Epidurals: Risks and benefits

 

Several investigators have reported a transient decrease in the frequency and intensity of uterine contractions after epidural analgesia. This effect was greater when epinephrine (1:200,000) was included in the injection and also when the clients were placed on their backs. When patients are maintained in the side-lying position, labor epidural analgesia does not seem to effect the frequency or intensity of uterine contractions.

Epidurals have been blamed for prolonged labor, but more women with malpresentations or difficult labors tend to choose this mode of analgesia so it might not be the analgesia causing the problem.

Women receiving epidurals are also more likely to receive oxytocin augmentation, but again, it is the women with prolonged labors who generally require a longer acting, more effective analgesic. Care providers may also intervene earlier or more forcefully when epidural analgesia is in effect because they know that the mother has good pain control.

The past few years have seen a great change in the way epidurals are administered and the drugs used for the procedure. We can no longer make generalizations based on old data and old techniques.

Epidural block provides effective labor analgesia and as care providers we are glad it is an option but it is not for every mother and every situation.

I have seen extremely frightened women requesting epidural analgesia during their initial exam, seven to eight months before birth. These women have often had a "bad experience" with a previous labor or a "good experience" with a past epidural. They fear that we will deny them their epidural when labor begins. I try to talk to them about differences in labors, babies and experiences. Deciding on epidural analgesia before labor begins is probably a decision not based on logical thought but one based on emotion and fear.

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