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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Health Care Reform Lends Support to Breastfeeding Moms, But Is It Enough?

If we’ve heard “breast is best” once, we’ve heard it a thousand times. Health experts agree the benefits of breastfeeding for both the baby and the mother are numerous. A study published earlier this week by the journal Pediatrics points out just how valuable breastfeeding can be. “If 90 percent of new moms in the United States breastfed their babies exclusively for the first six months, researchers estimate that as many as 900 more infants would survive each year, and the country would save about $13 billion in health care costs annually.”

It seems that while everyone gives lip service to the importance of breastfeeding, there isn’t a lot of support for women once they make the decision to breastfeed. Women have been asked to cover up or leave restaurants, water parks, airplanes, and stores when they try to give their baby what’s “best.” Maternity leave in the United States is, at best, 12 weeks. Women who work outside the home have often been forced to pump their breast milk in bathroom stalls, hide under a desk, or sit in their car just to get a little bit of privacy because rooms for nursing/pumping mothers just don’t exist. So yes, breast might be best for baby, but until there are more regulations in place that allow moms to breastfeed without so many roadblocks, how can breast be “best” for moms?

There is, however, a bit of good news on the horizon. Health Care Reform is lending some support to breastfeeding moms with the Reasonable Break Time for Nursing Mothers law.

  • Section 4207 of the Patient Protection and Affordable Care Act (also known as Health Care Reform), states that employers shall provide breastfeeding employees with “reasonable break time” and a private, non-bathroom place to express breast milk during the workday, up until the child’s first birthday.
  • Employers are not required to pay for time spent expressing milk, and employers of less than 50 employees shall not be required to provide the breaks if doing so would cause “undue hardship” to their business.

Tanya from The Motherwear Breastfeeding Blog thinks this is a step in the right direction. “I’m not thrilled that it extends the right for only up to 1 year (I pumped longer for my son), but what a huge difference this would make for mothers in the many states, mine included, that do not extend this right under state law!”

Currently, only 24 U.S. states, Puerto Rico, and the District of Columbia have legislation related to breastfeeding in the workplace. Yet women now comprise half the U.S. workforce, and are the primary breadwinner in nearly 4 out of 10 American families. The fastest growing segment of the workforce is women with children under age three.

Doula-ing is excited about the new law and calls it “a giant leap forward for mother’s who want to continue to breastfeed their babies once they return to work.”

Kim Hoppes, who doesn’t appear to be a fan of Health Care Reform is, however, pleased with this change. “Well, something good came out of the health care reform nightmare. Places now have to give breaks to nursing moms so they can pump.”

Lylah from Boston.com Moms seems to think the new law is not enough and asks, “How can we expect 90 percent of new moms to breastfeed without support in the workplace?”

One thing seems pretty clear: If it’s in the country’s best interests to have new moms nurse their infants exclusively for at least six months — and the billions of dollars in health care savings indicates that it may be — then new moms should get at least six months of paid leave in which they can do so. The United States and Australia are the only two industrialized countries in the world that do not offer paid maternity leave. And moms in the Outback have a sweeter deal than we do: In Australia, your job is protected for a year, but in the United States new working moms only get that guarantee for 12 weeks.

What do you think about the Reasonable Break Time for Nursing Mothers law? Is it too much? Not enough? Just right? None of the government’s business?

Photo credit: http://www.flickr.com/photos/tundakov/2550864384/

Cross-posted on BlogHer.

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Breastfeeding? Scheduled for a biopsy? Read this and pass it on.

Today I have a guest post from Tanya of Motherwear Breastfeeding Blog. She’s trying to spread the word about this valuable research and I’m happy to do my small part by passing it along to you. The original post is here and it is copied and pasted (with permission) below.

Picture this: You’re breastfeeding.  You notice a lump.  First maybe you think it’s a plugged duct.  But then it doesn’t go away, after many, many feedings.  You’re worried about it, so you make an appointment with your doctor, who doesn’t think it’s related to breastfeeding.  She sends you for a mammogram, but you’re told that you’ll have to have weaned for six months before the test can be done.  What do you do?*

I’ve mentioned before that I’m involved in a powerful research project based at the University of Massachusetts, and supported by the Love/Avon Army of Women breast cancer project.

I’d like to explain more about it now, and ask for your help in recruiting participants for it.

It’s probably news to most of us (it was to me) that when you make milk, cells from your milk ducts are exfoliated off in the process.  These are called epithelial cells, and they’re detectable in your milk.

Past research has demonstrated that long before we notice a lump, those epithelial cells start changing in ways that are precursors to the development of breast cancer.

Dr. Kathleen Arcaro, a UMass professor who studies breastfeeding and breast cancer risk wants to analyze those cells.  She’s been nice enough to visit a breastfeeding group I run, and answer questions about breastfeeding and breast cancer.

The primary goal of her research is to determine if it’s possible to create a non-invasive, early way of assessing our breast cancer risk through our breastmilk.  If it’s successful, it would also establish ‘molecular biomarkers’ for breast cancer risk.

An additional benefit to breastfeeding mothers is that we would not be told, as some are, to wean before a mammogram or biopsy can be done.  No more choosing between breastfeeding and a breast cancer test.  It could be as simple and sending in a milk sample to a lab!

In order to conduct this research, Dr. Kathleen Arcaro needs to find 250 women who are both lactating and scheduled for a biopsy.  To participate, you’d overnight milk samples to her lab, at no cost to you.

So if you, or someone you know, is both breastfeeding and scheduled for a biopsy, please ask them to email either me, Dr. Arcaro, or Dr. Sarah Lennington as soon as possible.  You can visit the project’s website to learn more.

If you write a blog or are in contact with lots of moms on a forum, please pass this link around!

And if you haven’t done it yet, register for the Love/Avon Army of Women.  You’ll join one million women volunteering to become part of a rich pool of women researchers can use to find the causes and prevention of breast cancer.  You can see other participating studies on the site.  Here’s a recent Today Show clip on the project.

* Mammograms can be done on lactating breasts, but they are viewed as less accurate than on non-lactating breasts.  Some doctors will do them, others require mothers to wean first.  Some send mothers for ultrasounds.