Here's the short version: epidurals don't necessarily increase the c/sec rate. The key word is "necessarily." If the study is done in an institution, as was the Sharma study, where care is managed by practitioners with a commitment to minimizing use of cesarean surgery (midwives care for clinic patients at this institution, and the c/sec rate is extraordinarily low in this study compared with typical US c/sec rates), where epidurals are given only in active labor, where practices encourage and support labor progress, and where pracitioners are patient with slow progress, then, yes, women can have epidurals and not increase their odds of c/sec. But, to use the researcher's lingo, the results of the Sharma study (as well as the other epidural studies conducted at the same hospital) cannot be generalized to institutions where conventional obstetric management is the norm.
Conversely, there are some institutions where practitioners have such high c/sec rates that the use or non-use of epiduals makes no difference. The woman is highly likely to have a c/sec whatever her individual characteristics or what she does or doesn't do.
However, there is a larger point to be made: Even if having an epidural doesn't affect a woman's chances of c/sec, she isn't out of the woods. She is still at substantially higher risk of a vaginal instrumental delivery, and vaginal instrumental deliveries and the episiotomies that usually accompany them can cause pelvic floor weakness and anal sphincter injury, as well as increasing genital trauma in general. There is also as frequent as a 1 in 3,000 chance of experiencing a life-threatening adverse reaction and increased likelihood of a list of temporary minor complications such as hematoma, urinary incontinence, and muscle weakness, which probably don't seem so minor to a woman trying to take care of a new baby.
Here's the real issue: This doctor seems to equate informing women of the disadvantages of epidurals with "scaring them." This is, to say the least, a patronizing attitude, but more importantly, it is a violation of their medical rights. Women are entitled to know the "cons" as well as the "pros" of any medical intervention, the alternatives, including doing nothing, and the pros and cons of the alternatives so that they can make an informed decision. Yours may have been an error of information, in which case, it is easily corrected in future, but this doctor's attitude is a much more serious problem.
-- Henci
By: Henci Goer |