My thoughts on a recent article about Epidurals & Labor

Sarah Higgs
Dec 11, 2017
3 min read

There has been a post circulating around Facebook with the title “Epidurals don’t prolong childbirth, study shows”, and the very first sentence goes on telling the reader not to worry about an epidural prolonging your labor or increasing your chance of cesarean’s. The article relates to a controlled study of 400 women, some of which were given an epidural in the second stage of labor, and some were given saline solution. The doctors, nor the mom’s knew what would be given to whom. The article goes on to say that the study proved there were no significant differences between length of labor, or number of births that ended in cesarean. Near the end of the article it states that the only real difference between the two groups was the pain relief; the group with saline experienced SLIGHTLY more pain WITH TIME. Sounds pretty good right? Any pregnant mom reading this article is going to think “great, less pain, and no worse chances for longer labor or intervention”, and why wouldn’t you? This article wants the reader to feel this way, but it couldn’t be more misleading. The article has come up in every mom group I belong to and I feel something needs to be said about it.

First major thing I see here, is that they do not clarify the fact that these moms were given either the epidural in the SECOND STAGE. What this means, is that all 400 moms had already become fully dilated, and were just about ready to push. This is a HUGE variable to not make clear. If you have already went through the notions of labor, and are just about at pushing phase, of course it won’t prolong your labor, you’re already 80% done! Second major variable that was not spoken about at all in the article is that all 400 women were given a low dose of epidural in their first stage of labor as well. Essentially all that was done is they either A) turned off the epidural at the second stage and replaced it with saline, or B) mom got another surge of medication. Main issue with this is that when the epidural is turned off, it doesn’t immediately stop working. An epidural takes 4.2 hours on average to clear out-of-body. So let’s go back to the study showing pain being the only slight difference between the two groups. Group with saline experienced slightly more pain OVER TIME. Essentially what this is saying is that the moms who were given saline in the second stage of labor, still did have the effects of an epidural, and yes as time went on and the epidural started to clear out, mom felt more pain. Given that we now have the facts of the study, it makes sense as to why both groups had very similar outcomes.

If mom is given an epidural during early labor, and is continually topped up when needed – it CAN in fact slow the progress of labor, and it DOES in fact increase your chances of interventions. What I feel needs to be taken away from the article is that yes, epidurals are an amazing tool to have in labor, and can in fact help a mom who has gone through as much labor as she can handle, and would like to medication to help her relax and rest to be ready for her final phase of pushing. However, if we go for an epidural too soon, we can indeed slow the progress of labor, which leads to medication given to speed it back up, then more epidural to help with the increased pain; and the cascade of intervention ensues.

A recent trial has started at some of our local hospitals; mom’s who are assessed for labor will be sent home or to walk if they are less than 6cm. What this does is decrease the likelihood of mom getting an epidural or other interventions too early which can interfere with her labor. This trial is discretionary to the doctor, so there are circumstances where mom will be admitted earlier, but as an overall rule, unless mom is in active labor, she will not be admitted. This trial has been started in hopes of decreasing cesarean and intervention rates. If you would like to discuss this trial further, or have any questions about epidurals, please don’t hesitate to contact me.