Earlier this month, the Cochrane Collaboration, an impartial and independent network of health practitioners, researchers, patient advocates, and other related professionals, published a systematic review (a summary of best available research) on the effectiveness and safety of women receiving an epidural early in labor versus late in labor. Prior to this research, the long-standing belief has been that women should wait to be dilated to between 4-6cm before having an epidural, due to the possibility that an epidural could slow down labor or increase the risk for cesarean if it is administered too early. (Editor's note: 4-6cm is still quite early in the laboring process; recently, active labor was redefined to begin at 6cm.)
After reviewing nine studies (all of which were randomized control trials, the "gold standard" of medical studies) that included a total of 15,752 women, researchers found that there was no significant difference in outcomes when an epidural is given either early or late in labor. They looked at the need for vacuum or forceps to help birth baby, the length of time for pushing, Apgar scores for baby, and umbilical cord pH levels (signaling how much oxygen baby received in labor).
The good news is that, if you plan to get an epidural during labor, research confirms that it doesn't matter whether you get it early on or later. But (you knew there'd be one, right?), there are a handful of items that this study does not point out, including:
- The effects of other pain medicine given to women in advance of receiving an epidural (like IV narcotics such as fentanyl, demarol, etc.)
- The overall side effects from and drawbacks to having epidural, including continuous fetal monitoring (which carries risks), limitations in mobility, drop in blood pressure, maternal fever, shivering, ringing of the ears, backache, soreness where the needle is inserted, nausea, difficulty urinating, spinal headache, nerve damage, increased need for instrument (vacuum or forceps) use in birth, and breastfeeding difficulties
- The difference in health and safety outcomes between women who don't receive an epidural versus those who do, including increased chance for instrumental delivery and cesarean, both of which carry multiple and significant risks
When considering your preference for pain management in labor, it's important to truly understand all of the options available, including benefits and risks. Even if you know for sure that you will have an epidural during labor, learning about non-pharmacological (ie, non-drug) pain management options is still important because:
- There is always a delay (some longer than others) from the time you request an epidural to the moment when your epidural kicks in and provides pain relief
- Epidurals don't always work as they were intended; coverage can be patchy and "breakthrough pain" can occur
Knowing other ways to handle and soothe pain outside of an epidural goes a long way toward helping you feel more in control of and happy with your birth experience. Take a quality childbirth education class during your pregnancy to discover the many ways in which you can manage pain during childbirth, as well as ways to keep your labor and birth as safe and healthy as possible if you have an epidural. A high quality childbirth class will cover both natural and pharmacological pain relief in detail.
Are you planning on having an epidural in labor? What do you think about this new research?