Comments on: Premature Rupture of Membranes at Term http://www.bellytales.com/2007/03/03/premature-rupture-of-membranes-at-term/ The Diary of a New Midwife Tue, 06 Jan 2009 10:09:00 +0000 http://wordpress.org/?v=2.7 hourly 1 By: arcem http://www.bellytales.com/2007/03/03/premature-rupture-of-membranes-at-term/comment-page-1/#comment-17615 arcem Wed, 02 May 2007 21:30:26 +0000 http://www.studentmidwife.org/2007/03/03/premature-rupture-of-membranes-at-term/#comment-17615 Even though there is a clear relationship between the use of pitocin and the use of epidurals, there is still some controversy whether pitocin contraction pain is stronger, therefore leads to epidurals. It would be very difficult to conduct a study that measures pain levels in natural labor v.s. pain levels in pitocin induced/augmented labors without taking into consideration length of labor, position of the baby, and other confounding factors. Therefore studies have not been able to determine this. Pitocin is many times used in labors that are longer, not progressing, complicated by infection, malposition, etc, which confounds results. Researchers in these studies concluded that it was the more difficult labors that ended in more epidurals, rather than the pitocin itself. In my experience as a student nurse midwife though, pitocin labors are very difficult to cope with for a woman. The rate of contractions can be very intense. A natural labor can have contractions that are more spaced out and there is a sense of control that is missing in pitocin labors. It almost seems as if once a woman is hooked on to pitocin, she has lost ownership of her labor. Maybe that also leads to more epidural use. These are issues that are very hard to study though, but leave it to midwives/SNMs to bring them to the table for discussion...:). Even though there is a clear relationship between the use of pitocin and the use of epidurals, there is still some controversy whether pitocin contraction pain is stronger, therefore leads to epidurals. It would be very difficult to conduct a study that measures pain levels in natural labor v.s. pain levels in pitocin induced/augmented labors without taking into consideration length of labor, position of the baby, and other confounding factors. Therefore studies have not been able to determine this. Pitocin is many times used in labors that are longer, not progressing, complicated by infection, malposition, etc, which confounds results. Researchers in these studies concluded that it was the more difficult labors that ended in more epidurals, rather than the pitocin itself.

In my experience as a student nurse midwife though, pitocin labors are very difficult to cope with for a woman. The rate of contractions can be very intense. A natural labor can have contractions that are more spaced out and there is a sense of control that is missing in pitocin labors. It almost seems as if once a woman is hooked on to pitocin, she has lost ownership of her labor. Maybe that also leads to more epidural use. These are issues that are very hard to study though, but leave it to midwives/SNMs to bring them to the table for discussion…:).

]]> By: mcsarahb http://www.bellytales.com/2007/03/03/premature-rupture-of-membranes-at-term/comment-page-1/#comment-17526 mcsarahb Wed, 02 May 2007 05:36:57 +0000 http://www.studentmidwife.org/2007/03/03/premature-rupture-of-membranes-at-term/#comment-17526 Of course. I will send it to you in June. Thanks! Of course. I will send it to you in June. Thanks!

]]> By: The Student http://www.bellytales.com/2007/03/03/premature-rupture-of-membranes-at-term/comment-page-1/#comment-16455 The Student Sat, 28 Apr 2007 02:24:06 +0000 http://www.studentmidwife.org/2007/03/03/premature-rupture-of-membranes-at-term/#comment-16455 Wow, neat! Of course use the references! They are only a small portion of all the references I ended up needing for my project, but they're a great starting place. Could I read your paper when you're done? This topic still interests me a great deal, and I'm always interested to see what other people are writing about and thinking about regarding this. Wow, neat! Of course use the references! They are only a small portion of all the references I ended up needing for my project, but they’re a great starting place. Could I read your paper when you’re done? This topic still interests me a great deal, and I’m always interested to see what other people are writing about and thinking about regarding this.

]]> By: mcsarahb http://www.bellytales.com/2007/03/03/premature-rupture-of-membranes-at-term/comment-page-1/#comment-16005 mcsarahb Thu, 26 Apr 2007 17:51:39 +0000 http://www.studentmidwife.org/2007/03/03/premature-rupture-of-membranes-at-term/#comment-16005 Thank you so much for this. I am a midwifery student doing a similar project and would love to use your reference list if you don't mind. This topic is pretty controversial at my university hospital, especially because there is a large homebirth community that often transfers care to our faculty practice after days of rupture. The potential implications are complicated, and thus, my interest and choice of topic for my IP paper. Thank you so much for this. I am a midwifery student doing a similar project and would love to use your reference list if you don’t mind. This topic is pretty controversial at my university hospital, especially because there is a large homebirth community that often transfers care to our faculty practice after days of rupture. The potential implications are complicated, and thus, my interest and choice of topic for my IP paper.

]]> By: The Student http://www.bellytales.com/2007/03/03/premature-rupture-of-membranes-at-term/comment-page-1/#comment-6273 The Student Fri, 09 Mar 2007 21:04:39 +0000 http://www.studentmidwife.org/2007/03/03/premature-rupture-of-membranes-at-term/#comment-6273 I don't think there's much debate about the fact that using pitocin often leads to an epidural. Pitocin IS a lot stronger than natural labor, and the biggest difference is that during natural labor, the body has the ability to create beta endorphins and enkephalins which boost a woman's natural pain tolerance. This happens slowly, though, as slow, natural labor is unfolding, so that by the time a woman is in true, active labor, her pain threshold is actually a lot higher than it would be otherwise; she has natural pain killers at work helping her (even though it's still quite painful!). With pitocin, the contractions ramp up so quickly that I don't think the body's natural pain defenses have time to kick in, which is why pit becomes so painful so quickly, and in many ways, I do think that an epidural is the more humane option to use when a woman is receiving pitocin titration. I often tell women on pitocin, especially those who were committed to natural childbirth and feel like they're failing on some level by requesting an epidural, to keep in mind that there is *nothing* natural about pitocin. Once that pitocin starts, you have to start to look at the labor differently than you did before, and this requires being able to roll with the punches, and use pain medication if you need it. Pitocin HURTS. It's really difficult to get through without pain medicine, and I don't think women need to feel like they're letting themselves down by asking for pain relief. 5 hours on pitocin without pain relief is quite an accomplishment! I don’t think there’s much debate about the fact that using pitocin often leads to an epidural. Pitocin IS a lot stronger than natural labor, and the biggest difference is that during natural labor, the body has the ability to create beta endorphins and enkephalins which boost a woman’s natural pain tolerance. This happens slowly, though, as slow, natural labor is unfolding, so that by the time a woman is in true, active labor, her pain threshold is actually a lot higher than it would be otherwise; she has natural pain killers at work helping her (even though it’s still quite painful!). With pitocin, the contractions ramp up so quickly that I don’t think the body’s natural pain defenses have time to kick in, which is why pit becomes so painful so quickly, and in many ways, I do think that an epidural is the more humane option to use when a woman is receiving pitocin titration. I often tell women on pitocin, especially those who were committed to natural childbirth and feel like they’re failing on some level by requesting an epidural, to keep in mind that there is *nothing* natural about pitocin. Once that pitocin starts, you have to start to look at the labor differently than you did before, and this requires being able to roll with the punches, and use pain medication if you need it. Pitocin HURTS. It’s really difficult to get through without pain medicine, and I don’t think women need to feel like they’re letting themselves down by asking for pain relief. 5 hours on pitocin without pain relief is quite an accomplishment!

]]> By: emjaybee http://www.bellytales.com/2007/03/03/premature-rupture-of-membranes-at-term/comment-page-1/#comment-6238 emjaybee Fri, 09 Mar 2007 04:30:59 +0000 http://www.studentmidwife.org/2007/03/03/premature-rupture-of-membranes-at-term/#comment-6238 Really impressive, thank you for posting this. If only my midwives had read it, perhaps they wouldn't have pushed me into the induction/pit/epidural/c-section spiral. Tell me...is there a lot of debate that inducing with pit doesn't increase use of epidurals? My own experience and that of many women is that pit contractions are so much harder and faster that an epidural is necessary. I had had very gentle contractions, but about 2 hours after pit started, they suddenly sped up so fast I couldn't brace against them or do anything to manage them (separate rant), though I suppose my anecdote =! data. I held out for 5 hours w/out epidural, but the pain was incredibly intense and unrelenting in a way that seemed different than what I was expecting. Really impressive, thank you for posting this. If only my midwives had read it, perhaps they wouldn’t have pushed me into the induction/pit/epidural/c-section spiral.

Tell me…is there a lot of debate that inducing with pit doesn’t increase use of epidurals? My own experience and that of many women is that pit contractions are so much harder and faster that an epidural is necessary. I had had very gentle contractions, but about 2 hours after pit started, they suddenly sped up so fast I couldn’t brace against them or do anything to manage them (separate rant), though I suppose my anecdote =! data. I held out for 5 hours w/out epidural, but the pain was incredibly intense and unrelenting in a way that seemed different than what I was expecting.

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