Managed VS natural births

Anne Rogers wrote:
My second (an unmedicated VBAC) had a 3++ hour pushings stage. Hate to
think how long it would have been if I had an epidural!


malposition? I had a 2+ hr pushing stage with my 2nd and lots of people said
ooh, she was bigger than your first, true, she was almost 3 pounds bigger,
but the issue was she was posterior and stayed that way, she could have been
a 4lber and still taken a while to get out. I did have an epidural, but it
didn't seem to hinder me, I was squatting at times!

Hard to say with that one. Epidurals are associated
with an increased incidence of malpresentation because the
anesthetic interferes with the normal operation of the pelvic
floor as it helps to get the baby into a better
position. But in your case, there were other reasons to
have the epidural which likely outweighed the possibility
of it increasing the odds of malpresentation.
It would be nice if every decision were clear cut,
but they're not ;-) You just play the odds as best you
can with the information you've got.

Best wishes,
Ericka

Hard to say with that one. Epidurals are associated
with an increased incidence of malpresentation because the
anesthetic interferes with the normal operation of the pelvic
floor as it helps to get the baby into a better
position. But in your case, there were other reasons to
have the epidural which likely outweighed the possibility
of it increasing the odds of malpresentation.
It would be nice if every decision were clear cut,
but they're not ;-) You just play the odds as best you
can with the information you've got.

well she was already posterior and had been without shifting for at least 4
weeks, I was very very limited in what I could do positioning and
movementwise to get her to turn, but I had been trying for ages. I suppose
she could have turned once labour kicked in without an epidural, but given
just how stubborn she was I doubt it. I even had intact waters until very
late, when I requested ARM, however when they were broken there was almost
nothing there (which might also explain how a big baby was hiding in a small
bump), so I don't think leaving the water there for her to turn can have
been much help.

Anne

Anne Rogers wrote:
Hard to say with that one. Epidurals are associated
with an increased incidence of malpresentation because the
anesthetic interferes with the normal operation of the pelvic
floor as it helps to get the baby into a better
position. But in your case, there were other reasons to
have the epidural which likely outweighed the possibility
of it increasing the odds of malpresentation.
It would be nice if every decision were clear cut,
but they're not ;-) You just play the odds as best you
can with the information you've got.


well she was already posterior and had been without shifting for at least 4
weeks, I was very very limited in what I could do positioning and
movementwise to get her to turn, but I had been trying for ages. I suppose
she could have turned once labour kicked in without an epidural, but given
just how stubborn she was I doubt it.

You can never tell for sure, and it's pointless to second
guess since you really needed that epidural for other reasons.
Studies have shown that babies often *do* turn anterior in labor
without an epidural, and the theory is that it is the process
of labor and the interaction of the baby with the pelvic floor
that helps that to happen. But, of course, some babies don't
turn regardless and yours might have been one of them.

Best wishes,
Ericka

I had two hospital births (both VBACs) without interventions. The first
VBAC I arrived at hospital just in time to push, so no one had time to
mess with me. The second time, I was there earlier, but things rock and
rolled, so again no time or need for any fooling with the process.

Incidentally, I had midwives both times, so that probably was the
difference. Here in Ontario, they have hospital priviledges.

Mary

Anonymama writes:

: I wonder if epidurals ever help _avoid_ further interventions?

Again, this anecdotal, but I can remember at least two reports
on this very newsgroup where women has been laboring for some
time, but because of fear and tension had failed to dialate.
(I think one of them was Naomi Purdue). After receiving an
epidural, they relaxed enough to dialate and give birth.

Now, I personally think this is very rare, (compared, say, to
the number of women for whom the epidural intefers with
contractions, but I think there is the occasional women that
it actually helps. But 2 or 3 cases in 10 years of newsgroup
reading and posting is not a lot. :-)

Larry

EPIDURAL INSANITY

See the quote from Marsden Wagner, MD below.


ALSO: PATIENT-CONTROLLED EPIDURAL ANESTHESIA/PCEA

Question for Brendan Carvalho, MD et al. See below...


First this...

PREGNANT WOMEN: Obstetricians are closing birth canals up to 30% and
keeping birth canals closed the "extra" up to 30% when babies get stuck.

It easy to allow your birth canal to open the "extra" up to 30%.

See Dents in babies' skulls...
http://health.groups.yahoo.com/group...t/message/3897


Carvalho et al. studied PATIENT-CONTROLLED EPIDURAL ANESTHESIA/PCEA

Int J Obstet Anesth. 2005 Jul;14(3):223-9. PubMed abstract

"Ultra-light" patient-controlled epidural analgesia during labor: effects of
varying regimens on analgesia and physician workload.

Carvalho B, Cohen SE, Giarrusso K, Durbin M, Riley ET, Lipman S.
Department of Anesthesia, Stanford University School of Medicine, Stanford,
California 94305, USA.

BACKGROUND: Patient-controlled epidural analgesia (PCEA) offers many
advantages over continuous epidural infusions for maintenance of labor
analgesia. Some of these benefits may depend on the PCEA settings. This
study evaluated several regimens for "ultra-light" (0.125%) PCEA with basal
continuous infusion (CI) in labor with goals of minimizing physician
interventions while providing good analgesia. METHODS: Two hundred and
twenty ASA I-II women receiving epidural analgesia during active labor
(cervical dilation 5 cm) were randomly assigned in a double-blind manner to
four treatment groups (n=30 in each). Analgesia was maintained with a
PCEA/CI pump using bupivacaine 0.0625% + sufentanil 0.35 microg/mL. PCEA
settings we group A: CI 10 mL/h, PCEA bolus 6 mL, 8-min lockout; group B:
CI 10 mL/h, PCEA bolus 12 mL, 16-min lockout; group C: CI 15 mL/h, PCEA
bolus 6 mL, 8-min lockout; group D: CI 15 mL/h, PCEA bolus 12 mL, 16-min
lockout. RESULTS: In groups A, B, C and D, 76, 77, 75 and 85% of parturients
respectively, required no physician rescue boluses. Pain scores were low and
maternal satisfaction was high in all groups, with minimal differences among
them. Spontaneous vaginal delivery occurred in 78% of patients overall,
instrumental (forceps or vacuum) delivery in 10% and cesarean section in
12%. CONCLUSIONS: These ultra-light PCEA regimens provided excellent
analgesia with minimal physician workload and a high spontaneous delivery
rate. Use of moderate to high-volume, ultra-light PCEA/CI techniques should
facilitate provision of labor analgesia in busy obstetric units.

FACT: Many obstetricians have women labor on their backs or buttocks (dorsal
or semisitting) thereby closing the birth canal up to 30% - PERHAPS ALSO
CAUSING PAIN (and eliciting understandable screams for epidurals) AND
INHIBITING DELIVERY before the baby reaches the pelvic outlet. That is, it
is conceivable that placing the woman on her back/buttocks - on her sacrum -
since it torques the sacral tip into the pelvic outlet - inhibits delivery
NEUROLOGICALLY - in addition to causing actual physical narrowing of the
pelvic outlet.

Many obstetricians KEEP the birth canal closed the "extra" up to 30% when
babies get stuck and forceps are applied.

QUESTION FOR CARVALHO ET AL.: In what position were the women in whom
instrumental (forceps or vacuum) delivery occurred?

in article , at
wrote on 12/20/05 10:04 AM:

Anonymama writes:

: I wonder if epidurals ever help _avoid_ further interventions?

Again, this anecdotal, but I can remember at least two reports
on this very newsgroup where women has been laboring for some
time, but because of fear and tension had failed to dialate.
(I think one of them was Naomi Purdue). After receiving an
epidural, they relaxed enough to dialate and give birth.

Now, I personally think this is very rare, (compared, say, to
the number of women for whom the epidural intefers with
contractions, but I think there is the occasional women that
it actually helps. But 2 or 3 cases in 10 years of newsgroup
reading and posting is not a lot. :-)

Larry

Interesting statement from 1999...

"[D]ata on the progress of labour before pain relief suggest that epidural
analgesia is a marker of pain severity and/or labour failure rather than the
cause of delayed progress in low-risk pregnancies."
--Mock et al. Int J Obstet Anesth. 1999 Apr;8(2):94-100. PubMed abstract

AGAIN: Many obstetricians have women labor on their backs or buttocks
(dorsal or semisitting) thereby closing the birth canal up to 30% - PERHAPS
ALSO CAUSING PAIN (and eliciting understandable screams for epidurals) AND
INHIBITING DELIVERY before the baby reaches the pelvic outlet. That is, it
is conceivable that placing the woman on her back/buttocks - on her sacrum -
since it torques the sacral tip into the pelvic outlet - inhibits delivery
NEUROLOGICALLY - in addition to causing actual physical narrowing of the
pelvic outlet.

Compelling obstetricians to allow birth canals to open the "extra" up to 30%
is not going to prevent all epidurals - it's just that obstetricians have no
business closing birth canals the "extra" up to 30%.

Here's the full Mock et al. 1999 PubMed abstract...

Int J Obstet Anesth. 1999 Apr;8(2):94-100. PubMed abstract
*
Are women requiring unplanned intrapartum epidural analgesia different in a
low-risk population?
Mock PM, Santos-Eggimann B, Clerc Berod A, Ditesheim PJ, Paccaud F.
Gynaecology and Obstetric Department, University of Geneva, Switzerland.

We studied 645 full-term low-risk women in early labour in 6 units to
evaluate the effects of maternal characteristics and obstetric management in
early labour on the use of epidural analgesia, and to analyse the
relationship between epidural analgesia, progress of labour and mode of
delivery using multiple logistic regression. Among variables present in
early labour, nulliparity, ethnicity and obstetric unit were the strongest
predictors of epidural analgesia requirement. In nulliparous women,
obstetric unit affected use of epidural analgesia (P0.05) and induction of
labour was associated with increased use of epidural analgesia (odds ratio
3.45, 95% CI: 1.45-7.90). In multiparous women, only ethnicity was
statistically significant (P0.05). Epidural analgesia was associated with
longer labours and more instrumental deliveries (odds ratio 2.93, 95%CI:
1.48-5.83). In the epidural group, however, we found a positive correlation
between first stage duration and elapsed time before epidural analgesia.
Furthermore, rate of cervical dilation was similar in the non epidural group
throughout the first stage (mean 3.41 cm/h, 95%CI: 3.19-3.63) and in the
epidural group after epidural analgesia decision (mean 3.99, 95% CI:
2.96-5.02), while the mean cervical dilatation rate before epidural
analgesia was 0.88 cm/h (95% CI: 0.72-1.04). The need for epidural analgesia
is, therefore, multifactorial and difficult to predict. Whereas nulliparity
increases epidural analgesia requirement, data on the progress of labour
before pain relief suggest that epidural analgesia is a marker of pain
severity and/or labour failure rather than the cause of delayed progress in
low-risk pregnancies.

END Mock et al. abstract

EPIDURAL INSANITY

Here's that quote from Marsden Wagner, MD...

³There is...an epidemic of epidural use in this country now. *Women are
being lied to and told that this is safe. *The data contradicts this.
Epidural causes somewhere between 4 and 10 times as much forceps or vacuum
births and causes between 2 and 4 times as many cesareans. *Since forceps,
vacuum births, and cesareans all carry significant risks for both the woman
and the baby, these are not benign procedures. *Every year women die just
from the epidural procedure itself. *The epidural is a very tricky procedure
and one that can be life-threatening if the tiniest slip is made.

³The American public does not know that women die from epidural anesthesia.
One of the biggest problems in the United States is that the medical
profession has stonewalled the information on pregnancy and birth. *It is
very difficult for the pubic to get true information...

³...Will American obstetricians willingly change? *I¹ll answer this by
asking another question. *Why should they? *They have all the money and
power. *I wrote in Pursuing the Birth Machine [1994], ³The American College
of Obstetrics and Gynecology, for the most part, has been passive in the
face of the epidemic of cesarean births. *The conservative and self-serving
stance of this organization is illustrated by an extraordinary statement
made recently by the former president of this College: ŒHome birth is child
abuse in its earliest form.¹² [Wagner M quoted in Gaskin IM. Interview with
Marsden Wagner author of Pursuing the Birth Machine [ACE Graphics 1994].
Birth Gazette 1995;11(4):6-12; available at OHSU]

Thanks for reading everyone.

Sincerely,

Todd

Dr. Gastaldo
Hillsboro, Oregon
USA


PS It is conceivable that the births studied by Brendan Carvalho, MD et al.
did not involve closing the birth canal up to 30% and keeping it closed when
forceps and vacuums were applied.

After all, I copied Brendan Carvalho, MD the post below after speaking to
him by telephone after verifying that - like most obstetricians - he was
apparently asphyxiating babies - denying umbilical cord oxygen - forcing
babies to breathe with their lungs before ready - in the process of robbing
babies of up to 50% of their blood volume.

See 'Scientifically' supporting mass child abuse by obstetricians
http://groups.google.com/group/
misc.kids.pregnancy/msg/7e3e71a8f5a79fd0

Hopefully Brendan Carvalho, MD is working to stop the twin grisly obstetric
practices of closing birth canals up to 30% and robbing babies of up to 50%
of their blood volume.

Oddly, the American College of Obstetricians and Gynecologists/ACOG is still
promoting closing birth canals the "extra" up to 30% - 13 years after I
reported to ACOG that semisitting closes...

ACOG is also promoting KEEPING the birth canal closed the "extra" up to 30%
when babies get stuck...

See ACOG's 2005 edition: How NOT to birth
http://health.groups.yahoo.com/group...t/message/3606

See also: RNs: 'Stitches, episiotomy, and postpartum complications'
(Maternal care learning needs)
http://health.groups.yahoo.com/group...t/message/3725

Epidural insanity is just part of the ongoing total obstetric insanity.

Again, thanks for reading everyone.

Sincerely,

Todd

Dr. Gastaldo
Hillsboro, Oregon
USA


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Patient-controlled epidural anesthesia/PCEA"

*