Failed Epidurals - new technology

[gailforce1]

Article in Daily Mail Health section from Tuesday 23 November 2010 - still available to read on internet. (Yes, I know, Daily Mail!!)
A new high-resolution ultra-sound has been researched in Canada which showed a successfull insertion rate of 91.8%. The first hospital in GB to use it is Ninewells Medical school in Dundee.
Apparently the failure of an epidural is a one of the factors leading to an increase in the number of women requesting a CS for their second birth. According to the Birth Trauma Assoc around 150,000 (a quarter of new Mothers) don't get the pain relief they need during labour (I find this a shocking statistic).
One reason given for the failure of epidurals is the lack of expetise of the anaesthetist. In many NHS hosspitals it is a junior anaethetist rather than a specialist obstetric anaesthetist doing the epidurals - the specialists are working in the theatres.
It is also difficult to insert an epidural if the patient is obese (15% of women are obese at their first antenatal appt).
However, even the most experienced anaesthetist can have problems if the women cannot keep still having left it too long to have an epidural or have been encouraged not to have one in case it slows labour.

So, given the cuts how long will it be before this new technology is available at all maternity units? Surely this should be a huge financial saving if it leads to a reduction in C Sections but more importantly that women get the pain relief they need.

[Ushy]

Yes, of course women who have epidurals are more likely to have assisted deliveries -there is an association - what isn't clear is that modern light (not heavy dose)epidurals are causal. Long traumatic deliveries give rise to more epidural requests - those births are heading for problems anyway.

The US anaesthetists think there is no proven causality - the UK anaesthetists think there is causality only with high doses for protracted periods.

[Cleofartra]

Amazing really that there aren't more profound effects with epidurals, given that they profoundly disrupt the hormonal cascade involved in labour and result in most mothers being immobile and having supine deliveries - both physiologically absolutely abnormal.

I had an epi with my first and found it a very interesting experience. Wouldn't have done it again though - don't like people fiddling with my body or feeling physically disabled.

[violethill]

I agree that it can be an interesting experience actually. I had one with my second birth, which was by CS. I found it fascinating that I could be absolutely wide awake, feel pressure, tugging, pulling, but no pain. Seeing as for major abdomininal surgery,it's either general anaesthetic (more risky) or epidural/spinal anesthetic, I had very little choice. It's not, however, something I would choose when there is no medical need.

Whether the causal link is established, there is enough of an associated risk of instrumental delivery for many women to avoid epidurals.

"Long traumatic deliveries give rise to more epidural requests "- again, yes, it's easy to establish a link; but these things are such a grey area. What one woman may describe as 'long and traumatic', another woman might just accept as a 'normal, painful birth'. A lot depends on your expectations, access to accurate info prior to the birth etc. I often think that the most useful piece of advice I was given before I had my babies was from a new mother who was quite honest and said 'You'll feel pain like you've never felt before and which you wouldn't believe possible'. I'm not saying women necessarily expect labour to be pain free, but I do think there's a large variation in what women expect/anticipate/tolerate.

I am also reminded of my midwife at my first birth, who told me afterwards that my labour had been very long and difficult (baby wasn't in a good position, she was big, and it was my first labour). The midwife told me that had I been in a hospital, she was 99% sure I'd have been encouraged to have interventions, both for the pain and to speed things up. If that had been the case, no doubt I would have totally believed afterwards that those interventions were inevitable. So, it's not as though every labour only ever has one outcome from the outset. Some labours will never go smoothly, and some babies need to be born by CS, right from the word go. However, there are many more births which could go in any direction, from totally natural, to fairly medicalised, to highly medicalised.

[Ushy]

Cleofartra - it is only the old style epidurals that meant you have to give birth on your back. You can sit bolt upright with a modern epidural - it only imobilises you if you have had it in place for a very long time which probably suggests you have got other problems anyway.

It is quite interesting because you can actually see the baby open his/her eyes for the first time but with a clear head and not in pain. (That was my experience anyway when I eventually got an epi with DS). I am not big into emotional moments but that was quite memorable!

[HelenLG]

Ushy,

I wish my experience of epidural was of clarity, but unfortunately I was on gas and air as well as a full dose epidural during my labour, so it's not so much clarity as a horrific confused blur.

My labour was the most horrible and painful thing I've ever gone through, and was the complete polar opposite of what I wanted to happen. That said, I wouldn't consider have CS for my next one (yes, I am considering another one!!), as although the birth was traumatic, I was fully mobile and recovering by the next day, which I wouldn't have been with CS.

[Cleofartra]

"Cleofartra - it is only the old style epidurals that meant you have to give birth on your back"

Even if you're sitting up you're still pushing a baby uphill, which isn't helpful sometimes. In reality most women in my local hospital (which offers low dose epidural)give birth in a semi-supine or supine position, epidural or no epidural. In fact 11% give birth lying completely flat and 19% give birth in stirrups. And that's at a London teaching hospital. . Over 50% give birth semi-supine - ie, sitting on their tail bone. In standing, squatting and kneeling positions the pelvis can open up much more.


And having to be continuously monitored as you are with an epidural doesn't really allow for true mobility in labour.

I can see what you're saying about how amazing it must be to see your baby emerge with a clear head. Personally though I found that the two unmedicated births I had were followed by much more intense and long lasting euphoria than when I gave birth with an epidural - the result of having normal postpartum hormone levels I assume, which you don't get with an epidural.

[Cleofartra]

Wanted to add, I can understand how you can have good birth outcomes with an epidural when a baby is well positioned and where the labour is driven along by syntocinon.

What I'd like to see is a comparison of outcomes for births when labour is difficult. I suspect the vast majority of women having long, difficult labours in this country eventually have epidurals. It'd be hard to design a study which compares outcomes for mothers having 24+ hours in active labour both with and without an epidural because most labours in the UK aren't 'allowed' to continue that long without augmentation and usually epidural. It's like trying to look at outcomes for prolonged pregnancy when 99% of the population accept induction before 42 weeks, and those that don't are a very unique, self-selecting group.

[violethill]

Agree - I wouldn't have wanted to give birth either lying flat or sitting - neither seem the optimum position. Also, if you want to be in water, that's ruled out if you go for an epidural