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Study suggests epidural does not slow second stage of labour

News 11 October 2017

A study published in the journal Obstetrics & Gynaecology, showed that the use of epidural analgesia in the second stage of labour made no difference to duration of labour, and suggests that the practise of minimising pain management in labour may be outdated.

The results show epidural also had no effect on normal vaginal delivery rate, incidence of episiotomy, the position of the fetus at birth or any other measures of fetal well-being. The study compared the effects of catheter-infused, low-concentration epidural anesthetic to a catheter-infused saline placebo in this double-blinded, randomized trial of 400 women.

Please attribute the following to Dr Patrick O’Brien, spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG):

“This is a fascinating study into the effect of epidural medication during the second stage of labour as the women who took part in the trial, as well as their doctors and midwives, were not aware if they were receiving the pain relief or a placebo. However, this was a relatively small study so more research is needed before any definitive conclusions can be made.

“Previous evidence has suggested a link between use of epidural and a longer stage of labour and therefore an increased risk of instrumental delivery, including the use of forceps or ventouse to assist delivery, particularly in women having their first baby.

“However, this study has shown that epidural during the second (pushing) stage of labour did not prolong labour at all. Neither did it increase a woman’s chance of having an assisted birth with forceps or ventouse, or of needing an episiotomy (a cut made in the area between the vagina and anus to widen the vagina opening).

“Unsurprisingly, women who had the placebo reported more pain then those who had the epidural pain relief.

“The conclusion from this study is that there is no down-side to having an epidural during the second stage of labour, while it is associated with less pain.

“Labour can be a very painful experience, although the intensity experienced differs from woman-to-woman. The decision to have an epidural, which is very safe form of pain relief, should lie with the woman, in consultation with her midwife or obstetrician, and she should be supported in her birth choice. A range of pain relief options are available and we would encourage women to explore these as part of her birth plan and in consultation with her midwife and/or obstetrician."