Traditionally, women in labor had to wait until their cervix dilated to 4 or 5 centimeters before receiving an epidural, an injection of anesthesia that numbs the abdomen, pelvis and genital area to quell the pain. Administering an epidural early was thought to increase the risk of a Cesarean birth.
Good news for pregnant women: According to the latest research, this is not true.
The study also exonerated early epidurals as a cause of a longer labor compared with epidurals that are administered closer to delivery. In addition, the study found that epidurals provide better pain relief than opioid medications.
The Study
Dr. Cynthia Wong, an associate professor of anesthesiology at Northwestern University's Feinberg School of Medicine in Chicago, and others suspected that the early administration of epidurals weren't to blame for a greater risk for C-sections. Instead, women who requested early pain relief may have had other risk factors for C-section delivery-for example, a baby who had a large head circumference.
To test this theory, Wong and her colleagues conducted a randomized trial that included 750 healthy, first-time mothers. Half received an epidural at their first request for pain relief, while the other half received an opioid analgesic, such as a morphine-like drug.
Women in the opioid group were assessed at their second request for pain relief. If they were less than 4 centimeters dilated, they were given another dose of opioid analgesia; if dilated more than 5 centimeters, they were given an epidural.
After the third request for pain relief, they were given an epidural regardless of their dilation status.
The Results
Early epidurals did not increase the rate of Cesarean births. In fact, the early epidural group had an 18% C-section rate, while the opioid group had a 21% rate.
"We found that the C-section rate did not differ, and we also found that women (who had) early epidurals had much better pain relief, labors went faster by over 80 minutes and their babies were born with higher Apgar scores," says Wong.
No Reason To Wait
"Labor without an epidural hurts," states Dr. Gilbert Grant, an obstetrical anesthesiologist at New York University Medical Center. "Modern medicine allows you to enjoy your labor without pain. Getting an early epidural is totally reasonable...There is no reason to wait until some arbitrary degree of cervical dilation occurs before receiving epidural pain relief," he adds.
Wong agrees. "If a woman wants to have an epidural, there's no reason she shouldn't ask for it and get it when she needs it," she says.
Grant advises pregnant women to discuss the issue of pain relief with their doctor or midwife long before labor begins. He says it's also a good idea for women to contact the hospital and talk with the anesthesiologist to make sure they're going to get the pain relief they want.
