Epidurals have become the "drug of choice" in maternity wards across the United States. As of 1997, "nearly two-thirds of all women who give birth in hospitals with high-volume obstetric units had an epidural during labor. In many hospitals, epidural analgesia is routine and is provided to more than 90 percent of all women who are in labor in that hospital." Yet epidurals are not without potential risks for both mother and baby, which is part of the reason the findings from a new study on laboring women are so promising.
A new study on the use of epidurals in labor reports laboring women given control over their epidural anesthesia resulted in a 30 percent reduction of the amount of anesthesia used and were "basically as comfortable" as women on a continuous dose. Researchers also report a trend toward fewer deliveries that required instrument assistance, such as forceps, in the patient-controlled group.
Dr. Peter Benstein, a professor of clinical obstetrics and gynecology and women's health at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, said:
"My personal belief is that epidurals tend to slow labor down. So, if you can get away with less medication with patient-controlled analgesia, I think it's a wonderful thing."
"And, it's not a surprise to me that women used less anesthesia. If you can titrate your own medication, you're probably not going to give yourself a lot. An anesthesiologist will tend to give you a little bit more because they want to make sure there's no pain."
The author of the epidural study is Dr. Michael Haydon, a perinatologist at Long Beach Memorial Medical Center in California. Reports Health Day News:
Generally, epidural anesthesia is given on a continuous basis, according to Haydon. But patient-controlled devices that can control delivery of the anesthesia are widely available, he added. Patients are given a button to push when they feel they need more medication. The devices are programmed to only provide a specific amount of medication for specific time periods to ensure that people don't give themselves too much.
The study randomly selected first-time mothers for one of three groups: "the standard dose given as a continuous infusion; a continuous infusion with an additional patient-controlled option; and patient-controlled anesthesia only." The first group used an average of 74.9 mg of anesthesia during labor. The second group used an average of 95.9 mg, while the patient-controlled group used the least anesthesia of all, an average of 52.8 mg, according to the study.
Women in the patient-controlled group did report slightly higher pain scores when they got to the pushing part of the delivery, but also reported being satisfied with their pain relief overall.
Women's Views On News says:
This is good news because epidurals, despite having made labor more bearable for scores of women, have their pitfalls: they can lead to prolonged labor and an increase in vacuum and forceps deliveries. They can also result in more C-sections, which is far from ideal.
Rebecca on Babble writes:
Less meds with the same level of relief? What’s not to like here? A lower dose of medication with adequate pain management would benefit both moms and babies. I find this study so exciting because it opens up new possibilities for women as active participants, not just passive patients, in hospital births. It’s ideas like these that may help us progress toward a hospital birth model that takes into account the needs of both babies and the mothers who give birth to them.
Laura Nelson at Think Baby writes about the study's findings and how they might impact maternity care in the United Kingdom.
Patient-controlled epidural analgesia is currently only available in one-fifth of hospitals in the UK due to the expensive costs of the equipment needed. Experts are now looking into whether the positive effects outweigh the costs. "The technique reduces the need for anaesthetic which in turn reduces the need for forceps delivery – and it gives women a feeling of control. The question is whether the small clinical advantages are enough to justify the cost of new equipment and staff training,” Dr Elizabeth McGrady, a honorary clinical lecturer in anaesthetics at Glasgow University said to the BBC.
Personally, I'm all for empowering women to be, as Rebecca said, "active participants" in hospital births. I hope this study leads to hospitals adopting this patient-controlled epidurals as standard practice for women who choose to have epidurals.
- Over at Women's Health and Pregnancy, there's an informative post with diagrams and pictures about how an epidural is given, as well as the pros and the cons.
- At Anticipation and Beyond, there's another informative post about the dangers of epidurals. The author writes, "This blog isn’t to insult those who have made this choice, but to increase your knowledge, so you can make informed choices for the future."
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