Mother knows best in epidural timing

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PregnancyEpidurals are the most common method of labor pain relief in the United States. The procedure involves injecting medication near the spinal column to provide continuous pain relief to the lower body. In the past, many health professionals would not administer epidurals until a woman was in active labor due to concerns that the timing of an epidural could slow contractions and affect the length of labor. A recent study published in The Cochrane Library suggests that the actual best time to give an epidural is when the woman asks for it getting one early or late in labor does not make a difference.

Lead author Dr. Sng Ban Leong of the KK Women s and Children s Hospital in Singapore and colleagues analyzed data from nine randomized control trials involving women receiving early or late epidural labor analgesia. Almost 16,000 first-time mothers were included in the analysis. Women were included in the early epidural group if their epidural was given when the cervix was less than four to five centimeters dilated. The late group included women who were given epidurals when the cervix was more than four to five centimeters dilated.

All nine studies showed no clinically meaningful difference in early vs. late epidurals for risk of Caesarean section (C-section), duration of labor, or need for an instrumental (assisted) birth. The authors conclude, there is predominantly high-quality evidence that early or late initiation of epidural analgesia for labor have similar effects on all measured outcomes. The also state that for first-time mothers in labor who request epidurals, it would appear that the time to initiate epidural analgesia is dependent upon women s requests.