding Guide – after first reading about it on PhD in Parenting. Maya said:

You might ask why I care whether a formula company sponsors a breastfeeding portion of a website. I care, because I want women to have a choice in how they feed their children. I care, because women aren’t being given proper information on nursing, which sabotages the attempts of women who want to breastfeed. I care because, believe it or not, formula advertising has been shown over and over again to have a negative effect on breastfeeding relationships. Formula advertising not only affects women’s choices in how to feed their children, whether they are conscious of it or not, but it results in drastically higher costs for families who choose to feed their children formula (who do you think ends up paying for the “free” samples given at the hospital and sent in the mail, as well as all those commercials and Internet ads?). That affects their choice as well.

Tumbling Boobs pointed out its not just parenting websites promoting Similac’s latest marketing ploy and included screen captures of a few medical providers that are actively promoting Similac’s feeding hotline to moms seeking breastfeeding help.

Annie from PhD in Parenting also pointed out that even WebMD’s breastfeeding guide is sponsored by Gerber (which is owned by Nestle). There are six Gerber ads on the page that is supposed to help mothers with breastfeeding! Annie, who said, “There has to be a way to stop this incredibly unethical and predatory infant formula marketing on websites pretending to offer breastfeeding support,” urges her readers to take action and lists a few ways to get involved.

Jem wrote a review of the book The Politics of Breastfeeding (which I will be adding to my must read list). She believes the book should be read not only by nursing moms, but by all women.

Reading the book frustrated me on so many levels. I’ve talked before about Nestle’s marketing practices before, but it goes beyond that. The origins of formula; unnecessary death of babies in both developed and ‘third world’ countries; the undermining of women because we’re “not good enough”/”not reliable enough” to maintain life; the supplementing with formula without permission from mums; the strange habit of separating babies from their mums in hospital, etc.

This book has changed the way I look at so many aspects of birth and infant care.

Taking a more light-hearted approach to the subject is Dou-la-la who’s humorous, but also disturbing post Breast is Best, Sponsored by Simfamil: Don Draper Explains It All For Us is sure to be enjoyed by many a Mad Men fan. Heck, I thought it was awesome and I’ve only watched about 15 minutes of Mad Men.

What is the solution? How do we stop undermining breastfeeding moms?
I think the best start is if formula companies would start following the World Health Organization’s International Code of Marketing Breast-Milk Substitutes. We all know formula exists. We all know where we can get some (even for free), if we so desire. The marketing and the deceit need to stop. If you are upset about the Babble/Similac partnership or the WebMD/Gerber/Nestle partnership, follow Annie’s lead and take action. Let the companies know you disagree with their choices and why and then spread the word.

“Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” — Margaret Mead

More Breastfeeding Booby Trap Posts:

Photo by benklocek via Flickr

Cross-posted on BlogHer

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First stitches – Wordless Wednesday

On Monday afternoon, Julian took a header into the corner of the coffee table at my sister’s office. I had just left and missed the trauma, but returned momentarily after my sister called me and we piled into the car and took him to the ER. Julian got 7 stitches above his left eye and was quite the little trooper.

In the ER, before stitches:

Later that day at home, after stitches:

In the moment, it wasn’t hard to be present for my little guy as he was restrained and stitched back up, but when I think about it now, after the fact, it makes me feel sick to my stomach. I hope I don’t have to go through that again anytime soon. You hear me, coffee tables?? Stay away from my kids’ heads! (We actually retired our coffee table to the basement years ago.)

I’m happy to report that Julian’s been acting just fine since the incident. His eye is mostly swollen shut, but it’s not affecting his desire to play and be his goofy ol’ self.

Ava decided to commemorate the occasion by drawing a portrait of Julian with his ouchee.

Julian gets his stitches out on Saturday – two days before his 3rd birthday. :P Happy birthday, wild boy!

See more Wordless Wednesday posts at the original WW home and at 5 Minutes for Mom.

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Guest post: Healthy bodies are good for the environment

After witnessing a site hacking on my very own blog (fer realz) and having a lot of crazy stuff going on in my personal life, I just haven’t been up to blogging this week. Thankfully, I have a guest blogger to fill in for me today. :)

Today’s guest post comes from Beth Terry of Fake Plastic Fish (thank you, Beth!) and is very timely considering all of the illness that has been plaguing the Crunchy Domestic Goddess household as of late. Beth works hard to live life with as little plastic as possible and to help others figure out plastic-free alternatives via her blog, Fake Plastic Fish.  Her plastic epiphany occurred in mid-2007 after stumbling upon the article Plastic Ocean, which she feels should be required reading for anyone who wonders what all this fuss is about plastic.

Healthy bodies are good for the environment

The ferocious flu that hit me several weeks ago resulted in quite a few trips to Kaiser Permanente. During one of those visits, I noticed something in the public restroom I’d never seen there before: a green bin and green liner… telltale signs of composting afoot. I moved in to take a closer look. Sure enough… compostable liner and a sign above the bin instructing users to deposit paper towel waste there.

Sick as I was, I had my camera with me and the presence of mind to snap a few shots, while curious restroom users stared. I forgot about this green moment in Kaiser until reading the Ecology Center‘s recent issue of Terrain Magazine on BART this morning, particularly the article, “When More then the Scrubs are Green.”

The piece describes the efforts of some medical institutions, including Kaiser, to reduce waste and switch to environmentally-safer products… from the food they serve patients to the carpets and furniture installed in buildings. And it points out that while a few hospitals have made changes to lighten their ecological footprint, most go through immense amounts of waste each day, much of it toxic, in an effort to protect patients’ health. Ironic, no?

But the part of the article that really hit me came towards the end (emphasis mine):

No matter what percentage of its trash a hospital recycles, or how local its food is, or how sustainable the building, the uncomfortable truth is that modern medical practices have a big impact on the environment…. Possibly the best way for each of us to reduce the impact of hospitals on the environment is to do our best to avoid using them. That means making lifestyle choices like eating well and exercising, and advocating for better access to good food and laws that clean up our air and water.

In my case, of course, it also means getting more sleep.

We often think about the relationship between ourselves and our environment in exactly the opposite way. Pollution in our air, water, and food is harmful to our bodies. This article shows one way that our sick bodies can then contribute to further degradation of our environment. It’s a vicious cycle, and someone needs to stop pedaling!

I’m guilty as charged. I stay up way too late. I imbibe excessive quantities of caffeine (My dentist advised me yesterday to give up coffee and I replied, “But I have. Many, many, many times.”) and sugar and baked goods. My exercise routine is suing me for neglect (I will run again, I swear!) and my ass is getting flatter by the minute from so much sitting. Many of you have heard this litany from me before.

What I’m doing to my body is not just harming me… it’s harming the whole planet. Yeah, fundamentally there’s no real separation between me and anything else anyway. But on the level of everyday human experience, it’s good to have a concrete reminder that the excuse, “I’m only hurting myself,” is ultimately meaningless. When I get sick, sickness in the world increases. Medical waste increases. Medical spending increases too! Actions become ineffective. It’s all just one big FAIL.

Now, before anyone jumps on me for “blaming the victim,” I’m not saying that people don’t get sick for totally random (as far as we can tell) reasons or due to factors over which they had no direct control. What I am saying that wellness is the responsibility of all of us… for all of us.

Healthy choices we can make that have far-reaching environmental consequences include:

1) Buying less plastic
2) Choosing organic food
3) Eating more plants and fewer animals
4) Driving less and biking/walking more
5) Practicing relaxation techniques like meditation, stretching, & breathing
6) GETTING ENOUGH SLEEP!

What are some ways that you keep both your body and the environment healthy?