Thanks for getting this discussion thread started. Being a writer and having been doing lots of research on this very subject, I couldn't help but to jump in and correct this statement you make: "But new studies show an epidural doesn't increase the chance that
vacuum, forceps, or C-sections will be needed during delivery, as has
been reported." Studies have always shown this, however, the best studies (i.e. peer reviewed, not sponsored by ACOG or drug companies or other vested interests, et cetera) show that there are correlations--significant correlations--between instrumental delivery and surgical delivery and epidural anesthesia.
I took this from childbirthconnections dot org which sponsors the Listening to Mothers surveys, by far the most comprehensive study of childbirth in America. This is what they say :
safety: the best available research finds that epidurals:
increase the length of the pushing phase of labor
increase the likelihood of birth with vacuum extraction or forceps
reduce the likelihood of "spontaneous vaginal birth," that is, birth with neither vacuum extraction, nor forceps, nor cesarean section
increase the likelihood of maternal fever, which in turn increases the chance that the baby will have blood drawn to check for infection and will be given antibiotics through an IV (intravenous) line as a precaution
increase the likelihood of serious tearing of perineal tissue into or through the rectal sphincter — probably due to the increased use of vacuum extraction or forceps
can adversely affect newborn behavior compared with unmedicated infants
increase the likelihood of newborn jaundice (Leighton and Halpern 2002 and Lieberman and O'Donoghue 2002, systematic reviews).
Studies disagree or data are not adequate to definitively determine, but epidurals may:
increase the length of the cervical dilation phase (before pushing) of labor
increase the likelihood of cesarean section
increase the likelihood of postpartum hemorrhage and retained placenta
adversely affect breastfeeding
increase the likelihood of inability to urinate and stress incontinence (loss of urine with laughing, coughing, or sneezing) in the early days and weeks after birth
in babies of mothers with fever, increase the likelihood of being born in poor condition and having seizures (Leighton and Halpern 2002 and Lieberman and O'Donoghue 2002, systematic reviews).
Even the American Family Physician says this in a 2003 article: "Doctors are not sure whether women who use epidurals are more likely to need a cesarean delivery. But epidurals might make your labor last longer, especially the second stage, when you are pushing your baby out of your body. Women who use epidurals are more likely to need a vacuum extractor or forceps put on their baby's head to help pull the baby out of their body. These steps make your perineum more likely to tear during delivery. Using an epidural might make you get a fever; then your baby might need blood tests and antibiotics." aafp dot org then search for the article "Labor Pain: What to Expect and Ways to Relieve Pain"
Epidurals are the most effective medical route for pain relief but they come with some real risks, especially those associated with teh "cascade of interventions" that often begins with the epidural. Women need to be aware of this and the alternatives so they can make smart choices. Epidurals should be one of many choices women are given, but a choice made in ignorance is not a real choice.
