Childbirth deaths from spinal anesthesia rising

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The number of U.S. women who die from anesthesia complications during childbirth has fallen sharply in recent decades. But deaths specifically related to so-called regional anesthesia, which includes epidurals and spinal blocks, have crept upward since the mid-1990s ...

... such deaths remain rare. But ... the results point to an area where anesthesia can be made safer for women.

... Regional anesthesia is considered quite safe. But in rare cases, patients can have a severe allergic reaction to the anesthetic, or the drug can cause breathing or heart problems.

... researchers found that between 1979 and 2002, childbirth deaths related to any anesthesia complication dropped by 59 percent among U.S. women.

There were three such deaths for every million live births between 1979 and 1990, compared with just over one death per million births between 1991 and 2002 ...

However, while deaths related to general anesthesia kept falling in the 1990s, those related to regional anesthesia rose slightly, from 2.5 deaths for every million C-sections between 1991 and 1996 to 3.8 per million between 1997 and 2002.

"I think the main thing is to get good prenatal care, and keep any medical conditions you have under control during pregnancy," ...

What about helping women to prepare and plan for a drug-free birth? This seems like the most logical step. In Australia, almost 50% women have an epidural in labour. If this figure was around 5% (for labour, not caesareans), this would make an enormous difference.

... Most of the women who died - 48 of the 56 -- had undergone a C-section. In the rest of the cases, the type of delivery was not reported.

Deaths related to general anesthesia during C-section declined markedly over the decade. From 1991 to 1996, there were 17 such deaths per one million C-sections; that rate fell to 6.5 per million for the years 1997 to 2002.

In contrast, deaths related to regional anesthesia during C-section inched up.

The reasons for the increase are not known ... the overall drop in anesthesia-related deaths since the 1970s is likely related to factors like safer drugs, better monitoring of women's heart rates, blood pressure and oxygen while under anesthesia, and an improved understanding of how individuals can react to anesthesia.

But ... the medical profession may have become too narrowly focused on preventing deaths related to general anesthesia, which typically is more risky.

Research in the 1970s and 80s ... showed that pregnant women were 17 times more likely to die from general anesthesia than regional. And people reacted to that.

"A good part of our energy was tunnel-visioned toward general anesthesia," ... "Maybe we've let the pendulum swing a bit in the other direction."

It is hard to study the potential reasons for the increase in deaths linked to regional anesthesia, precisely because they are so rare ...

Melissa Maimann, Essential Birth Consulting 0400 418 44