Study: Epidurals Don’t Slow Labor… Or Do They?

Research has illustrated that epidurals don’t prolong labor, right? Not so fast!Expectant mothers everywhere breathe a collective sigh of relief! After all, research has illustrated that epidurals don’t prolong labor, right? Not so fast!

If you have been reading the news lately, you may have seen the headlines about epidurals. They read, “Good News: Epidurals May Not Prolong Labor After All,” “Epidurals Do Not Prolong Labor,” “Epidural Does Not Slow Down Labor, US Research Finds,” and “Study Debunks Notion that Epidurals Prolong Labor.”

Epidurals are given as a method of reducing pain during labor and childbirth. Consisting of a mix of anesthetics and narcotics, they are delivered via a small catheter into the area around the spine. Approximately 60% of women delivering vaginally in the United States receive an epidural.

A November 2017 study published in the prestigious journal Obstetrics & Gynecology has gotten a lot of attention, and for a good reason. The study was a double-blinded randomized control trial, which is considered the “gold-standard” in research.

Researchers from Beth Israel Deaconess Medical Center (BIDMC) enrolled 400 first-time Chinese mothers who wished to have an epidural. They were all given a patient-controlled epidural analgesic pump during their first stage of labor. All mothers received pain medication through their epidural during this early phase of labor.

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Once the laboring moms reached the second stage of labor, they were randomized to either receive the anesthetic or saline placebo. Women who expressed pain were given additional doses of pain medication at their doctor’s discretion. Obstetricians were able to stop the epidural at any time, of which 38 did due to poor progression of labor.

The results were similar between the two groups of women. On average, it took 51 minutes to go from full dilation of the cervix to delivery in the saline group, and 52 minutes in the anesthetic group, illustrating no significant difference in laboring times.

However, it is important to note that the study examined women who decided to have an epidural to begin with. The study did not compare the laboring times of women who had an epidural to those who did not.

In fact, a 2014 retrospective study of over 42,000 women found that epidurals do indeed impact the second stage of labor. The women who received epidurals extended the second stage of labor by nearly two and a half hours more than those moms who did not have an epidural.

Further, the November 2017 study only examined the second stage of labor. Labor occurs in two distinct phases. Stage one of labor begins at the start of labor and continues until the cervix is dilated to 10 centimeters. This stage of labor is the longest stage, and can last from a few hours to a few days.

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The second stage of labor, or the pushing phase, begins when the cervix is dilated to 10 cm and ends with the birth of the baby. This stage can last anywhere from a few minutes to a couple of hours. The study did not account for the total duration of time that the laboring women had the epidural. Certainly, there is a great deal of variability if a woman had an epidural for 10 hours versus if she had an epidural for one hour.

Any mother who has given birth will tell you that “labor” includes the time that you first begin having contractions until you get to hold your new little bundle of joy. This study did not prove that epidurals don’t prolong labor. It did show that the use of an epidural may not prolong the “pushing” period, but given the variability of the study, that’s not even a given.

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