What’s the latest on epidurals in labor?

Over 70% of women in the United States have neuraxial anesthesia for pain control during labor. Neuraxial anesthesia refers to a group of pain relief techniques involving the spine: epidurals, spinals, combined spinal epidurals (CSE) and dural puncture epidural (DPE).   For the vast majority of cases, this type of anesthesia provides unparalleled pain relief with minimal risk to both the mother and the fetus.

Pain relief in labor is important.  There are all types of ways to help control pain for women in labor.  From changing positions, to using birthing balls, showers or tubs to nitrous oxide gas to IV opioids to epidurals, every woman should be informed of the choices available to her.   It’s been well established that when women feel involved in the decision-making process their satisfaction with the delivery experience is much higher.   It’s also clear that a woman’s perception of her pain levels during labor and delivery highly correlate with her satisfaction of labor and delivery.


A large Cochrane study was recently published that included over 40 trials involving over 11,000 women.   What they found is what we see everyday on labor and delivery:

  • Epidural anesthesia provides superior pain relief to women than other options
  • There was no increased risk of cesarean section in patients with or without an epidural
  • There was no increased risk of back pain in women who had or didn’t have an epidural
  • There was no adverse effect on the newborn seen in APGAR scores or in NICU admissions
  • There was no increased use of vacuum or forceps in the last 10 years in women with or without an epidural

When can a woman not have an epidural?

Every woman needs to be personally evaluated by the Anesthesiologist before deciding if she’s safe to have one placed.   There are very rare conditions that preclude the use of an epidural, these include: a bleeding disorder (including very low platelets that can occur with preeclampsia), infection of the lower back, and increased intracranial pressure.  

 

What are the downsides of having an epidural?

  • After you get an epidural, you will probably need to stay in bed and won’t be able to walk around.
  • An epidural can lower your blood pressure.
  • If you have an epidural for more than a few hours, you might get a fever. If this happens, the doctors might decide to give you or your baby antibiotics in case you have an infection.
  • After you give birth, you might have a headache.

                      

The bottom line?

If the pain you’re having in labor is more than you can bear, or you are so exhausted from the labor pains you’re not sure you’re going to “make it”, epidurals provide the most effective pain control available for laboring women.   If you do chose to get it, you should know that it’s safe, effective and does not cause harm to the mother or the baby.

 

 


El Camino Women’s Medical Group offers the latest Minimally Invasive Solutions for gynecologic problems.   Drs. Amy TengErika Balassiano, and Pooja Gupta, all members of AAGL (American Association of Gynecologic Laparoscopy) are highly trained and experienced in the field of Minimally Invasive Gynecgologic Surgery.   Dr. Erika Balassiano is also completed a Minimally Invasive Gynecologic Surgery Fellowship, under the supervision of world-renowned Dr. Camran Nezhat.

 

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