Reducing Infant Mortality

the doctor that performed a c-section on a pregnant woman at only 7 months should have their license revoked. what utter ridiculousness!
 
thanka2 said:
I just have a few questions regarding what you listed--

- There was a high chance that the baby will not engage, even during labor.
How do you know that the chance was high? Did the doctor tell you that? There are quite a few women for example who are facing a breach baby and the baby turns at the last second (or there are things that can be done safely and naturally to encourage the baby to engage) and the woman gives birth vaginally.
- by themselves, many induced labors end up in emergency C sections.
- emergency C sections are more risky than elective C sections.
Why do you say so? If you have an experienced surgeon, there shouldn't be any more risk involved in doing the c-section at the last minute than pre-planning it--unless there is already something going wrong with the child or mother. In both cases there is a major abdominal surgery taking place.
- Long labor is stressful for both the mother and the baby.
Had you gone through a long labor before? What do you base this assumption on? Labor itself can be a stressful situation--whether it's long or short. Having gone through an extremely long labor naturally myself (43 hours) I can say it was difficult but I wouldn't say that it was any more stressful--I guess it depends on how you define "stress." Part of what makes labor, labor is that it is something one needs to submit to and allow oneself to go through--not fight against--when it's fought against that's when it becomes stressful in my opinion. As far as stress caused to the baby--long labors often are no more stressful to the baby than short ones. There are women who labor for weeks with a child and the child shows no signs of stress during or after labor. I think that the images we get from Hollywood give us a lot of misinformation about what labor is and can be.
- I get fully covered by the insurance, and can stay in a private room, where my baby could room-in.
Because you had a pre-planned c-section you got fully covered by insurance with all the benefits?...or if you had chosen a different route, would you have received the same coverage?
- I totally trusted my doctor.

Just really curious to know. Thanks.
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Doctor said that the chance I may be able to have a vaginal delivery was like 20%. I trusted that he gave me that number based on his experience seeing patients on similar situation. I would have bet on that 20%, but then I weighted the pros and cons, and decided to have an elective C section.

As for the stress, I read or heard somewhere that each contraction is not only painful for the mother, but also for the baby, as he get pushed through the birth canal. It may be more difficult for my baby due to the cephalopelvic disproportion. Forceps doesn't sound fun either. This was going to be my first one, and we know that usually it takes longer time for the first one to come out... and we are not talking about how his little head may get stuck on the birth canal! Also my sister got induced at week 42, and after long hours of pain, she didn't dilate enough and had to go for an emergency C section. So I didn't want to suffer in vain. I really wish labor were like in the movies! On the movies, they are always fast!

As for the insurance, the coverage is very basic for natural delivery, but full coverage for complications (including C section due to medical reason). I may have tried for the natural delivery first (with a very basic package on a shared ward), but if that had fail and I had needed an emergency C section, I would have had to submit an emergency treatment guarantee form for the cost to be covered, and pay out of our pocket while the form was being processed. There were already lot of things to be worried about, so I didn't want to worry also about the form being approved, and the cost being covered or not.
 
thanka2 said:
I just have a few questions regarding what you listed--

- There was a high chance that the baby will not engage, even during labor.
How do you know that the chance was high? Did the doctor tell you that? There are quite a few women for example who are facing a breach baby and the baby turns at the last second (or there are things that can be done safely and naturally to encourage the baby to engage) and the woman gives birth vaginally.
- by themselves, many induced labors end up in emergency C sections.
- emergency C sections are more risky than elective C sections.
Why do you say so? If you have an experienced surgeon, there shouldn't be any more risk involved in doing the c-section at the last minute than pre-planning it--unless there is already something going wrong with the child or mother. In both cases there is a major abdominal surgery taking place.
- Long labor is stressful for both the mother and the baby.
Had you gone through a long labor before? What do you base this assumption on? Labor itself can be a stressful situation--whether it's long or short. Having gone through an extremely long labor naturally myself (43 hours) I can say it was difficult but I wouldn't say that it was any more stressful--I guess it depends on how you define "stress." Part of what makes labor, labor is that it is something one needs to submit to and allow oneself to go through--not fight against--when it's fought against that's when it becomes stressful in my opinion. As far as stress caused to the baby--long labors often are no more stressful to the baby than short ones. There are women who labor for weeks with a child and the child shows no signs of stress during or after labor. I think that the images we get from Hollywood give us a lot of misinformation about what labor is and can be.
- I get fully covered by the insurance, and can stay in a private room, where my baby could room-in.
Because you had a pre-planned c-section you got fully covered by insurance with all the benefits?...or if you had chosen a different route, would you have received the same coverage?
- I totally trusted my doctor.

Just really curious to know. Thanks.
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Just a couple of thing I would like to mention.

If a baby doesn?t engage by 40 weeks, nature isn?t taking its course and one has to start considering possible reasons as to why the head isn't coming down. It is true that you may have an induction and end up have a beautiful vaginal delivery (and that?s what we all hope for!), but having a high head increases you risk of other complications (eg cord prolapse, obstructed labour with the cervix not dilating) and thus increases your chances of an emergency caesarean section (sorry I don?t know the exact numbers on this).

Emergency caesarean sections are generally considered to carry more risk than a planned elective caesarean section. Though many emergency caesareans usually occur with no hiccups, there are many factors that come into play which increase their risk compared to elective. For example, having a caesarean in labour after your waters have broken increases the risk of infection (upward spread from the vagina). Also emergency caesareans can occur when staff may not be around or in optimum condition for the surgery (eg obstetricians / anaesthetists / paediatricians may not be at their optimum performance in the middle of the night, likewise with midwives and theatre staff; also if you run into complications there may be a need for support from other specialties, for instance like ICU ? those doctors are around in closer vicinity in more numerous numbers during the day than at night time) and more often than not emergency caesarean sections are done in a more of a hurry relative to electives, hence theatre and medical preparation for the surgery may not be as optimal as an elective caesarean.

Labour is a stressful event and babies do get tired. Every time the uterus contracts, there is temporary diminished blood flow to the baby, and if this happens constantly or over a long period of time, babies can get hypoxic and tired. It?s like the baby?s running a marathon in there. Most babies are quite resilient and cope remarkably well, however the longer the labour is, the more tired our bubs will be.

That's all. Cheers! :-)
 
Also one more thing, emergency caesareans usually occur when there is a problem with bub or mum ... hence an added risk is that bub or mum may not be in optimal condition in the first place (eg. you may have an emergency caesarean for fetal distress, where bub's distressed because he/she has had to endure labour - this may not have occurred if bub was not put through that hypoxic event of labour).

All in all, I'm very pro-vaginal delivery and it is beautiful to have a normal vaginal birth, however, sometimes (as with other things in life) things don't go to plan. I think the way interventions are used is a very controversial topic, which everyone will, and has a right to, have their own opinion on. :-)
 
I would argue that exposing your sensitive baby to the narcotics (which most definitely pass the placenta--I mean, c'mon people--if you're not allowed to take most pain medications during pregnancy because they could affect the fetus, why would a heavy dose of pain killers at the very end not have any effect?) found in the pain killers and medications administered after most interventions would prove way more stressful to the baby's neurological system than a "long" labor. (And to define "long" is probably pretty hard to do--for some women, more than a few hours--or even an hour-- would be considered "too long") For this reason, babies are monitored during labor to ensure that they aren't suffering any stress. Birth isn't an easy process and there is nothing that is going to be make it stress-free physically for babies or women (even taking every intervention possible to avoid pain and discomfort is going to have it's price in the end--usually in the health and development of your child) but it is a natural process that works. Babies who are exposed to heavy duty pain killers often have trouble maintaining their temperatures when they leave the womb and the neurological probably go undetected or are diagnosed as something else years later.

To me, it doesn't make any sense to go for a c-section because you "might need one" in the end. "Might" is a pretty big word. Also, I think that if you assume that a child is fully developed just because on a chart somewhere it says "40 weeks" and you start pushing things because "the baby has not engaged" because you assume that that 40 week estimation is infallible then you're putting a lot of trust in a number that could very well be wrong. If I was in that position--sitting at "40 weeks" (according to a doctor's estimate) and the baby had not "dropped" then I would be doing everything imaginable (and natural) to get that child to drop--and there are things out there to do that. I have no problem waiting 2 or more weeks past my due date in order to give that baby time to fully develop and drop. Afterall, every child is different. Myself, I was nearly 3 weeks overdue and born completely naturally with no complications--I say I turned out okay. :)
 
thanka2 said:
I mean, c'mon people--if you're not allowed to take most pain medications during pregnancy because they could affect the fetus, why would a heavy dose of pain killers at the very end not have any effect?)
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Thanka2, no offence meant here but your post sounds rather condescending and judgemental. can I ask where you obtained your medical degree? Pregnancy and labour can be a stressful enough time for a woman and I am sure that the majority of people go in with the intention of having a perfect, natural, drug free delvery, but this is not always possible and at the end of the day each woman will make a decision at the time that they feel is best for her and her child. Can you provide articles and video evidence to support your claim that pain medicaton during labour has a detrimental affect on the baby?
 
AmyH said:
Thanka2, no offence meant here but your post sounds rather condescending and judgemental. can I ask where you obtained your medical degree? Pregnancy and labour can be a stressful enough time for a woman and I am sure that the majority of people go in with the intention of having a perfect, natural, drug free delvery, but this is not always possible and at the end of the day each woman will make a decision at the time that they feel is best for her and her child. Can you provide articles and video evidence to support your claim that pain medicaton during labour has a detrimental affect on the baby?
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No offense taken and none meant. Of course I have no medical degree but I just don't understand why last week I went to a doctor in Hong Kong because I've been having severe back pain and was told at max the only thing I could take safely for my baby would be 2 panadol. But, many doctors will say that the pain medication given to women in childbirth (epidurals etc) has no effect on the baby--I feel like it's really a misrepresentation. As I said, it doesn't make any sense to me that women would feel comfortable accepting such strong drugs that probably do have some effect on their children. Yes, labor is painful--it can be horribly painful but I don't understand why women would choose to risk their children's health so easily for convenience and comfort. And I think that probably is at the heart of the video I posted. Doctors are doctors but they are also working for a customer--so I feel like many just bend to the "market demand" and in the turn the health of newly born children suffers. There is always a time for everything but I feel like the true risks and side effects of interventions are rarely presented for what they are so it makes it easier for women to choose interventions with a clear conscience.

I don't know how many studies have been done on the effect that meds have on the baby at birth but talk to some midwives about what babies look like when they come out after experiencing narcotics--there is a huge difference in color and response. I will try to find more specific things as I've read some things on this topic when preparing for the birth of my son.
 
my previous post was quite harsh and abrupt so let me first apologise for that! I have no experience with natural childbirth but did go through 24 hours of active labour on my second (thought I could be one of those mums to have a sucessful VBAC but it was not to be!) This labour was drug free until I was advised that it was probably likely that I would need a C-section due to issues with the baby getting distressed so the doctor advised me to have an epidural which they could then top up to perform the surgery if it was necessary.
The epidural was working for half an hour before I had to have the c-section but my daughter was born crying, and within an hour she was breast feeding, had her eyes open and was very alert so I can assume that the drugs in the spinal block had no real affect on her (but I have not had a drug free natural laboured chld to compare her to!)

I defintely agree that it is worth while getting as prepared and educated as possible before labour but not all birth plans work out in the end and I dont think that women should feel guilty if they had some pain medication or if the birth ended in a c-secton, as long as both mother and baby come out it safely.
 
In my case, week 40 was really my 40th week, as my ovulation was induced using clomid, and the ovulation date determined be OPK. Also at my week 40 scan, the doctor noticed that my placenta was starting to age, so adviced me not to wait for too long.
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Just for the record, epidurals are completely safe in labour - it is a local anaesthetic that goes into the spine that is used, and the amount that gets through to bub (if any) is so minimal that it is not considered significant. On the other hand, narcotics such as morphine and pethidine (which are given systemiclly) can go straight through from maternal bloodstream to bub, this is normally only an issue when it is given within a few hours prior to bub being born - this causes similar side effects as it does in an adult (ie. sleepiness and hence feeding difficulties, respiratory depresssion). However, prior to labour, opioids are generally considered safe and are commonly used in pregnancy ("generally" being Pregnancy category B or C). Of course, the safest thing is no drugs at all, but one has to weigh up the benefits and risks of pain relief (eg. there is no point refusing pain relief to a mum who is hysterical in pain, cos she's not going to be able to labour efficiently while she is so hysterical).

Also I would hope that if someone has a due date set by an obstetrician, it is one that is within two weeks of being accurate. Generally if you have an early "dating" ultrasound (7-13 weeks) and know your period dates, and they roughly agree with each other (say within a week), you can be pretty sure that the accurate due date is within that week. However, if there was some mix up and, for instance, your accurate due date was actually 2 weeks earlier than you thought (so you thought you were 38 weeks but you are actually 36 weeks), sure you may end up with a premature baby which is not ideal and may end up with complications (as could any term baby) - but most babies born after 34 weeks these days usually do quite well and act as term babies anyway. However on the other hand, if your accurate due date was 2 weeks later than you thought (so you think you're 40 weeks but are actually 42 weeks), there is known to be a significant risk of placental insufficiency which rises exponentially after 42 weeks and this may end up in a stillbirth. This is why most inductions are planned at around 10 days overdue, to give you a couple of days to labour and have your baby before the risk starts increasing at 14 days overdue. Thanka2 you are very lucky that you did well at 43 weeks! If my only choice was to have bub premature (<37wks) or post dates (>42wks), I'd definitely go premmie! Sorry, probably diverting from the topic a little!

As for the mode of delivery, it needs to be individualised for every mum and can be quite a grey area - and it's all about weighing up the risks and benefits of vaginal birth versus caesarean. Every mum is different so it's a bit difficult to make a general comment on this one.

Sorry for writing so much! I'll stop now :-)
 
By the way, I just watched the video clip. Some interesting things I noted:
1. There were mainly neonatologists, family physicians and midwives speaking; but no obstetricians?
2. Yes the caesarean section rate is a lot higher than it is meant to be (WHO recommends 15%, the current rate is 30%)
3. Litigation does play a significant part in the rise in intervention. Obstetricians get sued if they don't intervene and a bad outcome occurs, so more often than not, they tend to play on the 'safe' side and intervene to deliver the baby if they can.
4. "Midwives and family physicians have the lowest infant mortality rate" - well that's probably cos they palm off all the high risk cases to the obstetricians!
5. Most of the premature babies on the clip look like they are a lot less than 34 weeks gestation. We are saving more of these extremely premature babies these days, therefore it is only natural to have a corresponding increase in neonatal mortality as well.
 
I also find myself wondering what is classified as a heavy narcotic. All narcotics are opiate-based; the drug in spinal epidurals most certainly is not. I have read that a small amount of epidural drug passes through the placenta, and some babies have come out a big sluggish, but this can also be attributed to long and stressful vaginal labours. I just think that implying that epidurals, the most common form of pain control during labour, is a bit misrepresentative and misleading.

I was one of the women who wanted a drug-free vaginal birth with no interventions. But hey, things changed, and I asked for an epidural after a couple hours on oxytocin. We all have different pain thresholds. I didn't feel it would adversely affect my baby. Furthermore, since I later had a c-section, I received more of the drug into my epidural, and then some more since it wasn't working well. My son came out kicking and screaming like a wild animal and got perfect responses in his apgar. He has not had a single serious health issue coming up on 2 years now.
I can't say the same would have been true if he was born vaginally, who knows what might have transpired?
 
laial said:
Also I would hope that if someone has a due date set by an obstetrician, it is one that is within two weeks of being accurate. Generally if you have an early "dating" ultrasound (7-13 weeks) and know your period dates, and they roughly agree with each other (say within a week), you can be pretty sure that the accurate due date is within that week. However, if there was some mix up and, for instance, your accurate due date was actually 2 weeks earlier than you thought (so you thought you were 38 weeks but you are actually 36 weeks), sure you may end up with a premature baby which is not ideal and may end up with complications (as could any term baby) - but most babies born after 34 weeks these days usually do quite well and act as term babies anyway. However on the other hand, if your accurate due date was 2 weeks later than you thought (so you think you're 40 weeks but are actually 42 weeks), there is known to be a significant risk of placental insufficiency which rises exponentially after 42 weeks and this may end up in a stillbirth. This is why most inductions are planned at around 10 days overdue, to give you a couple of days to labour and have your baby before the risk starts increasing at 14 days overdue. Thanka2 you are very lucky that you did well at 43 weeks! If my only choice was to have bub premature (<37wks) or post dates (>42wks), I'd definitely go premmie! Sorry, probably diverting from the topic a little!

As for the mode of delivery, it needs to be individualised for every mum and can be quite a grey area - and it's all about weighing up the risks and benefits of vaginal birth versus caesarean. Every mum is different so it's a bit difficult to make a general comment on this one.

Sorry for writing so much! I'll stop now :-)
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One thing I'd like to just try to make clear again--I'm not saying that the doctors totally misjudge how long the baby has been in the womb because I do believe that the measurements used (ultrasound mostly) are a lot more accurate than they once were. So, I'm not saying that most womens' due dates are actually off. I am saying that every child is different so some may need 40 weeks and some may need more time to be fully ready to come out of the womb--before they are developed to the optimal point. Just because we say that the due date for babies is exactly 40 weeks doesn't mean all babies are completely ready to come out. In the same way, some babies may be fully developed and ready to be born at 38 weeks but I think it's better to leave it up to the baby to decide--healthier that way. Just a little sidenote, I believe much more in holistic medicine than I do in western medicine as with every health problem I've ever encountered, western methods did little if nothing (except drain my bank account) and I only found relief from more holistic treatments. Therefore, when it comes to childbirth, I just take everything the western doctors in the hospital say with a grain of salt. Like I said, I just come from a very different point of view than I think most of the women here do. That's not good or bad--it's just a difference and that's why it's very hard to not come off as if I'm from a different planet.

Oh, and also, I didn't go overdue to 43 weeks. (My mom was overdue by three weeks with me, though). My due date was November 28 (my husband's birthday, actually) and at 1 am on November 28, just naturally, I went into labor. I had also been employing a lot of natural labor induction methods from 38 weeks on because I was just ready for that baby to come out but he decided at 40 weeks exactly it was time.

I had steady, painful contractions at 5 minutes apart or less for the duration--the contractions never stopped or let up or got weaker. Labor progressed--slowly, painfully, slowly. My labor was really long--43 hours long. So, my son was born on the night of November 29 at 9:43 pm. I guess, the labor was then probably longer than 43 hours.

I don't believe in luck. I had to endure a lot to get to the point of actually birthing my son and I had nothing but back labor from the get-go. Anyone who has had back labor knows that it sucks. Initially when the baby was descending his head was turned to the side so that increased the pain (he was looking over his shoulder as he was coming down the birth canal).

As my labor was slower (I had already been in labor for over 24 hours at this point), one of the doctors came in at one point (a really young guy) and started trying to scare me into augmenting the labor with pitocin. These were his words and I quote, "You don't want to be like one of those women in sub-Saharan Africa that labor in the desert for days and then die in childbirth, do you?" We listened to his words and when he left, my husband and I almost burst into laughter (if I hadn't been in pain, I probably would have laughed). It was just ridiculous the scenario he was presenting and there was no stress or danger to the baby or me so there was no need to do anything except just go through labor. I'm glad I didn't choose to augment labor with pitocin and I'm glad I had a midwife who in her words "went to bat for me."

Part of the lip of my cervix was holding his head back so the midwife went in and literally ran her fingers around the cervix to allow his head to descend further--that was extremely painful. It took several contractions to do this and I just remember pleading with her, "Please take your hand out" but she just replied in her Texas drawl, "Oh, honey, I'm going to have to stick it in there again in just a couple of minutes so I'm just going to leave it in there."

I guess I just had the right type of midwife for me--at one point she literally looked at me and said, "Stop it. You're carrying on and you're wasting energy. You need all the energy you can save for later so you just calm yourself down and focus." I was kind of displeased at her at that moment but she knew what to say and do to help me get the job done. She knew what my commitment to myself and my baby was and she helped me stick to it even when I wanted to give up--she just firmly but gently reminded me of what I had said I wanted. She was the sweetest lady from Texas (I'm not from Texas, BTW) in all of my prenatal appointments but she was an absolute no-compromise coach when it came to the birth.

Anyway, that's part of my experience.

I also don't mean to come off as a b*tch--actually, I just come from a vastly different school of thought than most ladies here, I realize. It doesn't really do much good for me to share my opinion (in its full-strength) here because I've had a very different background, upbringing and experience altogether, I think. And, yes, I am opinionated and there are grounds to my opinion but it's really hard to explain here on this forum without really offending a lot of women.

So, I realize I'm not going to change your mind and you're not going to change mine and that's cool.
 
Wow Thanka2 that sounds like quite an ordeal you went through with your labour ! I come from a western medical background, hence lots of scientific and evidence-based explanations (for example, if you have a prolonged active first stage or second stage of labour, the uterus tends to get tired from contracting and contracts less in the postpartum period, hence increasing the risk for a postpartum haemorrhage, which can be a life threatening emergency - probably one of the reasons why your doc said what he did, though he could have said it nicer :-). I respect that everyone has differing views, and I think that is part of what makes medicine, and in particular obstetrics, interesting. However, it also makes obstetric issues controversial, because there are no right or wrong answers - just whatever is right for the individual, which is not for anyone else to judge. I think ultimately it is up to each mum to make informed decisions (as much as possible) about her own pregnancy and labour, ask lots of questions, stay as sensible as possible and try not to be pressured into doing or not doing anything. At the end of the day, we're all aiming for the same goal - that is healthy mum and healthy bub! :-)
 
laial said:
By the way, I just watched the video clip. Some interesting things I noted:
1. There were mainly neonatologists, family physicians and midwives speaking; but no obstetricians?
the high risk cases to the obstetricians!
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Did you also notice how the video brought out that there are basically two schools of thought when it comes to childbirth--there is the system that is more risk-based and then there is the midwifery approach. And I think that a lot of OBGYNs go by the former so this video spoke to the latter side.

Also, they had:

The former director (directed for 15 years) of the Women and Children's section of the WHO (also a perinatologist which is a subspecialist concerned with the care of the mother and fetus at higher-than-normal risk for complications)
At least one other doctor who is also a perinatologist
PhD with 25 years of experience now focusing on infant brain development
Researcher who focuses on prenatal and perinatal psychology, prematurity, neuroscience, and psychotherapy
The Medical Officer, County of San Bernadino Department of Public Health

Along with scores of very highly qualified doctors and specialists who contributed to the film
 
laial said:
Wow Thanka2 that sounds like quite an ordeal you went through with your labour ! I come from a western medical background, hence lots of scientific and evidence-based explanations (for example, if you have a prolonged active first stage or second stage of labour, the uterus tends to get tired from contracting and contracts less in the postpartum period, hence increasing the risk for a postpartum haemorrhage, which can be a life threatening emergency - probably one of the reasons why your doc said what he did, though he could have said it nicer :-). I respect that everyone has differing views, and I think that is part of what makes medicine, and in particular obstetrics, interesting. However, it also makes obstetric issues controversial, because there are no right or wrong answers - just whatever is right for the individual, which is not for anyone else to judge. I think ultimately it is up to each mum to make informed decisions (as much as possible) about her own pregnancy and labour, ask lots of questions, stay as sensible as possible and try not to be pressured into doing or not doing anything. At the end of the day, we're all aiming for the same goal - that is healthy mum and healthy bub! :-)
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It was and I also hemorrhaged. But my skilled midwife who has been helping with births in homes, hospitals and birthing center for 30 years took one look at me when I had my first appointment with her at 29 weeks and said, "You have red hair and fair skin and in my experience women with your complexion tend to have bleeding problems." She also said there were no official studies on the matter but her observations told her otherwise. She added, "But don't worry, if that happens, I know what to do. You're in good hands." And I was in good hands. There is some history of bleeding problems on my mother's side of the family with the women as well. But, the thing I appreciated is that my midwife always communicated to me with a sense of frankness without pushing an attitude of fear. I get the absolute opposite vibe from most of the doctors I've met. It's like they see a "ghost around every corner" and every woman could be a potential high-risk case. I think the video pointed to this as well--there is the risk-based model of care and I believe that is the standard in Hong Kong as well.

The know-it-all doctor had no basis for what he was talking about. It wasn't about him being nice--it was about him doing his job in a respectful way not trying to manipulate me while I was in labor. Even my midwife was actually very "unkind" (she really pissed me off during labor because she wasn't coddling me at certain points--but in retrospect that is what I needed--she was a tough coach!) --but she spoke to me as an equal and she spoke with authority--she didn't need to try to scare me to lay out my options. I think that some doctors really think that their patients are idiots (the ones I've met in HK mostly do) and so the best way to get them to do what the doctor wants is to scare them into it. It's not respectful and it's manipulative, in my opinion.

First of all, I was not in sub-Saharan Africa, laboring in the desert without access to medical care, secondly, neither I nor the baby were showing any signs of physical distress (besides labor pain--but, hey, that's. labor)--basically, my labor wasn't moving fast enough for his time schedule. My midwife was not alarmed. My nurses were not alarmed--and truth be told in a hospital (at least where I come from) the midwives and nurses handle 85% of the workload--sometimes the doctors just rush in to play "superstar" as the baby comes sliding out. In my case, I chose not to have a doctor and avoided that cost altogether. My midwife saved my life and she was just as informed, experienced and good at dealing with my "high risk" case as any doctor would have been.

So, even though I did hemorrhage which created personal complications for me--that was after my son was born and if I had it to do over again, I would still go through it the way I did because I believe firmly from my own observations that it was the best choice for my child. It took guts and what we call "intestinal fortitude" to do it and after I was done my midwife told me, "Now, there is nothing you can't do or make it through"--in some ways I believe she was totally right.
 
Shenzhennifer said:
I also find myself wondering what is classified as a heavy narcotic. All narcotics are opiate-based; the drug in spinal epidurals most certainly is not. I have read that a small amount of epidural drug passes through the placenta, and some babies have come out a big sluggish, but this can also be attributed to long and stressful vaginal labours. I just think that implying that epidurals, the most common form of pain control during labour, is a bit misrepresentative and misleading.

I was one of the women who wanted a drug-free vaginal birth with no interventions. But hey, things changed, and I asked for an epidural after a couple hours on oxytocin. We all have different pain thresholds. I didn't feel it would adversely affect my baby. Furthermore, since I later had a c-section, I received more of the drug into my epidural, and then some more since it wasn't working well. My son came out kicking and screaming like a wild animal and got perfect responses in his apgar. He has not had a single serious health issue coming up on 2 years now.
I can't say the same would have been true if he was born vaginally, who knows what might have transpired?
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I was curious also about the exact contents of an epidural and this is a little of what I found:

Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics, such as fentanyl and sufentanil, to decrease the required dose of local anesthetic. This way pain relief is achieved with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or stabilize the mother’s blood pressure.
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So, let's go through and see:

-bupivacaine
* Studies on animals show adverse effect and toxicity on fetus.
* No adequate and well controlled studies done on pregnant women.
* Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
* Crosses placenta by diffusion.
* Human studies revealed no birth defects.
* Animal studies revealed increased incidence of fetal death and skeletal abnormalities when used in high doses.

chloroprocaine
* Studies on animals show adverse effect and toxicity on fetus.
* No adequate and well controlled studies done on pregnant women.
* Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
* Crosses placenta by diffusion.
* Human studies revealed no birth defects.
* Animal studies revealed increased incidence of fetal death and skeletal abnormalities when used in high doses.


lidocaine
* Controlled studies done on animals in reproduction do not indicate risk to the fetus.
* No adequate and well-controlled studies done on pregnant women.
* Crosses placenta by diffusion.
* Human studies revealed no birth defects.
* Animal studies revealed no adverse fetal effects.

fentanyl
* Studies on animals show adverse effect and toxicity on fetus.
* No adequate and well controlled studies done on pregnant women.
* Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
# can cause loss of fetal heart rate variability without hypoxia.
# With epidural fentanyl, neonatal respiratory depression may occur.
 
I submitted my last post without finishing the list.

Here is the continuation:

epinephrine
* Studies on animals show adverse effect and toxicity on fetus.
* No adequate and well controlled studies done on pregnant women.
* Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
# Teratogenic (capable of causing developmental abnormalities) in some animals.
# No well controlled human data but suggested possible association with eye, ear, digital defects and club foot during first trimester exposure, and with musculoskeletal defects and umbilical hernia during exposure anytime during pregnancy.
# It may cause uterine vessels spasm and potentiate the effects of oxytoxic drugs on the uterus resulting in fetal hypoxia and bradycardia.

morphine
* Studies on animals show adverse effect and toxicity on fetus.
* No adequate and well controlled studies done on pregnant women.
* Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
* Crosses human placenta rapidly.
* No adequate data in first trimester exposure but reported association with inguinal hernia after anytime use during pregnancy.
* Chronic maternal use of the drug causes neonatal withdrawal and respiratory depression.

So, the things that stick out about this information to me are:
-in every case "no adequate and well controlled studies [have been] done on pregnant women"
-almost every item has been found to have adverse effects and toxicity to the fetus in animals
-the reason why the narcotics are given is to make the effects of the drug last longer, otherwise there would be little point in going through the trouble of putting the needle in if the drugs would not hold for the length of the labor or c-section
-the drugs all pass the placenta and in the case of morphine it does so "rapidly" (as I had heard several people argue that "oh, these drugs only effect you--they don't ever get to the baby")
-and something I may or may have not mentioned is that right now at 7 months pregnant I'm allowed to take up to two panadol "safely" for any pain I have (and I've had some really serious back pain this time--that renders me incapable of working some days) and the doctor will continue to tell me that this is the appropriate dosage of pain medicine. I asked if I might use a topical pain reliever called voltaren which is simply a cream that is applied to the skin that many people use for arthritis pain or cramps. I was told strictly that this could be harmful to the baby and I should not do it. This is a rather "weak" topical treatment compared with an epidural. Yet, if I go to the hospital and I'm in labor, the thing that was deemed "harmful to the baby" the day before all of a sudden is administered without any reference to the possible risks. To me, that seems very unbalanced. I wonder if you ask most pregnant women, "So, what exactly is in an epidural and what are the potential side-effects and risks to mother and baby? Did your doctor go over this with you?"--how many women could say, "Yes, I was informed about this by my doctor" unless the woman herself was very proactive and asked the doctor and then hounded him for specific information.

In an unrelated thought--it is similar with birth control pills which carry an increased risk for blood clotting problems. I was never informed of this when I was prescribed the medication and not only that the doctor didn't even ask about my family history to see if I was at risk for this (which I am--my maternal grandmother had blood clotting problems and died of a blood clot and my mother has also had issues in the past). I wonder how many other women experience this sort of situation.
 
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