Mothers having babies these days could find themselves backing right up into their epidural. A recent study by researchers at Northwestern University in Chicago, Illinois, and published February 2005 in the New England Journal of Medicine, could dispel a long-held belief among obstetricians that getting an epidural early in labor increases your chance of a cesarean section delivery.
Doctors have long thought that epidurals given before a woman's cervix was dilated 4-5 centimeters increase the risk of a cesarean. For that reason, says Cynthia A. Wong, MD, lead author of the study, many doctors have delayed letting their laboring patients have an epidural until labor is well established -- often hours after arrival at the hospital.
In the Northwestern study, 750 women in labor with a cervix dilation of less than 4 centimeters were selected for one of two pain relief options: 1) an epidural as soon as they requested pain relief, regardless of how much their cervix was dilated; or 2) an injection of a morphine-like drug when they first requested -- but no epidural until they were 4 centimeters or more dilated or had asked for pain relief for a third time. Dr. Wong says her data on all the women shows that the early epidural did not increase the rate of cesarean delivery, and also provided much better pain relief for the mothers than the morphine-like drug.
The epidural given in Dr. Wong's study is called a combined spinal epidural (CSE). The CSE technique involves the injection of a narcotic medication, Fentanyl, into the spinal fluid at the time that the epidural catheter is placed into the epidural space outside the membrane that contains the spinal fluid and spinal nerves. The narcotic medication in the spinal fluid gives pain relief for one and a half hours without causing relaxation of the abdominal and pelvic muscles. When the narcotic effects wore off, and the mothers requested more pain relief, a traditional epidural was established by injecting a local anesthetic into the epidural catheters and infusing that local anesthetic throughout labor and delivery.
More and more hospitals are offering the combination epidural these days, says Dr. Dana Hershey, a physician with Southeast Anesthesiology Consultants in Charlotte, North Carolina. Dr. Wong says that other published studies confirm the fact that epidural space epidurals also do not increase the risk of cesarean sections so "women can feel comfortable opting for an earlier epidural regardless of which option their hospital provides."
Bottom Line for Expectant Parents
For now, the American College of Obstetricians and Gynecologists recommends the following course of action when it comes to epidurals: "ACOG supports waiting, when feasible, to give laboring women epidurals until they have dilated four to five centimeters. However, since labor produces severe pain for many women, ACOG believes that a woman's request for an epidural should be the deciding factor, even if she hasn't yet reached a four- to five-centimeter dilation." Dr. Hershey and other physicians think Dr. Wong's research could push ACOG to rethink that policy recommendation.
Most important, says Dr. Hershey, is not to wait until labor to discuss epidural options with your obstetrician. The green light to have an epidural when you are in labor is actually given by your obstetrician, not by the nurse or anesthesiologist. So take the time during a pregnancy visit to discuss epidural options with your physician.
Originally published on AmericanBaby.com, March 2005.
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