Early epidural does not raise c-section risk

Women in labor who need early pain relief need not fear that an epidural makes it more likely that they'll have to have a cesarean.

Compared with intravenous narcotic pain control, new research shows, epidural pain control started in early labor does not increase the probability that women will undergo a c-section.

Moreover, an early epidural seems to provide better pain control and may shorten the duration of labor.

Previous reports have linked epidural analgesia with an elevated risk of cesarean delivery, but it is possible that this increased risk was due to related factors and not to the epidural per se, the researchers note in this week's New England Journal of Medicine.

To determine if epidural pain control is an inherent risk factor for c-section, Dr. Cynthia A. Wong, from Northwestern University in Chicago, and colleagues assessed the outcomes of 750 pregnant women who received epidural pain control or intravenous hydromorphone started in the early stages of labor.

In contrast to previous reports, the c-section rate in the epidural group was actually slightly lower than that seen in the comparison group: 17.8 versus 20.7 percent.

There was evidence that epidural pain control hastened delivery. The time from the start of pain control until delivery was significantly shorter in the epidural group.

In addition, epidural anesthesia was associated with significant improvements in pain and with better Apgar scores, the system used to evaluate infants in the first minutes of life.

In a related editorial, Dr. William Camann, from Brigham and Women's Hospital in Boston, comments that for women who experience severe pain in early labor and desire pain control, the new findings "make it clear that safe, effective pain relief with the use of (epidural pain control) should not be withheld simply because" they haven't passed some arbitrary stage.

SOURCE: New England Journal of Medicine, February 17, 2005.