Epidural Effects on Childbirth
When it comes to relief of labor pain, everyone agrees epidurals are the best medication for the job. But when the question of how an epidural effects labor is asked, a variety of points of view compete for attention. In fact, there is some heated disagreement on epidural effects in childbirth.
Part of the problem lies in the fact that an epdural is a process for administering medications - not a medication itself. So two women receiving epidurals in two different hospitals at the same time could have very different experiences. The amount and type of medications vary as much as the policies around epidural use. Unfortunately, it is difficult to draw conclusions about the combined effects of such a variety of procedures.
The second part of the problem is in the research itself. Most research into pain medication use for labor is interested in how well the medication eliminates the pain. Side effects are usually a secondary issue, if the research looks at them at all.
In order to find out more about the effects of epdurals on labor, the Maternity Center Association included reviews of epidurals in its project into the nature of labor pain and its management. As a part of the project, two separate teams of researchers investigated the effects of epidurals on childbirth, and a third researcher reviewed the most common side effects.
Where they agree
The two review groups agreed that women who used epidural pain relief were more likely to have a longer second stage of labor (pushing), more likely to need forceps or vacuum extraction and more likely to have a fever.
Where only one team explored
Some effects of epidurals were only investigated by one team or the other, so were only found by one team. Among these effects of epidurals are:
- Increased need for oxytocin after epidural administration;
- Increased risk of low blood pressure while using epidural;
- Decreased spontaneous birth;
- Increased risk your baby will be evaluated for infection and receive antibiotics;
- Increase risk your baby will be jaundiced.
The researchers also found that epidurals may be associated with:
- fetal malpresentation (meaning baby is not in a good position);
- breathing problems in the baby immediately after birth;
- babies scoring lower on the Neonatal Behavioral Assessment Scale (NBAS);
Where they disagree
In four areas the teams came to different conclusions:
- Length of first stage labor - one team found no difference and the other found insufficient data to make a comparison;
- Cesarean birth rate - one team found no difference while the other found insufficient data to make a comparison;
- Breast-feeding success - one team found no difference at 6 weeks while the other found insufficient data to make a comparison;
- Urinary problems - one team found an increase in urinary incontinence after birth with no difference at 3 or 12 months, the other team found insufficient data for comparison.
Why did they find different results? Each team set its own criteria for what studies could be included in the project. A study that may have been acceptable to one team may have been unacceptable to another. Because they used different sets of research they found some contradictory results.
Most common side effects
In examining the most common side effects, the research team focused on the effects of the "light" or "walking" epidural. They found a wide range of frequency in side effects.
- Itching was very common when narcotics were included in the epidural mixture (62%); but was rare when narcotics were not included (less than 4%).
- Sedation happened to 21% of the women on average with a wide rage of frequency
- Only one study specifically looked at catheterization, in that study up to 61% of the women received a catheter in labor. The range for voiding difficulties ran from 0% to 68%.
- Hypotension (low blood pressure) again had a wide range of occurrence from 0% to 50%. Six of the studies had rates above 24%.
- Up to 25% of the women in the studies did not walk at any time in labor. Rates varied from 30% up to 85% of women not walking. Even in groups that were encouraged to walk, 34-85% of the women did not.
References:
Goer, Henci. The Thinking Woman's Guide to a Better Birth. 1999. New York: The Berkley Publishing Group.
Enkin, Keirse, Nilson, Crowther, Duley, Hodnett and Hofmeyr. A guide to effective care in pregnancy and childbirth Third Edition. 2000. Oxford: Oxford University Press.
The Nature and Management of Labor and Pain Symposium Steering Committee. The Nature and Managment of labor Pain: Executive Summary. Journal of Obstetrics and Gynecology. May 2002; 186:5 S1-S15.
What would you like next?Understand what changes are being assessed during a cervical exam. Find local resources in the The Natural Childbirth Directory. Learn about comfort measures to help you manage labor. Discover ways to stay comfortable during pregnancy. Explore how exercise and nutrition can help you achieve your birth plan goals. |
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