Franny: I agree that sometimes the epi can slow labor/contractions. I"m not entirely sure, but I may have experienced this myself. The reason I say I'm not sure is because one other nurse came in and said, "well, your monitor got moved when they put the epi. in, so it's not getting the contractions." and then when she readjusted it, they were visible on the chart.

I do, however, believe that it is not your responsibility (as the one in labor) to determine whether your perenium is stretching to the point of almost tearing - that is your doctor's job. So, by having the epidural, tearing isn't your fault - it's your doctor's for not making the call sooner to give you an episiotomy. I had the epidural. I pushed for almost 1.5 hours. The doc came in and noticed I was stretching a lot, so he made the call to do the episiotomy. I would not have been able to make that decision, even if I'd felt the pain - I would have thought it was part of labor, not that my perenium was stretching almost to the point of tearing. So, I do not believe that having or not having an epi. will be more beneficial in mothers determining whether or not they need to be cut.

I think that walking around does speed up labor a lot more than people give it credit. One woman told me that her labor wasn't progressing well and that she climbed up and down stairs for a while and that did the trick. I kind of laughed it off (I was still 36 weeks pregnant.) Then, I got checked, was only under 1cm dilated, with a soft cervix. I was told to walk for 2 hours (there at the hospital) and we'd see where things went from there. I was determined to not be sent home again! I walked around and around (only stopping to use the restroom) and walked up and down stairs. Two hours later, I was 3-4 cm, completely effaced. I told my friend (who was due 4 months after me) that she should walk a lot and climb stairs to bring labor on (because in the past, she's always been induced...she said she's never gone into labor on her own), and she laughed it off. I think she thought I was kidding.

Anyway, there are pros and cons to the epi, just like with anything else. If I had to do it again, I would walk around and labor naturally as long as possible, and then MAYBE get the epidural at the end (if at all). BTW: I had no side effects from it - only a sore back for a few days where the needle/catheter was placed.

A friend of mine just passed me this link on inducing labour, use of pitocin, and so forth. I thought it important to pass it on:

http://www.mothering.com/pregnancy-birth/let-the-baby-decide-the-case-against-inducing-labor

Franny, I noticed that a lot of the referenced materials are over 20 years old. Any recent scientific studies of this out there? My baby (not even overdue) had a bowel movement while in utero. I know that this can be very dangerous and I cannot imagine having to go another 2 weeks of pregnancy (it was really wearing out my body and emotions) and risk my baby getting meconium (sp?) in her lungs. Luckily, specialists were called to be there when I delivered because my membranes were ruptured by the doc and he saw the meconium and my daughter was okay. I know this isn't the case for many children who have bowel movements in utero.

As I said, I'd be interested to see a recent scientifically backed up study about dangers of induction and epidurals. As far as I was told (at childbirth class at the hospital by an anesthesiologist), a recent study shows that epidurals don't increase the rate of c-sections. Actually, I couldn't get the full article, but the abstract is here (looks like it's from 2001):

"Objective: More than 50% of pregnant women in the United States are using epidural analgesia for labor pain. However, whether epidural analgesia prolongs labor and increases the risk of cesarean delivery remains controversial. Study Design: We examined this question in a community-based, tertiary military medical center where the rate of continuous epidural analgesia in labor increased from 1% to 84% in a 1-year period while other conditions remained unchangeda natural experiment. We systematically selected 507 and 581 singleton, nulliparous, term pregnancies with spontaneous onset of labor and vertex presentation from the respective times before and after the times that epidural analgesia was available on request during labor. We compared duration of labor, rate of cesarean delivery, instrumental delivery, and oxytocin use between these two groups. Results: Despite a rapid and dramatic increase in epidural analgesia during labor (from 1% to 84% in 1 year), rates of cesarean delivery overall and for dystocia remained the same (for overall cesarean delivery: adjusted relative risk, 0.8; 95% confidence interval, 0.6-1.2; for dystocia: adjusted relative risk, 1.0; 95% confidence interval, 0.7-1.6). Overall instrumental delivery did not increase (adjusted relative risk, 1.0; 95% confidence interval, 0.8-1.4), nor did the duration of the first stage and the active phase of labor (multivariate analysis; P > .1). However, the second stage of labor was significantly longer by about 25 minutes (P < .001). Conclusion: Epidural analgesia during labor does not increase the risk of cesarean delivery, nor does it necessarily increase oxytocin use or instrumental delivery caused by dystocia. The duration of the active phase of labor appears unchanged, but the second stage of labor is likely prolonged. (Am J Obstet Gynecol 2001;185:128-34)."

So, it seems it prolongs the second phase of labor (pushing) but doesn't increase rate of cesareans.

Dee, just this fall a survey of the society of obstetricians in Canada admitted that they believed that epidurals slowed labour:
http://www.calgaryherald.com/health/Almost+half+obstetricians+back+section+request/2017237/story.html

When you get an epidural, you also often have continuous monitoring of the baby, which in itself can slow labour...add to that, other complications from the use of pitocin to augment labour when it has slowed...you have a recipe for disaster.

Here is another story:
http://www.msnbc.msn.com/id/9818616/page/1/

As I wrote elsewhere, most epis are given with some narcotics, and the narcotics are likely the culprits in slowing labour, causing distress, and so forth, perhaps more than the analgesia itself.

In addition, I had a meconium baby, who almost died at birth. Many babies are born with mec, with absolutely no ill effects, because they continue to get oxygen thru the placenta as long as they are in utero. However, complications may arise if the baby is in "fetal distress" and has a lowered heart rate. At that point, the baby can try to start to breathe in utero, something that would not normally happen, and unfortunately, the mec that is present can get inhaled, damaging the lungs.

But often, it is the pitocin that will actually stress the baby out, and make him pass the mec in the first place! So,it is a vicious circle....

The first article is not research about effects of epidurals or other technology for birthing; it's about attitudes of Canadian doctors: "Overall, 549 obstetricians, 897 family physicians, 545 nurses, 400 midwives and 192 doulas from across Canada were surveyed in 2008-2009 on their attitudes toward labour and birth."

I haven't heard that fetal monitoring itself can slow down labor. Perhaps the fact that a mother is lying down, as opposed to walking, during fetal monitoring is the reason, but not the monitoring itself. Some mothers lie down even without monitoring of baby.

I also wanted to add that my membranes were artificially ruptured when the doc saw the meconium and before that, I didn't have any sort of drugs whatsoever (neither pitocin nor epidural). I was told that mec. is common as mothers get closer to their due date and it happens in about a third of births (I'm not sure how accurate that is though, but that's what I was told.) I don't believe my epi or pitocin put my baby in distress at all because her HR was monitored and it never spiked or dropped.

Dee, it was late at night, so I only posted a couple of things that came to mind. Yes, the first is a survey. But it shows that the majority of Canadian ob-gyns DO BELIEVE that epidurals slow labour. After all, they have witnessed it and witness it every day in their delivery rooms!

Why do epis slow labour? Probably i large part, as you write, because the mom is often on continuous fetal monitoring, and so, flat on her back in bed. Sure, some moms may stay in that position epi or not, but generlaly, if yo do not have continuous fetal monitoring, if you donot have a needle in your back, and if you are not on IV , it is much easier to get up and walk around, and let gravity help get your baby out! Movement alone, like walking up and down the hallways, can help with dilation and proper positioning of baby to get him out.

Fetal monitoring in itself can also slow down or cause complications, because it can give false readings, which in turn may make doctors panic, and intervene, when they normally would not have....resulting, for example, in an uneeded c-s:

http://www.cnn.com/2009/HEALTH/11/11/caesarean.section.risks/index.html

And an induction does cahnge the nature of things, and does often lead to increases in c-s, as per the above article.

Epidurals are generally administered with narcotics. Again, the continuous fetal monitoring in itself, combined with the lack of mobility of mom, can contribute to problems, and slowing down labour, or giving false alarms as to the health of baby, leading to other interventions. Further, they increase health complications in mom, such as fever, and so forth. In addition, though, the IV narcotics administered in itself with epis can cause fetal distress.

Because of the fact that an epi MAY slow down labour, the md's may then decide to "augment" the labour of labour with pitocin, to get it "going again". Pitocin alone can cause fetal distress.

Some moms may choose to be induced, even when there is no medical indication to do so, such as because of the convenience of certain dates. They should know that it is indeed documented that there is a link between induction, and c-s.

Ihn the same fashio, other moms may simply choose to go for a c-s...which means more $$ for the md and the hospital, and THREE TIMES INCREASEd RISK of neonatal death, as per the CDC:
http://www.associatedcontent.com/article/1980192/cdc_says_cesarean_triples_neonatal.html?cat=25

And that does not take into account the additional, risks of maternal mortality, the highest in the U.S. in decades!
http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf

The fact is, that an induction is often more painful than 'natural" labour...so a mom often ends up having to have an epidural, which can create further risks (slow-down of labour, lack of mobility of mother, increased monitoring, fetal distress, etc.).

But very few moms are truly infomred of all of the procedures that the surgeons do on them.....

Same for many anaesthesiologists. I truly believed that I could go on no longer, when I asked for the epi with my third. I asked for assurances, that it would be safe. I was told it was safe, even after specifically telling him that I would rather die than to have something happen to my baby, and after my baby had shown signs of fetal distress, lik his HR dropping from 160 to 50, and staying there for a whopping 5 mins, before slowly getting back to 120. He was so gung-ho to "do me'", when instead, he should have told me the truth: an epi is clearly contraindicated if the baby is already in distress, for Chrissake! What does that tell you? Even after I ASKED, I was misinformed! Just so he coul try his hand at an extra procedure on me (it was a teaching hospital).

New study says new moms miscalculate due dates, adding to preemie births via elective c-sections and inductions, and other complications:

http://www.healthday.com/Article.asp?AID=633303

Here is an article that discusses the following:
1)RISK OF CESAREAN SECTION FOLLOWING ELECTIVE INDUCTION IS INFLUENCED BY CHOICE OF PHYSICIAN;
2)EVIDENCE DOES NOT SUPPORT THE COMMON PRACTICE OF LETTING EPIDURAL WEAR OFF LATE IN LABOR
3)INADEQUATE SLEEP LATE IN PREGNANCY MAY INCREASE RISK OF PROLONGED LABOR AND CESAREAN SECTION
4) ANTIMICROBIAL PROPERTIES OF AMNIOTIC FLUID AND VERNIX CASEOSA ARE SIMILAR TO THOSE FOUND IN BREAST MILK

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595247/

I think if I was going to experiance a vaginal delivery I wuold e asking for an epi at the right point in time. I personally would rather have a slightly longer labor then experiance the mass pain with contractions. I think since I suffer pain on a daily bases my tolerance of pain is greatly reduced. I am experiancing this fact for the second time this pregnancy. WIth my new found hemroid issue I am really not tolerating the pain of them very well and I can only imagine that the pain of pushing a baby out has gt to be a lot worse then emroids....

Maybe Im the wrong person for the discussions of natural vs medical intervention really.... because my life has become a medical 3 ring circus. I have had to learn to rely on medical intervention for even having a tolerable day of pain so I am probally a bit jaded really. Oh well..... what ever everyones choices are Im sure it will work out in the end for the best... as my husband always says.. everything happens for a reason

WHO says elective c-sections are too risky:

http://www.scientificamerican.com/blog/post.cfm?id=elective-cesarean-sections-are-too-2010-01-11

This is truly crazy:
Hospital dispatches COPS to woman's home, after she refuses to be induced!
http://www.news.com.au/national/overdue-pregnant-nsw-woman-gets-police-check-up/story-e6frfkvr-1225820277538

Wow is all I can say!
I am not going to sit here and Google because frankly, you can find any article out there to prove/disprove any point...this is the world wide web, you look hard enough you can find anything!!!!!

What I am going to share is my experience with and without epidurals during the births of my children.

first baby born in 1995, induced by pitocin, had the epidural, it worked great I was 21 at the time and with that epidural I really could have passed a Toyota out of my girl stuff and would have known no differently. labored for 7 hours I was 39 w 6 days at the time.

second baby born in 2006, I was 32. was coerced into the epidural, having an empty catheter placed into my back because I was being induced 8 hour later. I was told get it now or go without, should have went without. Pain relief was only one hour long, the nurse refused to lsiten to me when I said it was gone and I didn't push til nearly 4 hours later also with pitocin because my water spontaneously broke at 36w4d. Epidural was completely useless. This birth was 22 hours long, although my water broke this baby just didn't want to move and my labor did not progress. 14 hours after my water broke I was at 2cm. The c-section clock was going because of fears of him being in me for too long because my water had broke, but he was born vaginally.

Next baby, born 38w 5d, no epidural was denied one, Got to the hospital, doc broke my water he came 4 minutes later and truly although it went natural it was quite violent for him and I often wonder if the birth trauma was the reason why this baby is no longer here? The doc was in a big hurry to leave so he could take his kids to school, I have not seen that doc since he delivered that baby.

Next baby, born at 38w 2d. Was having steady contractions all night, got to the hospital labor stalled out but it was noticed that she had a heart rate variable which meant her heart rate dropped on each contraction (they were still there just not steady), went for the epi, it part way worked, it really was the safest of all the pain options with her heart variable. It made me to the point where pain was manageable, labor stalled at 8 cm so I was stuck wanting to push and not being ready for nearly one hour, it was hell...Nurse had me do a few squats, I stood at the side of the bed, epidural and all and did them...again the c-section clock was running because her heart rate was dropping, doc gave me 30 minutes to push and was doing the c-section, she came at 6:30 exactly. Although it only part way worked I do not regret having the epidural for her birth.

Really you can read studies all day long that are pro/con epidurals but truly your best information is from real people who have lived it....
AND
I was not given any consent forms for any of my epidurals, my husband was the one who signed. I know this because he read it all to me...I remember this last time waving my hand and saying just sign the damn thing....
I sitll am undecided what I will do the next time.