Many patients are concerned that epidural blocks have an adverse effect on the course of labor. Early studies of epidural blocks reported the following results:
- labor was often slowed;
- more oxytocin (Pitocin) was needed to induce contractions;
- more surgical deliveries were performed; and
- more women had cesarean deliveries.
However, several factors should be taken into account when interpreting these studies:
- First, epidural techniques have changed dramatically over recent decades. Less-concentrated solutions of anesthetic medications are now used. Anesthesiologists have found that this results in a block that is not as dense and that promotes less relaxation of the pelvic floor.
- Second, the timing of an epidural block has changed over the years. Although controversial, many physicians believe that epidural analgesia during the latent phase of the first stage of labor is more likely to cause delay. Most doctors now wait until the patient is in active labor before placing an epidural block. Often, intravenous narcotics are used in the latent phase of labor and epidural is reserved for the active phase or if narcotic pain relief is not adequate.
- In many cases, intrathecal injection (injection within the covering of the spinal cord) during the latent phase of labor has replaced early epidural block.
Recent studies have found no increase in the rate of cesarean delivery or labor dysfunction among women who have received properly administered epidural blocks. In fact, one study reported a decreased risk of cesarean delivery in women who receive epidural analgesia during labor. Based on recent reports of epidural use during labor, and changes in blocking technique, the following general conclusions can be drawn:
- Full epidural blocks should be avoided during the latent, early phase of the first stage of labor. Other methods of pain relief should be used until regular painful contractions occur, and cervical dilation reaches at least 3 or 4 centimeters. If pain relief is necessary before then, intravenous or intrathecal medication can be used.
- The patient and her obstetrician should understand that uterine activity is often decreased for a brief period immediately after placement of an epidural block. If activity does not resume, both doctor and patient should be willing to accept the need for supplementing labor with oxytocin.
- It is not necessary to withhold epidural analgesia during the second stage of labor because of concern that the patient will not have the urge to push. The person administering the epidural should have the expertise to provide analgesia without complete anesthesia. In other words, the patient should be able to feel pelvic floor pressure and push without feeling pain. In the unusual case that the analgesia is too dense and the patient cannot feel the urge to push, the medication can be discontinued until it wears off and sensation returns. If the baby is doing well, this delay should not be problematic and will increase the likelihood of a vaginal delivery.
- The second stage of labor should not be cut short. There is a tendency for the second stage to be prolonged in women who have received epidural analgesia, and this stage should be allowed to persist. For patients who are delivering for the first time, the normal second stage can be extended from two hours to at least three hours; for women who have previously delivered vaginally, the second stage can be extended to at least two hours.
- The rate of cesarean section does not appear to be increased in women who have received epidurals. However, the rate of spontaneous vaginal delivery is slightly lower overall and is replaced by a slightly higher rate of forceps deliveries.
For more information, go to Walking Epidural During Delivery and Risks of Epidurals During Delivery.
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