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 Some earlier reports had suggested that starting epidural anesthesia
early might prolong labor or increase the likelihood of a cesarean
section - more commonly known as a C-section.
But a new formal review of past studies, published by The Cochrane
Library, found that length of labor and the need for surgical
intervention did not differ between women who received epidurals
during early or later stages of labor.
“I think there are still providers that were trained in the earlier
era, when they preferred their patients to receive an epidural in
the later stages of labor,” said Dr. Neil Seligman.
Seligman, who was not involved in the new analysis, is a maternal
and fetal medicine expert at University of Rochester Medical Center
in New York.
"The literature has been fairly consistent that epidurals do not
meaningfully prolong labor," he said. "There may be a small
difference but there is no meaningful difference."
For the new analysis, researchers led by Dr. Ban Leong Sng of
Singapore’s KK Women’s and Children’s Hospital reviewed clinical
trials that randomly assigned about 16,000 women to receive
epidurals during early or later stages of labor.
Epidural medications are delivered into a space near the spinal
cord.
An epidural was considered "early" if the cervix (the lower part of
the womb) was open no more than four to five centimeters (about two
inches). "Later" epidurals were started when the cervix was open
more widely.
There were no differences between the two groups in the need for
C-sections or other interventions, such as forceps, during labor.
There was also no difference in the length of the second or
“pushing” stage of labor between the two groups.
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“We conclude that it would appear to be advantageous to initiate
epidural analgesia for labor early, when requested by the woman,”
the researchers write.
They say the findings support the recommendation of the American
College of Obstetricians and Gynecologists, which says a woman’s
request for an epidural during labor should guide its use – unless
there are other complications or concerns.
Ideally, Seligman said the conversation about epidurals and pain
control during labor should start in the doctor's office before
labor even begins.
"Even if the patient has no preconceptions, you can introduce the
idea, 'Have you thought about how you’re going to control pain
during labor?'" Seligman said.
SOURCE: http://bit.ly/MvDtGQ The
Cochrane Library, online October 9, 2014.
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