The best time to offer pain relief to a woman in labor is when she requests it, according to a study.
“The evidence we have does not provide a compelling reason why this [request] should be refused,” Dr. Ban Leong Sng, head of women’s anesthesia at KK Women’s and Children’s Hospital in Singapore, said in a statement, speaking about mothers who ask for an epidural early in their labor. “The right time to give the epidural is when the woman requests pain relief.”
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The right time to give the epidural is when the woman requests pain relief.
Although previous studies indicated that early initiation of an epidural correlated with longer labors and increased risk of cesarean delivery, Dr. Sng and his colleagues did not find clinically significant support for this in their meta-analysis of nine randomized, controlled studies of 15,752 pregnant women who received epidural at various times during their labor. The finding appears online in the Cochrane Library.
“There is predominantly high-quality evidence that early or late initiation of epidural analgesia for labor have similar effects on all measured outcomes,” Dr. Sng and his associates wrote.
The risk ratio for cesarean delivery with early vs. late initiation of epidural was 1.02 (95% confidence interval, 0.96 to 1.08). Similarly, there was no notable difference in the risk for instrumental birth correlative to the timing of the epidural (relative risk 0.93%; 95% CI 0.86 to 1.01).
The mean difference between early or late epidural when it came to the duration of the second stage of labor was about three and a half minutes (95% CI, -6.71 to 0.27). The authors noted that there was “significant heterogeneity” in the duration of the first stage of labor, and that their data were not pooled.
As for fetal outcomes, results were similar. The differences in Apgar scores of less than 7 at 1 minute post partum in infants born to mothers who’d had early or late initiation of pain relief was negligible (RR 0.96; 95% CI 0.84 to 1.10). There also were no clinically significant differences in Apgar scores less than 7 at 5 minutes post partum (RR 0.96; 95% CI, 0.69 to 1.33).
In addition, the difference in umbilical arterial pH in infants born to mothers with early or late epidural was negligible (mean difference, 0.01; 95% CI -0.01 to 0.03).
The authors noted the studies they analyzed varied in their definition of “early” and “late” epidural; however, early initiation was typically defined as when there was cervical dilation of less than 4-5 cm. Late initiation typically was considered to be when there was cervical dilation of 4-5 cm or more. Analgesic doses also varied across the studies, as did pain relief administered before initiation of the epidural.
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