Epidurals - side effects- calling for some solid data please

[blondecat]

I have a while to go yet but I have started to think about pain relief for birth

I am not dogmatic either way - simply want the best for self and baby.

Did a fair bit of googling and watched some epidural videos. Shudder. Probably should have skipped that one.

What I am looking for is some solid evidence on epidural outcomes since bulk of material online is either of the epi great or natural childbirth advocates scare variety. I don't mean to be rude but when I read some of the latter talking about 30% plus infection rates in mothers with epi with no studies properly quoted and then I see a study of epidurals used in cancer treatments with ~2% rate [4% of surface and less than 1% deep infections] with epidural cathers held in place for 30 days or more, I know which one I take more seriously. And whoever wrote the dormer should be thoroughly ashamed of themselves - I don't like people trying to scare us into doing / not doing something.

So, anyone?

Data on mobile epidurals. Peer reviewed studies only. Ideally 50 plus cases.

Infection rates
Increase in interventions - but not just talk of the "cascade" - ideally studies which filtered out cause / effect I.e. You may have an intervention because of epi or you may have an epi because of circumstances which make it more likely anyway that you will have other interventions

Incidence of headaches / back pain - short and long term
Allergic reactions
Rates of failed epidurals

I will fire this off at my ob-gen as well. Bet he will be pleased.

Just tp get us started here's something I found:
(from Howell C, Chalmers I. A review of prospectively controlled comparisons of epidural forms of pain relief during labour. International Journal of Obstetric Anesthesia 1991; 2:1-17.

Number of trials included 11

Vomiting: two trials reported no differences (7/59 versus 6/61)

Maternal hypotension: one trial reported increased maternal hypotension (6/49 versus 1/51).

Progress of labour: four trials showed prolonged stage one and two with epidural based on weighted mean differences (approx. 1000 patients).

Oxytocin use: six trials showed increased need with epidural, based on the odds ratio (approximately 1000 patients).

Surgical amniotomy: one trial reported no difference (39/49 versus 46/51).

Foetal heart rate abnormality/meconium passage. Five trials showed no difference (92/518 versus 106/534).

Fever: one trial reported increased fever with epidural (58/243 versus 16/259).

Malposition: three trials suggested a predisposition to malposition of presenting part (23/154 versus 11/150).

Instrumental vaginal delivery: six trials of 1252 women showed that epidural block maintained beyond the end of the first stage is associated with increased assisted vaginal delivery. The NNT for assisted vaginal delivery is 9.6 (6.7 to 17) compared with standard control treatments. Based on a small number of women, there was no difference when a block was used for first stage only (18/67 versus 14/64).

Caesarean section: nine studies show no significant increase in overall rate (85/843 versus 65/831), and five trials show no increase for dystocia (38/553 versus 34/571). One trial combined rates of caesarean section and assisted deliveries for dystocia, and reported that the rate was increased in epidural group. No effect on foetal distress was seen (16/524 versus 10/539).

Foetus and neonate: no consistent picture emerged for effects on neonatal arterial pH or Apgar scores or neonatal jaundice. One trial reported preliminary evidence of increased rates of hypoglycaemia in neonates of mothers receiving epidural. This needs further confirmation.

Ps
Nnt - shows you how many patients need to have a treatment compared to control group for 1result - ie. Nnt of 1 means every patient given a treatment gets a result. I am sure some mums-netters can explain better

Link
www.medicine.ox.ac.uk/bandolier/booth/painpag/Acutrev/labour/AP056.html

www.oaa-anaes.ac.uk/content.asp?ContentID=185

should link through to information leaflet from Obstetric Anaesthetists association which gives summary of risks.

What is your attitude to risk - is 1:200 low or high ? Knowing the risk of something happening is one thing - your attitude to that risk is something else - does it help or hinder your decision making ? A risk of say 1:200 doesn't mean every 200th person would be affected, the first 10 might be and then no-one for ages...it's all relative.

Note of caution, make sure the trials you're looking at control for parity. Epidurals appear to have very different outcomes for first time mums.

Have you looked at this study from the Cochrane index?

here

Worth noting that most studies use women receiving opioids for pain relief as the control group, not women having unmedicated births.

I reckon if they did a trial where they compared outcomes for first time mums having epidural analgesia with those having one to one care from a named midwife, mobility in labour and access to a birth pool the picture would be very different in terms of maternal satisfaction and in terms of rates of birth complication.

This is my own 'research' with a sample size of two!

Had DS1 with epidural after 7 hours of non progress. Blissful! Really not bothered about little prick in the spine when I was rigid and immobile with labour pain. Labour progressed faster after that as I relaxed. I became feverish though. Would have had to be spinal blocked anyway as he ended up forceps del, but he had a v large head and it tilted back.

The recovery was a bit trickier - immobile for 12 hours so couldn't care for him on my own in the night, catheter - ugh, generally hard to get going and feel 'right' again.

DS2 no epidural, labour painful but I coped - pethidine or meptid was amazing at helping me cope. Delivery a little shocking as the sensations were new to me, but at least that part is over quickly. Recovery was amazingly quick, I felt superb after the birth.

Based on the two, I'd try to avoid epidural if I have a third.