- Epidural analgesia has no impact on the duration of the second stage of labor
- Exchanging the epidural anesthetic with a saline placebo also made no difference in the duration of the second stage of labor
Epidural analgesia, a mix of anesthetics and narcotics is the most effective method of labor pain relief. Long epidural medication was found to have no impact on the duration of the second stage of labor, reveals a new study.
Epidural analgesia has been widely in use since the 1970s. The anesthesia is delivered by the catheter, which is placed close to the nerves of the spine.
In previous studies, it was found that epidurals had slowed the second stage of labor. The second stage of labor begins when the cervix is completely dilated and ends when the baby is delivered.
Duration of the second stage of labor is longer and is found to be linked to adverse outcomes. Obstetricians reduce or discontinue epidural pain management regularly to speed up this stage of labor.
The research team at Beth Israel Deaconess Medical Center (BIDMC) say that this practice could be out-of-date and misguided. The paper was published in the journal Obstetrics & Gynecology.
The results showed that epidural medication had no impact on the duration of the second stage of labor, normal vaginal delivery rate, the position of the fetus at birth, the incidence of episiotomy or any other measure of fetal well-being.
About 400 women participated in this double-blinded, randomized trial. The effects of catheter-infused, low-concentration epidural anesthetic were compared with the catheter-infused saline in the placebo.
Philip E. Hess, MD, Director of Obstetric Anesthesia at BIDMC and Associate Professor of Anaesthesia and Obstetrics at Harvard Medical School and senior author said, "We found that exchanging the epidural anesthetic with a saline placebo made no difference in the duration of the second stage of labor,"
There was no difference seen in the pain scores between groups statistically. But, slowly the pain scores increased in women receiving the saline placebo.
Findings of the Study
Participants who were involved in the study were healthy and were first-time mothers. In the first stage of labor, the participants were provided with a patient-controlled epidural analgesic pump.
Every mother was given the active pain medication during their early stage of labor. When participants reached the second stage of labor, they were randomized to receive either the active anesthetic or the saline placebo. The active anesthetics included were ropivacaine and sufentanil that were given in low doses.
In this stage of labor, nobody knew if the catheter-delivered infusions had the active pain medication or the saline placebo, not even mothers, investigators, obstetricians or midwives, reveals the study.
Women who were in excessive pain received unblinded doses of the active pain medication under doctors' careful observation. Based on clinical indicators, doctors could also terminate epidural infusions at any time.
Active Medication or Saline
The duration of the second stage of labor in the primary outcome was similar between both the groups. About 52 minutes in women who received active pain medication and 51 minutes for women receiving the saline, which is a difference of 3.3 percent only.
The median times were almost similar. About 45 minutes for those women who were on active pain medication and 46 for those who were on saline.
Obstetricians were asked to stop epidural infusions in about 38 women for poor progression of labor. Among these 17 women were in the saline group and 21 women were in the active medication group.
Hess and his colleagues observed various other outcomes apart from taking note of duration of the second stage of labor. The research team measured fetal health and well-being including birth weight, Apgar scores, and umbilical artery pH.
The patient-reported pain scores were compared with the patient satisfaction with pain control measures. Twice as many women given the placebo were found to have lower satisfaction with their pain relief than those who were provided with the anesthetics
"Ethically, if epidural medications result in a negative effect on the second stage of labor, one could argue that a mild increase in maternal pain could be balanced by a successful vaginal delivery. We didn't see any negative effects, but epidural analgesia in the second stage of labor remains controversial, and merits follow up studies," explained Hess.