In a study of 750 women, researchers found that getting an epidural when the cervix is less than four centimeters dilated did not increase the cesarean delivery rate and provided significantly better pain relief. "We also found shorter labors in the early epidural group compared to those who received the standard narcotic an injection of hydromorphone (a morphine-like drug) and didn't get the epidural until after four centimeters dilation," says lead author Cynthia Wong, MD, section chief for Obstetric Anesthesiology at Northwestern Memorial Hospital and associate professor of Anesthesiology at Northwestern University's Feinberg School of Medicine. "In addition, the babies whose mothers had early epidurals had a decreased incidence of having a below normal one-minute Apgar score." Apgar scores are a widely used assessment of a newborn's initial condition that factors heart rate, respiration, muscle tone, reflux response and color.
The American College of Obstetricians and Gynecologists recommends that when feasible, obstetric practitioners should delay the administration of epidural anesthesia in women with their first pregnancy until the cervical dilation reaches at least 4 to 5 centimeters and other forms of analgesia should be used until that time. This recommendation was based on studies that found an association between the initiation of epidurals early in labor and an increased cesarean delivery rate. "We hypothesized that the findings of these earlier studies linking epidurals to increased risk of cesarean delivery could be explained by other factors," says Dr. Wong. "For example, asking for an epidural earlier may be a marker for a bigger baby, which causes more pain early in labor and also inc
Contact: Amanda Widtfeldt
Northwestern Memorial Hospital