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 “Many obstetric providers believe that the numbness and weakness in
a woman’s legs from epidural medications may affect a woman’s
ability to push out a baby,” said senior study author Dr. Philip
Hess, an anesthesiology researcher at Harvard Medical School and
Beth Israel Deaconess Medical Center in Boston.
“Our study focused on this question, and we found that this is not
true,” Hess said by email. “Continuing epidural medication while
pushing had no effect whatsoever on the time it took a woman to
deliver her baby, or any other measured variable.”
For the experiment, researchers randomly assigned 400 first-time
mothers at a maternity hospital in Nanjing, China, to either
continue or discontinue epidurals started earlier in labor when it
came time to push.
The doctors and mothers didn’t know whether pain medication was
continued during the second stage of labor, which starts when the
cervix is fully dilated and women can begin to push.
That’s because all of the women kept catheters that were inserted to
deliver pain medication earlier in labor. Half of them received pain
medicine through the catheters while they pushed, and the rest of
them got saline solutions that looked identical but contained no
drugs.
With pain relief, the average time it took women to deliver babies
once their cervix fully dilated was 52 minutes, compared to 51
minutes with saline, a difference that was too small to rule out the
possibility that it was due to chance, researchers report in
Obstetrics & Gynecology.
There also wasn’t a meaningful difference in the proportion of women
who had what’s known as spontaneous vaginal deliveries, when women
don’t need interventions like drugs to induce labor, forceps or
vacuums to help remove babies or surgical cesarean section
deliveries.
With an epidural, 193 women, or 97 percent, had spontaneous vaginal
deliveries, compared to 198, or 99 percent, with saline.
Not surprisingly, women reported higher pain levels and less
satisfaction with their pain relief when they didn’t get continued
epidural medication during delivery.
Doctors stopped epidurals during the second stage of labor in 38
cases when delivery wasn’t progressing quickly enough. It turned out
that 17 of these patients were receiving saline, and 21 were getting
epidural pain medicines.
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One limitation of the study is that it was done at a single
hospital, and labor and delivery or epidural protocols might differ
elsewhere, researchers note. The results in Chinese first-time
mothers also might not reflect what would happen for women with
different racial or ethnic backgrounds or for women who had already
had at least one baby.
Still, epidurals used today are much different than they were a
generation ago, and the findings suggest it may be time for doctors
to rethink their approach to pain relief during delivery, Hess said.
“Today’s epidural pain relief can be targeted to providing good pain
relief with minimal weakness,” Hess said. “So much so that in some
centers like my own, women are strong enough to be able to walk (the
walking epidural).”
Even though it’s not yet clear if all women would experience results
similar to what happened in the study, the results should reassure
patients that the benefits of pain relief during the second stage of
labor don’t come at the expense of a longer labor, said Dr. Joseph
Wax, chair of the committee on obstetric practice for the American
College of Obstetricians and Gynecologists and a researcher at Tufts
University School of Medicine in Boston.
“The findings may encourage providers and women to continue epidural
use for pain relief during the second stage without undue concerns
regarding increasing labor duration,” Wax, who wasn’t involved in
the study, said by email.
SOURCE: http://bit.ly/2ziQiig Obstetrics & Gynecology, online
October 10, 2017.
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