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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
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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
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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
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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
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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
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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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