'OK there is a small increase in low instrumentals (i in 20) but there is debate as to whether this is to due with the epidural or just that women in more pain have more complications anyway. You are no more likely to tear with an epidural because although you might possibly have increased instrumental, you are less likely to suffer a severe tear through uncontrollable pushing. As far lengthening labour by 15 minutes, well who cares if you are not in pain?
So basically, it is down to choice. The cascade of intervention is a myth. '
I'm not convinced it's a myth. I've had three labours; two with epidural, one without.
I dn't know the figures in regard to CS as a result of epidural, but in general terms, the more you have done to you, the more you consequently have done in addition.
So, take first labour - I didn't understand the levels of pain that were possible, I mean across the spectrum, and requested an epidural about halfway through - maybe 4/5 hours into it. What I didn't know was that I'd then be strapped on my back, unable to walk around and monitored. I also didn't know it would slow things down, orthat I'd not be able to feel when I was pushing or make any attempt to try harder, thus leading to the ventouse being wielded, though it wasn' ued in the end as my mum told them not to.
And I didn't know I'd not be able to feel my legs for another 24 hours, or stand up to reach my baby when he cried, or have uncontrollable sickness as a reaction to it - leading to my bby giving up, going back to sleep and the MWs, when they did finally come (no one responded to the buzzer) telling me if he didn't feed within a couple of hours he'd be given a bottle. (he had already breastfed at birth). And the mere fact of being in hospital meaning I wasn't allowed him in my bed to encourage this - I ignored them and did it anyway, and he fed.
This is what I consider a cascade of intervention. Albeit a mild one.
Also when you say 'uncontrollable pushing' I think that's exactly what happens, normaly - I certainly was unaware I was pushing ds1 out, I couldn't feel a thing. Ds2 was unmedicated home birth and I felt my body pushing but could no way stop it. Ds3 I was able to push more but not less. It just happens.