Early Epidural Won't Raise
C-Section Risk By
JEFF DONN
BOSTON
(AP) - Pregnant women can be given a low-dose epidural
early in labor without raising their chances of a
Caesarean section, according to a study that could
change the way obstetricians practice and make
childbirth a lot less painful for many mothers-to-be.
The
finding could lead doctors to consider offering early
epidurals to hundreds of thousands more American women
in first-time labor each year.
Though medical authorities
recently dropped their reservations about giving women
epidurals early in labor, some doctors and patients
still prefer to wait until labor is further along. They
worry that the painkiller's numbing effect will
interfere with a woman's ability to push, prolonging
labor and prompting a C-section.
This study appears to debunk the
notion about C-sections and calls into question the one
about prolonged labor, too.
``Women
often feel guilty or weak when they request an epidural
early in labor. I hope this study will help women see
that there is no shame in asking for an epidural,'' said
lead author Dr. Cynthia Wong of Northwestern University
in Chicago. ``The message for women and their
obstetricians and gynecologists is that there is no
reason why women who want an epidural should not get it
when they first request it.''
The study
was reported in Thursday's New England Journal of
Medicine.
More than
3.5 million women go into labor each year in this
country. Epidural use has greatly expanded over the past
decade, to more than 1.5 million women annually.
Epidurals
deliver numbing medicine through a skinny plastic tube
that is threaded into the back, close to spinal nerves,
mostly bypassing the mother's bloodstream. More recent
techniques, sometimes called ``walking epidurals,''
provide lighter doses, allow women to push, and even
enable them to walk throughout labor.
Doctors
have welcomed epidurals as an alternative to
``systemic'' pain medicine through the bloodstream,
which can leave a woman feeling nauseated and doped-up
and even enter the baby's body.
The
Northwestern University study tested a type of low-dose
pain relief known as a ``combined spinal epidural.'' A
small dose of pain reliever is first injected into the
spinal fluid, and the epidural is later fed through the
same hole into a space a bit farther from the spine.
In this
study, 728 women in first-time labor were divided into
two groups. One group received the spinal shot and then
got epidurals when the cervix was dilated to about 2
centimeters. The other group initially received
pain-relieving medicine directly into their
bloodstreams, and put off epidurals until 4 centimeters
if they could tolerate the pain.
In the
end, the C-section rate was statistically a tie: 18
percent in the early epidural group and 21 percent in
the delayed group.
The early
epidural group also delivered 90 minutes sooner than the
other women, who averaged eight hours in labor. However,
Dr. Gary Hankins, an obstetrician at the University of
Texas Medical Branch at Galveston who helped shape the
medical guidelines, said it is not clear if that finding
would apply broadly.
Lisa
DeCook of Glenview, Ill., was a study subject in the
early epidural group and delivered her daughter
vaginally. She said the pain before the epidural was
``intense.''
``Then
once I got it, I really don't remember feeling any pain
or contractions. It was good for me,'' she said. She
chose an epidural on Tuesday when she vaginally
delivered her second healthy baby, a boy, at
Northwestern Memorial Hospital.
The
finding seems to contradict some previous research
showing that women who got early epidurals underwent
more C-sections. In 2002, the American College of
Obstetricians and Gynecologists recommended against
epidurals before 4 centimeters of dilation. In July,
though, it dropped a specific threshold.
``There's
really no reason to withhold the treatment if a women is
in terrible pain at 1 or 2 or 3 centimeters dilation,''
said Dr. David Birnbach, a University of Miami
anesthesiologist who is on the College of Obstetricians
committee that devises the guidelines.
As for
why the earlier research reached a different conclusion,
it could be that some of the women had underlying
problems - such as an unusually big baby - that can
cause more pain, make women request early epidurals, and
also require a C-section, researchers said.
This
study examined only first pregnancies, but C-sections
are less frequent and therefore less of a worry in later
pregnancies.
Other
studies would be needed to settle whether early
epidurals promote C-sections at higher doses or in case
of medically induced labor, doctors said.
On the
Net:
02/16/05 20:37
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