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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Kourtney Kardashian: Inspiring Women with her Zen-like Childbirth?

Two weeks ago I wrote about the way childbirth is generally portrayed, even mocked, in popular culture and how that often negatively colors women’s beliefs about birth. Sunday, however, on the season finale of the E! network reality show Keeping Up With The Kardashians, surprisingly, amazingly labor and birth were shown in a largely positive light. In the episode, which had a record 4.8 million viewers, Kourtney Kardashian, 30, calmly gave birth to her first child Mason Dash Disick (born on Dec. 14, 2009).

I have to admit I don’t actually watch the Kardashians, but thanks to Jezebel, I was able to watch some clips from the episode. (Go watch. I’ll wait.) My friend Denise, who blogs at Eat Play Love, told me that she saw the whole episode and said, “I have to admit for the K-women coming off as such primadonnas the episode/birth was shown in a great way. I was shocked.”

Instead of the typical Hollywood water-breaking all over the floor in one big “sploosh!” followed by the frantic Oh-my-God-I’m-freaking-out-and-have-to-get-to-the-hospital-RIGHT-NOW, after Kourtney’s water broke and was shown(!) slowly trickling out onto the floor, she was totally calm, did some laundry, said she needed to shave, took a shower and put on make-up all before going to the hospital. A reality TV show actually showing reality? Wow!

Then there was the birth scene at the hospital, which appeared very serene. Kourtney was surrounded by her family who all looked on in awe as baby Mason was born. She appeared very calm, even zen-like. Once the baby was half way out, the doctor asked Kourtney if she wanted to grab him and she did. She reached down between her legs and pulled her baby right out of her vagina and onto her chest. It was amazingly peaceful and really quite beautiful.

Of course that had to be followed by some commentary from her sister Khloe saying, “that’s not normal.” But uh, yeah, actually it is. That’s what normal birth can look like.

Photo credit: The Unnecesarean

I can’t find any information about whether Kourtney received an epidural or gave birth unmedicated, but she certainly looks very zen in the video. She said in this interview about labor, “It was surprisingly easy and just an incredible experience. I always thought your first is supposed to be really hard, but it was easy.”

Regardless of whether or not she had an epidural, the fact that E! showed (millions!) what a normal, peaceful birth can look like is seriously huge, especially when you consider the demographic watching this show. According to this LA Times article, “Kardashian viewers tend to be single, college-educated women with no children, white-collar jobs and annual salaries of more than $60,000.” Keeping Up With The Kardashians “is the highest-rated series on cable among women ages 18 to 34.”

The Unnecesarean had this to say:

Kourtney Kardashian and E! showing a generation of young women someone reaching down and pulling their baby out of their vagina was one of the coolest things I’ve seen in a long time. Cedars Sinai in Los Angeles has gained a reputation as the celebrity c-section center, but there’s some mother-friendly stuff going on in the clips on Jezebel.

I didn’t watch the whole episode, but I smiled at the clip of her water breaking. When do you ever see that televised beyond the ridiculous images of actors having a gallon of water dumped between their legs, then instantly doubling over with contractions and being rushed down the hall to L&D on a gurney?

Momotics said Kourtney Kardashian renewed her “faith in birth.”

I was SO impressed to see Kourtney so calm, and cool while giving birth to her son Mason who was born in December. It seems like Hollywood has had a huge rash of scheduled cesareans, inductions, and over all just horribly medicalized births and this was just a huge refresh to the Hollywood natural birth stigma.

Carla Fran from Millicent and Carla Fran calls Kourtney “awesome.”

I cannot believe, I repeat, I cannot believe that the Kardashians are paving the way for positive images of childbirth. Last night’s finale showed Kourtney Kardashian going into labor, and pretty much backing up what doulas, Rikki Lake, and your friendly neighborhood midwife have been saying all along.

This finale is tremendous because of the audience the show has. If young girls see pop icons like Kourtney Kardashian having this kind of birth experience, their expectation of the event in their own lives is changed. I hope an entire generation of people saw this and thought “I didn’t know it could be like that.”

It would seem that’s exactly what some women thought. Here are a few of the comments on the Jezebel blog:

  • Kali Mama: “While am all for freedom of choice and choosing your own birth plan, big props for girlfriend not being too posh to push. No elective c-sections or nothing.”
  • Doyouloveit: “For years I’ve been chanting that I will get a C-section if I ever procreate, ‘Knock me completely out! I want to wake up like it’s Christmas morning with a baby under the tree!’
    But wow! Kourtney was really inspiring! Why can’t it always be shown this beautifully? Great documentary film making, Keeping Up With The Kardashians!”
  • Lilspitfire: “I am not a big fan of reality TV but the way they showed childbirth in this episode was nothing but positive.”
  • La Madrugada: “Okay, as someone who’s going to give birth to her first kid in a month and a half, I have to say, this is AWESOME. I’m not a huge fan of this show, but seeing a woman laughing and relaxed while in labor is extremely cool.”
  • Gra: “I have never given birth and therefore had NO IDEA that this was even possible. Its weird to realize that everything I know about labor and birth is based on what I’ve seen in the movies.”
  • Hotpants McGee: “It’s so crazy to say this, but I think I learned something from a Kardashian! Kourt was AMAZING. I had no idea you could just pull it out! I still can’t believe it. She could have just stayed home and done it all by herself!”

Yep, the Kardashians are changing the way women view birth – for the better. Who woulda thunk it?

Cross-posed on 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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