September 11, 2013
Volume 15, Issue 19
Midwifery Today E-News
“Epidural”
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In This Week’s Issue


Learn about breech birth with Cornelia Enning, Carol Gautschi and Gail Tully

Belgium conferenceYou will spend the morning with Cornelia Enning as she shows you how to work with breeches in water and explains the advantages of waterbirth for breech presentation. In the afternoon, Carol Gautschi (pictured) and Gail Tully will show you how to turn breech babies and discuss what to do if the baby won’t turn. The class covers palpation skills, estimating fetal weight, amniotic fluid, how to communicate with the baby with touch and words and much more.

Learn more about the Belgium conference.


Come to our conference in Harrisburg, Pennsylvania!

Harrisburg conferenceMark your calendars and save the date: April 23–27, 2014. You’ll be able to choose from a wide variety of classes including Breech Workshop, Optimal Fetal Positioning, Spinning Babies, Cultural Aspects of Resuscitation and Midwifery Skills.

Learn more about the Harrisburg conference.



Quote of the Week

Giving birth should be your greatest achievement, not your greatest fear.

Jane Weideman


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The Art of Midwifery

Even a forced smile releases endorphins, the body’s natural pain medicine that is similar to morphine. When we are with a birthing woman who is in pain, it may help to tell some good jokes—or even some not so good ones, especially in early labor. Carry a joke book in your birth bag!

Marianne Manley, excerpted from “Get Out the Joke Books,” Sharing Midwifery Knowledge, Tricks of the Trade, Vol. IV, a Midwifery Today book
View table of contents / Order the book


ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.


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Jan’s Corner

Tools of Technology

Tools of technology, such as ultrasound and epidural, if used judiciously, can be useful in birth care. But, when these tools are used routinely, they become dangerous and rob mom of her birth power. There are consequences to every procedure. Epidurals may be a “choice” in these times, but the mother deserves to know the real dangers of this choice to herself and her baby. Those consequences do not go away even if the choice is made to have an epidural. In some cases an epidural will save mom from a cesarean. I found in my homebirth practice about 0.5–1% of mothers were saved from a cesarean by an epidural because they were finally able to relax, dilate and birth their babies.

Mothers who have suffered sexual abuse sometimes find an epidural to be a choice that will save them from a cesarean because then they do not have to feel the baby move through their violated place. I believe homebirth with an understanding midwife is an excellent choice for these moms (and really, all healthy moms!).

Moms need to weigh all of the evidence they can find. In this issue of E-News you will find many issues mothers have and are dealing with in regards to epidurals. Michel Odent’s Primal Health Research Database has information as well as past issues of Midwifery Today. The interesting thing is that when moms labor at home, they do not ask for an epidural. A few will transport to the hospital for pain relief. My limited wisdom tells me it is best to have a homebirth with a good midwife to avoid an epidural and a myriad of other interventions.

Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

Jan on Twitter: https://twitter.com/jantritten
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Featured Article

Just Say No to Drugs

Are mothers more likely to give birth by c-section if they receive an epidural? With rates for both c-sections and epidurals at all-time highs, many obstetricians have put two and two together and come to the conclusion that the latter contributes to the former―especially in first-time moms.

Rather than coming straight out and saying so (and maybe discouraging mothers from having an epidural), most hospitals simply refuse to give one until a mother is well into active labor―anywhere from 4 to 7 cm dilation. The rationale is that the later a mother gets an epidural, the less time is left for side-effects to occur and complicate the normal progression of birth. The American College of Obstetricians and Gynecologists (ACOG) said as much in 2002 when they issued Practice Bulletin #36, advising their colleagues to “delay the administration of epidural in nulliparous women.”

However, if obstetricians suspect an early epidural is a harbinger of the kind of slow-paced labor that often leads to an emergency c-section, anesthesiologists beg to differ. The way one team of anesthesiologists tells it in a recent article in the New England Journal of Medicine (NEJM) (17 Feb 2005), rather than the early epidural per se, the need for pain relief early in labor often signals another risk factor for a cesarean, such as dysfunctional labor; which hurts more, lasts longer and often ends in a c-section―with or without an early epidural.

To prove their point and stop what they see as the inhumane policy of depriving women of their right to an epidural whenever they want one, the Department of Anesthesiology at the Feinberg School of Medicine of Northwestern University in Chicago, Illinois, set up a test trial of their own, dividing 750 carefully screened and matched mothers into two groups: a “test” group allowed to have the first half of a combined spinal/epidural as soon as they asked for pain relief and a “control” group, made to wait for their epidurals until reaching 4–5 cm of cervical dilation or by their third request for pain relief, whichever came first.

In the final analysis, a strange thing happened: The early epidural “test” moms had a slightly lower rate of c-sections than the “control” moms in the late epidural group. Their labor-to-delivery times were also approximately 90 minutes shorter. Perhaps best of all, their babies scored slightly better on their Apgar scores.

These were surprisingly good test results for epidural advocates everywhere, which were proudly presented in the prestigious NEJM and quickly leaked to the public media, which spread the word all over the world under such eye-catching headlines as, “No Gain, No Pain, in Delaying Epidural” (New York Times, 18 Feb 2005), “Numbing News: Early Epidural Not Too Risky” (Ivanhoe News Wire, 17 Feb 2005) and the more down to earth: “Gimme That Epidural” (www.usnews.com/usnews/health/briefs/pain/hb050217a.htm. Accessed 7 Nov 2005).

But was it too good to be true?

Surely breaking news reports don’t lie, but neither do they always tell the truth, the whole truth and nothing but…. Omitted information can be every bit as misleading as misquoted data. So, too, can word choice.

Mothers-in-waiting who read all the nice things being written in the news about receiving an early epidural would be best advised to also read the full report as it appeared in the NEJM, under the more cautious title: “Risks of Cesarean Delivery with Neuraxial Analgesia Given Early versus Late in Labor.”

Those who do so may come to the conclusion (as I did) that if this test trial proved anything at all, it was that all epidural combinations lead to more c-sections, whenever they’re given―early or late in labor. The high rates of c-sections in both the “early” and “late” epidural groups, indicated as much.

Esther Marilus
Excerpted from “Just Say No to Drugs,” Midwifery Today, Issue 76
View table of contents / Order the back issue


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Choose your classes from our Eugene 2013 conference!

Bring the conference home with your choice of classes on a portable USB drive. Classes available include Midwifery Skills, Developing Your Breech Skills, The First Hour after Birth, Shoulder Dystocia, Art in Midwifery and Birth, Prolonged Labor and Malpresentation. Just go here to select the classes you want and place your order.

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Discover the essentials of supportive touch.
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In Touch Techniques for Birth, Leslie Piper, LMT, and Leslie Stager, RN, LMT, show you how to make touch a part of your midwifery practice. You’ll learn about contraindications, acupressure, reflexology, hydrotherapy, general comfort strokes, pain relieving techniques and more. A special feature includes a midwife’s story of the use of belly rub and emotional support to encourage labor. This DVD belongs in your midwifery library! Get the DVD.


Are you prepared for prolonged labor?
The Prolonged Labor HandbookMidwifery Today’s The Prolonged Labor Handbook discusses the benefits of positioning, trusting birth, and the political ramifications of time assessment and responsibility. You’ll also learn ways to prevent prolonged labor, including herbal remedies and psychological assessment. Part of the Holistic Clinical Series, The Prolonged Labor Handbook belongs in your birth bag! Buy the book.


Website Update

Read this editorial from Midwifery Today magazine, Issue 107, now on our website:

  • From the Editor: Changing Birth Practices by Jan Tritten

    Excerpt: Changing birth practices is as hard as changing culture, because that is essentially what we are trying to do. Culture is often against us. We fault doctors and the medical approach to birth (and rightfully so!) … But don’t we have a hard time giving up unneeded vaginal checks, talking needlessly, using Cytotec and other harmful drugs, disturbing motherbaby unnecessarily in the first hour after birth and on and on?


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Birth Q&A

Q: If you had an epidural during labor/birth, did you experience any adverse side effects?

— Midwifery Today

A: With my first baby, I had an epidural that was not put in quite right. It numbed me fine, but when it was removed, I was leaking spinal fluid and got an unbelievable spinal headache! After suffering for two days from a horrendous headache (all I was offered in the hospital was caffeinated beverages, which did absolutely nothing for the headache), I finally went back to the hospital and had to have a blood patch. They took blood from my arm and put it in my back where I had my epidural to repair the damage. Within an hour, my headache was gone. It definitely made me nervous to ever have another epidural!

— Mary McNeil Baron

A: I had one during my first birth. My back has never been the same. I have a lot of sciatic pain and numbness in one of my legs often. The epidural was four years ago.

— Ashleigh Corrigan

A: My son was so drugged from the epidural that he did not cry at birth and was not able to latch on for 10 days!

— Heidi Basford Kerkhof

A: I didn’t have any issues at all. I was thankful!

— Kayla Leib

A: With my first birth I was very uneducated, scared and just did not know what to do or how to do it! The nurses came in and gave me Pitocin for no reason at all. I needed something to take the edge off, so I got Demerol. Then they scared me into getting an epidural. The anesthesiologist had to go into my back twice! The epidural wore off on my left side―it felt like my insides were being torn and that my left hip and leg were going to explode! One of the most painful parts was when they took the drip line out of my back. For over a year afterwards I had horrible constant back pain. I could hardly bend over to change my son’s diaper.

Now I am six weeks postpartum with my second baby. I went all natural and was ready to leave the hospital right after I gave birth! It was the most unbelievable experience I have ever had in my entire life. My natural birth hurt way less than my drugged one. I labored at home and was 8 cm when I arrived at the hospital! There were no ill side effects. I had horrible postpartum depression after my first birth, which I attribute to the Pitocin and epidural. I bled for weeks with my first, but was down to spotting in a matter of days with my second.

I will always recommend that women become educated on natural labor techniques so they are fearless and confident.

— Katie Curry

A: I had an epidural with my first two births. It helped with the discomfort a lot, but it didn’t work completely on my right side either time. I only got the epidural because I was scared with my first two births. With both of the births I was very nauseated and tired afterwards. With my first I got a very bad infection, but never found out where it was. I had a fever of 103 and had to go back to the hospital for two days. I don’t know if that was epidural-related. With our third, I decided to go all natural at a birth center. It was such a different experience! So amazing! So much easier! I felt so much better after delivery. No nausea, I had energy and I went home three hours after the birth. Being able to move wherever and however I chose made the whole experience less painful, and I didn’t tear! It was intense at the end, but totally doable and totally worth it. I will forever recommend a drug-free birth. What an awesome, beautiful, empowering experience birth can be for a woman. Trust your bodies, ladies!

— Chanel Craig

A: When I was 17 I gave birth to a beautiful little boy and started my life of back problems as a result of an epidural. I also had ringworm at the insertion site following the birth. I was unable to move my legs and push effectively as a result of the epidural. My son was lethargic and had trouble keeping warm, which I believe was due to the epidural. Eighteen years later I still have back pain as a result of this epidural.

— Michele Dangelo

A: I had two; both times I also had Pitocin because of big, overdue babies. I didn’t notice any of the side effects I ought to have had (I’ve read some of the literature). I felt great afterwards. Both kids are great and socially and academically normal. I had one other induction and three completely natural births. I have not detected any differences between my children or my recoveries. All their breastfeeding habits were similar.

— Rachel Lucas Anderson


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You want to be a midwife, but where do you start?

Are you an aspiring midwife who’s looking for the right school? Or maybe you’re trying to decide if midwifery is the path for you. Visit our Better Birth Education Opportunities page to discover ways to start or continue your education.



Conference Chatter

Birth Pain Relief Class in Belgium

We have less than two months to go until our conference in Blankenberge, Belgium, and we’re all getting very excited, as I’m sure all of you who are attending are, too! Since the theme of this E-News is the epidural, I thought I’d highlight one of the many amazing classes we’re offering that relates to this topic. The amazing midwife Verena Schmid is teaching a class called “Physiological Analgesia in Labor,” which covers the topic of pain relief in childbirth. Verena will analyze a woman’s need for pain relief and for a normal birth in different settings and offer an individualized answer to her needs through a systematic approach. In the class you will also learn to set the foundations for prenatal training for coping with pain. We hope you can join us for this very special class.

To learn more about this class and the other classes that will be at our October conference, please visit our Belgium page.

If you have any questions about this conference or any conference, past or future, please feel free to drop me a note at conference@midwiferytoday.com and I’ll be happy to assist you.

— Andrea Goldman


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Stories

During my birth the epidural line somehow disconnected from my back. I was trying for a waterbirth at a hospital, but ultimately got the epidural after almost 24 hours of labor. It worked, at first, but then as it came time to push, I could feel everything. No one believed me, so they kept upping the epidural medicine. I pushed for three hours and felt everything. The epidural line kept beeping so the nurse kept hitting a button to make it stop. After my son was born, a nurse was annoyed because she thought my waterbirth tub had leaked all over the floor. Someone then noticed that it wasn’t water from the tub all over the floor―it was from the epidural line that had disconnected from my back! I tried to contest the charge for the epidural, but failed and still had to pay for it. I couldn’t believe a nurse didn’t notice, especially since the alarm kept going off!

— Jenny Gullen


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