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Yet Another reason to avoid an epidural...



 
 
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  #1  
Old June 1st 05, 05:42 PM
Ericka Kammerer
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Default Yet Another reason to avoid an epidural...


Obstet Gynecol. 2005 May;105(5):974-82. Related Articles, Links

Changes in fetal position during labor and their association with
epidural analgesia.

Lieberman E, Davidson K, Lee-Parritz A, Shearer E.

Departments of Obstetrics and Gynecology, Brigham and Women's
Hospital, Harvard Medical School, and Boston Medical Center, Boston,
Massachusetts.

OBJECTIVE: To evaluate whether epidural analgesia is associated with a
higher rate of abnormal fetal head position at delivery. METHODS: We
conducted a prospective cohort study of 1,562 women to evaluate changes
in fetal position during labor by using serial ultrasound examinations.
Ultrasound examinations were performed at enrollment, epidural
administration, 4 hours after the initial ultrasonography if epidural
had not been administered, and late in labor ( 8 cm). Information about
fetal head position at delivery was obtained from the provider. RESULTS:
Regardless of fetal head position at enrollment (occiput transverse,
occiput posterior, or occiput anterior), most fetuses were occiput
anterior at delivery (enrollment position: occiput transverse 78%,
occiput posterior 80%, occiput anterior 83%, P = .1). Final fetal
position was established close to delivery. Of fetuses that were occiput
posterior late in labor, only 20.7% were occiput posterior at delivery.
Changes in fetal head position were common, and 36% of women had an
occiput posterior fetus on at least one ultrasound examination. Women
receiving epidural did not have more occiput posterior fetuses at the
enrollment (23.4% epidural versus 26.0 no epidural, P = .9) or the
epidural/4-hour ultrasound examination (24.9% epidural, 28.3% no
epidural), but did have more occiput posterior fetuses at delivery
(12.9% epidural versus 3.3% no epidural, P = .002); the association
remained in a multivariate model (adjusted odds ratio 4.0, 95%
confidence interval 1.4-11.1). CONCLUSION: Fetal position changes are
common during labor, with the final fetal position established close to
delivery. Our demonstration of a strong association of epidural with
fetal occiput posterior position at delivery represents a mechanism that
may contribute to the lower rate of spontaneous vaginal delivery
consistently observed with epidural. LEVEL OF EVIDENCE: II-2.

  #2  
Old June 24th 05, 08:29 PM
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My baby was posterior - I never knew what that meant until the time I
was pushing my 8 lb 9.6 oz son out the OB said something about him
being "right of posterior". I'm not sure at what point she knew he was
posterior.

My doula said she suspected the whole time that he was posterior
because I had such a long and horribly painful (unmedicated) labor
(lots of back pain too, and shooting down my legs) but she didn't tell
me that.

But anyhow, after I had him I read up some on occipitoposterior
position at birth in the medical journals and I was horrified to find
out that over 40% of women with posterior position end up having a
c-section, and over 40% also need instrument assistance. I'm sooo glad
I decided not to have an epidural even though my labor was terribly
painful - I honestly feel like if I had one, given that my son was
posterior, or "right of posterior" whatever that means, I would've
ended up with a c-section delivery or forceps or something. Maybe me
not choosing the epidural made him turn from full posterior to right of
posterior which made his birth be a little "easier" than it might have
been.

Jenny

  #3  
Old June 24th 05, 08:31 PM
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My baby was posterior - I never knew what that meant until the time I
was pushing my 8 lb 9.6 oz son out the OB said something about him
being "right of posterior". I'm not sure at what point she knew he was
posterior.

My doula said she suspected the whole time that he was posterior
because I had such a long and horribly painful (unmedicated) labor
(lots of back pain too, and shooting down my legs) but she didn't tell
me that.

But anyhow, after I had him I read up some on occipitoposterior
position at birth in the medical journals and I was horrified to find
out that over 40% of women with posterior position end up having a
c-section, and over 40% also need instrument assistance. I'm sooo glad
I decided not to have an epidural even though my labor was terribly
painful - I honestly feel like if I had one, given that my son was
posterior, or "right of posterior" whatever that means, I would've
ended up with a c-section delivery or forceps or something. Maybe me
not choosing the epidural made him turn from full posterior to right of
posterior which made his birth be a little "easier" than it might have
been.

Jenny

  #4  
Old June 26th 05, 08:47 AM
KC
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My second baby was posterior during labor. I could tell by the back
pain, but because I had no epidural, I was driven by my body into hands
and knees position which is a good position for posterior babies to
turn in. It was the only position I could tolerate in that labor, and
out she came anterior. So, I can totally see how an epidural could
keep the baby from getting to anterior because you are stuck laying
down.

KC

  #5  
Old June 27th 05, 04:32 PM
Cathy Weeks
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KC wrote:
My second baby was posterior during labor. I could tell by the back
pain, but because I had no epidural, I was driven by my body into hands
and knees position which is a good position for posterior babies to
turn in. It was the only position I could tolerate in that labor, and
out she came anterior. So, I can totally see how an epidural could
keep the baby from getting to anterior because you are stuck laying
down.


I dunno - the idea of a NEEDLE being stuck into my SPINE was a good
enough reason for me to try and avoid it. However, if I HAD needed to
transfer to a hospital (I had a home birth) and required a pain killer,
epidural was my preferred choice, simply because I wanted to be fully
alert. I know how my body handles painkillers, and except for your
typical analgesics like aspirin/tylenol/advil they make me sleepy, so I
would assume the same would happen in labor.

Cathy Weeks

  #6  
Old June 27th 05, 08:52 PM
Cathy Weeks
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Cathy Weeks wrote:
KC wrote:
My second baby was posterior during labor. I could tell by the back
pain, but because I had no epidural, I was driven by my body into hands
and knees position which is a good position for posterior babies to
turn in. It was the only position I could tolerate in that labor, and
out she came anterior. So, I can totally see how an epidural could
keep the baby from getting to anterior because you are stuck laying
down.


I dunno - the idea of a NEEDLE being stuck into my SPINE was a good
enough reason for me to try and avoid it. However, if I HAD needed to
transfer to a hospital (I had a home birth) and required a pain killer,
epidural was my preferred choice, simply because I wanted to be fully
alert. I know how my body handles painkillers, and except for your
typical analgesics like aspirin/tylenol/advil they make me sleepy, so I
would assume the same would happen in labor.


I'm sorry to have responded to my own post - but my original note was
supposed to be in response to Ericka/OP's note. It seems rather like a
non-sequitor here.

Cathy Weeks

 




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