No benefit seen for stopping epidural during labor

Stopping epidural medications during the last stages of labor does not improve pregnancy outcomes, but it does markedly increase pain, results of a review study suggest.

Epidural pain relievers increase the risk of pregnancy complications, such as the need to use forceps for delivery, so many doctors allow the epidural to "wear off" at the end of the first part of labor in an effort to improve outcomes, researchers note.

However, according to their report in the journal The Cochrane Library, there is not enough evidence to support this practice.

Dr. S. Torvaldsen, at the University of Sydney in Australia, and colleagues conducted a literature search to identify studies that looked at the effects of stopping epidurals during labor. The five studies they found included 462 women in labor with their first baby.

Compared with continuous use of epidural drugs, discontinuing such medications during labor did not dramatically reduce the need for forceps delivery or other types of "instrumental" delivery, the authors note. Moreover, this practice did not reduce the risk of fetal positioning problems or improve the baby's appearance at birth.

In contrast, stopping the epidural drugs early did seem to increase pain. Twenty-two percent of women whose epidurals were stopped early complained of inadequate pain relief compared with just 6 percent of women who received epidural drugs until birth.

"A much larger study than any of those included in this review would be needed to determine the real impact of the intervention," Torvaldsen's team writes.

They also point out that these studies were at least 14 years old, and since that time various strategies have been implemented to reduce the risk of instrumental deliveries, such as having the patient in an upright position and delaying the start of pushing.

The authors conclude that "women should be informed of the risks and benefits of discontinuing epidural analgesia, and encouraged to participate in the decision of whether to discontinue or not."

SOURCE: The Cochrane Library, online October 18, 2004.