Epidurals Appear Safe in Early Labor

Study Says Early Epidurals Do Not Lead to Need for C-Sections

Feb. 16, 2005 - There is reassuring news for pregnant women who want to avoid as much of the pain of childbirth as possible. New research shows that having an epidural early in labor does not increase the chances of a C-section delivery and may even shorten delivery times.

The study, reported in the Feb. 17 issue of The New England Journal of Medicine, presents the best evidence yet that women in labor can safely have an epidural at any point in the process, obstetric anesthesiologist William Camann, MD, tells WebMD.

Many obstetricians still delay spinal anesthesia until delivery is imminent. Typically patients are well into the stages of labor where the cervix has sufficiently opened and the child is about to be delivered. This practice is based on studies that have shown an association between giving an epidural during early labor and an increased risk of C-section delivery.

"Once it is clear that a woman is in active labor, she and her obstetrician or midwife can make the decision [about when to administer an epidural] based on her level of discomfort," says Camann. "There is no need to wait."

Early Pain Suggests Difficult Delivery

About 60% of the roughly 4 million women who give birth in the United States each year end up having an epidural anesthetic to block the pain of childbirth. These anesthetics can also cause muscle relaxation.

Past studies have repeatedly linked epidurals early in labor with higher rates of cesarean sections. The epidural blocks the mother's desire to push. As a result, many physicians and hospitals have a policy of withholding epidurals until a laboring patient's cervix has dilated to 4 or 5 centimeters.

But it has not been clear if early epidurals really increase the risk for cesarean sections or if needing pain relief early in labor is an indication that the delivery will be more difficult.

In an attempt to answer this question, Cynthia A. Wong, MD, and colleagues from Northwestern University conducted a trial that included 750 women giving birth to their first child.

The women were included in the study if they asked for pain relief early in labor -- before their cervixes had dilated to 4 cm. Half the women were given epidurals as soon as they asked for pain relief, and the other half were initially given a narcotic painkiller until their cervixes dilated to 4 cm. Only then did they receive epidurals.

The percentage of women in the early epidural group who ended up having C-section deliveries was slightly less than in the group treated with the narcotic -- 18% vs. 21%.

Even more significant, the average labor time among women who had vaginal deliveries was almost an hour and a half shorter in the early epidural group, and these women also reported better overall pain relief and less nausea and vomiting.

No Need to Suffer

"I hope this makes physicians more comfortable with the idea that it is OK to give an epidural when a woman asks for pain relief early in labor without worrying that it will adversely affect the outcome," Wong says.

She offered one caveat, however. The women in the study received epidurals designed to maximize pain relief while minimizing muscle impairment. It is not clear if early treatment outcomes would be as good in women who receive traditional epidurals that result in more numbness and greater muscle impairment.

In an editorial accompanying the study, Camann wrote that the findings make it clear that early epidural pain relief is a safe and effective option for women who choose to have medication.

"But that doesn't mean that we are advocating epidurals for everyone," he tells WebMD. "Women should be allowed to make the choice that is best for them. Some will choose to have epidurals and others won't. Either decision should be supported."

Show Sources

SOURCES: Wong, C. The New England Journal of Medicine, Feb. 17, 2005; vol 352: pp 655-665. Cynthia A. Wong, MD, department of anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago. William Camann, MD, director of obstetric anesthesia, Brigham and Women's Hospital, Boston; vice president, Society for Obstetric Anesthesia and Perinatology.
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