By: Laurie Edwards for Uterus1There is great news for pregnant women who may be considering the use of an epidural during labor. In contrast to widely-held beliefs, a new study found that administering an epidural does not increase the risk of Caesarean births. For expectant mothers, this translates into much less painful deliveries. For physicians, the study has the potential to reshape the entire way in which they approach childbirth.
“The message for women and their obstetricians and gynecologists is that there is no reason why women who want an epidural should not get it when they first request it,” said lead study author and chief of obstetric anesthesiology at Chicago’s Northwestern Medical Hospital Cynthia Wong.
The use of epidurals has increased greatly in the last 10 years; of the 3.5 million expectant mothers each year, more than 1.5 million of them receive the anesthetic. Doctors have preferred them to more systemic painkillers that enter the bloodstream and can leave women feeling overly-drugged and nauseated and can even enter the baby’s body.
Still, for the more than 2.5 million women who do not request them, this new study offers convincing new reasons to consider them.
An epidural is an anesthetic injected to reduce the excruciating pain of childbirth. Despite this intense pain, Dr. Wong said that women often feel “guilty or weak” for requesting the numbing agent. She hopes this study, published in the recent issue of the New England Journal of Medicine, will minimize these very feelings and convince them that “there is no shame in asking for an epidural.”
Prior research suggested that using an epidural early in labor prolonged it, interfered with pushing and increased the likelihood that a C-section – the removal of the fetus through an incision in the abdominal wall and the uterus – would result.
In contrast, the study found that the earlier the epidural is given to a woman in labor – before the cervix is dilated to four centimeters – the shorter the total labor will be and the less painful.
Northwestern researchers looked at 728 women in labor for the first time and divided these women into two groups. In the first group, women were given an epidural when they were two centimeters dilated. In the second group, the women received pain relief medication directly into their bloodstream and, providing they could tolerate the pain, they waited until there were four centimeters dilated to receive an epidural.
Answering the question of C-section risk, the two groups were statistically comparable: 18 percent of women in the early epidural group required C-sections, while 21 percent of the women in the delayed epidural group needed them.
In addition, the women in the early epidural group delivered their babies an average of 90 minutes earlier than the second group, who were in labor for an average of eight hours.
So why did prior research prompt experts to shy away from using epidurals, especially early in labor? It could be that the women in these earlier studies had underlying medical complications, such as an unusually large baby. Such a condition could cause even more pain and lead women to ask for epidurals earlier on, and could require C-sections regardless.
Since C-sections are less likely to occur in later pregnancies, this study focused only on first-time pregnant women.
