Apart from the risk relating to Caesaearn Section, there other problems
with epidural analgesia. A study published in this month's American
Journal of Obstetrics and Gynaecology has found an increased risk of
urinary retention in the postpartum period in women who had epidurals.
They suggest that perineal damage possible related to the increased
incidence of operative vaginal birth may be the reason.
Musselwhite K et al 2007 Use of epidural anesthesia and the risk of
acute postpartum urinary retention. American Journal of Obstetrics and
Gynecology. 196 (5) pp 472.e1-472.e5
Joan Cameron
>>> Jane Sandall <[log in to unmask]> 29/04/2007 18:08 >>>
I wonder if you could help me with a question I am grappling with on
a Labour Ward Forum.
Are you aware of any current research that shows a link between
epidurals and caesareans?
I sit on a NHS Labour Ward Forum, where there is a concerning trend to
direct women with a BMI greater than 35 directly to an anaesthetist, who
persuasively encourages them to have an epidural in early labour. The
caesarean section rate is also approximately 26%, not all of which can
be ascribed to high BMI women!
I know there are risks with a high BMI, and epidurals are easier to
site in early labour, but I am very concerned on several counts.
Firstly it rockets women in to a higher risk category that might not
need to be there. Secondly there is no hint of informed decision making
- the anaesthetist is very directive and persuasive. But my third and
greatest concern, and the one for which I would be grateful for your
help, is that the anaesthetist claims that there is categorically no
extra risk of a caesarean for these women as a result of the epidural.
At the last LWF, a junior doctor also claimed this for epidurals.
I have found several research papers that cite no extra risk - however
I can see flaws in the research.
From my own practice as an NCT antenatal teacher and tutor I strongly
believe that there is a link. I am aware of several pieces of research
linking epidurals and increased risk of caesarean.
This is one of them:-
The effect of intrapartum epidural analgesia on nulliparous labor: a
randomized, controlled, prospective trial. Thorp JA, Hu DH, Albin RL, et
al. Am J Obstet Gynecol 1993;169(4):851-8.
OBJECTIVE: Our purpose was to determine the effect of epidural
analgesia on nulliparous labor and delivery. STUDY DESIGN: Normal term
nulliparous women in early spontaneous labor were randomized to receive
either narcotic or epidural analgesia. RESULTS: When compared with the
group receiving narcotic analgesia (n = 45), the group receiving
epidural analgesia (n = 48) had a significant prolongation in the first
and second stages of labor, an increased requirement for oxytocin
augmentation, and a significant slowing in the rate of cervical
dilatation. Epidural analgesia was associated with a significant
increase in malposition (4.4% vs 18.8%, p < 0.05). Cesarean delivery
occurred more frequently in the epidural group (2.2% vs 25%, p < 0.05),
primarily related to an increase in cesarean section for dystocia (2.2%
vs 16.7%, p < 0.05). CONCLUSIONS: In a randomized, controlled,
prospective trial epidural analgesia resulted in a significant
prolongation in the first and second stages of labor and a significant
increase in the frequency of cesarean delivery, primarily related to
dystocia.
I have found another that links induction and epidural with caesarean
(Kaul et al (2004), and a BMJ 2004 piece that low dose epidurals don't
show a link with caesareans - however what's a 'low dose', and what are
the links to caesareans with 'high dose' epidurals?
I am concerned at tabling research from 1993. I would be very grateful
for any other research or further detail you might have. Conversely, if
I am wrong I more than happy to be set right.
Thank you for your help.
Pam
Pam Fenton
National Childbirth Trust - National Tutor
tel. 01494 718502
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