Don't Believe Everything You Read About Epidurals

Do epidurals prolong labour? Read the recent headlines and you'd think we finally answered that question once and for all - with epidurals turning out to have no effect. But the study actually asked what happens if you already have an epidural, and turn it off as you're pushing out the baby.

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The Headline: Epidurals Do Not Prolong Labor (New York Times)

The Story: The study looked at the effects of epidurals in the "second stage" of labour, and really, do any of us actually know what the second stage of labour really is? Obstetricians do, but I suspect most of the people writing and tweeting the headlines do not.

What we think of as "labour" is really the first stage of labour: When the cervix is dilating, and you're feeling contractions, and it hurts, and you're getting ready to go to the hospital, and then you're at the hospital, and there are still hours to go, and oh god how will I ever get through this, ow ow ow ow.

The second stage of labour is when you're finally dilated to 10cm and get to start pushing. It may take an hour or two if this is your first baby. If you've done this before, pushing may only be a matter of minutes.

(There is a third stage. It happens after the baby is born.)

So what happened in this study about the pushing stage of labour? Four hundred women at one hospital in China, all giving birth for the first time, got epidurals during the first stage of labour. When it was time to push, some of them kept getting the anaesthetic fluid in their epidurals, while others got a saline placebo. The idea was to test whether doctors should be turning off the epidural when it's pushing time.

In the end, the people who had the real epidural and the fake epidural during pushing both delivered equally quickly (51 versus 52 minutes of pushing, on average). On the other hand, a 2014 study found that epidurals do prolong pushing, and their numbers were three versus five and a half hours. Big difference.

The 2014 study just looked at charts from women who did and didn't get an epidural; there was no funny business going on with a placebo. That means these two studies are asking totally different questions. The new study is the right way to study whether the anesthetic in the epidural interferes with pushing itself. The 2014 study includes the whole experience, including your doctor's biases, the fact that it's harder to move around when you're tethered to an epidural machine, and a million other factors that are involved in what actually happens when you request an epidural.

The Takeaway: If you're thinking about whether to get an epidural, you're probably wondering whether it's going to prolong your total time in labour, not whether it's going to shave a few minutes off the pushing stage. There is evidence that epidurals do increase the first stage (the long, otherwise hurty part) of labour, and this new study didn't contradict that. Whether epidurals lengthen the pushing stage is still up in the air.

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