A woman in labour should be given an epidural when she asks for pain relief, a new study suggests today.
A systemic Cochrane review of 9 studies collected the best available evidence on early and late epidurals and compared their effects.
The research team reviewed data the studies that involved 15,752 first-time mothers who were randomly assigned to “early” or “late” groups. Those in the early group were given epidurals when they were less than 4 to 5 centimetres dilated, while those in the late group waited until they were 4 to 5 centimetres or more dilated.
Analysis of the results revealed that those women who had early epidurals were no more or less likely to need a Caesarean section than those who had late epidurals.
Earlier epidurals made no difference to the likelihood of needing an assisted birth involving forceps or suction, or to the amount of time spent in the second, ‘pushing’ stage of labour. For other aspects that were measured, early and late epidural also had similar effects.
Lead researcher Dr Ban Leong Sng, who is also the deputy head and senior consultant of the Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital (KKH), Singapore, said: “The right time to give the epidural is when the woman requests pain relief.
“If they request an epidural early during their labour, the evidence we have does not provide a compelling reason why this should be refused.”
Although the researchers found no effect of early epidural on the length of time spent in the pushing stage, they were unable to reach firm conclusions about effects on the time to reach full cervical dilation.
“We can’t rule out the possibility that starting epidural pain relief earlier may lead to shorter labour,” said Sng. “This is because there was a lot of variation in the results of the studies we looked at in terms of the length of the first stage of labour.”
This review was undertaken by researchers from KKH, Duke-NUS Graduate Medical School, Singapore Clinical Research Institute and a medical student from NUS Yong Loo Lin School of Medicine, Singapore.
Sng BL, Leong WL et al. Early versus late initiation of epidural analgesia for labour. Cochrane Database of Systematic Reviews 2014 9 October 2014; doi: 10.1002/14651858.CD007238.pub2. [abstract]
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