Birth Planning, Research

How effective is an epidural?

epiduralWhen it comes to relief of labor pain, everyone agrees epidurals are the best medication for the job. But when the question of how an epidural affects labor is asked, a variety of points of view compete for attention. In fact, there is some heated disagreement on epidurals in childbirth.

Part of the problem lies in the fact that an epdural is a process for administering medications – not a medication itself. So two women receiving epidurals in two different hospitals at the same time could have very different experiences. The amount and type of medications vary as much as the policies around epidural use. Unfortunately, it is difficult to draw conclusions about the combined effects of such a variety of procedures.

The second part of the problem is in the research itself. Most research into pain medication use for labor is interested in how well the medication eliminates the pain. Side effects are usually a secondary issue, if the research looks at them at all.

In order to find out more about the effects of epidurals on labor, the Maternity Center Association included reviews of epidurals in its project into the nature of labor pain and its management. As a part of the project, two separate teams of researchers investigated the effects of epidurals on childbirth, and a third researcher reviewed the most common side effects.

Where they agree

The two review groups agreed that women who used epidural pain relief were more likely to have a longer second stage of labor (pushing), more likely to need forceps or vacuum extraction and more likely to have a fever.

Where only one team explored

Some effects of epidurals were only investigated by one team or the other, so were only found by one team. Among these effects of epidurals are:

  • Increased need for oxytocin after epidural administration;
  • Increased risk of low blood pressure while using epidural;
  • Decreased spontaneous birth;
  • Increased risk your baby will be evaluated for infection and receive antibiotics;
  • Increase risk your baby will be jaundiced.
 The researchers also found that epidurals may be associated with:
  • fetal malpresentation (meaning baby is not in a good position);
  • breathing problems in the baby immediately after birth;
  • babies scoring lower on the Neonatal Behavioral Assessment Scale (NBAS);
 Where they disagree

In four areas the teams came to different conclusions:

  • Length of first stage labor – one team found no difference and the other found insufficient data to make a comparison;
  • Cesarean birth rate – one team found no difference while the other found insufficient data to make a comparison;
  • Breast-feeding success – one team found no difference at 6 weeks while the other found insufficient data to make a comparison;
  • Urinary problems – one team found an increase in urinary incontinence after birth with no difference at 3 or 12 months, the other team found insufficient data for comparison.

Why did they find different results? Each team set its own criteria for what studies could be included in the project. A study that may have been acceptable to one team may have been unacceptable to another. Because they used different sets of research they found some contradictory results.some contradictory results.

References
Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.

Goer, Henci. The Thinking Woman’s Guide to a Better Birth. 1999. New York: The Berkley Publishing Group.

Jennifer (Author)