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Epidurals do not affect duration of second stage of labor
Despite the long-held belief that epidurals prolong labor, new research demonstrates that epidurals have no impact on the duration of the second stage of labor or any other outcomes, aside from increasing maternal satisfaction of pain relief, compared with placebo, according to a study published in Obstetrics & Gynecology.
“The second stage of labor, when the mother is trying to push the baby out, is physically demanding for mom, and is also physically stressful for the baby,” Philip E. Hess, MD, senior author and director of obstetric anesthesia at Beth Israel Deaconess Medical Center and associate professor of anesthesia and of obstetrics at Harvard Medical School, told Healio Internal Medicine. “The use of epidural pain relief during this stage has been controversial, with many providers believing that it slows down the birth process.”
“Often, women have their epidural pain relief turned down, or even off, based on the personal preference of the obstetric provider that the second stage will be more successful,” he continued. “This can lead to a lot of pain. In the US, and around the world, this happens to thousands of woman every day.”
Between March 2015 and September 2015, Shen and colleagues conducted a double-blind, placebo-controlled trial to determine if receiving epidural analgesia during the second stage of labor affects the duration of labor in 400 nulliparous women with term cephalic singleton pregnancies.
During the first stage of labor, all women received an initial bolus of 8 mL to 10 mL of 0.08% ropivacaine with 0.4 micrograms/mL of sufentanil, followed by an infusion of the same solution at 8 mL per hour that was patient controlled. Participants were randomly assigned to a blinded infusion of the same solution (n = 200) or placebo saline infusion at the onset of the second stage of labor.
In an intention-to-treat analysis, the researchers found that the duration of the second stage of labor was similar between both groups: 52 minutes in the epidural group and 51 minutes in the saline group. The median times of second stage of labor were also similar: 45 minutes for the epidural group vs. 46 minutes for the saline group. Participants also had similar rates of spontaneous vaginal delivery (96.5% vs. 99%) and similar pain scores during the second stage of labor. Satisfaction scores of 8 or less were reported more often by women receiving placebo than those receiving epidural (30.5% vs. 16%).
“Modern epidural techniques and medications can be tailored to provide pain relief with minimal weakness in a woman’s legs,” Hess said. “Our study suggests that the practice of turning epidural medications down doesn’t shorten the time it takes to deliver the baby, or seem to have any positive effect at all.”
Hess added, “It is possible that as a result of our study and the work of others, providers will be less likely to turn epidural medications down as a routine practice. Both providers and mothers should feel confident that maintaining adequate pain relief can promote a positive birth experience without affecting the woman’s ability to push.” – by Alaina Tedesco
Disclosure: The authors report no relevant financial disclosures.