The Best Time to Get an Epidural

Epidural Timing Should Not Be an Issue in Labor

Laboring Woman
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For many years there has been an argument about when the best time to get an epidural was in labor. Early thoughts on the topics were that there may be the potential to slow down labor or even increase the cesarean section rate if an epidural was given too early in labor. This lead to some hospitals and practitioners to be very conservative with the timing of epidurals, often having policies that required a woman to reach a certain dilation, often at least four centimeters, and sometimes as late as six centimeters.

The Cochrane Database of Systematic Reviews published a look at the difference in many outcomes in both the health of the mother, the baby, the length of labor (first and second stage), and a variety of other measures, and found no real differences in almost 15,000 women. This is great news for women who are planning to use epidural anesthesia.

Currently, the Centers for Disease Control and Prevention (CDC) say that about 61% of women in the United States will use an epidural for pain relief in labor. Though this number varies drastically by region, with some hospitals having near 100% epidural rates and others with very low epidural rates.

A few things to point out:

  • This review is only measuring early epidural versus late epidural. It does not include a look at no epidural versus epidural.
  • The study can’t really assess the benefit or risk of medications and techniques used in conjunction with or prior to an epidural. An example: A mother requests and receives a shot of IV narcotics prior to getting an epidural.
  • In the abstract, I did not see a discussion of some commonly thought of risks.
  • Epidural anesthesia has changed drastically over the decades. In the first years of wide spread use, the medications were given in larger amounts and the way a woman experienced an epidural then (typically completely numb) to now (varies, but many have some ability to move and feel pressure with no pain).

    The bottom line is that if you wish to get an epidural for your labor, don’t sweat the timing of it. You should get an epidural when you feel that it is the best option for you, and not according to a clock.

    Sources

    Osterman MJK, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008. National vital statistics reports; vol 59 no 5. Hyattsville, MD: National Center for Health Statistics. 2011.

    Sng B, Leong W, Zeng Y, Siddiqui F, Assam PN, Lim Y, Chan ESY, Sia AT. Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews 2014, Issue 10. Art. No.: CD007238. DOI: 10.1002/14651858.CD007238.pub2 - See more at: http://summaries.cochrane.org/CD007238/PREG_early-versus-late-initiation-of-epidural-analgesia-for-labour#sthash.NiJZ0QDS.dpuf

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