Study Debunks Notion That Epidurals Prolong Labor

From Drugs.com - October 10, 2017

Study Debunks Notion That Epidurals Prolong Labor

TUESDAY, Oct. 10, 2017 -- Epidurals are a popular form of pain control for women during labor, but they have long been blamed for hindering progress in the delivery room.

However, new research challenges this widely held belief, suggesting that epidurals have no effect on how long labor lasts -- or when babies are born.

"We found that exchanging the epidural anesthetic with a [non-drug] saline placebo made no difference in the duration of the second stage of labor," said study lead researcher Dr. Philip Hess. He directs obstetric anesthesia at Beth Israel Deaconess Medical Center in Boston.

Dr. Jennifer Wu, an ob/gyn who reviewed the new findings, said there are "important aspects to this study."

Use of "low-dose epidurals versus placebos during the pushing stage of labor did not increase duration of pushing" or the need for a C-section, said Wu, who works at Lenox Hill Hospital in New York City.

As the study authors explained, epidurals involve a combination of strong painkillers and anesthetics delivered through a tube placed near the nerves of the spine. But since their introduction in the 1970s, epidurals have been thought by some to slow labor once the cervix is completely dilated -- a period known as the second stage of labor.

When this stage of labor is prolonged and the birth of a baby is delayed, the risk for complications also rises. As a result, some doctors may reduce or cease epidural pain management in an attempt to speed up delivery.

But do epidurals really prolong labor? Wu said that sometimes it can seem that way to patients.

"Patients often cite longer pushing as a reason they are trying to avoid epidural," she explained. "The difficulty for these patients is that there may be many hours of contractions -- and lack of sleep -- before they even get to the second stage or the 'pushing' stage. So, when patients are too numb to push effectively, doctors often cite this as a reason to turn down epidural."

But, of course, reductions in epidural pain relief can mean more discomfort for the woman, Wu noted. It's a "delicate balance," she said.

In the new study, the Boston team compared the effects of low-dose epidural to an ineffective saline solution placebo, both of which were delivered through a catheter.

The study involved 400 healthy women delivering their first baby. These first-time mothers received epidurals during the early stage of labor. But once they reached the second stage, they were randomly assigned to receive either the epidural or the placebo, Hess explained.

The study was double-blinded, meaning that neither the women nor the doctors knew whether they received the epidural or the saline solution. However, women in extreme, excessive pain were knowingly given pain medication as directed by their doctors. The doctors could also stop epidural pain control at any time.


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