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WILL AN EPIDURAL INCREASE YOUR RISK OF C-SECTION?

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We know that epidurals can lengthen the amount of time women spend in labor, especially during the second stage also known as the pushing stage.

(It’s hard to push effectively when you can’t feel contractions.) We also know that lengthy labours and ineffective pushing are leading contributors to C-sections, but how long is too long? And should women fore-go epidurals if they want to avoid C-sections?

Well, there are certainly a few things to keep in mind, in light of a new study published in Obstetrics and Gynecology. Researchers at the University of California, San Francisco, analysed the records of 42,268 women who delivered vaginally without problems between 1976 and 2008, half of whom had epidurals. The goal: To compare the average length of second stage labour among women who had epidurals with women who didn’t.

Turns out, the pushing stage lasted much longer for the women who had epidurals more than we previously thought. We’re talking about 5.6 hours for first-timers who had epidurals vs. 3.3 hours for women who went without one. Experienced mothers went as long as 4.25 hours with an epidural and 1.35 hours without. Still, they had normal births and healthy babies.

Here’s what you do, whether or not you decide to have an epidural:

  • Be wary of intervention

The implications of this study are bigger than not wanting to push for too long (though that's nobody's idea of fun).
It also means doctors may intervene unnecessarily: The American Congress of Obstetricians and Gynecologists recommends intervention (via forceps, vacuum extractors, Pitocin, or C-section) if the second stage lasts longer than three hours for first-time mothers with epidurals or two hours for first-timers without. (Yep, that means some doctors may be too eager to intervene even if you don’t have an epidural.) The lesson? Doctors need to chill out and let Mother Nature do her thing, in her own sweet time.

  • Ask questions

If you’ve been stuck in second stage for longer than your doctor likes, and she’s starting to make C-section noises, ask her if there’s any indication that your baby is in trouble (especially if you’ve had an epidural).

If the answer is “yes,” ask what else you can do (change positions, etc.) to improve baby’s stability. If the answer is no, ask her what the danger is of waiting a while longer. Ask her if she’s read the latest study that recommends she use patience on her patients before she reaches for instruments.

  • Tell your doc to chill out

If there’s nothing wrong with you or baby, then tell her you’ll be pushing longer. Remember, your doctor will make recommendations based on her best knowledge, but it’s up to you to decide what you’ll do with that information.

  • Start the pushing stage later

A process referred to as “labouring down” means that you don’t need to start pushing as soon as you reach ten centimeters. If you don’t feel an urge to push (which many mothers with epidurals won’t feel), you can continue resting and the uterus will continue contracting and pushing the baby lower and lower in the birth canal.

At some point, you’ll need to pitch in and help your uterus (and your baby) out, but as long as the baby is stable there’s no reason to start the timer on second stage by pushing before you have to. The longer you spend pushing, the more tired you may become (and the more impatient your providers may become), which might increase your likelihood of a C-section.

Written By: Jeanne Faulkner. She is a registered nurse with over 20 years experience working in maternal health and 18 years working in labor and delivery.  She's Senior Writer for Every Mother Counts, a global maternal health advocacy organization and the author of The Complete Illustrated Birthing Companion (Quayside Press, 2013). 

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