interesting bbc article about epidurals

[tiredfeet]

just wondered if other people had any thoughts on this article ?

Hello, are you wondering wether to have one or not?

What isn't pointed out in the BBC article is that having an epidural raises the risk of needing forceps or having a slower labour - the 2 biggest risk factors associated with muscle damage.

Yes, this study showed that women with epidurals did better overall, but I would wonder how the women were chosen for the study. 33% CS rate is enormously high, so possibly these were higher risk women or women at a hospital which pushed interventions. And when you take out the CS women, it's not that big a study to be comparing outcomes.

The study author mentions that pushing too much, too soon without an epidural could be a reason for damage. Well, with a well monitored MW attended birth, with a women who has done antenatal classes (where they talk about not pushing too soon and how to help control this) you should reduce the risk of this happening anyway. Active and water births could also reduce the risks associated with a long second stage by helping you and the baby to get into optimal positions for pushing.

It's interesting, but it certainly isn't sufficient evidence to have an epidural purely on the basis of not wanting to risk your pelvic floor muscles, particularly as it's known that having an epidural means you're at higher risk of needing interventions and having a longer labour.

It does make an argument for doing more pelvic floor strengthening work before and after birth and attending good antenatal classes to learn about how and when to push. Also having a good birth attendant so that you can get guidance on when to push if you need it.

yes I thought the main thing it made me think was of the need for good pelvic floor exercises before and after.

one of the articles that I found on reading the links to that thread points out that the risks of epidurals leading to more interventions is often overstated however, because such research often ignores that fact that women with more complicated labours (long, back to back, etc ) to begin with are more likely to request epidurals, and this distorts the figures.

I agree it wouldn't be a sensible reason to have an epidural solely to protect pelvic floor muscles, but at the same time I think the article helps show that actually things are much less black and white than they are sometimes presented.

yes, good point tiredfeet - epidurals being associated with more interventions, and epidurals causing more interventions are 2 very different things. I see that confusion on MN a lot.

Good post japhrimel.

It's a very small study, and there's no clarity about whether it's comparing like with like.

A woman who has attended good quality antenatal classes and is confident about breathing/when to push/when not to push and who is attended by a good, experienced midwife, is going to be at a lower risk of pushing too soon or at the wrong time than a woman who hasn't had that support.

If the study is of women who all gave birth in hospital, then a lot depends on their access to 1 to 1 care during labour, continuity of care, experience of midwives...... etc

thanks Barkfox yes thats what I was trying to say really.

Interesting article. I think there are lots of women giving birth in hospital who are probably having prolonged second stages - longer than they ought to be.

Perhaps a result of women giving birth in supine positions, and with the birth environment and medical practices suppressing the fetus ejection syndrome:

here

I can see how an epidural might help with pelvic floor damage (as long as the mother doesn't then need a forceps birth) as the mother won't be pushing until the baby is very very low down in the birth canal.

That said, many women (over half of first time mothers) who have an epidural also end up an episiotomy, which as we all know is a second degree cut that goes through skin and muscle, and is associated with more nerve damage, long term pain and painful intercourse than spontaneous tears. I wonder how much discussion of this there was in the research?

Sorry, meant to add, made me think of the Tricia Anderson article again: create birthing environments and protocols which increase the likelihood of dysfunctional labour. Then invent something expensive, high tech and invasive (and with a whole load of attendant risks) to solve the problem. Feel god-like for trumping mother-nature, who is clearly crap at designing the human machinery of birth.

Is this a midwife Thread?

I was adamant that I would not have an epidural I posted my concerns on here. Within a couple of hours of being in hospital I had requested an epidural, it was a back to back labour and I had a previous c-section. My labour resulted in an emergency c-section as my labour was slow to progess, I never got beyond 9 cm. It is possible that my labour was slow because I opted for the epidural so early on, however I don't regret having the epidural I think it was the right thing for me to do under the circumstances.

What's a "midwife Thread" catherinedenerve?

This is interesting as I had a epidural with my first labour and afterwards I felt like I had been in a car crash and has no pelvic floor control at all. I had pushed so hard that I had no feeling of control at all. I could not tell when I wanted a wee for about 24 hours. Thankfully it did come back!

Had 2 natural births subsequently and did not have this problem at all. I don't think it is the epidural that causes the problems it is the supine position and not being able to work with the contractions effectively.

It would be a thread where people are discussing the subject in a slightly abstract manner
-up until thedollshouse- by opposition to an empirical manner.

I am just annoyed because I got tiredfeet out of the Unanswered well thinking she wanted some info, and she ignored me.

But Thank You Japhrimel.

I haven't yet had a baby - and have a science background - so discussing something like this in an abstract manner is the only way I could.

Japhrimel, really there is nothing wrong with being informed.
It is fine to have theorical/empirical discussion, whatever.
It was just a silly way to tell coldfeet that I thought she was being rude.