Marienne, Im sure Denis will reply, but in case there is a delay, the
best person to contact is Betty-Anne Daviss: [log in to unmask]
all the best
Soo
Professor Soo Downe
Director
Midwifery Studies Research Unit
University of Central Lancashire
Preston PR1 2HE
Lancashire
England
+44 (0) 1772 893815
tel: 01772 893815
>>> Marianne Prins <[log in to unmask]> 09/27/07 9:35 am >>>
Hi Dennis,
Thank you for forwarding the email about labour epidural and
caesarean.
You write about the MANA curve....It sounds interesting but
unfortunately I have never heard from this curve. Looked on Pubmed but
couldn't find more details. Can you help me?
Thanks,
Marianne Prins
>>> Denis Walsh <[log in to unmask]> 09/27/07 9:17 >>>
Hi,
I am also very interested in this topic. Have you across the idea of
physiological plateaus in labour and the MANA Curve?
Denis Walsh
Reader in Normal Birth
University of Central Lancashire
Independent Midwifery Consultant
Home address:
366 Hinckley Rd
Leicester LE3 0TN
Mobile: 07905735777
From: A forum for discussion on midwifery and reproductive health
research.
[mailto:[log in to unmask]] On Behalf Of Hanne
Kjærgaard
Sent: 26 September 2007 11:15
To: [log in to unmask]
Subject: Vedr.:SV: link between epidurals and caesareans?
Hi
You will find some more recent studies in these three references:
Anim-Somuah M, Smyth R, Howell C. Epidural versus non-epidural or no
analgesia in labour.HYPERLINK
"http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A
bstract&list_uids=10796196&itool=pubmed_Abstract" \nCochrane Database
Syst
Rev. 2005; Issue 4. Art. No.: CD000331. HYPERLINK
"javascript:AL_get(this,%20'jour',%20'Cochrane%20Database%20Syst%20Rev.');"
\nDOI: 10.1002/14651858.CD000331.pub2.
And in two reviews, one by Leighton and one by Lieberman, published
in
the
same issue of Am J Obstst Gynecol 2002;186.
Beatrice Hogg: you seem to be interested in oxytocin and dystocia. Are
you
studying these subjects? I am writnig on my thesis on dystocia in
nulliparous women rigth now, and I am interested in contact with other
researchers in this field, so please give me a note if you are doing
research in the field of dystocia and oxytocics,
Kind regards
Hanne
Hanne Kjaergaard
RM, doctoral student
Copenhagen University Hospital
+ 45 35 45 88 75
-----"A forum for discussion on midwifery and reproductive health
research."
<[log in to unmask]> skrev: -----
Til: [log in to unmask]
Fra: Beatrice Hogg <[log in to unmask]>
Sendt af: "A forum for discussion on midwifery and reproductive health
research." <[log in to unmask]>
Dato: 09/26/2007 11:23AM
Emne: SV: link between epidurals and caesareans?
Hi, search for Cnattingius ? he has put together delivery results for
obese
women inSwedenand seen that there is a higher risk for them to have
complicated pregnancies and deliveries. High bloodpressure,
miscarriages,
still born babies, preterm delivery, problems during and after
delivery
and
higher risk for a caesarean with the risk of trombosis,
wound-infections
etc. But research about fatness or obese pregnant women is rather new
but
there is more research today than just a few years ago. If you search
at Pub
Med or Medline databanks for risks with epidurals and caesareans you
will
see some risks of prolonged labour, dissatisfaction with labour but
also
problems with breastfeeding and bonding to the baby afterwards. Search
for
Nissen. E, Lilja.G, Widström AM, Uvnäs-Moberg, K. Elevation of
oxytocin
early postpartum in women. Acta Obstetrica Gynecol Scand
1995;74:530-533.
About obesity again it has a threefold risk of having a stillborn baby
i.e.
higher risk than smoking mothers have. I feel that if it is possible
obese
women should deliver their babies vaginally
if the baby is OK.
Epidurals and cesaerian section can inhibit the production of oxytocin
because Fergusońs reflex is blocked. In following study it is shown
that
oxytocinproduction is decreased when epidurals are used ? Hillan EM.
Maternal-infant attachment following caesarean delivery J Clin Nurs
1992;1:33-37 . Hope this was some help and that you might find newer
articles in the subject.
Beatrice Hogg
_____
Från: A forum for discussion on midwifery and reproductive health
research.
[mailto:[log in to unmask]] För Jane Sandall
Skickat: den 29 april 2007 19:09
Till: [log in to unmask]
Ämne: link between epidurals and caesareans?
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
HYPERLINK "mailto:[log in to unmask]"[log in to unmask]
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